Predicting risk: developing and testing of a nomogram to predict hospitalisation in chronic heart failure (CHF- Risk Study)

Chronic heart failure (CHF) is the leading cause of hospital admission in the elderly. Currently, no absolute risk model for rehospitalisation exists. The CHF-Risk Study was a 3 phase study that led to the development of a nomogram using a derivation cohort of a contemporaneous Australian CHF population. Factors associated with an increased risk of cardiovascular rehospitalisation were: age; living alone; a sedentary lifestyle and the presence of multiple co-morbid conditions

The role of b-type natriuretic peptide in heart failure management

Summary. Heart failure is a complex clinical syndrome that manifests itself with signs and symptoms which are neither sensitive nor specific for the diagnosis of heart failure. Natriuretic peptides and in particular b-type natriuretic peptide (and nt-proBNP) are widely used in clinical practice around the world as a maker of heart failure. BNP is primarly released from the left ventricle in response to pressure and volume overload. The strongest evidence for the use of BNP is to rule in or rule out heart failure as cause of breathlessness in people who present to the emergency room. There is enthusiasm for use of BNP as a market of heart failure severity as well as a predictor of outcomes in people with heart failure and trials are ongoing. Nesiritide, a recombinant form of BNP is currently being tested as a possible treatment in people with acutely decompensated heart failure

Role of nurse-surgeons in global surgical care : A scoping review

Aim To identify the roles of nurse-surgeons in the provision of surgical care. Design Scoping review. Methods This scoping review adhered to the JBI guideline for scoping reviews and EQUATOR Network's PRISMA-ScR checklist. Searches were performed from May 2022 to July 2022 using a combination of MeSH headings, keywords and filters via database and hand searching based on the eligibility criteria. Keywords included nurse-surgeon, nurse endoscopist, nurse hysteroscopist and nurse cystoscopist. Data sources were CINAHL, Cochrane, Google Scholar, PubMed and Scopus. Descriptive analysis was used to report the findings. Results Ninety-six included records indicated nurse-surgeon practice in 26 countries. Forty-one nurse-surgeon titles were found, the majority of which were types of nurse practitioner. A total of 5,684,198 surgeries were performed by nurse-surgeons varying from laparotomies to biopsies. Nine records reported that nurse-surgeons perform surgeries safely and on par with physicians with zero to minimal complications. Nineteen records reported improved surgical care efficiency by nurse-surgeons in terms of patient access to surgery, waiting times, surgery times, patient show rates, patient education, physician workload and junior physicians' training. Seven records reported high patient satisfaction. Nurse-surgeons were cost-effective according to five records. Thirteen records recommended the standardization of nurse-surgeon practice. Conclusion Nurse-surgeons performed millions of surgeries worldwide assisting in easing the global surgical burden. This review identified the roles and benefits nurse-surgeons play in global surgical care. Research gaps on nurse-surgeon roles were discovered including the ambiguity in nurse-surgeon titles and the need to regulate nurse-surgeon practice. Impact This research addressed the clinical safety, quality, contribution to timely surgical access and cost efficiency of nurse-surgeon performed surgeries, as well as the need to standardize nurse-surgeon practice and use a more consistent nurse-surgeon title to ensure role identification and monitoring

Impact of nurse-surgeons on patient-centred outcomes : A systematic review

Background: Nurse-surgeons have been performing surgeries for decades. Yet, their impact on perioperative clinical outcomes has not been explored in detail. Objective: To investigate the impact of nurse-surgeons on patient-centred outcomes. Design: Systematic review Method: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram and checklist for systematic reviews were used as the screening and reporting guideline. CINAHL, Cochrane Library, MEDLINE, and PubMed databases were searched for articles that fit the review’s eligibility criteria. A combination of Medical Subject Headings, keywords and filters for each database were used. Following screening and full text review, the Mixed Methods Appraisal Tool was used for quality assessment and the Grading of Recommendations, Assessment, Development and Evaluations framework for certainty and confidence assessment. Narrative synthesis was used to report the findings due to the design heterogeneity of the included studies. Results: Forty-eight (n = 48) patient-centred outcomes were identified from 25 included studies. These outcomes were grouped into four categories: patient satisfaction and experience; waiting list; perioperative complications; and quality of surgical care. Patient satisfaction and experience was rated high to very high in 16 studies; none reported patient dissatisfaction. Waiting lists improved in eight studies. Perioperative complications were none to very low in nine studies. Mortality rates in the nurse-surgeon group were better than the physician group in three studies. The quality of care in the performance of surgeries by nurse-surgeons was either similar or better than physicians in ten studies. Conclusions: Nurse-surgeons performed safe, satisfactory, and high-quality surgeries with minimal perioperative complications similar to physicians. The use of nurse-surgeons has significantly reduced waiting lists regardless of surgical specialty. Policies around nurse-surgeon practice needs to be developed at national and international levels to streamline the delivery of much needed surgical services amidst the coronavirus pandemic in the areas of cancer diagnostic surgeries, emergency surgeries, minor surgeries, and remote and rural health

