Nursing and Midwifery - Journal Articles
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Item Healthcare professionals’ perspectives on use of PCSK9 inhibitors in cardiovascular disease: an in-depth qualitative study(Oxford University Press, 2024-05-24) Lee, Geraldine A.; Durante, Angela; Baker, Edward E.; Vellone, Ercole; Caggianelli, Gabriele; Dellafiore, Federica; Khan, Mutiba; Khatib, Rani; European Society of Cardiology; Amgen; Novo NordiskAim: Injectable medicines such as PCSK-9 inhibitors are increasingly used to manage risk factors for cardiovascular events with little information around the perceptions of healthcare professionals (HCPs) on the administrative and clinical practicalities. The aim was to identify the facilitators and barriers on the use of injectable therapies with CV benefits through interviews with HCPs. Methods and results: Qualitative interviews were conducted in the United Kingdom (London and Leeds) and Italy (Rome and Milan) in 2021. Coding was undertaken using NVivo and thematic analysis performed. A total of 38 HCPs were interviewed, 19 in each country composing of physicians (n = 18), pharmacists (n = 10), nurses (n = 9) and pharmacy technician (n = 1). Four themes emerged: (i) Clinicians’ previous experiences with injectable therapies (ii) Challenges with patients’ behaviours and beliefs (iii) Clinicians’ knowledge of injectable therapies and therapeutic inertia and (iv) Organisational and governance issues. The behaviour and beliefs from healthcare professionals focused on facilitating behaviour change as well as the poor interdisciplinary working and collaboration. Therapeutic inertia was raised where physicians either lacked awareness of injectable therapies or were unwilling to prescribe them. The importance of facilitating patient education on injection techniques was highlighted while organisational and governance issues identified the lack of guidance to inform practice. Clear pathways are required to identify those who were eligible for injectable therapies as well as on how injectables should be prescribed. Conclusion: If medicine optimisation is to be achieved, there needs to be structured processes in place to identify eligible patients and the development of educational material.Item Ethical issues in dysphagia management(Georg Thieme Verlag KG, 2020-06-25) Leslie, Paula; Lisiecka, DominikaDysphagia management is complex and requires balancing individuals' preferences, quality of life, and medical consequences. Ethical challenges are not uncommon given the complexity of dysphagia. Professionals must engage in ethical reflection and shared decision-making when managing dysphagia. Recognizing one's own presuppositions and beliefs may be fundamental to ensuring an ethical approach. The goal of this article is to apply principles of ethics using hypothetical case studies of dysphagia. To this end, we will describe the challenges of working with the disorder of dysphagia; the influence of culture on decision-making about eating and feeding; the importance of information disclosure and respect for individuals' refusal of recommendations; and the interplay of ethical reflection, evidence, and clinical judgment when making complex dysphagia management decisions. These concepts should be kept in mind to ensure compassionate and competent care of the person with eating, drinking, or swallowing problems and their family caregivers.Item Implementation of a Frailty Care Bundle (FCB) targeting mobilisation, nutrition and cognitive engagement to reduce hospital associated decline in older orthopaedic trauma patients: pretest-posttest intervention study(Hylonome Publications, 2024-03) Naughton, Corina; de Foubert, Marguerite; Cummins, Helen; McCullagh, Ruth; Wills, Teresa; Skelton, Dawn A.; Dahly, Darren; O’Mahony, Denis; Ahern, Emer; Tedesco, Salvatore; Sullivan, Bridie O.; Health Research Board; Health Service ExecutiveObjective: To implement and evaluate a Frailty Care Bundle (FCB) targeting mobilisation, nutrition, and cognition in older trauma patients to reduce hospital associated decline. Methods: We used a two group, pretest-posttest design. The FCB intervention was delivered on two orthopaedic wards and two rehabilitation wards, guided by behaviour change theory (COM-B) to implement changes in ward routines (patient mobility goals, nurse assisted mobilisation, mealtimes, communication). Primary outcomes were patient participants' return to pre-trauma functional capability (modified Barthel Index - mBI) at 6-8 weeks post-hospital discharge and average hospital daily step-count. Statistical analysis compared pre versus post FCB group differences using ordinal regression and log-linear models. Results: We recruited 120 patients (pre n=60 and post n=60), and 74 (pre n=43, post n=36) were retained at follow-up. Median age was 78 years and 83% were female. There was a non-significant trend for higher mBI scores (improved function) in the post compared to pre FCB group (OR 2.29, 95% CI 0.98-5.36), associated with an average 11% increase in step-count. Conclusion: It was feasible, during the Covid-19 pandemic, for multidisciplinary teams to implement elements of the FCB. Clinical facilitation supported teams to prioritise fundamental care above competing demands, but sustainability requires ongoing attention. ISRCTN registry: ISRCTN15145850 (https://doi.org/10.1186/ISRCTN15145850)Item How do mental health professionals use humor? A systematic review(Taylor & Francis, 2024-01-31) Goodwin, John; O’Malley, Maria; McCarthy, KarenAlthough the value of humor is appreciated in mental health care, little is known about how professionals employ humor. The purpose of this systematic review was to explore how mental health professionals use humor. Academic databases were systemically searched. Papers were subjected to quality appraisal. Ten studies met eligibility criteria. Mental health staff used humor to cope with stress and adversity. They also used humor to enhance relationships with service users, and to erode team-related power dynamics. It was suggested that knowing when to use humor appropriately was dependent on experience and how well staff knew service users. However, it was also found that staff’s use of humor was sometimes negatively perceived by service users, as it could reinforce power dynamics. Due to the limited and low level of evidence, it is recommended that rigorous research in the area of humor in mental health practice is undertaken.Item The not so hidden effects of climate change related heatwaves on the cardiovascular system(Elsevier Ltd., 2023-10-25) Lee, Geraldine; Hendriks, Jeroen