Essential elements nurses have to address to promote a safe discharge in paediatrics: A systematic review and narrative synthesis

Aim: The aim of the study was to synthesize the evidence on the essential elements, nurses must address when they perform therapeutic education to patients and their caregivers to promote a safe paediatric hospital-to-home discharge. Design: A systematic review and narrative synthesis. Methods: The search strategy identifies studies published between 2016 and 2023. The quality of the included studies was assessed using the Critical Appraisal Skills Programme checklists. The protocol of this review was not registered. A search of three electronic databases (PubMed, CINAHL and Web of Science) and a search in the reference lists of the included studies was conducted in February 2021 and June 2023. Results: Fifteen studies met the inclusion criteria. The essential elements identified are grouped into the following topics: emergency management, physiological needs, medical device and medications management, long-term management and short-term management. Nurses have a critical role in ensuring patient safety and quality of care, and the nurses' competence makes the difference in the discharge's related outcomes. Our results can help the nursing profession implement comprehensive discharge projects. Our results support the improvement of nurse-led paediatric discharge programmes. Nurse managers can identify the grey areas of therapeutic education provided in their units and work for their improvement. Following the implementation of therapeutic education on these topics, measuring the discharge's related outcomes could be interesting. This study addresses the problem of managing a safe and efficient nurse-led discharge in a paediatric setting. It presents evidence on the essential elements to promote a safe paediatric discharge at home. These could impact nursing practice by using them to implement project and discharge pathways. We have adhered to relevant EQUATOR guidelines—PRISMA guidelines for reporting systematic review. No patients, service users, caregivers or public members were involved in this study due to its nature (systematic review)

Antiplatelet treatment compared with anticoagulation treatment for cervical artery dissection (CADISS): a randomised trial

Background: Extracranial carotid and vertebral artery dissection is an important cause of stroke, especially in young people. In some observational studies it has been associated with a high risk of recurrent stroke. Both antiplatelet drugs and anticoagulant drugs are used to reduce risk of stroke but whether one treatment strategy is more effective than the other is unknown. We compared their efficacy in the Cervical Artery Dissection in Stroke Study (CADISS), with the additional aim of establishing the true risk of recurrent stroke. Methods: We did this randomised trial at hospitals with specialised stroke or neurology services (39 in the UK and seven in Australia). We included patients with extracranial carotid and vertebral dissection with onset of symptoms within the past 7 days. Patients were randomly assigned (1:1) by an automated telephone randomisation service to receive antiplatelet drugs or anticoagulant drugs (specific treatment decided by the local clinician) for 3 months. Patients and clinicians were not masked to allocation, but investigators assessing endpoints were. The primary endpoint was ipsilateral stroke or death in the intention-to-treat population. The trial was registered with EUDract (2006-002827-18) and ISRN (CTN44555237). Findings: We enrolled 250 participants (118 carotid, 132 vertebral). Mean time to randomisation was 3·65 days (SD 1·91). The major presenting symptoms were stroke or transient ischaemic attack (n=224) and local symptoms (headache, neck pain, or Horner's syndrome; n=26). 126 participants were assigned to antiplatelet treatment versus 124 to anticoagulant treatment. Overall, four (2%) of 250 patients had stroke recurrence (all ipsilateral). Stroke or death occurred in three (2%) of 126 patients versus one (1%) of 124 (odds ratio [OR] 0·335, 95% CI 0·006–4·233; p=0·63). There were no deaths, but one major bleeding (subarachnoid haemorrhage) in the anticoagulant group. Central review of imaging failed to confirm dissection in 52 patients. Preplanned per-protocol analysis excluding these patients showed stroke or death in three (3%) of 101 patients in the antiplatelet group versus one (1%) of 96 patients in the anticoagulant group (OR 0·346, 95% CI 0·006–4·390; p=0·66). Interpretation: We found no difference in efficacy of antiplatelet and anticoagulant drugs at preventing stroke and death in patients with symptomatic carotid and vertebral artery dissection but stroke was rare in both groups, and much rarer than reported in some observational studies. Diagnosis of dissection was not confirmed after review in many cases, suggesting that radiographic criteria are not always correctly applied in routine clinical practice. Funding: Stroke Association.H.S. Markus ... T. Kleinig ... et al. (CADISS trial investigators

‘Hearing silences’: Exploring culturally safe transitional care: A qualitative study among Turkish-speaking migrant frail older adults

