The Second Triennial Systematic Literature Review of European Nursing Research: Impact on Patient Outcomes and Implications for Evidence-Based Practice

Written on behalf of the European Academy of Nursing Science REFLECTION review group: José Amendoeira, Polytechnic Institute of Santarem, Santarem, Portugal; (…) p.9European research in nursing has been criticized as overwhelmingly descriptive, wasteful and with little relevance to clinical practice. This second triennial review follows our previous review of articles published in 2010, to determine whether the situation has changed.info:eu-repo/semantics/publishedVersio

Psychosocial predictors of health-related quality of life and health service utilisation in people with chronic low back pain

Psychological and social factors have been shown, separately, to predict outcome in individuals with chronic low back pain. Few previous studies, however, have integrated both psychological and social factors, using prospective study of clinic populations of low back pain patients, to identify which are the most important targets for treatment. One hundred and eight patients with chronic low back pain, newly referred to an orthopaedic outpatient clinic, completed assessments of demographic characteristics, details of back pain, measures of anxiety and depression (Hospital Anxiety and Depression Scale, HADS), fearful beliefs about pain (Fear Avoidance Beliefs Questionnaire), social stresses (Life Events and Difficulties Schedule) and physical aspects of health‐related quality of life [SF‐36 Physical Component summary Score scale (PCS)]. Six months later subjects completed the SF‐36 PCS and the number of healthcare contacts during follow‐up was recorded. Independent predictors of SF‐36 PCS at 6‐month follow‐up were duration of pain [(standardised regression coefficient (β) = −0.18, p = 0.04), HADS score (β) = −0.27, p = 0.003] and back pain related social difficulties (β = −0.42, p < 0.0005). Number of healthcare contacts over the 6 months ranged from 1 to 29, and was independently predicted by perceived cause of pain [Incident Rate Ratio (IRR) = 1.46, p = 0.03], Fear Avoidance Beliefs about work (IRR = 1.02, p = 0.009) and back pain related social difficulties (IRR = 1.16, p = 0.03). To conclude, anxiety, depression, fear avoidance beliefs relating to work and back pain related stresses predict impairment in subsequent physical health‐related quality of life and number of healthcare contacts. Interventions targeting these psychosocial variables in clinic patients may lead to improved quality of life and healthcare costs

The state of European nursing research : dead, alive, or chronically diseased? a systematic literature review

Background: Reviews of nursing research have suggested that most is descriptive; with no more than 15% providing strong evidence for practice. No studies have examined this from the perspective of nursing research conducted in Europe. Objective: The aim of this study was to review reports of European clinical nursing research in the top 20 nursing journals in 2010 to establish a baseline of nursing research activity in the year immediately prior to the launch of a European Science Foundation network to increase the proportion of intervention research in Europe. Methods: We identified eligible reports that were then data-extracted by two independent reviewers. Disagreements were resolved through pair discussion and independent arbitration. We appraised and synthesized topics, methods, and the extent to which studies were programmatic. We synthesized data as proportions of study reports meeting our a priori categorization criteria. Results: We identified 1995 published reports and included 223 from 21 European countries, of which 193 (86.6%) reported studies of primary research only, 30 (13.5%) secondary research, and three (1.4%) a mix of primary and secondary. Methodological description was often poor, misleading, or even absent. One hundred (44.8%) articles reported observational studies, 87 (39.0%) qualitative studies. We found 26 (11.7%) articles reporting experimental studies, 10 (4.5%) of which were randomized controlled trials. We found 29 (13.0%) reports located within a larger program of research. Seventy-six (34.1%) articles reported studies of nursing interventions. Linking Evidence to Action: European research in nursing reported in the leading nursing journals remains descriptive and poorly described. Only a third of research reports concerned nursing interventions, and a tiny proportion were part of a programmatic endeavor. Researchers in nursing must become better educated and skilled in developing, testing, evaluating, and reporting complex nursing interventions. Editors of nursing journals should insist on systematic reporting of research designs and methods in published articles

Researching complex interventions in health: the state of the art

CITATION: Craig, P., et al. 2016. Researching complex interventions in health : the state of the art. BMC Health Services Research, 16:101, doi:10.1186/s12913-016-1274-0.The original publication is available at https://bmchealthservres.biomedcentral.comENGLISH SUMMARY : Keynote presentationsPublishers' Versio

