The Prevalence of Cognitive Frailty and Its Association with Sleep duration and Depression Among Older Adults with Heart Failure

OBJECTIVES

The prevalence of cognitive frailty and its associated factors in older population with heart failure have not been extensively studied. We investigated the prevalence of cognitive frailty and its association with sleep duration and depression among older adults with heart failure.

METHODS

This secondary analysis used a cross-sectional sample with 168 older adults with heart failure from an academic tertiary care hospital in South Korea.

RESULTS

Cognitive frailty was found in 58 (34.5%) older adults with heart failure. Our main finding revealed that longer sleep durations of ≥ 8 h (adjusted odds ratio (OR) = 2.62, 95% confidence interval (CI) = 1.04-6.59) and depression (adjusted OR = 2.84, 95% CI = 1.22-6.61) predicted an increased risk of cognitive frailty.

CONCLUSIONS

Early detection on changes in sleep patterns and depression can play a crucial role in reducing the risk of cognitive frailty in patients with heart failure. Longitudinal studies are needed to explore that sleep patterns and depression are both linked to greater risk of developing cognitive frailty among older adults with heart failure.

CLINICAL IMPLICATIONS

Development of a validated instrument for cognitive frailty screening may be beneficial for older adults with heart failure to prevent adverse outcomes.

Prognostic role of sarcopenia on major adverse cardiac events among patients who underwent successful percutaneous coronary intervention: a retrospective cohort study

AIMS

We investigated the prevalence of sarcopenia and its influence on 1-year major adverse cardiac events (MACEs) in patients after successful percutaneous coronary intervention (PCI).

METHODS AND RESULTS

This retrospective medical record review using purposive sampling was conducted at a tertiary care university hospital in Korea. Medical records of a total of 303 patients (≥40 years) who underwent successful PCI between January 2014 and December 2020 were analysed. We retrospectively assessed sarcopenia at initial admission. Sarcopenia was assessed by a sarcopenia index based on a ratio of serum creatinine to serum cystatin C. MACE rates were evaluated within l year after PCI. A Kaplan-Meier analysis with a log-rank test was performed to compare the time with 1-year MACE event-free survival between groups with and without sarcopenia. Cox proportional hazards regression was conducted to assess sarcopenia's influence on MACE. The prevalence of sarcopenia and 1-year MACE after PCI were 24.8 and 8.6%, respectively. We found that sarcopenia at admission (hazard ratio, 3.01; 95% confidence interval, 1.22-7.38, P = 0.017) was significantly associated with 1-year MACE among patients after PCI.

CONCLUSION

Expanding knowledge of sarcopenia among cardiovascular nurses may aid in early recognition of patients at risk of sarcopenia. Our finding implies that the sarcopenia index based on serum creatinine and cystatin C may be available as a prognostic factor for MACE in patients undergoing PCI. Future studies should be conducted to prospectively validate the sarcopenia index with a multi-centre, large sample.

Machine Learning-Based 30-Day Readmission Prediction Models for Patients with Heart Failure: A Systematic Review

AIMS

Heart failure (HF) is one of the most frequent diagnoses for 30-day readmission after hospital discharge. Nurses have role in reducing unplanned readmission and providing quality of care during HF trajectories. This systematic review assessed the quality and significant factors of machine learning (ML)-based 30-day HF readmission prediction models.

METHODS AND RESULTS

Eight academic and electronic databases were searched to identify all relevant articles published between 2013 and 2023. Thirteen studies met our inclusion criteria. The sample sizes of the selected studies ranged from 1,778 to 272,778 patients, and patients' average age ranged from 70 to 81 years. Quality appraisal was performed.

CONCLUSION

The most commonly used ML approaches were Random Forest and XGBoost. The 30-day HF readmission rates ranged from 1.2% to 39.4%. The area under the receiver operating characteristic curve for models predicting 30-day HF readmission were between 0.51 and 0.93. Significant predictors included sixty variables with nine categories (socio-demographics, vital signs, medical history, therapy, echocardiographic findings, prescribed medications, laboratory results, comorbidities, and hospital performance index). Future studies using ML algorithms should evaluate the predictive quality of the factors associated with 30-day HF readmission presented in this review, considering different healthcare systems and type of HF. More prospective cohort studies with combining structured and unstructured data are required to improve the quality of ML based prediction model, which may help nurses and other healthcare professionals assess early and accurate 30-day HF readmission predictions and plan individualized care after hospital discharge.

REGISTRATION

This study protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) (CRD 42023455584).

Self-care Behavior Based on Integrated Behavioral Model in Patients With Atrial Fibrillation: A Structural Equation Modeling Approach

BACKGROUND

There is limited research exploring the behavioral intentions, beliefs, and application of theoretical models in relation to self-care in patients with atrial fibrillation (AF).

OBJECTIVE

This study aimed to identify the factors that influence self-care behavior in patients with AF.

METHODS

The study used an integrated behavioral model and collected data from 216 patients diagnosed with AF. Data were analyzed using SPSS 24.0 and AMOS/WIN 24.0 to verify the fit of the hypothesis model, confirm factor analysis, and the validity of the hypothesis itself.

RESULTS

Self-care behavioral intention (β = 0.433, p < .001) and habit (β = 0.395, p = .005) had a significant direct effect, while instrumental attitude (β = 0.077, p = .045), injunctive norm (β = 0.084, p = .037), and self-efficacy (β = 0.249, p = .011) had a significant indirect effect on self-care behavior, explaining 64.4% of the variance.

CONCLUSION

The final model validated the factors that impact self-care behavior in patients with AF, highlighting the importance of fostering positive recognition of instrumental attitude, bolstering social influence and self-efficacy through significant individuals to improve self-care behavior. It is recommended to create an intervention program that encourages intentions and motivations for self-care behavior and incorporates tactics to make self-care behavior a habit. The study's path diagram can serve as a conceptual framework for designing strategies to enhance self-care behavior in patients with AF.

Eight-year trajectories and predictors of cognitive function in community-dwelling Korean older adults with cardiovascular diseases

PURPOSE

This study aims to identify longitudinal patterns and predictors of cognitive function trajectories among Korean older adults with cardiovascular diseases.

DESIGN

This study is a longitudinal panel analysis based on secondary data. Data from the the Korean Longitudinal Study of Ageing (KLoSA) were used for analysis.

METHODS

The KLoSA is a representative panel survey of older Koreans. We analyzed responses from 301 participants aged ≥65 years who completed the same survey more than three times out of five waves between 2012 and 2020.

FINDINGS

Latent class growth modeling identified two trajectories of cognitive function in older people with cardiovascular diseases: "low and declining" (n = 81, 26.9%) and "high and declining" (n = 220, 73.1%). Participants in "the low and declining trajectory group" were more likely to have a low educational level, weak handgrip strength, depression, and low social participation at baseline than those in "the high and declining trajectory group."

CONCLUSIONS

Our results indicate a need to develop community-based tailored interventions for improving handgrip strength, mental health, and social participation in delaying cognitive decline in older people with cardiovascular diseases considering their educational level.

CLINICAL RELEVANCE

Healthcare providers should be more concerned about older people with a weaker handgrip, depression, and low social activities as a high-risk group for cognitive decline over time in cardiovascular care. Therefore, it is necessary to evaluate them early with standardized tools and make subsequent strategies for the older population with cardiovascular diseases.

Factors associated with 30-day in-hospital mortality in critically ill adult patients receiving extracorporeal membrane oxygenation: A retrospective cohort study

OBJECTIVE

To identify factors associated with the 30-day in-hospital mortality rate among adult patients requiring extracorporeal membrane oxygenation (ECMO) in intensive care units.

RESEARCH METHODOLOGY

Retrospective cohort study including 148 patients who underwent ECMO for at least 48 h between March 2010 and August 2021. The patients were divided into survivors and non-survivors based on their 30-day in-hospital survival. We obtained the sociodemographic information and pre- and post-ECMO data from electronic medical records. Kaplan-Meier survival curves and Multivariate Cox proportional hazards regression were used to analyse the data.

SETTING

A tertiary-care university hospital in South Korea.

MAIN OUTCOME MEASURES

The 30-day in-hospital mortality rate was the principal outcome measure.

RESULTS

The 30-day in-hospital mortality rate was 49.3% (n = 73). Kaplan-Meier analysis demonstrated that the duration of ECMO support in the 50th percentile of surviving patients was 13 days. Multivariable Cox regression analysis showed that new-onset renal failure, lower mean arterial pressure, and ECMO weaning failure were associated with an increased 30-day in-hospital mortality risk among patients who received ECMO. Subgroup analysis also revealed a significant association between weaning failure and 30-day in-hospital mortality after adjusting for covariates in patients undergoing veno-arterial ECMO.

