Fundamental nursing care: a systematic review of the evidence on the effect of nursing care interventions for nutrition, elimination, mobility and hygiene

This is the final version of the article. Available from Wiley via the DOI in this record.AIMS AND OBJECTIVES: To determine the effects of nursing interventions for people's nutrition, elimination, mobility and hygiene needs. BACKGROUND: Patient experience of health care is sensitive to nursing quality. A refocus on fundamental nursing care is undermined by lack of evidence of effectiveness for interventions in core areas such as elimination, nutrition, mobility and hygiene. DESIGN: SYSTEMATIC REVIEW: METHODS: We searched for and included experimental studies on interventions by professionally qualified and unregistered nurses that addressed participants' nutrition, elimination, mobility and hygiene needs. We extracted data on scope, quality and results of studies followed by descriptive narrative synthesis of included study outcomes using a novel form of harvest plots. RESULTS: We included 149 studies, 35 nutrition, 56 elimination, 16 mobility, 39 hygiene, and three addressing two or more areas simultaneously (67 randomised controlled trials (RCTs), 32 non-RCTs and 50 uncontrolled trials). Studies into interventions on participant self-management of nutrition (n=25), oral health (n=26), catheter care (n=23), and self-management of elimination (n=21) were the most prevalent. Most studies focussed their outcomes on observational or physiological measures, with very few collecting patient reported outcomes, such as quality of life, experience or self-reported symptoms. All but 13 studies were of low quality and at significant risk of bias. The majority of studies did not define primary outcomes, included multiple measures of identical concepts, used inappropriate analyses, and did not conform to standard reporting quality criteria. CONCLUSIONS: The current evidence for fundamental nursing care interventions is sparse, of poor quality and unfit to provide evidence-based guidance to practising nurses. This article is protected by copyright. All rights reserved.This study was funded by a Programme Development Grant from the UK National Institute of Health Research (NIHR). RP-DG-1214-10001. David Richards and Victoria Goodwin receive funding support from the UK National Institute for Health Research South West Peninsula Collaboration for Leadership in Applied Health Research and Care

Low temperature decreases bone mass in mice: Implications for humans

ObjectivesHumans exhibit significant ecogeographic variation in bone size and shape. However, it is unclear how significantly environmental temperature influences cortical and trabecular bone, making it difficult to recognize adaptation versus acclimatization in past populations. There is some evidence that cold‐induced bone loss results from sympathetic nervous system activation and can be reduced by nonshivering thermogenesis (NST) via uncoupling protein (UCP1) in brown adipose tissue (BAT). Here we test two hypotheses: (1) low temperature induces impaired cortical and trabecular bone acquisition and (2) UCP1, a marker of NST in BAT, increases in proportion to degree of low‐temperature exposure.MethodsWe housed wildtype C57BL/6J male mice in pairs at 26 °C (thermoneutrality), 22 °C (standard), and 20 °C (cool) from 3 weeks to 6 or 12 weeks of age with access to food and water ad libitum (N = 8/group).ResultsCool housed mice ate more but had lower body fat at 20 °C versus 26 °C. Mice at 20 °C had markedly lower distal femur trabecular bone volume fraction, thickness, and connectivity density and lower midshaft femur cortical bone area fraction versus mice at 26 °C (p < .05 for all). UCP1 expression in BAT was inversely related to temperature.DiscussionThese results support the hypothesis that low temperature was detrimental to bone mass acquisition. Nonshivering thermogenesis in brown adipose tissue increased in proportion to low‐temperature exposure but was insufficient to prevent bone loss. These data show that chronic exposure to low temperature impairs bone architecture, suggesting climate may contribute to phenotypic variation in humans and other hominins.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/146428/1/ajpa23684.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/146428/2/ajpa23684_am.pd

Scenario trees and policy selection for multistage stochastic programming using machine learning