Integrating quantitative and qualitative data and findings when undertaking randomised controlled trials

It is common to undertake qualitative research alongside randomised controlled trials (RCTs) when evaluating complex interventions. Researchers tend to analyse these datasets one by one and then consider their findings separately within the discussion section of the final report, rarely integrating quantitative and qualitative data or findings, and missing opportunities to combine data in order to add rigour, enabling thorough and more complete analysis, provide credibility to results, and generate further important insights about the intervention under evaluation. This paper reports on a 2 day expert meeting funded by the United Kingdom Medical Research Council Hubs for Trials Methodology Research with the aims to identify current strengths and weaknesses in the integration of quantitative and qualitative methods in clinical trials, establish the next steps required to provide the trials community with guidance on the integration of mixed methods in RCTs and set-up a network of individuals, groups and organisations willing to collaborate on related methodological activity. We summarise integration techniques and go beyond previous publications by highlighting the potential value of integration using three examples that are specific to RCTs. We suggest that applying mixed methods integration techniques to data or findings from studies involving both RCTs and qualitative research can yield insights that might be useful for understanding variation in outcomes, the mechanism by which interventions have an impact, and identifying ways of tailoring therapy to patient preference and type. Given a general lack of examples and knowledge of these techniques, researchers and funders will need future guidance on how to undertake and appraise them

A theory-based educational intervention targeting nurses' attitudes and knowledge concerning cancer-related pain management: A study protocol of a quasi-experimental design

<p>Abstract</p> <p>Background</p> <p>Pain is one of the most frequent problems among patients diagnosed with cancer. Despite the availability of effective pharmacological treatments, this group of patients often receives less than optimal treatment. Research into nurses' pain management highlights certain factors, such as lack of knowledge and attitudes and inadequate procedures for systematic pain assessment, as common barriers to effective pain management. However, educational interventions targeting nurses' pain management have shown promise. As cancer-related pain is also known to have a negative effect on vital aspects of the patient's life, as well as being commonly associated with problems such as sleep, fatigue, depression and anxiety, further development of knowledge within this area is warranted.</p> <p>Methods/design</p> <p>A quasi-experimental study design will be used to investigate whether the implementation of guidelines for systematic daily pain assessments following a theory-based educational intervention will result in an improvement in knowledge and attitude among nurses. A further aim is to investigate whether the intervention that targets nurses' behaviour will improve hospital patients' perception of pain. Data regarding nurses' knowledge and attitudes to pain (primary outcome), patient perception regarding pain (secondary outcome), together with socio-demographic variables, will be collected at baseline and at four weeks and 12 weeks following the intervention.</p> <p>Discussion</p> <p>Nursing care is nowadays acknowledged as an increasingly complicated activity and "nursing complexity is such that it can be seen as the quintessential complex intervention." To be able to change and improve clinical practice thus requires multiple points of attack appropriate to meet complex challenges. Consequently, we expect the theory-based intervention used in our quasi-experimental study to improve care as well as quality of life for this group of patients and we also envisage that evidence-based guidelines targeting this patient group's pain will be implemented more widely.</p> <p>Trial Registration Number</p> <p>ClinicalTrials.gov <a href="http://www.clinicaltrials.gov/ct2/show/NCT01313234">NCT01313234</a></p

Mixed methods in health service research : where do we go from here?