CONCLUSION

Close monitoring of post-ECMO renal function and mean arterial pressure is required to minimize the risk of 30-day in-hospital mortality, especially in adults within the first two weeks of ECMO initiation. Moreover, the success of ECMO weaning should be optimized by collaboration within the ECMO team.

IMPLICATIONS FOR CLINICAL PRACTICE

Critical care nurses should pay close attention to patients' response to weaning trials as well as alternations in renal function and mean arterial pressure during ECMO support. Furthermore, developing nursing care guidelines for adult patients receiving ECMO and standardized training programs for nurses in intensive care, are required in Korea.

Structural equation modeling of factors associated with nursing students' professionalism during the COVID-19 pandemic

This study aimed to determine the factors associated with nursing professionalism among Korean nursing students. This cross-sectional study was carried out using a convenient sample comprising 247 students enrolled in a four-year Bachelor of Science Nursing program from September 6-27, 2021. A self-reported structured questionnaire was employed to explore the relationships among ego-resilience, self-leadership, clinical learning environment, academic satisfaction, clinical competency, and nursing professionalism by utilizing structural equation modeling. The modified model exhibited good fit indices. Learning-related factors, including clinical learning environments, academic satisfaction, and clinical competency, directly affected nursing professionalism. Self-leadership and the clinical learning environment were indirectly associated with nursing professionalism via both academic satisfaction and clinical competency. Regarding ego-resilience, it only indirectly affected nursing professionalism via academic satisfaction. Creating a student-centered learning environment may be vital to improve students' major and clinical performance, thereby boosting nursing professionalism. Furthermore, nurse educators should consider individual psychological aspects of students when designing the nursing curriculum to foster nursing professionalism. Longitudinal studies are needed to determine if our model is available to explain the development of professionalism among nursing students.

One-year trajectories of self-care behaviours and unplanned hospital readmissions among patients with heart failure: A prospective longitudinal study

AIM AND OBJECTIVES

This study aimed to identify the associations between longitudinal trajectories of self-care behaviours and unplanned hospital readmissions in patients with heart failure.

BACKGROUND

Adherence to self-care behaviours is crucial to prevent hospital readmissions; however, self-care behaviours remain unsatisfactory among patients with heart failure. Studies of long-term trajectories of self-care behaviours and their influence on hospital readmissions are limited in this population.

DESIGN

A prospective, longitudinal observational study.

METHODS

Among 137 participants with heart failure (mean age 67.36 years, 62% men), we analysed the 1-year follow-up data to determine the association between 1-year trajectories of self-care behaviours and hospital readmissions using Kaplan-Meier analysis and multivariable Cox regression, adjusted for confounding variables.

RESULTS

Self-care behaviour trajectories of heart failure patients were classified as 'high-stable' (58.4%) or 'low-sustained' (41.6%). The cumulative rate of readmissions for the low-sustained class was higher than that of the high-stable class for all periods. Factors influencing readmissions included anaemia, cognitive function, frailty and self-care behaviours trajectories. The low-sustained class had a 2.77 times higher risk of readmissions within 1 year than that in the high-stable class.

CONCLUSIONS

Longitudinal self-care behaviours pattern trajectories of heart failure patients were stratified as high-stable and low-sustained. Routine follow-up assessment of patients' self-care behavioural patterns, including anaemia and frailty, and cognitive function can minimise unplanned hospital readmissions.

RELEVANCE TO CLINICAL PRACTICE

Identification of trajectory patterns of self-care behaviours over time and provision of timely and individualised care can reduce readmissions for heart failure patients. Healthcare professionals should recognise the significance of developing tailored strategies incorporating longitudinal self-care behavioural patterns in heart failure patients.

REPORTING METHOD

The study has been reported in accordance with the STROBE checklist (Appendix S1).

PATIENT OR PUBLIC CONTRIBUTION

Patients have completed a self-reported questionnaire after providing informed consent.

The role of patient activation in self-care behaviours of Korean older adults with heart failure

AIM

This study was aimed at investigating the level of patient activation, and its association with self-care behaviours in older people with heart failure.

DESIGN

Cross-sectional secondary data analysis was conducted.

METHODS

We included a total of 182 Korean patients with heart failure who were aged ≥65 years for a cardiovascular outpatient clinic visit. Baseline characteristics, the Patient Activation Measure (PAM), health literacy, disease knowledge and self-care behaviours were collected via a self-administered questionnaire.

RESULTS

The proportion of patient activation at Levels 1 and 2 was 22.5% and 14.3%, respectively. Highly activated patients had a high level of health literacy, disease knowledge and self-care behaviours. After adjusting for confounding factors, we observed that patient activation was the only statiscally significant predictor of self-care behaviours among older people with heart failure. Healthcare professionals should help patients take active roles in their self-care through a comprehensive needs assessment including health literacy and disease knowledge.

Associations of dual use of tobacco cigarettes and e-cigarettes, sleep duration, physical activity and depressive symptoms among middle-aged and older Korean adults

AIM

There is limited evidence of the association between dual tobacco-e-cigarette use and health-related variables in Korea. Thus, this study aimed to investigate the associations between types of cigarette smoking, sleep duration, physical activity and depressive symptoms among Korean adults.

DESIGN

A cross-sectional study design using the 2019 Korean Community Health Survey.

METHODS

The study subjects consisted of 179,004 adults older than 40 years from a total of 229,099 individuals. Self-reported general characteristics, smoking history, sleep duration, physical activity and depressive symptoms were analysed.

RESULTS

In multinomial logistic regression, dual users of tobacco cigarettes and e-cigarettes were more likely to have sleep duration of less than 7 h per day and to report both mild and moderate-to-severe depressive symptoms than non-smokers. Single use of either cigarettes or e-cigarettes increased the risk of short sleep duration and moderate-to-severe depressive symptoms.

Longitudinal patterns and predictors of self-care behavior trajectories among Korean patients with heart failure: A 6-month prospective study

PURPOSE

This study aimed to identify distinct trajectories of self-care behaviors over 6 months after hospital discharge in patients with heart failure, including the baseline predictors affecting these trajectories.

DESIGN

This was a prospective longitudinal observational cohort study with a 6-month follow-up.

METHODS

A total of 158 patients with heart failure (mean age = 66.75 years, 62.7% men) were included in this study. Patients' characteristics, including cognitive function, health literacy, and social support were collected as possible baseline predictors of self-care behavior trajectories using a structured questionnaire and an electronic medical record review. Self-care behaviors were evaluated using the Korean version of the nine-item European Heart Failure Self-care Behavior Scale at baseline, 1, 3, and 6 months after hospital discharge. Latent growth model analysis was conducted to identify the homogeneous subgroups with distinct trajectories of self-care behaviors. Subsequently, multinomial logistic regression was used to assess whether baseline predictors were associated with these trajectories in patients with heart failure.

RESULTS

Three distinct self-care behavior trajectory groups were identified: "low-decreased" (n = 33, 20.9%), "middle-increased" (n = 93, 58.9%), and "high-sustained" (n = 32, 20.2%). The multinomial logistic regression analysis showed that baseline adequate health literacy and positive social support significantly predicted patients' belonging to both the middle-increased and high-sustained self-care behavior trajectory groups compared to the low-decreased group. Importantly, better cognitive function at baseline was only significantly associated with the high-sustained self-care behavior trajectory compared to the low-decreased trajectory.

CONCLUSION

Our study revealed that only one-fifth of the patients belonged to the high-sustained self-care behavior group 6 months after hospital discharge. Strategies aimed at improving cognitive function, health literacy, and social support should be developed to sustain satisfactory self-care behaviors in patients with heart failure. Further studies with long-term follow-ups are required to identify other possible factors, as well as the baseline predictors of this study affecting longitudinal trajectories of self-care behaviors.

CLINICAL RELEVANCE

Healthcare providers should recognize and evaluate the distinct patterns of self-care behaviors over time in patients with heart failure. Importantly, assessing baseline cognitive function, health literacy, and social support before hospital discharge may be necessary to prevent a decline in self-care behaviors over time.

Initial Development of User-Based Quality Evaluation Questionnaire of Smartwatch Technology for Applying to Healthcare

Background

Smartwatches are a consumer wearable device offering a potential, practical, and affordable method to collect personal health data in healthy adults. For patients with chronic diseases, this would enable symptom monitoring and aid clinical decision making. Therefore, providing customized checklists to recommend smartwatches is beneficial. However, few studies have evaluated the practical functions of smartwatches and their influence on user acceptance. We aimed at developing a reliable tool to assess the quality of smartwatches from the users' perspective.