Aims: This study aimed to investigate the experiences and transitional care needs of Turkish frail older adults living in the UK and determine how this information can be utilized to improve the provision of culturally sensitive care during the transitional period. Design: Qualitative descriptive research with semi-structured individual interviews. Methods: “The ‘Silences’ Framework guided the research design, from conceptualizing the research question to structuring the report of final outputs. For this study, semi-structured, in-depth interviews were conducted with sixteen older adults living with frailty and five family caregivers between January and May of 2023 in the United Kingdom. Results: Major themes that were identified included: (i) information and communication, (ii) care and support, (iii) the role of culture and (iv) trust and satisfaction. Further analysis, through discussion and immersion in the data, revealed that care transition periods were presented alongside three phases of transitional care: pre-transition (during hospitalization), early-transition (the period between discharge and the 7th day after discharge) and late transition (the period between the 8th day and 12th month after discharge). Conclusions: Our study revealed that the communication and informational needs of frail older individuals change during the transition period. While Turkish older adults and family caregivers expressed satisfaction with healthcare services in the UK, many struggled due to a lack of knowledge on how to access them. Impact: The support of family caregivers is a crucial component in facilitating transitional care for frail older patients, as they help in accessing healthcare services and using technological devices or platforms. It should be noted that family caregivers often hold the same level of authority as their elderly Turkish counterparts. Patient or Public Contribution: No patient or public contribution

Experiences of nurses involved in natural disaster relief: A meta-synthesis of qualitative literature

Aim: To explore nurses’ experiences in natural disaster response. Background: Nurses are key to disaster response. There is a growing body of qualitative research exploring this emerging nursing issue. However, there is a need to synthesise and summarise this body of knowledge to identify the overarching elements of how nurses experience working in disaster situations to reflect on their experiences so that we may help shape future clinical practice, research and education. Design: Qualitative meta-synthesis. Method: Following PROSPERO guidelines (Moher et al., 2015), an exhaustive and systematic literature search and quality appraisal was undertaken in December 2019 to reveal nurses’ experiences during natural disaster response. Sandelowski and Barroso's systematic retrieval, analysis and interpretation of findings method was used to produce a meta-summary of findings from 10 papers evaluating experiences across 9 disasters. A meta-aggregation was used to synthesise the findings from the studies and was methodically quality assessed with PRISMA and CASP. Results: Our findings aggregated data from 42 sub-themes, into the following four themes to capture nurses’ experiences after responding to disasters. These included agile response; leadership and innovative problem solving; building resilience; positive communication and need for psychological/emotional support. Discussion: This meta-synthesis provides evidence to illustrate nurses’ resilience and leadership capabilities as means to manage and perceive their disaster relief response. Factors such as emotional intelligence, capacity to react to changing situations, to manage scant resources in extreme situations were highlighted in nurses practising in highly stressful environments. Managers can use these examples to support ways to improve disaster management policies, but also, to engage in support for their staff. Relevance to clinical practice: The role of nursing staff in disaster rescue is receiving significant attention. Understanding nurses’ experiences during disaster rescue can help future leaders to improve capacity to respond and nursing preparedness through education, training and management, but also for continuing emotional support after the event

School-linked sexual health services for young people (SSHYP): a survey and systematic review concerning current models, effectiveness, cost-effectiveness and research opportunities