Resilience, posttraumatic growth and psychological wellbeing of paramedicine clinicians : An integrative review

Clinicians in paramedicine are exposed to stressful events at work that have potential to cause negative psychological outcomes. Posttraumatic growth (PTG), resilience and psychological wellbeing, however, are adaptive psychological states that can also occur following trauma and adversity. Synthesis of knowledge on these positive outcomes can provide insight into resources needed to support paramedicine clinicians. To examine and synthesise what is known of PTG, resilience and psychological wellbeing of paramedicine clinicians, including the experience of these phenomena and relationship between them. An integrative review of peer-reviewed empirical literature published in English from 2013 to 2022 was conducted, following Whittemore and Knafl’s method. CINAHL Complete, MEDLINE Complete, PsycINFO, Scopus and Embase databases were searched. Included articles were quality appraised, with data analysed using the constant comparison method. Thirteen articles were included, with results synthesised into four categories. Mean PTG scores were reportedly moderate, and resilience ranged from average to above average. PTG and resilience had positive and negative relationships with specific coping strategies including dysfunctional coping, active coping, planning, venting emotions, social and emotional support and mental and behavioural disengagement. PTG scores were significantly lower for clinicians with longer shift duration and paramedics compared to emergency medical technicians. Resilience scores were higher for clinicians working part-time. Wellbeing was reportedly moderate and associated with the psychosocial climate established by managers. Qualitative findings indicated that workplace culture was perceived as stoic and masculine, which served to undermine staff resilience and willingness to disclose emotions. To support PTG and resilience, organisations should work to reduce stressors in workplace culture, including management and clinical supervision style, and offer employment flexibility. Organisations can upskill clinicians’ capacity for positive adaptation to adversity with professional development targeting identified coping strategies. Future research could examine clinicians’ experiences of PTG, resilience and wellbeing, and the relationship between them

The perspectives of internationally qualified nurses regarding their specialty skill transition to Australia : A cross-sectional survey

Aim To identify barriers and facilitators of speciality skill transfer for internationally qualified nurses in Australia from the nurses' perspective. Design A cross-sectional study. Methods A cross-sectional online survey was distributed through social media, snowballing and nursing professional organization. Data analysed using Statistical Package for the Social Sciences. Data Sources Online survey data from participants matching the inclusion criteria were collected from July to September 2022. Results Survey results reveal facilitators (competence, scope of practice, linguistic sufficiency, understanding of decision-making) and barriers (lack of opportunity, transition pathways, confidence in overseas education, financial instability) for internationally qualified nurses' speciality skill utilization in Australia. Conclusion Identifying and addressing barriers and facilitators, along with developing tailored transition pathways, are crucial for maximizing speciality skill utilization among internationally qualified nurses. These findings have implications for policymakers, healthcare organizations and nurses. They highlight the need to address barriers, facilitate smooth transitions and implement proactive measures for internationally qualified nurses to effectively utilize their specialty skills. Impact The study addresses maximizing skill usage for internationally qualified nurses, identifies barriers and facilitators for specialty skill transfer in Australia and will impact policymakers, healthcare organizations and nurses by guiding strategies for safe nursing service delivery and optimizing patient care. Reporting Method STROBE checklist. Patient or Public Contribution A total of 71 internationally qualified nurses contributed their experiences and opinions. What Does this Paper Contribute to the Wider Global Clinical Community? Lack of opportunity and the lack of transition pathways inhibit the use of specialty nursing skills by internationally qualified nurses. This study's findings contradict the result of other studies that suggest language is a significant obstacle to the utilization of specialty skills of internationally qualified nurses. Trial and Protocol Registration The protocol is registered on OSF. The data for this study are available for sharing with the reviewers upon request. However, it is worth noting that ethical approval has not been obtained specifically for web sharing, and therefore, the data has not been posted in any repositories or public platforms

Fever, Hyperglycemia, and Swallowing Management in Stroke Unit and Non–Stroke-Unit European Hospitals : A Quality in Acute Stroke Care (QASC) Europe Substudy