Methods

To develop the smartwatch rating scale (SWRS), we conducted a comprehensive literature review as well as reviewed relevant websites. The SWRS includes 22 items for the usability (usability, functionality, safety, material, and display) and five items for the acceptance and adoption domain (satisfaction and intention). We measured the scale's internal consistency and inter-rater reliability by evaluating seven smartwatches.

Results

The overall scale demonstrated an excellent level of internal consistency (Cronbach's alpha = 0.91), with each subscale's internal consistency above good level (0.74 ~ 0.92). Inter-rater reliability using intraclass correlation coefficients (ICC) was at good level (2-way random ICC = 0.82, 95% CI 0.09 - 0.97).

Conclusions

The SWRS is reliable, which can meet the need for assessment of smartwatch technology for utilizing in personal healthcare. Accounting for users' perspectives will help make the most of technology without impairing the human aspects of care, this study can help consumers choose a smartwatch based on their preferences and provide guidelines for developing user-friendly wearable devices aimed at health behavior changes.

Factors associated with self-management after hybrid revascularization in patients with peripheral artery disease: A structural equations model

AIM

To investigate the factors associated with self-management after hybrid revascularization in patients with lower extremity peripheral artery disease using a structural equation modelling approach.

DESIGN

A cross-sectional study was adopted.

METHODS

A total of 221 patients who underwent hybrid revascularization for peripheral artery disease of the lower limbs were included from outpatient clinics at a 1200-bed tertiary care hospital in Korea. Data were collected using a self-reported questionnaire between December 1, 2019, and August 31, 2020. Structural equation modelling was applied to test the hypothetical model.

RESULTS

The item mean score of participants' self-management was 6.28 (standard deviation, 0.83) out of 8. The structural equation modelling had a good fit index. Autonomy support from healthcare providers was directly associated with self-management (β = 0.20, p = 0.041). Illness perception directly (β = -0.33, p = 0.031) and indirectly (β = -0.19, p = 0.032) influenced self-management through competence and relatedness in patients with peripheral artery disease. The construct of autonomy support from healthcare providers, illness perception, competence and relatedness accounted for 49% of the variance in self-management. The Sobel test confirmed the statistically significant mediating effects of competence (z = -4.52, p < 0.001) and relatedness (z = -2.12, p < 0.001) on the relationship between illness perception and self-management.

CONCLUSION

Our findings revealed that autonomy support from healthcare providers and patients' illness perception directly influenced patients' self-management. Additionally, patients' illness perception can indirectly influence self-management through their perceived competence and relatedness.

IMPACT

Healthcare providers' autonomy support to patients may promote self-care behaviours, leading to greater autonomous motivation. Assessment of patients' illness perception before patient education is vital to designing effective self-management strategies which can improve patients' perceived competency and meaningful relatedness with healthcare providers.

Association of sleep duration and physical frailty with cognitive function in older patients with coexisting atrial fibrillation and heart failure

AIM

To investigate the associations of sleep duration and physical frailty with cognitive function in older patients with both atrial fibrillation and heart failure.

DESIGN

This study used a cross-sectional, secondary data analysis design.

METHOD

We included outpatients aged ≥ 65 years with coexisting atrial fibrillation and heart failure in South Korea. We used a sample of 176 patients (men = 100) with HF among 277 data from the parent study. The data were collected through a self-report, structured questionnaire and electronic medical record.

RESULTS

Our main finding showed that long sleep duration and physically frail status were significant predictors of cognitive impairment in older adults with both atrial fibrillation and heart failure. Healthcare providers should be aware of the importance of assessing sleep duration and physical activity in older adults with both atrial fibrillation and heart failure to prevent or delay cognitive impairment.

Challenges and Learning Needs of Nurse-Patients' Family Communication: Focus Group Interviews With Intensive Care Unit Nurses in South Korea

Intensive care unit (ICU) nurses are expected to facilitate effective day-to-day communication with patients and family members at the bedside. To date, communication training for ICU health care professionals has targeted mainly intensivists-in-training, but there is limited data on communication experience and needs to be evaluated among ICU nurses. This qualitative study used focus group interviews to explore daily communication experiences with patients' families and communication training needs and preferences among ICU nurses in South Korea. Five focus group interviews were conducted with 27 ICU nurses (4-6 nurses per group). The results of inductive qualitative content analysis highlighted four main categories: "Perceived difficulties during communication," "burden from working conditions," "endeavors to promote communication skills," and "strategies for cultivating effective communication." Regarding suggestions for future communication training, nurses preferred interactive learning with peer-support over traditional methods (e.g., lectures). Nurses also suggested that communication training for ICU nurses should include learning skills appropriate for difficult situations (e.g., angry family members). Findings from this study can serve as a framework for stakeholders in ICU care and healthcare education (e.g., hospital and nursing administrators, nurse educators) when designing communication training to support ICU nurses with their practical knowledge and communication skills.

Combined influence of sedentary behaviours and chronic pain on depressive symptoms in older Korean adults with hypertension

AIMS

Depressive symptoms in hypertensive patients are linked to poor adherence to treatment. Sedentary behaviours and chronic pain can increase blood pressure and depressive symptoms, respectively. However, the impact of their coexistence on depressive symptoms in older adults with hypertension has not yet been investigated. This study aimed to identify the combined influence of sedentary behaviours and chronic pain on depressive symptoms in older adults with hypertension in Korea.

METHODS AND RESULTS

This cross-sectional study used data from the sixth Korea National Health and Nutrition Examination Survey from January to December 2014. The survey adopted multistage stratified sampling by geographical region, gender, and age. For the data analysis, a total of 573 patients with hypertension aged 65 years or older were included. Approximately, 61.0% of depressed older patients had both sedentary behaviours and chronic pain compared with patients without depressive symptoms. In multivariate logistic regression analysis, compared with patients without either sedentary behaviours or chronic pain, older adults with hypertension who presented both sedentary behaviours, and chronic pain had the highest risk of depressive symptoms (odds ratio = 13.86, 95% confidence interval = 5.87-32.71; P < 0.001).

CONCLUSION

Coexistence of sedentary behaviours and chronic pain in older hypertensive patients may lead to depressive symptoms. Evaluating both sedentary behaviours and chronic pain when assessing depressive symptoms in patients with hypertension would be beneficial in planning a patient-centred approach for controlling blood pressure. More prospective cohort studies with larger samples are required to identify the causal relationships.

Associations among social jetlag, sleep-related characteristics, premenstrual symptoms, depression, and body mass index of female nursing students

PURPOSE

This study aimed to identify the predictors of female nursing students' body mass index (BMI), including social jetlag.

DESIGN AND METHODS

This secondary data analysis of a cross-sectional survey conducted in 2015 included data of 304 female undergraduate nursing students. A hierarchical regression analysis was performed to identify the predictors of BMI.

FINDINGS

Social jetlag was the most potent predictor of BMI, followed by premenstrual symptoms and sleep quality.

PRACTICE IMPLICATIONS

This study presents foundational data for developing interventions for social jetlag management as a strategy to prevent obesity in female nursing students by identifying factors predicting BMI.

Home-dwelling older adults' experiences of living with both frailty and multimorbidity: A meta-ethnography

OBJECTIVES

To systematically review qualitative studies about home-dwelling older adults' experiences of living with both frailty and multimorbidity.

METHODS

This study adopted a meta-ethnography; the databases included PubMed, Embase, CINAHL, Web of Science, PsycINFO, SCOPUS, and Google Scholar. Qualitative peer-reviewed articles in English were searched up to December 31, 2021. Themes and concepts were extracted through constant comparison across the included studies by three reviewers.

RESULTS

Of the 147 articles screened, nine qualitative articles, encompassing a total sample of 173 participants, were included. The four final synthesised themes were 'Being isolated in a closed life,' 'Being dependent on help from others,' 'Rebuilding to maximise quality of life,' and 'Struggling to live a meaningful life.'

CONCLUSION

Home-dwelling older adults with both frailty and multimorbidity are more likely to be socially isolated due to their physical limitations and lack of integration between hospital-based care and community healthcare services.

Integration of visual thinking strategies to undergraduate health assessment course: A mixed-method feasibility study

BACKGROUND

The COVID-19 pandemic has accelerated demands for a shift from traditional face-to-face learning to online learning. Visual Thinking Strategies (VTS) is an inquiry-based teaching method using various visual artworks to improve critical thinking and interpersonal skills. VTS has been studied in health professional education mostly in art gallery settings. Implementing VTS during online learning in nursing education has not yet been investigated.

OBJECTIVES

This study evaluated the feasibility of incorporating VTS into an undergraduate nursing health assessment course and explored students' perceptions and experiences of VTS.