Background: Report based on a service-mapping study and a systematic review concerning sexual health services for young people, either based in or closely linked to schools. Objectives: To identify current forms of school-based sexual health services (SBSHS) and school-linked sexual health services (SLSHS) in the UK, review and synthesise existing evidence from qualitative and quantitative studies concerning the effectiveness, acceptability and cost-effectiveness of these types of service and to identify potential areas for further research. Data sources: Electronic databases were searched from 1985 onwards. For published material: the Cochrane Library (1991–), MEDLINE, PREMEDLINE (2007–), CINAHL, EMBASE, AMED, ASSIA (1987–), IBSS, ERIC, PsycINFO, Science Citation Index (SCI) and Social Sciences Citation Index. For unpublished material and grey literature: the Social Care Institute of Excellence Research Register; the National Research Register (1997–), ReFeR; Index to Theses, and HMIC. Review methods: A service-mapping questionnaire was circulated to school nurses in all parts of the UK, and semistructured telephone interviews with service coordinators in NHS and local authority (LA) roles were conducted. An evidence synthesis was performed based on a systematic review of the quantitative evidence about service effectiveness, qualitative evidence about user and professional views and a mixed-methods synthesis. A proof-of-concept model for assessing cost-effectiveness was drawn up. Results: Three broad types of UK sexual health service provision were identified. Firstly, SBSHS staffed by school nurses, offering ‘minimal’ or ‘basic’ levels of service. Secondly, SBSHS and SLSHS staffed by a multiprofessional team, but not medical practitioners, offering ‘basic’ or ‘intermediate’ levels of service. Thirdly, SBSHS and SLSHS staffed by a multiprofessional team, including medical practitioners offering ‘intermediate’ or ‘comprehensive’ levels of service. The systematic review showed that SBSHS are not associated with higher rates of sexual activity among young people, nor with an earlier age of first intercourse. There was evidence to show positive effects in terms of reductions in births to teenage mothers, and in chlamydial infection rates among young men, although this evidence coming primarily from the USA. Therefore, the findings need to be tested in relation to UK-based services. Also evidence to suggest that broad-based, holistic service models, not restricted to sexual health, offer the strongest basis for protecting young people’s privacy and confidentiality, countering perceived stigmatisation, offering the most comprehensive range of products and services, and maximising service uptake. Findings from the mapping study also indicate that broad-based services, which include medical practitioner input within a multiprofessional team, meet the stated preferences of staff and of young people most clearly. Partnership-based developments of this kind also conform to the broad policy principles embodied in the Every Child Matters framework in the UK and allied policy initiatives. However, neither these service models nor narrower ones have been rigorously evaluated in terms of their impact on the key outcomes of conception rates and sexually transmitted infection (STI) rates, in the UK or in other countries. Therefore, appropriate data were not found to support cost-effectiveness modelling. Limitations: Low response rate to the questionnaire. Scotland, Wales and Northern Ireland were under-represented. Also, the distinction made in the questionnaire between ‘general health’ and ‘sexual health’ services did not prove robust. Conclusions: There is no single, dominant service model in the UK. The systematic review demonstrated that the evidence base for these services remains limited and uneven, and draws largely on US studies. Qualitative research is needed to develop robust process and outcome indicators for the evaluation of SLSHS/SBSHS in the UK. These indicators could then be used both in local evaluations, and in large, longitudinal studies of service effectiveness and cost-effectiveness. Future research should examine the impact of the differing types of services currently evolving in the UK, encompassing school-based and school-linked models, as well as models with and without medical practitioner involvement

Supporting LGBTQ+ students: a focus group study with Junior High School nurses

LBGTQ+ students often miss the support and information they need in the school nursing, but little is known about junior high school (JHS) nurses’ work with LGBTQ+ students. 15 JHS nurses were interviewed in focus groups about their perceptions of supporting LGBTQ+ students. Four interconnected themes were identified with inductive thematic analysis: (1) JHS nurses’ professional identity and practice; (2) Recognition of sexual and gender diversity in school; (3) Family acceptance process; and (4) LGBTQ+ students as school nursing clients. JHS nurses self-identified as accepting professionals, but having limited skills, knowledge, and education needed in supporting LGBTQ+ students. Supporting LGBTQ+ students is a complex phenomenon, and to enhance JHS nurses’ competence in providing care for these students, sexual and gender diversity needs to be included in evidence-based nursing information sources, covered in nursing education, and the school needs to be secured as LGBTQ+ safe place

Uncertainty in geometry of fibre preforms manufactured with Automated Dry Fibre Placement (ADFP) and its effects on permeability

Resin transfer moulding is one of several processes available for manufacturing fibre-reinforced composites from dry fibre reinforcement. Recently, dry reinforcements made with Automated Dry Fibre Placement have been introduced into the aerospace industry. Typically, the permeability of the reinforcement is assumed to be constant throughout the dry preform geometry whereas in reality it possesses inevitable uncertainty due to variability in geometry. This uncertainty propagates to the uncertainty of the mould filling and the fill time, one of the important variables in resin injection. It makes characterisation of the permeability and its variability an important task for design of the resin transfer moulding process. In this study, variability of the geometry of a reinforcement manufactured using Automated Dry Fibre Placement is studied. Permeability of the manufactured preforms is measured experimentally and compared to stochastic simulations based on an analytical model and a stochastic geometry model. The simulations showed that difference between the actual geometry and the designed geometry can result in 50% reduction of the permeability. The stochastic geometry model predicts results within 20% of the experimental values

