Nurses' assessment of health literacy requirements for adult inpatients: An integrative review

ISSUE ADDRESSED

This paper reviews current research which examines nurses' assessment of patient's health literacy in the acute hospital setting. Research highlights, that patients with low health literacy have more frequent hospitalisations and are more likely to be re-admitted. Within the healthcare team, nurses are primarily responsible for teaching patients and deciphering health communication, to enhance understanding. Within the acute care setting, there remains a disparity in patient understanding of information, despite nurse-led education. The health literacy assessment and tailoring of information by nurses, is becoming more important with shorter stays, plus limited family visits and the wearing of masks with COVID-19 related changes.

METHODS

An integrative review across four nursing databases, from 2010 and June 2022 was conducted. The integrative framework included problem identification, literature search, data evaluation, data analysis with thematic analysis, and results presentation.

RESULTS

Nine studies were included. Common themes were nurses' overestimation of patients' health literacy, the use of universal precautions, and adapting communication techniques to improve education moments.

CONCLUSION

The findings of this review indicate a tendency among nurses to overestimate their patients' health literacy levels, which can result in ineffective health education and inadequate discharge planning.

SO WHAT

Nurses decipher health communication for their patients. Designing tailored patient communication and education could potentially be a cost saving measure for hospitals by reducing length of stay and reducing readmissions. Health literacy training should be incorporated into nursing practice.

Critical importance of patient-reported outcomes for a comprehensive assessment of psoriatic arthritis patients

Introduction

Psoriatic arthritis (PsA) is a heterogeneous, chronic inflammatory disease that negatively impacts patients' quality of life. Patient-reported outcome measures (PROMs) are used to capture patient perspectives in disease assessment, and physicians use the Disease Activity Index for Psoriatic Arthritis (DAPSA) to evaluate disease activity in PsA. The study aimed to assess the relationship between PROMs and the DAPSA score in consecutive outpatients affected by PsA.

Materials and methods

A cross-sectional study was conducted from March 2018 to October 2020 at the PsA clinic of the ARNAS Civico in Palermo (Italy), enrolling outpatients with PsA. Patients were assessed for their disease activity according to the DAPSA score, and PROMs, such as PHQ-9, HAQ, FACIT-F, and PsAID, were evaluated. Linear regression analysis evaluated the relationship between the DAPSA Score and the included PROMs.

Results

158 PsA consecutive peripheral subset psoriatic arthritis outpatients were recruited. The median years of illness was 10.6 (9.3-11.9), and the median DAPSA score was 19.02 (9-33.1). The regression analysis highlighted a strong relationship between the DAPSA score and the PsAID (adjR2 26%, p < 0.0001), the FACIT-F (adjR2 25.4%, p < 0.0001), the HAQ (adjR2 23.7%, p < 0.0001), and PHQ-9 (adjR2 15%, p < 0.0001).

Conclusion

PROMs are strongly associated with the DAPSA score, but it allows in-depth evaluation of the impact of the disease on different domains of PsA patients' life.

Should adding pain, oxygen saturation and physical assessment to vital signs become the new standard of care for detecting blood transfusion reactions?

BACKGROUND AND OBJECTIVES

Clinicians sought to ascertain what frequency of vital signs best detects blood transfusion reactions. This review discusses early and delayed blood product transfusion reaction detection through the lens of scientific literature.

METHODS

A comprehensive appraisal of published literature was conducted using Integrative Research Review methodology through June 2022 not limited to English or research in Cumulative Index to Nursing and Allied Health Literature, Cochrane Library of Systematic Reviews, Medline and PubMed.

RESULTS

Full-text articles in the final sample included four articles discussing vital signs detecting blood transfusion reactions and four articles reporting the importance of adding physical assessments for early reaction detection. None of the studies provided evidence regarding how often vital signs should be monitored to detect transfusion reactions. No studies included identical screening components for detecting blood product transfusion reactions. Main themes emerged including variations in what was included in vital signs, importance of respiratory assessment, inclusion of physical assessment, nurse documentation and reporting compliance, and patient and family inclusion in transfusion reaction recognition.

CONCLUSION

Vital sign components varied across reviewed studies. Respiratory rate and pain were not always included in 'vital signs' to identify transfusion reactions. Only low-level data and no clinical trials loosely informing frequency of vital sign monitoring to transfusion reaction detection were found. Respiratory (to include oxygen saturation, lung sounds and respiratory rate) and pain assessment emerged as crucial to acute and delayed transfusion reaction recognition. The disconnect between 'vital signs' and the varied vital sign components reported to detect transfusion reactions in scientific literature requires further exploration.

Body image and scar assessment: A longitudinal cohort analysis of cardiothoracic, neurosurgery and urology patients

BACKGROUND

Scar severity and scar viewing are known to affect body image. The literature is lacking on the relationship between body image and surgical scar assessment. The aims of this study were to compare patients from 3 different surgical departments in terms of body image and scar assessment at discharge, in comparison with nurses' scar assessment, and 3 months post-surgery. In addition, the research examined age and gender in relation to the main variables.

METHODS

A longitudinal, comparative, correlational study was conducted using an instrument which included a health history, a nurses scar assessment tool and a patient scar assessment tool at hospital discharge, as well as a body image tool used both at discharge and at 3 months' post-surgery. The 10-item body image scale was comprised of affective items, behavioural items and cognitive items. The STROCSS 2019 checklist is used.

RESULTS

75 patients were studied who were mostly male (68.0%) with a mean age of 59 and married (77.3%). The sample distribution of departments included 30.7% cardiothoracic, 29.3% neurosurgery and 40% urology. Cardiothoracic patients displayed a significant negative body image pre-surgery compared to post-surgery. Neurosurgical patients' scar assessments were significantly higher than nurses' assessments with no differences found in the other departments.

CONCLUSIONS

The healthcare team needs to consider engaging patients in post-surgery discussions concerning scarring and body image. The results of this study revealed that expectations in both clinician and patient participants need to be assessed and evaluated for congruency in order to offer a greater patient-focused peri-operative experience.

Applying critical thinking to nursing

Critical thinking and writing are skills that are not easy to acquire. The term 'critical' is used differently in social and clinical contexts. Nursing students need time to master the inquisitive and ruminative aspects of critical thinking that are required in academic environments. This article outlines what is meant by critical thinking in academic settings, in relation to both theory and reflective practice. It explains how the focus of a question affects the sort of critical thinking required and offers two taxonomies of learning, to which students can refer when analysing essay requirements. The article concludes with examples of analytical writing in reference to theory and reflective practice.