DESIGN

A single-group, posttest-only, concurrent mixed-methods design was used.

SETTING

This study was conducted in an urban nursing college in Seoul, Korea.

PARTICIPANTS

A convenience sample of 60 second-year undergraduate nursing students enrolled in a health assessment course.

METHODS

We integrated VTS into three skills lab sessions (assessment of older adults, skin assessment, and musculoskeletal system assessment) via on-site sessions or real-time online videoconferencing sessions. Through an online survey, we obtained sociodemographic information, previous VTS experience, measures of teaching orientation, perception of arts-based learning, and VTS evaluation. Additionally, participants were asked to comment on their VTS experiences through free-response questions.

RESULTS

Participants rated VTS as an interesting and easy-to-concentrate learning method compared with traditional classes during a COVID-19 pandemic. In participants' narratives, being able to learn diverse perspectives, expanding the scope of thoughts and observations, and sustainable learning were the most commonly positive experiences. A lack of familiarity and the open-ended nature of observations were reported as the most common challenges.

CONCLUSION

Applying VTS in undergraduate nursing education may help students develop critical thinking, communication, and collaboration skills. As an alternative to traditional teaching, implementing VTS via online may have potential to motivate students' engagement to active learning. Future randomized controlled trials are warranted to build evidence on the benefits of VTS.

Prevalence, associated factors and adverse outcomes of workplace violence towards nurses in psychiatric settings: A systematic review

Workplace violence towards psychiatric nurses by psychiatric patients is common, which can potentially affect care quality as well as nurses' health. This study aimed to synthesize the literature on workplace violence towards psychiatric nurses and identify the prevalence and factors influencing workplace violence and related outcomes. PubMed, Cochrane Library, CINAHL, EMBASE and PsychINFO were searched for English articles on workplace violence against psychiatric nurses published from January 2011 to December 2020. Sixteen articles were selected for the systematic review. This was followed by quality assessment and data extraction. The workplace violence prevalence ranged 11.4-97.6%. Diagnosis of the patient; nurse-related factors such as age, sex, marital status, education, emotional intelligence level and personality; and work shift were associated with the occurrence of workplace violence. Psychiatric nurses who experienced workplace violence had primarily poor mental health such as depressive symptoms and negative work-related outcomes such as turnover intention. The results revealed that there were relatively few patient-related factors associated with workplace violence and few reports on workplace violence-related to nurses' physical health, suggesting the need for a multi-dimensional approach. Future studies are needed to develop standardized instruments for workplace violence investigation considering inpatients psychiatric settings. Effective workplace violence prevention strategies should consider comprehensive patient-, nurse- and occupation-related factors.

Work stress and perceived organisational support on young Korean nurses' care for COVID-19 patients

Background

Since the outbreak of COVID-19 worldwide, frontline nurses have faced tremendous stress. Younger nurses in their early-to-mid careers can be more exposed to burnout and work stress, and perceived organisational support can influence the quality of nursing care for vulnerable patients.

Aim

To identify the impact of younger nurses’ work stress and perceived organisational support on their willingness to care for COVID-19 patients.

Methods

The cross-sectional secondary data analysis included 211 hospital nurses (<35 years) in South Korea with a mean age of 24.60 years (SD=1.90). Multiple logistic regression analysis was used to identify the factors influencing willingness to care.

Findings

Supplying personal protective equipment, training in the use of personal protective equipment, lower work stress, and positive perceptions of organisational support significantly increased early-career nurses’ willingness to care. For mid-career nurses, being male and higher work stress significantly increased their willingness to care.

Discussion

Support, including COVID-19-related education or training, should be provided to reduce work stress arising from being exposed to infection or while providing care to critically ill patients, especially among early-career nurses. Support from nurse managers, senior staff, and colleagues could help younger nurses cope better with the challenges of COVID-19, thus increasing their willingness to care.

Conclusion

Perceived organisational support may facilitate early-career nurses’ organisational commitment. Healthy work environments can relieve early-to-mid-career nurses’ work stress, thus facilitating patient-centred care.

Intervention types and their effects on workplace bullying among nurses: A systematic review

AIM

To integrate the literature on workplace bullying among nurses and identify characteristics of anti-bullying interventions.

BACKGROUND

Workplace bullying in nursing is a major concern, potentially affecting nursing practice, patient outcomes, and nurses' health.

EVALUATION

PubMed, Cochrane Library, CINAHL, EMBASE, and PsychINFO were searched for English articles published between December 2020 and January 2021 on workplace bullying among nurses. Eight articles were selected, and a quality assessment and data extraction followed.

KEY ISSUES

While the studies employed various intervention approaches, their workplace bullying conceptualizations and instruments varied, as did the outcome variables selected to assess the effects of the intervention.

CONCLUSION

Anti-bullying interventions were effective, and the methods of their delivery have diversified. However, issues such as the lack of conceptual clarity, intervention specificity, and elaboration remain unaddressed. Further studies are needed to develop updated and standardized instruments to tailor anti-bullying interventions.

IMPLICATIONS FOR NURSING MANAGEMENT

Upgraded intervention strategies that reflect the contemporary nursing context and participant characteristics are warranted to ensure workplace bullying prevention. Active intervention by upper management is essential to develop and implement effective workplace bullying interventions.

Linkage of Optimism With Depressive Symptoms Among the Stroke Survivor and Caregiver Dyads at 2 Years Post Stroke: Dyadic Mediation Approach

BACKGROUND

Depressive symptoms are substantial among stroke survivors and their caregivers in poststroke management. Optimism and social support are known to protect against depressive symptoms. However, little is known about how optimism and social support contribute to depressive symptoms among stroke survivor-caregiver dyads. The study's purpose was to examine actor and partner effects of optimism on depressive symptoms through perceived social support among stroke survivors and caregiver dyads in the chronic stage of rehabilitation.

METHODS

Stroke survivors and caregivers (N = 105 dyads) completed the survey at 2 years of follow-up after the first stroke. Depressive symptoms, optimism, and perceived social support were assessed using the Center for Epidemiologic Studies-Depression, the Life Orientation Test, and the Interpersonal Support Evaluation List. The Actor-Partner Interdependence Model Extended to Mediation analysis was used to test the indirect effect of optimism on depressive symptoms through perceived social support.

RESULTS

Higher optimism was significantly associated with lower depressive symptoms for caregivers (direct actor effect, -0.6844; 95% confidence interval [CI], -0.9844 to -0.3844) and stroke survivors (direct partner effect, -0.4189; 95% CI, -0.0789 to -0.0889). Perceived social support availability significantly mediated the association between optimism and depressive symptoms for stroke survivors (indirect effect, -0.1957; 95% CI, -0.3923 to -0.0670). Caregiver perceived social support availability was also a significant mediator between caregivers' optimism and stroke survivors' depressive symptoms (indirect effect, 0.1658; 95% CI, 0.0559-0.3128).

CONCLUSIONS

Intervention improving dyad members' optimism and social support would be beneficial to improve depressive symptoms of the stroke survivors and caregivers in chronic stroke management.

Psycho-behavioural factors influencing COVID-19 vaccine hesitancy among Korean adults: The moderating role of age

Aims

This study aimed to identify the psycho‐behavioural factors influencing coronavirus disease 2019 (COVID‐19) vaccine hesitancy among Korean adults. We examined the primary effects of eHealth literacy, social responsibility and self‐efficacy on COVID‐19 vaccine hesitancy using the information‐motivation‐behavioural skills (IMB) model. The moderating effect of age on the relationship between psycho‐behavioural factors and COVID‐19 vaccine hesitancy was also examined.

Design

The study used a cross‐sectional survey design.

Methods

An online survey was completed by 500 Korean adults (253 men and 247 women) aged 20–60 years. Data collection took place in May 2021. The constructed hypothetical model for eHealth literacy, social responsibility, self‐efficacy and age was evaluated using partial least squares structural equation modelling (PLS‐SEM).

Results

eHealth literacy, social responsibility and self‐efficacy had significant negative effects on COVID‐19 vaccine hesitancy. Age had a significant moderating effect on COVID‐19 vaccine hesitancy. The moderating effects of age on the relationship between eHealth literacy and COVID‐19 vaccine hesitancy and between social responsibility and COVID‐19 vaccine hesitancy enhanced the explanatory power by high effect size. The overall fitness of the hypothetical model was good. The standardized root mean square residual value was 0.007, which explained 18.5% of the COVID‐19 vaccine hesitancy.

Conclusion

To reduce COVID‐19 vaccine hesitancy among Korean adults, a strategic approach that considers age should be adopted to enhance eHealth literacy, social responsibility and self‐efficacy.