In the 21st century, it is more obvious than ever before that health services research and its practitioners exist in an extremely complex contextual environment. Consequently, at the heart of understanding how to deliver an evidence base for safe and effective care in a set- ting characterised by multifaceted health care demands, is the real- isation that no one research method in isolation will suffice. This realisation, together with the REWARD group ’ s contention that 85 % of health service research conducted – and most importantly mainly funded by public money – is ‘ waste ’ , is one of the reasons why frameworks such as the MRC guidance on complex interventions, and mixed methods designs are subject to intensified attention. This plenary address aims to discuss the contribution of mixed methods to researching complex interventions within the MRC framework and to consider its place in contemporary health service research. The MRC framework for researching complex interventions has highlighted the importance of research designs including both qualitative and quantita- tive approaches. However when reviewing the literature prior to writing my chapter in our recent textbook, it was clear that designing and conducting truly mixed methods research presents health service re- searchers with a number of challenges. Predominant amongst these are the selection of designs from suggested typologies, methodological reporting, critical evaluation and most importantly ensuring that the core feature in true mixed methods (as opposed to multi-methods) de- signs – analytical and methodological integration – is implemented. To be able to conduct mixed methods approaches that are rigorously de- signed, logically executed, and transparently reported, we need to move to a position where funders, researchers, journal editors and re- search consumers demand methodological integration of methods and data from study outset, rather than as a mere afterthought in the dis- cussion section of research reports

Quality of life among older people. Their experience, need of help, health, social support, everyday activities and sense of coherence

The overall aim of this thesis was to investigate QoL and Health-Related QoL (HRQoL) among people aged 75 years and over in relation to socio-demographic variables, need of ADL help, various degrees of present QoL, self-rated health (SRH), health complaints, everyday activities, social support and sense of coherence (SOC). A further aim was to test a QoL scale and to illuminate older people's experience of QoL. Data were collected by questionnaires sent to a population-based sample and by an interview study. Study I comprised 469 people (83.2, SD 5.7). In study II 1,093 people (82.7, SD 5.3) participated, whilst study III comprised of 385 people (84.6, SD 5.7). Eleven people aged 80 years and over participated in an interview study (Paper IV). Quantitative data were analysed by descriptive, comparative, correlation statistics and by a two-step cluster analysis, multiple linear regression and factor analyses. The qualitative data were analysed inspired by the hermeneutic phenomenological method. Health complaints such as pain, fatigue and mobility impairment (Paper I) predicted low QoL and HRQoL. Reporting fair and poor SRH, not spending time outdoors and being nervous and/or worried also proved to predict low QoL whilst SOC and social support positively influenced QoL (Paper III). Women reported more health complaints (Paper I) and were more vulnerable in terms of having lower QoL and HRQoL than men (Papers I?II). The same vulnerability in terms of low QoL and HRQoL was found among those in need of ADL help in comparison with those not needing such help. Those needing ADL help as well as women additionally had lower scores in several of the separate QoL areas (Paper II). The construct and cross-validation of the QoL instrument showed that eight out of ten primordial QoL areas were replicated. The instrument differentiated between those in need of ADL help and not, as well as between gender (Paper II). In paper III, three groups, high, intermediate and low present QoL were identified through cluster analysis. Half of the sample were at risk or had low present QoL. The most notable differences were found between those with high (47.8%) and low (18.4%) present QoL, especially in terms of total QoL, SRH, health complaints, social support, physical activities and SOC. The oldest most vulnerable people constituted those with low present QoL, whereas those with high present QoL shared several features with ?successful ageing?, excellent or good SRH, physical activity, low frequencies of health complaints, high total QoL and SOC. Those with intermediate present QoL (33.8%) differed from those with high present QoL in various ways but were less exposed in several respects than those with low present QoL (Paper III). The interviews (Paper IV) revealed that QoL in old age meant a preserved self and meaning in existence. How QoL was valued depended on the meaning the people attached to the areas of importance for their QoL. Their ability to adapt was also found to be important for how they evaluated their QoL. Areas not generally included when measuring QoL quantitatively, such as the meaning of home and philosophy of life, became discernible. Health complaints such as pain mobility impairment, fatigue and being nervous and/or worried as well as reporting fair and poor SRH together with not spending time outdoors had a negative influence on QoL, However, social support and SOC had the opposite influence on QoL among older people. Women and those dependent on ADL help reported lower total QoL as well as HRQoL but also lower scores in QoL areas outside health and physical functioning. The tested QoL instrument were reasonably stable and differentiated between being and not being in need of help as well as between women. Within the group of independent seemingly healthy older people, there was a group reporting low to very low present QoL. The lower present QoL could be a manifestation of the ageing process but perhaps also of less adaptive resources. QoL in old age meant a preserved ?self? and ?meaning? in existence. Areas not generally included in QoL measures were included in the older people's evaluation of their QoL