Barriers and facilitators to self-care in chronic heart failure: A meta-synthesis of qualitative studies

Chronic heart failure (CHF) is a costly condition that places large demands on self-care. Failure to adhere with self-care recommendations is common and associated with frequent hospitalization. Understanding the factors that enable or inhibit self-care is essential in developing effective health care interventions. This qualitative review was conducted to address the research question, "What are the barriers and facilitators to self-care among patients with CHF?" Electronic databases including Medline, EMBASE, CINAHL, Web of Science, Scopus and Google scholar were searched. Articles were included if they were peer reviewed (1995 to 2012), in English language and investigated at least one contextual or individual factor impacting on self-care in CHF patients > 18years. The criteria defined by Kuper et al. including clarity and appropriateness of sampling, data collection and data analysis were used to appraise the quality of articles. Twenty-three articles met the inclusion criteria. Factors impacting on self-care included: factors related to symptoms of CHF and the self-care process; factors related to personal characteristics; environmental and health care system factors. Important factors such as socioeconomic situation and education level have not been explored extensively and there is minimal data on the influence of age, gender, selfconfidence and duration of disease. Although there is an emerging literature, further research is required to address the barriers and facilitators of self-care in patients with CHF in order to provide an appropriate guide for intervention strategies to improve self-care in CHF. © 2013 Siabani et al

Non-pharmacological management interventions for COPD: An overview of Cochrane systematic reviews

© 2013 The Cochrane Collaboration. Published by JohnWiley & Sons, Ltd. This is the protocol for a review and there is no abstract. The objectives are as follows: To a) summarise the evidence, b) identify gaps in the evidence base and c) describe elements of non-pharmacological, non-surgical and non-device interventions for the management of COPD using a standardised taxonomy for disease management adapted from the American Heart Association (Krumholz 2006)

The feminization of aging: How will this impact on health outcomes and services?

We conducted an integrative review to identify issues and challenges that face aging women and to distinguish areas for future research. We found that many older women continue to face inequities related to health and often are invisible within the discourse of aging policy. In this article we argue for a greater focus on the unique needs of women, a gendered approach to policy and intervention development, and promotion of the health of women across the life span. Policymakers, health care workers, and researchers need to consider the perspective of gender as well as age when implementing and evaluating effective interventions. © Taylor & Francis Group, LLC

Dying in the margins: Understanding palliative care and socioeconomic deprivation in the developed world

Context: Individuals from low socioeconomic (SE) groups have less resources and poorer health outcomes. Understanding the nature of access to appropriate end-of-life care services for this group is important. Objectives: To evaluate the literature in the developed world for barriers to access for low SE groups. Methods: Electronic databases searched in the review included MEDLINE (1996-2010), CINAHL (1996-2010), PsychINFO (2000-2010), Cochrane Library (2010), and EMBASE (1996-2010). Publications were searched for key terms "socioeconomic disadvantage," "socioeconomic," "poverty," "poor" paired with "end-of-life care," "palliative care," "dying," and "terminal Illness." Articles were analyzed using existing descriptions for dimensions of access to health services, which include availability, affordability, acceptability, and geographical access. Results: A total of 67 articles were identified for the literature review. Literature describing end-of-life care and low SE status was limited. Findings from the review were summarized under the headings for dimensions of access. Conclusion: Low SE groups experience barriers to access in palliative care services. Identification and evaluation of interventions aimed at reducing this disparity is required. © 2011 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved

Families, nurses and organisations contributing factors to medication administration error in paediatrics: a literature review