Impact

The findings of this study suggest that providing correct health information online related to the COVID‐19 vaccine is likely to be effective in decreasing COVID‐19 vaccine hesitancy in older individuals, whereas inspiring a sense of social responsibility is more likely to be effective in younger individuals. These strategic nursing interventions could contribute to improving COVID‐19 vaccination rates among Korean adults.

Psychometric Validation of the Korean Version of the Heart Failure-Specific Health Literacy Scale

BACKGROUND AND PURPOSE

The goals of heart failure (HF) management include lowering adverse outcomes through optimal self-care. Health literacy has a significant role in ensuring optimal and effective HF self-care. Unfortunately, the proportion of low health literacy in HF patients is higher than those with other chronic diseases as well as the general population. Thus, healthcare providers need to screen HF patients. The HF-Specific Health Literacy Scale is a specific questionnaire to screen the health literacy in HF patients; however, the Korean version has not yet been validated. The study aimed to investigate the reliability and validity of the Korean version of the HF-Specific Health Literacy Scale.

METHODS

We adopted a cross-sectional study design with 386 outpatients with chronic HF from a tertiary care hospital in Cheonan, South Korea. Data were collected from April to December 2020.

RESULTS

The exploratory factor analysis revealed a three-factor (functional, communicative, and critical health literacy) 12-item structure of the scale. The result of the confirmatory factor analysis confirmed a good statistical fit for the data. The Korean version of the tool demonstrated satisfactory convergent and discriminant validity. The criterion validity analysis revealed significant correlation with general health literacy and knowledge about HF. The Korean version of the tool for 12 items had adequate overall internal consistency.

IMPLICATIONS FOR PRACTICE

The Korean version of the HF-Specific tool can be easily utilized for assessing health literacy level for HF patient education. Moreover, the tool can help healthcare providers develop strategies for promoting HF patients' health literacy.

Associated Factors and Health Outcomes of Health Literacy and Physical Frailty Among Older Adults: A Systematic Review

The current review aimed to systematically describe and synthesize health outcomes and factors associated with health literacy and physical frailty among older adults. Seven electronic databases were searched for observational studies published in English, from database inception to March 31, 2021. The study protocol was registered with PROSPERO. Two reviewers independently performed study selection, data extraction, and quality assessment using the Newcastle-Ottawa Scale. Among the 479 studies identified, nine (6,337 participants) met eligibility criteria. Common factors associated with health literacy and physical frailty were lower educational level, multiple comorbidities, and cognitive dysfunction. Health literacy was mainly associated with self-reported outcomes, whereas physical frailty was related to clinical outcomes. Prospective studies are required to identify the impact of limited health literacy, combined with frailty, on long-term health outcomes in older adults. Health literacy interventions should consider the older adult population with multiple comorbidities. [Research in Gerontological Nursing, xx(x), xx-xx.].

Perioperative risk factors for new-onset postoperative atrial fibrillation among patients after isolated coronary artery bypass grafting: A retrospective study

AIMS

Incidence of atrial fibrillation is considerably high after open heart surgery, which may prolong hospitalization and increase mortality. The aim of the present study is to investigate the perioperative risk factors for the occurrence of new-onset atrial fibrillation following isolated coronary artery bypass grafting.

DESIGN

A retrospective study.

METHODS

A total of 327 Korean patients recorded to have undergone first-time isolated coronary artery bypass grafting and no preoperative history of atrial fibrillation were included. The data were obtained from electronic health record from January 2010 to December 2019 at a tertiary care hospital. Predictors of new-onset atrial fibrillation after the surgery were identified by multivariate logistic regression analysis.

RESULTS

The incidence rate of new-onset atrial fibrillation after coronary artery bypass grafting was approximately 28.4%, and the highest occurrence rate was 44.1% on postoperative day 2. Our main finding showed that advanced age was the strongest predictor of atrial fibrillation after coronary artery bypass grafting. In addition, history of stroke and depression, chronic obstructive pulmonary disease and intraoperative use of intra-aortic balloon pump were shown to be the risk factors.

CONCLUSION

Our findings showed that approximately 28% patients had new-onset atrial fibrillation after the surgery. Healthcare professionals should proactively assess risk factors for postoperative atrial fibrillation and focus more on older adults with pre-existing comorbidities, such as stroke, depression and chronic obstructive pulmonary disease.

IMPACT

Older adults with history of stroke, depression and comorbid chronic obstructive pulmonary disease should be carefully monitored closely during perioperative period. The study highlights that early assessment of new-onset postoperative atrial fibrillation can contribute to promote the quality of nursing care and frontline nurses may be a vital role in timely detection of atrial fibrillation after surgery. Prospective studies are required to identify the mechanisms connecting perioperative risk factors for atrial fibrillation after cardiac surgery.

Perioperative risk factors for new-onset postoperative atrial fibrillation after coronary artery bypass grafting: a systematic review

Background

Postoperative atrial fibrillation (POAF) is the most common cardiac dysrhythmia to occur after coronary artery bypass grafting (CABG). However, the risk factors for new-onset POAF after CABG during the perioperative period have yet to be clearly defined. Accordingly, the aim of our systematic review was to evaluate the perioperative predictors of new-onset POAF after isolated CABG.

Method

Our review methods adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. We searched seven electronic databases (PubMed, Embase, CINAHL, PsycArticles, Cochrane, Web of Science, and SCOPUS) to identify all relevant English articles published up to January 2020. Identified studies were screened independently by two researchers for selection, according to predefined criteria. The Newcastle–Ottawa Scale was used to evaluate the quality of studies retained.

Results

After screening, nine studies were retained for analysis, including 4798 patients, of whom 1555 (32.4%) experienced new-onset POAF after CABG. The incidence rate of new-onset POAF ranged between 17.3% and 47.4%. The following risk factors were identified: old age (p < 0.001), a high preoperative serum creatinine level (p = 0.001), a low preoperative hemoglobin level (p = 0.007), a low left ventricle ejection fraction in Asian patients (p = 0.001), essential hypertension (p < 0.001), chronic obstructive pulmonary disease (p = 0.010), renal failure (p = 0.009), cardiopulmonary bypass use (p = 0.002), perfusion time (p = 0.017), postoperative use of inotropes (p < 0.001), postoperative renal failure (p = 0.001), and re-operation (p = 0.005). All studies included in the analysis were of good quality.

Conclusions

The risk factors identified in our review could be used to improve monitoring of at-risk patients for early detection and treatment of new-onset POAF after CABG, reducing the risk of other complications and negative clinical outcomes.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12872-021-02224-x.

Developing a conceptual model of older patients' decision-making process in choosing dialysis or conservative care using meta-ethnography

AIMS

To systematically review and synthesize qualitative evidence related to decision-making for treatment modalities among older adults with end-stage renal disease.

DESIGN

A meta-synthesis of the qualitative research was conducted.

DATA SOURCES

A comprehensive literature review using PubMed, CINAHL, PsycINFO, Embase, Web of Sciences and Cochrane was systematically conducted. Qualitative studies published in English from January 2010 to October 2020 were considered.

REVIEW METHODS

Qualitative studies were systematically identified and critically appraised. Data synthesis was performed independently by two reviewers. This review followed the Enhancing Transparency in Reporting the Synthesis of Qualitative Research statement.

RESULTS

Seven qualitative studies, with publication years ranging from 2015 to 2019, were included in the analysis. Overall, the review comprised studies with a total of 133 participants aged between 61 and 93 years. Through meta-synthesis, three themes were identified: 'reflecting on treatment options', 'confronting difficult decisions' and 'maintaining hope in everyday life'.

CONCLUSION

Our findings reflect that older adults have varying preferences for treatment options. These preferences are influenced by various factors such as considering the possibility of opting for dialysis and the practical applicability of treatment options. The synthesized conceptual model serves as the first step towards the conceptualization of the treatment-related decision-making process facilitated by adequate communication, in which patients should be encouraged to speak up, and healthcare providers should listen actively to their patients. This review can provide a strategy for providers to communicate treatment options with older patients with ESRD.

IMPACT

Healthcare providers should be sensitive to older adults' preferences, priorities and treatment goals related to worrying about burdening their families and their outlook on life before deciding treatment modality. Our findings highlight that shared decision-making should be tailored to each of the older patients to provide comprehensive and individualized patient-centred care.