Stroke unit care reduces patient morbidity and mortality. The Quality in Acute Stroke Care Europe Study achieved significant large-scale translation of nurse-initiated protocols to manage Fever, hyperglycemia (Sugar), and Swallowing (FeSS) in 64 hospitals across 17 European countries. However, not all hospitals had stroke units. Our study aimed to compare FeSS protocol adherence in stroke unit versus non–stroke-unit hospitals. METHODS: An observational study using Quality in Acute Stroke Care Europe Study postimplementation data was undertaken. Hospitals were categorized using 4 evidence-based characteristics for defining a stroke unit, collected from an organizational survey of participating hospitals. Differences in FeSS Protocol adherence between stroke unit and non–stroke-unit hospitals were investigated using mixed-effects logistic regression, adjusting for age, sex, and National Institutes of Health Stroke Scale. RESULTS: Of the 56 hospitals from 16 countries providing organizational data, 34 (61%) met all 4 stroke unit characteristics, contributing data for 1825 of 2871 patients (64%) (stroke unit hospitals). Of the remaining 22 hospitals (39%), 17 (77%) met 3 of the 4 stroke unit characteristics (non–stroke-unit hospitals). There were no differences between hospitals with a stroke unit and those without for postimplementation adherence to fever (49% stroke unit vs 57% non–stroke unit; odds ratio [OR], 0.400; 95% confidence interval [CI], 0.087-1.844; P = .240), hyperglycemia (50% stroke unit vs 57% non–stroke unit; OR, 0.403; 95% CI, 0.087–1.856; P = .243), swallowing (75% stroke unit vs 60% non–stroke unit; OR, 1.702; 95% CI, 0.643–4.502; P = .284), or overall FeSS Protocol adherence (36% stroke unit vs 36% non–stroke unit; OR, 0.466; 95% CI, 0.106–2.043; P = .311). CONCLUSION: Our results demonstrate that the nurse-initiated FeSS Protocols can be implemented by hospitals regardless of stroke unit status. This is noteworthy because hospitals without stroke unit resources that care for acute stroke patients can potentially implement these protocols. Further effort is needed to ensure better adherence to the FeSS Protocols

The association between unexplained falls and cardiac arrhythmias : A scoping literature review

Background Falls in older adults are common. Age is a risk factor for falls and with an ageing population, presentation to the emergency department (ED) resulting from falls is rising. Reasons for falls in older adults are numerous and include cardiac arrhythmias. However, older patients who present with falls do not appear to be routinely screened for cardiac arrhythmias. Objectives To determine the association between cardiac arrhythmias and unexplained falls in older adults presenting to the ED and to identify the processes for cardiac screening in patients presenting to the ED after an unexplained fall. Methods A scoping literature review was conducted because of the scarce number of primary research articles using an investigational design to undertake a detailed systematic review. Several databases were searched using the search terms: emergency department; trauma centers; arrhythmias cardiac; fall; and accidental fall. Data sources A structured and systematic search using MEDLINE, Embase, and PubMed was conducted from 2002 to December 2017. Results Five quantitative studies were included in this review that reported on adults who presented to the ED after an unexplained fall. Several factors associated with falls and cardiac arrhythmias were extracted from the data. These included age, past history of falls, current medications, comorbidities, electrocardiography, and other cardiac findings. Conclusion Falls in the elderly population account for a significant number of presentations to the ED. A number of known factors are associated with falls in elderly patients, including cardiovascular causes, yet specific individualised factors are largely unknown. There is no routine screening process for the identification of cardiovascular risk factors in those who present to the ED with an unexplained fall. Further research is needed to identify specific cardiac factors associated with the risk of unexplained falls in this patient cohort and to transfer these findings into a routine screening process

The effect of nurse-led education on hospitalisation, readmission, quality of life and cost in adults with heart failure. A systematic review

Objective The purpose of this systematic review was to highlight the effect of nurse-led 1:1 patient education sessions on Quality of Life (QoL), readmission rates and healthcare costs for adults with heart failure (HF) living independently in the community. Method A systematic review of randomised control trials was undertaken. Using the search terms nurse, education, heart failure, hospitalisation, readmission, rehospitalisation, economic burden, cost, expenditure and quality of life in PubMed, CINAHL and Google Scholar databases were searched. Papers pertaining to nurse-led 1:1 HF disease management of education of adults in the community with a history of HF were reviewed. Result The results of this review identified nurse-led education sessions for adults with HF contribute to reduction in hospital readmissions, reduction in hospitalisation and a cost benefit. Additionally, higher functioning and improved QoL were also identified. Conclusion These results suggest that nurse-led patient education for adults with HF improves QoL and reduces hospital admissions and readmissions. Practice implications Nurse-led education can be delivered utilising diverse methods and impact to reduce readmission as well as hospitalisation

Biomedical, socioeconomic and demographic predictors of heart failure readmissions : A systematic review

Aims To identify the biomedical, socioeconomic and demographic predictors of heart failure (HF) related readmissions in adult patients with HF. Methods This systematic review was conducted in March 2020 using the databases EMBASE, CINAHL and Medline to identify publications between 2015–2020. The resulting articles were systematically reviewed according to the PRISMA guidelines. Results Eighteen (18) studies were included in this review. Unemployment (HR=1.09; 95%CI=1.05–1.14; p=0.03) was the only socioeconomic factor predictive of HF-readmissions. Socio-Economic Indexes for Areas (SEIFA) scores did not predict HF readmissions in adults with HF (p>0.05). All patients included in the studies had pre-existing HF. Based on the included studies, Indigenous status was identified as a risk factor for HF readmissions in 1 study (p0.05). New York Heart Association (NYHA) class, brain natriuretic peptide (BNP) levels, and heart rate were also predictive of HF readmission (p0.05). Conclusions This review identified unemployment, Indigenous status, NYHA class, heart rate, and BNP levels to predict HF related readmissions in adult patients with HF. Adding demographic and socioeconomic variables to readmission risk models has the potential to more accurately target patients at risk of readmissions