We propose a hybrid algorithmic strategy for complex stochastic optimization problems, which combines the use of scenario trees from multistage stochastic programming with machine learning techniques for learning a policy in the form of a statistical model, in the context of constrained vector-valued decisions. Such a policy allows one to run out-of-sample simulations over a large number of independent scenarios, and obtain a signal on the quality of the approximation scheme used to solve the multistage stochastic program. We propose to apply this fast simulation technique to choose the best tree from a set of scenario trees. A solution scheme is introduced, where several scenario trees with random branching structure are solved in parallel, and where the tree from which the best policy for the true problem could be learned is ultimately retained. Numerical tests show that excellent trade-offs can be achieved between run times and solution quality

Seniors' experiences of living in special housing accommodation

This article presents a hermeneutic phenomenological analysis of interview material in which 12 seniors living in Special Housing Accommodation (SHA) facilities reflect on the experience of living in such facilities. Of particular interest in the analysis is living in a SHA as a phenomenon. The finding shows that the phenomenon of lived experience in a SHA seems to be a state of ambiguity regarding one's existence, which is made up of several constituents (elements of meaning). The analysis contributes to the understanding of how the phenomenon of SHA living is coming into existence as a need, due to an individual's failing health; however, the SHA is not considered to be a true home. Accordingly, this has consequences to the subject position for the seniors in that they have to navigate between existing and not existing. The seniors learn to cope with living in the SHA by lowering their expectations of life and existence while the SHA provides the prerequisites for their existence. An implication for promoting care is to support the seniors to enable a full existence of life within SHA living

Home: The place the older adult can not imagine living without

<p>Abstract</p> <p>Background</p> <p>Rapidly aging populations with an increased desire to remain at home and changes in health policy that promote the transfer of health care from formal places, as hospitals and institutions, to the more informal setting of one's home support the need for further research that is designed specifically to understand the experience of home among older adults. Yet, little is known among health care providers about the older adult's experience of home. The aim of this study was to understand the experience of home as experienced by older adults living in a rural community in Sweden.</p> <p>Methods</p> <p>Hermeneutical interpretation, as developed by von Post and Eriksson and based on Gadamer's philosophical hermeneutics, was used to interpret interviews with six older adults. The interpretation included a self examination of the researcher's experiences and prejudices and proceeded through several readings which integrated the text with the reader, allowed new questions to emerge, fused the horizons, summarized main and sub-themes and allowed a new understanding to emerge.</p> <p>Results</p> <p>Two main and six sub-themes emerged. Home was experienced as the place the older adult could not imagine living without but also as the place one might be forced to leave. The older adult's thoughts vacillated between the well known present and all its comforts and the unknown future with all its questions and fears, including the underlying threat of loosing one's home.</p> <p>Conclusions</p> <p>Home has become so integral to life itself and such an intimate part of the older adult's being that when older adults lose their home, they also loose the place closest to their heart, the place where they are at home and can maintain their identity, integrity and way of living. Additional effort needs to be made to understand the older adult's experience of home within home health care in order to minimize intrusion and maximize care. There is a need to more fully explore the older adult's experience with health care providers in the home and its impact on the older adult's sense of "being at home" and their health and overall well-being.</p

Seed Quality Behaviour Variation of Moth Bean during Storage in Different Packaging

An experiment was carried out in order to assess the behavior of the moth bean seed quality in 4 types of packaging&nbsp;including cloth, gunny, HDPE, and vacuum-packed bags for 18 months. After two months of storage, the moisture content of the seeds fluctuated greatly in cloth, gunny, and HDPE bags (conventional packaging) because these materials are pervious, but the moisture content of the seeds did not vary in vacuum packed bags as the polythene bag used for the vacuum package was thicker, had a lower water vapor and oxygen transmission rate. Further,&nbsp;seeds in conventional packaging’s&nbsp;developed bruchid infestations after 4 months of storage but no infestation was found in vacuum-packed bags until 18 months. The bruchid infestation caused the germination rate of the seeds to drop to less than 20%.&nbsp; In comparison to the initial state, even after 18 months of storage, there was little change in the parameters used for measuring seed quality (germination, total seedling length, seedling dry weight, moisture content, and protein content). Therefore, without the use of chemicals, moth bean seeds can be safely stored using vacuum packaging technology