Perceptions of Patient Safety Culture and Medication Error Reporting among Early- and Mid-Career Female Nurses in South Korea

Reporting medication errors is crucial for improving quality of care and patient safety in acute care settings. To date, little is known about how reporting varies between early and mid-career nurses. Thus, this study used a cross-sectional, secondary data analysis design to investigate the differences between early (under the age of 35) and mid-career (ages 35-54) female nurses by examining their perceptions of patient safety culture using the Korean Hospital Survey on Patient Safety Culture (HSPSC) and single-item self-report measure of medication error reporting. A total of 311 hospital nurses (260 early-career and 51 mid-career nurses) completed questionnaires on perceived patient safety culture and medication error reporting. Early-career nurses had lower levels of perception regarding patient safety culture (p = 0.034) compared to mid-career nurses. A multiple logistic regression analysis showed that relatively short clinical experience (<3 years) and a higher level of perceived patient safety culture increased the rate of appropriate medication error reporting among early-career nurses. However, there was no significant association between perception of patient safety culture and medication error reporting among mid-career nurses. Future studies should investigate the role of positive perception of patient safety culture on reporting errors considering multidimensional aspects, and include hospital contextual factors among early-, mid-, and late-career nurses.

Predictors of unplanned 30-day readmissions after coronary artery bypass graft: a systematic review and meta-analysis of cohort studies

AIMS

Coronary artery bypass graft (CABG) is one of the most performed cardiac surgery globally. CABG is known to have a high rate of short-term readmissions. The 30-day unplanned readmission rate as a quality measure is associated with adverse health outcomes. This study aimed to identify and synthesize the perioperative risk factors for 30-day unplanned readmission after CABG.

METHODS AND RESULTS

We systematically searched seven databases and reviewed studies to identify all eligible English articles published from 1 October 1999 to 30 September 2019. Random-effect models were employed to perform pooled analyses. Odds ratio and 95% confidence interval were used to estimate the risk factors for 30-day unplanned readmission. The 30-day hospital readmission rates after CABG ranged from 9.2% to 18.9% in 14 cohort studies. Among preoperative characteristics, older adults, female, weight loss, high serum creatinine, anticoagulant use or dialysis, and comorbidities were found to be statistically significant. Postoperative complications, prolonged length of hospital stay, and mechanical ventilation were revealed as the postoperative risk factors for 30-day unplanned readmission. However, intraoperative risk factors were not found to be significant in this review.

CONCLUSION

Our findings emphasize the importance of a comprehensive assessment during the perioperative period of CABG. Healthcare professionals can perform a readmission risk stratification and develop strategies to reduce readmission rates after CABG using the risk factors identified in this review. Future studies with prospective cohort samples are needed to identify the personal or psychosocial factors influencing readmission after CABG, including perioperative risk factors.

Impact of Hospital Nurses' Perception on Clinical Alarms and Patient Safety Culture on Alarm Management Practice

This study aimed to identify the impact of nurses' perception of clinical alarms and patient safety culture on alarm management. Additionally, we aimed to describe the importance of clinical alarm issues. The data were collected from 21 August to 10 September 2020. The study participants were 116 nurses working in a tertiary acute care hospital in Korea. The self-report questionnaire included general characteristics, clinical alarm issues, nurses' alarm perception, patient safety culture, and alarm management practice. The mean age of nurses was 28.04 ± 4.06 years, with 5.71 ± 4.35 years of total clinical experience. For the importance of alarm issues, frequent false alarms leading to reduced attention or response was the most important issue. Hierarchical linear regression analysis revealed that a higher level of nurses' perceived patient safety culture was the strongest predictor of better alarm management practice (p < 0.001), followed by their perception of clinical alarms (p = 0.034). In addition, female nurses (p = 0.004), charge nurses (p = 0.013), and nurses who work less than 40 h per week (p = 0.008) were more likely to work better in alarm management practice. Future studies are needed to develop standardized alarm management guidelines by improving nurses' positive perceptions of clinical alarms and patient safety culture.

Predictors of Early and Late Unplanned Intensive Care Unit Readmission: A Retrospective Cohort Study

PURPOSE

Intensive care unit (ICU) readmission is considered one of the major quality indicators of critical care. Reducing ICU readmission can improve patients' outcomes and optimize health resources, but there are limited data on the predictors of unplanned ICU readmission. This study aimed to identify the risk factors associated with unplanned ICU readmission within 48 hr (early) and after 48 hr (late) from ICU discharge.

DESIGN

Retrospective cohort study.

METHODS

Data were collected from patients' electronic medical records in a 24-bed medical ICU at a tertiary academic medical center in Busan, South Korea. Among all the patients admitted to the medical ICU (n = 1,033) between January 2015 and December 2017, 739 eligible patients were analyzed. A multivariable multinomial logistic regression model was conducted to identify predictors of ICU readmission.

FINDINGS

Out of the 739 patients analyzed, 66 (8.9%) were readmitted to the medical ICU: 13 (1.8%) as early readmission and 53 (7.1%) as late readmission. Two significant predictors were identified for early readmission: ICU admission from the ward (odds ratio [OR] = 4.14; 95% confidence interval [CI] 1.25, 13.67) and mechanical ventilation support >14 days (OR = 13.25; 95% CI 1.78, 98.89). For late ICU admission, there were four risk factors: ICU admission from the ward (OR = 2.69; 95% CI 1.44, 5.05), tracheostomy placement (OR = 3.58; 95% CI 1.49, 8.59), mechanical ventilation support >14 days (OR = 4.77; 95% CI 1.67, 13.63), and continuous renal replacement therapy (OR = 4.57; 95% CI 2.42, 8.63).

CONCLUSIONS

To prevent unplanned ICU readmission in patients at high risk, it is necessary to investigate further the role of clinical judgment and communication within the ICU clinical team and institutional-level support regarding ICU readmission events.

CLINICAL RELEVANCE

Both ICU nurses and nurses in post-ICU settings should be aware of the potential risk factors associated with early and late ICU readmission. Predictors and readmission strategies may be different for early and late readmissions. Prospective multicenter studies are needed to examine how these factors influence post-ICU outcomes.

Sex Differences in the Association between Atrial Fibrillation and 90-Day Adverse Outcomes among Older Adults with Heart Failure: A Retrospective Cohort Study

Sex differences in the prognostic impact of coexisting atrial fibrillation (AF) in older patients with heart failure (HF) have not been well-studied. This study, therefore, compared sex differences in the association between AF and its 90-day adverse outcomes (hospital readmissions and emergency room (ER) visits) among older adults with HF. Of the 250 older adult patients, the prevalence rates of coexisting AF between male and female HF patients were 46.0% and 31.0%, respectively. In both male and female older patients, patients with AF have a significantly higher readmission rate (male 46.0%, and female 34.3%) than those without AF (male 6.8%, and female 12.8%). However, there are no significant differences in the association between AF and ER visits in both male and female older HF patients. The multivariate logistic analysis showed that coexisting AF significantly increased the risk of 90-day hospital readmission in both male and female older patients. In addition, older age in males and longer periods of time after an HF diagnosis in females were associated with an increased risk of hospital readmission. Consequently, prospective cohort studies are needed to identify the impact of coexisting AF on short- and long-term outcomes in older adult HF patients by sex.

Gender differences in the impact of frailty on 90-day hospital readmission in heart failure patients: a retrospective cohort study

AIMS

Frequent hospital readmissions after heart failure (HF) are common, however, there is limited data on the association between frailty status and hospital readmission in HF patients. This study aimed to examine the 90-day hospital readmission rates and gender differences in the impact of frailty on 90-day hospital readmission in HF patients.

METHODS AND RESULTS

We retrospectively analysed hospital discharge records of 279 patients (men = 169, women = 110) who were diagnosed with HF between January 2017 and December 2018. Frailty was assessed using the Korean version of the FRAIL scale. A logistic regression analysis was conducted to explore the factors predicting 90-day hospital readmission by gender. The prevalence of frailty and 90-day hospital readmissions were ∼54.4% and 22.7% in women, compared with 45.6% and 27.8% in men, respectively. Frail patients with HF have an increased risk of 90-day hospital readmission in both males and females. Particularly, women with frailty had a higher risk of 90-day hospital readmission [adjusted odds ratio (OR) 6.72, 95% confidence interval (CI) 1.41-32.09] than men with frailty (adjusted OR 4.40, 95% CI 1.73-11.17).

CONCLUSION

Our findings highlight that readmission within 90 days of hospitalization for HF can be predicted by patients' frailty. More importantly, we found that women with frailty have a greater risk of readmission than men with frailty. Screening for frailty should therefore be integrated into the assessment of HF patients. Tailored interventions for preventing adverse outcomes should consider gender-associated factors in HF patients with frailty.

Critical care nurses' communication challenges during handovers: A systematic review and qualitative meta-synthesis

AIMS

To review and synthesize qualitative studies to gain a deeper understanding of critical care nurses' inter-departmental and shift-to-shift handover challenges.