Interconnecting PV on New York City's Secondary Network Distribution System

The U.S. Department of Energy (DOE) has teamed with cities across the country through the Solar America Cities (SAC) partnership program to help reduce barriers and accelerate implementation of solar energy. The New York City SAC team is a partnership between the City University of New York (CUNY), the New York City Mayor s Office of Long-term Planning and Sustainability, and the New York City Economic Development Corporation (NYCEDC).The New York City SAC team is working with DOE s National Renewable Energy Laboratory (NREL) and Con Edison, the local utility, to develop a roadmap for photovoltaic (PV) installations in the five boroughs. The city set a goal to increase its installed PV capacity from1.1 MW in 2005 to 8.1 MW by 2015 (the maximum allowed in 2005). A key barrier to reaching this goal, however, is the complexity of the interconnection process with the local utility. Unique challenges are associated with connecting distributed PV systems to secondary network distribution systems (simplified to ÃÂâÃÂÃÂÃÂÃÂnetworksÃÂâÃÂÃÂÃÂàin this report). Although most areas of the country use simpler radial distribution systems to distribute electricity, larger metropolitan areas like New York City typically use networks to increase reliability in large load centers. Unlike the radial distribution system, where each customer receives power through a single line, a network uses a grid of interconnected lines to deliver power to each customer through several parallel circuits and sources. This redundancy improves reliability, but it also requires more complicated coordination and protection schemes that can be disrupted by energy exported from distributed PV systems. Currently, Con Edison studies each potential PV system in New York City to evaluate the system s impact on the network, but this is time consuming for utility engineers and may delay the customer s project or add cost for larger installations. City leaders would like to streamline this process to facilitate faster, simpler, and less expensive distributed PV system interconnections. To assess ways to improve the interconnection process, NREL conducted a four-part study with support from DOE. The NREL team then compiled the final reports from each study into this report. In Section 1ÃÂâÃÂÃÂÃÂÃÂPV Deployment Analysis for New York CityÃÂâÃÂÃÂÃÂÃÂwe analyze the technical potential for rooftop PV systems in the city. This analysis evaluates potential PV power production in ten Con Edison networks of various locations and building densities (ranging from high density apartments to lower density single family homes). Next, we compare the potential power production to network loads to determine where and when PV generation is most likely to exceed network load and disrupt network protection schemes. The results of this analysis may assist Con Edison in evaluating future PV interconnection applications and in planning future network protection system upgrades. This analysis may also assist other utilities interconnecting PV systems to networks by defining a method for assessing the technical potential of PV in the network and its impact on network loads. Section 2ÃÂâÃÂÃÂÃÂÃÂA Briefing for Policy Makers on Connecting PV to a Network GridÃÂâÃÂÃÂÃÂÃÂpresents an overview intended for nontechnical stakeholders. This section describes the issues associated with interconnecting PV systems to networks, along with possible solutions. Section 3ÃÂâÃÂÃÂÃÂÃÂTechnical Review of Concerns and Solutions to PV Interconnection in New York CityÃÂâÃÂÃÂÃÂÃÂsummarizes common concerns of utility engineers and network experts about interconnecting PV systems to secondary networks. This section also contains detailed descriptions of nine solutions, including advantages and disadvantages, potential impacts, and road maps for deployment. Section 4ÃÂâÃÂÃÂÃÂÃÂUtility Application Process ReviewÃÂâÃÂÃÂÃÂÃÂlooks at utility interconnection application processes across the country and identifies administrative best practices for efficient PV interconnection

Contemporary nursing graduates\u27 transition to practice: A critical review of transition models

AIM AND OBJECTIVE: To critically review contemporary transition theories to determine how they apply to the newly qualified graduate registered nurse programmes. BACKGROUND: Graduate nurse transition to employment is the time of significant change which has resulted in high attrition rates. Graduates are often challenged by their expectation of nursing practice and the reality of the role. The transition from hospital-based training to university-based training has resulted in the need for primary employment to commence with graduate/orientation/internship programmes to help support new graduates transition into clinical practice. One transition model, Duchscher\u27s stages of transition theory, utilised three former theories to develop a final model. DESIGN: A narrative critical literature review. METHOD: The theories selected for the review were Kramer\u27s reality shock theory, Benner\u27s novice to expert theory, Bridges transition theory and Duchscher\u27s stages of transition theory. CONCLUSION: Duchscher\u27s stages of transition theory reflects the experiences of registered nursing transition into the workforce directly from university. The application of the theory is effective to guide understanding of the current challenges that new graduate nurse\u27s experience today. There is a need for new graduates to complete their university degree as advanced beginners in order to decrease the experience of transition shock and keep pace with rapidly changing demands of the clinical environment. This may be achieved by increasing ward-based simulation in university education. A theoretical framework can provide a deep understanding of the various stages and processes of transition and enable development of successful programmes. RELEVANCE TO CLINICAL PRACTICE: Both universities and hospitals need to adapt their current practice to align with the needs of new graduates due to large student numbers and ongoing systematic advancements to decrease the attrition rate