Background: Medication error is the most common adverse event for hospitalised children and can lead to significant harm. Despite decades of research and implementation of a number of initiatives, the error rates continue to rise, particularly those associated with administration. Objectives: The objective of this literature review is to explore the factors involving nurses, families and healthcare systems that impact on medication administration errors in paediatric patients. Design: A review was undertaken of studies that reported on factors that contribute to a rise or fall in medication administration errors, from family, nurse and organisational perspectives. The following databases were searched: Medline, Embase, CINAHL and the Cochrane library. The title, abstract and full article were reviewed for relevance. Articles were excluded if they were not research studies, they related to medications and not medication administration errors or they referred to medical errors rather than medication errors. Results: A total of 15 studies met the inclusion criteria. The factors contributing to medication administration errors are communication failure between the parents and healthcare professionals, nurse workload, failure to adhere to policy and guidelines, interruptions, inexperience and insufficient nurse education from organisations. Strategies that were reported to reduce errors were double-checking by two nurses, implementing educational sessions, use of computerised prescribing and barcoding administration systems. Yet despite such interventions, errors persist. The review highlighted families that have a central role in caring for the child and therefore are key to the administration process, but have largely been ignored in research studies relating to medication administration. Conclusions: While there is a consensus about the factors that contribute to errors, sustainable and effective solutions remain elusive. To date, families have not been included as key stakeholders in researching or developing effective interventions to reduce medication administration errors

The food safety impact of salt and sodium reduction initiatives

Excessive or high salt or sodium intake is known to cause hypertension and other diseases. Within the United Kingdom voluntary targets for salt reduction have been set and laid out in the Secretary of State responsibility deal. This review considers the options available to food manufacturers to enable them to reduce salt and the potential food safety risks associated with those options. Gaps in research and knowledge within the areas of information supplied to food manufacturers, alternative solutions for salt replacement and the food safety impact of salt reduction are discussed

Dying in the hospital setting: A systematic review of quantitative studies identifying the elements of end-of-life care that patients and their families rank as being most important

© The Author(s) 2015. Background: The majority of expected deaths occur in hospitals where optimal end-of-life care is not yet fully realised, as evidenced by recent reviews outlining experience of care. Better understanding what patients and their families consider to be the most important elements of inpatient end-of-life care is crucial to addressing this gap. Aim and design: This systematic review aimed to ascertain the five most important elements of inpatient end-of-life care as identified by patients with palliative care needs and their families. Data sources: Nine electronic databases from 1990 to 2014 were searched along with key internet search engines and handsearching of included article reference lists. Quality of included studies was appraised by two researchers. Results: Of 1859 articles, 8 met the inclusion criteria generating data from 1141 patients and 3117 families. Synthesis of the top five elements identified four common end-of-life care domains considered important to both patients and their families, namely, (1) effective communication and shared decision making, (2) expert care, (3) respectful and compassionate care and (4) trust and confidence in clinicians. The final domains differed with financial affairs being important to families, while an adequate environment for care and minimising burden both being important to patients. Conclusion: This review adds to what has been known for over two decades in relation to patient and family priorities for end-of-life care within the hospital setting. The challenge for health care services is to act on this evidence, reconfigure care systems accordingly and ensure universal access to optimal end-of-life care within hospitals

Diversity characteristics and the experiences of nursing students during clinical placements: A qualitative study of student, faculty and supervisors' views

Background: Little is known about which diversity characteristics if any, impact on nursing students' clinical placements or how these may affect the quality of their learning experiences. There is therefore a need to better understand these effects not only from the student's perspective but also from the perspective of the staff who supervise them, in order to ensure students obtain maximal benefit from their placements. Aim: To describe the clinical experiences of nursing students and the diversity characteristics that affect this learning experience. Methods: Data were collected from a series of open-ended questions embedded within a larger anonymous web-based survey, from August 2011 to March 2012. Participants included first, second and third year undergraduate Bachelor of Nursing students (N = 704) and faculty members involved in the clinical learning environment (N = 165) from seven Australian universities. Findings: Qualitative findings were clustered into three main themes: differences, difficulty and discrimination, each with three subthemes. Conclusion: Findings suggest a need to offer appropriate support for nursing students who feel different because of diversity characteristics. Whilst some of the participant perceptions are confronting they provide valuable insights for universities developing curricula and the clinical placement facilities where students obtain their experience