BACKGROUND

Good-quality nurse-to-nurse handover promotes patient safety, while poor handover has been associated with medical errors. However, systematic reviews of qualitative approaches for better understanding the handover experiences of critical care nurses are lacking.

EVALUATION

Systematic review methods incorporating meta-synthesis were used. A comprehensive search of seven databases was conducted. Two independent reviewers performed data extraction and evaluated ten studies using the Critical Appraisal Screening Program. Findings were analysed and synthesized using thematic analysis. The transactional model of communication was used to guide the analysis.

KEY ISSUES

A total of 10 qualitative studies were included. Seven major handover themes were identified: (a) expectations of perfection, (b) need for partnership, (c) unilateral communication, (d) obstacles to information acquisition, (e) lack of pertinent patient information, (f) need for a structured handover and (g) interruptions/distractions.

CONCLUSIONS

Handovers should be considered an essential part of patient-centred care for ensuring continuity of care.

IMPLICATIONS FOR NURSING MANAGEMENT

Poor communication during a handover could increase the nurse's burden or stress and adversely affect patient care. Therefore, training should be provided on explicit handover communication.

Mediating effects of social support between Type D personality and self-care behaviours among heart failure patients

AIMS

Patients with heart failure exhibit poor adherence to self-care behaviours. Recent studies have shown a link between Type D personality, social support, and self-care behaviours of patients with chronic diseases. However, the mechanisms underlying this relationship have received little empirical attention in those with heart failure. This study aimed to identify the mediating effects of social support in the relationship between Type D personality and self-care behaviours in patients with heart failure.

DESIGN

This study employed a descriptive cross-sectional design.

METHODS

The sample comprised 170 patients aged over 18 years who had been diagnosed with heart failure for over 6 months and visited a tertiary care university hospital in Seoul. From April-July 2019, data were collected through an interview conducted using a structured questionnaire and a review of medical records by two trained research assistants. Multiple regression models were tested using the SPSS PROCESS procedure with bootstrapping to determine the significance of the mediation.

RESULTS

The prevalence of Type D personality in patients with heart failure was 20.0%. Significant associations were identified among Type D personality, social support, and self-care behaviours. Results revealed an indirect effect, suggesting that the effects of Type D personality on self-care behaviours were mediated by social support.

CONCLUSION

Heart failure patients with Type D personality were likely to lack social support, which may have influenced their low adherence to self-care behaviours. Thus, to facilitate long-lasting self-care behaviours, it is vital to provide supportive care or educational programs for patients with Type D personality.

IMPACT

Providing sustainable social support can have a positive impact on the long-term self-care maintenance of patients with heart failure patients who have a Type D personality. Future studies are required to further elucidate the underlying mechanisms of the relationship between Type D personality, social support, and self-care behaviours.

Factors Associated with In-Hospital Mortality after Continuous Renal Replacement Therapy for Critically Ill Patients: A Systematic Review and Meta-Analysis

Continuous renal replacement therapy (CRRT) is a broadly-accepted treatment for critically ill patients with acute kidney injury to optimize fluid and electrolyte management. Despite intensive dialysis care, there is a high mortality rate among these patients. There is uncertainty regarding the factors associated with in-hospital mortality among patients requiring CRRT. This review evaluates how various risk factors influence the in-hospital mortality of critically ill patients who require CRRT. Five databases were surveyed to gather relevant publications up to 30 June 2020. We identified 752 works, of which we retrieved 38 in full text. Finally, six cohort studies that evaluated 1190 patients were eligible. The in-hospital mortality rate in these studies ranged from 38.6 to 62.4%. Our meta-analysis results showed that older age, lower body mass index, higher APACHE II and SOFA scores, lower systolic and diastolic blood pressure, decreased serum creatinine level, and increased serum sodium level were significantly associated with increased in-hospital mortality in critically ill patients who received CRRT. These results suggest that there are multiple modifiable factors that influence the risk of in-hospital mortality in critically ill patients undergoing CRRT. Further, healthcare professionals should take more care when CRRT is performed on older adults.

Effectiveness of Nurse-Led Heart Failure Self-Care Education on Health Outcomes of Heart Failure Patients: A Systematic Review and Meta-Analysis

Poor self-care behaviors can lead to an increase in the risk of adverse health outcomes among patients with heart failure. Although a number of studies have investigated the effectiveness of nurse-led self-care education, the evidence regarding the effects of nurse-led intervention in heart failure remains uncertain. This study aimed to evaluate evidence on the effectiveness of nurse-led heart failure self-care education on health outcomes in patients with heart failure. To identify studies testing nurse-led education designed to improve self-care among heart failure patients, comprehensive search methods were used between January 2000 and October 2019 to systematically search six electronic databases: PubMed, CINAHL, Embase, Cochrane library, Web of Science, and SCOPUS. All the eligible study data elements were independently assessed and analyzed using random-effects meta-analysis methods. Of 612 studies, eight articles were eligible for this study. Nurse-led heart failure self-care education significantly reduced the risk of all-cause readmission (risk ratio (RR) = 0.75, 95% confidence interval (CI) = 0.66–0.85), heart failure specific readmission (RR = 0.60, 95% CI = 0.42–0.85), and all-cause mortality or readmission (RR = 0.71, 95% CI = 0.61–0.82). However, nurse-led heart failure self-care education was not associated with improvements in the quality of life and heart failure knowledge. Studies on the effectiveness of nurse-led heart failure self-care education mostly report only the positive effects on patients’ health outcomes, whereas evidence of the effectiveness of the nurse-led approach is still limited. Therefore, high quality randomized controlled trials with detailed and explicit descriptions on the components of the interventions are needed.

The roles of health literacy and social support in improving adherence to self-care behaviours among older adults with heart failure

Aim

To describe the associations between health literacy, social support and self‐care behaviours in older adults with heart failure.

Design

A cross‐sectional descriptive study.

Methods

A total of 252 older adults were recruited from a tertiary care hospital from September 2018–February 2019. Structured questionnaires and medical record reviews were used for data collection. Two steps of hierarchical regression analysis were employed to determine the predictors of self‐care behaviours.

Results

Health literacy (β = 0.27, p < .001) and social support (β = 0.32, p < .001) were significant determinants of self‐care behaviours in older adults with heart failure. Together, they explained 22% of the variance in self‐care behaviours.

Conclusion

Health literacy and perceived social support were positively associated with self‐care behaviours among older heart failure patients. Our findings can help health professionals develop heart failure self‐care interventions to enhance health literacy skills and social support for older adults.

Social Activities and Health-Related Quality of Life in Rural Older Adults in South Korea: A 4-Year Longitudinal Analysis

During later life, inadequate social interactions may be associated with worse quality of life in older adults. Rural older adults are prone to developing unhealthy lifestyles related to social activities, which can lead to a poorer quality of life than that enjoyed by older adults living in urban areas. This study aimed to describe longitudinal changes in social activity participation and health-related quality of life among rural older adults, exploring potential associations with changes to in-person social activity over four years. We used prospective community-based cohort data from the Korean Social Life, Health, and Aging Project (KSHAP) collected between December 2011 and January 2016. The sample included 525 older adults who completed the measure of health-related quality of life. Our results showed a significant change in health-related quality of life according to changes in participation in meeting with friends. Even though an individual's participation in other social activities did not show significant differences in health-related quality of life, our findings imply that in-person social activities may be an important resource to encourage participation in physical activities and to develop other positive outcomes, such as a sense of belonging or satisfaction with later life, among rural older adults.

Patients' needs and perspectives for using mobile phone interventions to improve heart failure self-care: A qualitative study

AIMS

To explore heart failure patients' needs and perspectives for using mobile health technology at home before developing a mobile phone-based heart failure self-care intervention.

DESIGN

A qualitative interview study.

METHODS

Purposive sampling was used to conduct semi-structured individual interviews with patients diagnosed with chronic heart failure (N = 20). Data were collected from November 2018 - May 2019. All interviews were audio-recorded and transcribed verbatim and data were analysed using qualitative content analysis.

RESULTS

The four themes that emerged from the interviews were as follows: 'The demand for reliable and customized health information', 'Valuable features of mobile phone applications', 'Barriers to adopting mobile health service', and 'Expected benefits of using mobile health technology'. Participants in this study required personalized health-related information and reminders for improving their self-care behaviours. However, while difficulties in using mobile phone applications posed the main obstacle, users expected mobile health services to improve their overall quality of life.

CONCLUSION

Despite mobile phone technology's potential benefits for effective self-care strategies at home, there were some obstacles such as security issues, application costs, and the need for user friendly designs and reliable information for patients' optimal use.

IMPACT

This study highlights that healthcare professionals should consider patients' needs and preferences to promote the acceptability of mobile health technology. This study's findings can guide the future design and implementation of mobile health interventions for improving self-care among patients with heart failure.

Gender Differences Regarding the Impact of Change in Cognitive Function on the Functional Status of Intensive Care Unit Survivors: A Prospective Cohort Study

PURPOSE

This study aimed to identify gender differences with regard to the impact of change in cognitive function on functional status 3 months after receiving critical care.

DESIGN AND METHODS

This prospective cohort study investigated 152 intensive care unit (ICU) patients. Their functional status and cognitive function were assessed using the validated Korean version of the Modified Barthel Index and Mini-Mental State Examination, respectively. Hierarchical regression was used to evaluate the impact of change in cognitive function on functional status in ICU survivors by gender.

FINDINGS

The proportion of women suffering from consistent cognitive impairment was significantly higher than that of men. Women had a rate of improvement to normal cognitive function within 3 months after discharge that was higher than that of men. Functional status 3 months after discharge was significantly lower for patients whose cognitive impairment was consistent than that for those whose cognitive function was normal. The impact of change in cognitive function on men (R² change = .28) was greater than that on women (R² change = .13).

CONCLUSIONS

Persistent cognitive impairment after critical illness had a negative effect on functional status in ICU survivors. Importantly, the negative impact of consistent cognitive impairment was greater in men than in women.

CLINICAL RELEVANCE

Early careful assessment of functional and cognitive status after critical illness is warranted. Strategies addressing the gender-specific characteristics related to cognitive improvement should also be developed.

Hospital Nurses' Perception of Death and Self-Reported Performance of End-of-Life Care: Mediating Role of Attitude towards End-of-Life Care

Few studies have explored how nurses in acute care hospitals perceive and perform end-of-life care in Korea. Therefore, this study aimed to evaluate the influence of nurses' perceptions of death on end-of-life care performance and analyze the mediating role of attitude towards end-of-life care among hospital nurses. This cross-sectional study included a total of 250 nurses who have had experience with end-of-life care from four general hospitals in Korea. We used the Korean validated tools with the View of Life and Death Scale, the Frommelt Attitudes Toward Care of the Dying (FATCOD) scale, and the performance of end-of-life care. Hierarchical linear regression and mediation analysis, applying the bootstrapping method. The results of hierarchical linear regression showed that nurses' positive perceptions of death and attitude towards end-of-life care were significantly associated with their performance of end-of-life care. A mediation analysis further revealed that nurses' attitude towards end-of-life care mediates the relationship between the perceptions of death and performance of end-of-life care. Our findings suggest that supportive and practical death educational programs should be designed, based on nurses' professional experience and work environment, which will enable them to provide better end-of-life care.

Challenges Experienced by Family Caregivers of the Adult Intensive Care Unit Patients in Korea: An Integrative Review

Consistent with global trends, population aging in South Korea is necessitating increasing admissions to intensive care units (ICU). This integrative review describes the challenges experienced by family caregivers of ICU patients in South Korea and evaluates relevant intervention studies. Using Whittemore and Knafl's methods, we identify and synthesize findings from 20 (14 descriptive and 6 experimental design) articles and evaluate study quality. South Korean ICU family caregivers reported challenges such as feelings of powerlessness and vulnerability, difficulty in maintaining their own health and well-being, and mixed feelings regarding patients' transition to the general ward. Intervention studies, which were based on quasi-experimental design, examined modified visiting hours, information provision strategies, nurse-led transitional care programs, and educational support. Findings highlight the current state of the science in this topic area in South Korea. Future studies should use more robust methods, such as longitudinal cohort studies and randomized controlled trials.

Hospital Nurses' Perceived Patient Safety Culture and Adverse Nurse Outcomes in Korea

BACKGROUND

Hospital nurses are likely to be the first to observe patient safety issues in clinical settings, and thus it is important to include their views on patient safety culture. However, there are few studies addressing the influence of nurses' perceived patient safety culture on adverse nurse outcomes as quality of care.

PURPOSE

This study was to identify the relationship between nurses' perceptions of patient safety culture and adverse nurse outcomes in Korea.

METHODS

This cross-sectional study was included 299 nurses at two tertiary hospitals. Hierarchical linear regression was conducted to examine the impact of patient safety culture on adverse nurse outcomes among hospital nurses.

RESULTS

The mean score of patient safety culture and adverse nurse outcomes were 3.50 out of 5 points and 3.07 out of 4 points respectively. In hierarchical linear regression, hospital work environment, the attitude of supervisor/manager, and hospital climate/culture of patient safety culture predicted adverse nurse outcomes after adjusting for general characteristics.

CONCLUSIONS

It is crucial for healthcare facilities to assess or evaluate their current patient safety culture perceptions on a regular basis. Furthermore, provision workshops and staff training on changing behaviors and perceptions regarding patient safety activities can improve nursing performance in clinical settings.

Development and psychometric testing of the self-care scale for patients with chronic atrial fibrillation (AF-SCS-10)

BACKGROUND

Patients with atrial fibrillation (AF) require continuous self-care due to possible complications and side effects from treatment. However, existing tools do not capture all of the critical factors of AF self-care and have limited evidence of reliability and validity.

AIMS

The aim of this study was to develop and evaluate a new Atrial Fibrillation Self-Care Scale-10 (AF-SCS-10) that assesses disease-specific, multidimensional, person-centered self-care for AF patients in South Korea.

METHODS

For this cross-sectional research design, 290 individuals over 20 years of age with a diagnosis of AF for at least three months were recruited. A literature review and in-depth interviews were utilized to identify the scale items. An expert panel evaluated the validity and reliability of a preliminary scale. Exploratory factor analysis and parallel analysis was performed to extract factors; confirmatory factor analysis (CFA) was performed to evaluate fit on the factor structures. Criterion validity was supported by the correlation between AF-SCS-10 and AF quality of life.

RESULTS

The internal consistency reliability coefficient was 0.87. Three factors, "self-care knowledge," "self-care behavior," and "self-care resources" were extracted from the exploratory factory analysis, explaining 79.30% of the total variance in the data. The three-factor model was also confirmed by parallel analysis; CFA met the fitness criteria.

CONCLUSION

There is preliminary evidence for internal consistency reliability, as well as content and construct validity, for the AF-SCS-10. Future research is needed to confirm the study results using a larger, more culturally diverse sample.

Transitional Care Interventions for Patients with Heart Failure: An Integrative Review

Heart failure (HF) is a life-limiting illness and presents as a gradual functional decline with intermittent episodes of acute deterioration and some recovery. In addition, HF often occurs in conjunction with other chronic diseases, resulting in complex comorbidities. Hospital readmissions for HF, including emergency department (ED) visits, are considered preventable. Majority of the patients with HF are often discharged early in the recovery period with inadequate self-care instructions. To address these issues, transitional care interventions have been implemented with the common objective of reducing the rate of hospital readmission, including ED visits. However, there is a lack of evidence regarding the benefits and adverse effects of transitional care interventions on clinical outcomes and patient-related outcomes of patients with HF. This integrative review aims to identify the components of transitional care interventions and the effectiveness of these interventions in improving health outcomes of patients with HF. Five databases were searched from January 2000 to December 2019, and 25 articles were included.

Caring experiences of family caregivers of patients with heart failure: A meta-ethnographic review of the past 10 years

Background:

Living with heart failure, a debilitating disease with an unpredictable course, requires ongoing adaptation and management not only from patients but also from their families. Family caregivers have been known to be key facilitators of self-management of heart failure. An integrative understanding of the experiences of family caregivers will provide essential information for improving the quality of life of persons with heart failure and their families.

Aims:

This study aimed to integrate and synthesize the findings of qualitative studies on family members’ experiences of caring for patients with heart failure.

Methods:

We employed the meta-ethnography methodology. Five electronic bibliographic databases were used to retrieve studies published from April 2009–March 2019 that explored family caregivers’ experiences of caring for patients with heart failure. Twelve qualitative studies were finally included for the synthesis, based on the eligibility criteria.

Results:

Three themes were identified: “shouldering the entire burden,” “starting a new life,” and “balancing caregiving and everyday life.” These three themes illustrate how family caregivers fulfilled caregiving roles, what helped them juggle their multiple responsibilities, and how they struck a balance between life as caregivers and individuals in their own right.

Conclusion:

This review provides a deeper understanding of family caregivers’ experiences of caring for patients with heart failure. The findings can help healthcare providers in the development and implementation of tailored interventions for both patients and family caregivers.