Multidisciplinary Health Care Research Articles

Analyzing and Mitigating the Risks of Patient Harm During Operating Room to Intensive Care Unit Patient Handoffs.

Patients continue to suffer from preventable harm and uneven quality outcomes. Reliable clinical outcomes depend on the quality of robust administrative systems and reliable support processes. Critically ill patient handoffs from the operating room to the intensive care unit are known high-risk events. We describe a novel perspective on how risk factors associated with the process of patient handoff communication between the operating room (OR) and the intensive care unit (ICU) can lead to flawed communication, degraded team awareness, medical errors and increased patient harm. Data was collected from two semi-structured focus groups using a five-step risk management approach at a tertiary hospital in São Paulo, Brazil. We conducted a failure modes, effects and analysis (FMEA) with multidisciplinary healthcare providers consisting of attending physicians, anesthesiologists, nurses, and physiotherapists involved in patient handoffs. We analyzed the results using a similitude analysis to evaluate the effectiveness of implementing this novel risk management approach. We identified the handoffs risks associated with patients, staff, institution, and potential financial risks. The FMEA identified 12 process failures and 36 causes that generated 12 consequences and pointed to robust needed preventive measures to mitigate handoff risks. The clinical teams reported that this approach allowed them to see the process more completely as a whole not only in their narrow siloes, thus understanding the enablers and difficulties of the other team members and how this understanding can shed light on their mental models, actions and the process reliability. Teams identified key steps in the OR to ICU handoff process that are prone to the highest hazards to patients, hospital and staff and are currently targeted for process improvement. Evidence driven recommendations intended for reducing the risks associated with patient handoffs are presented. Implementing a dynamic risk management, interdisciplinary approach was used to redesign the OR to ICU patient handoff approach around the patient's and clinician's needs. The risk management program helped healthcare providers identify handoff steps, highlighting risky handoff process failures, making it possible to identify actionable failures, consequences, and define preventative action plans for mitigating the risks to improve the quality and safety of patient handoffs.

How to deliver person-centred care for people living with heart failure: a multi stakeholder interview study with patients, caregivers and healthcare professionals in Thailand

ContextHeart failure has high, growing global prevalence, morbidity and mortality, and is a leading cause of death with serious health-related suffering in low- and middle-income countries. Person-centred care (PCC) is a critical component of high-quality healthcare and is particularly vital in the context of a serious illness such as heart failure. However, there are limited data exploring PCC in this population in low- and middle-income settings.AimThe aim of this study was to explore how clinical services could respond to the PCC needs of individuals living with heart failure in Thailand, with potential for adaptation in other settings. The specific objectives were (i) to understand the experiences and needs of persons living with heart failure, their caregivers and HCPs; (ii) to explore specific practical actions that can help deliver PCC for heart failure patients in this setting.MethodsCross-sectional qualitative study. In depth, semi-structured interviews were conducted in Thailand with heart failure patients (n = 14), their caregivers (n = 10) and healthcare professionals (n = 12). Framework analysis was conducted with deductive coding to populate an a priori coding frame based on Santana et al’s PCC model (2018) and Giusti et al’s systematic review (2020), with further inductive coding of novel findings to expand the frame. The study is reported in accordance with the consolidated criteria for reporting qualitative research guidelines (COREQ).ResultsThe findings reveal specific practice actions that deliver PCC for persons living with heart failure in Thailand, such as (i) compassionate communication by healthcare professionals; (ii) effective teamwork amongst multidisciplinary healthcare professionals; (iii) proactive responses to physical, psychosocial, relational and information needs of patients and caregivers; (iv) engaging patients and families in symptom management; (v) providing opportunities for patients to be cared for in the community; and (vi) responding to the social determinants of health, illness and healthcare access.ConclusionPerson-centred healthcare systems must aim to address the social determinants of illness and place focus on community- and home-based care. Heart failure patients and caregivers must be supported to self-manage, including how to recognise symptoms and take appropriate action. Delivering PCC in such a way has the potential to improve outcomes for patients, enhance patients’ sense of agency and experiences of care, improve health equity, and reduce hospital admissions, relieving pressure on the hospital system and reducing overall costs of care.

DAFNE is agile and responsive—a beacon of best practice

The original Dose Adjustment For Normal Eating (DAFNE) randomised controlled trial (RCT) was conducted nearly 25 years ago.1 It has transformed structured education for type 1 diabetes (T1DM) across the UK and is still evolving through its evidence base of further RCTs,2-3 and routine collection of real-world evidence (RWE),4 thereby proving that what works in a research setting, also benefits people with T1DM in the large number (more than half) of the hospital Trusts that have adopted DAFNE countrywide. This review summarises the latest national audit data, and describes future work responding to the rapid changes in technology used in T1DM, how we are evolving to support people living with type 2 diabetes (T2DM), and adapting our learning materials in the digital age. Through the strength and depth of committed multidisciplinary healthcare professionals (HCPs) we have been able to expand our portfolio of learning materials available to DAFNE centres, who pay a nominal annual fee of ~£5,000. By partnering with the Open University we now offer free accredited online learning to a wide range of HCPs, thereby helping to upskill the diabetes workforce at no extra cost to the NHS. Finally, in a new and exciting collaboration with the Diabetes Technology Network (DTN) and industry colleagues, DAFNE offers free online training to all people living with T1DM to prepare them for closed-loop therapy.

Disordered Eating Behaviors and Weight Regain in Post-Bariatric Patients.

Weight regain has serious health consequences after bariatric surgery, and disordered eating behaviors (EBs) may be involved in it. We compared disordered EB symptoms in post-bariatric patients according to low vs. high ratio of weight regain (RWR) and investigated associations between disordered EB symptoms with weight regain and time since surgery. We recruited ninety-four patients who had undergone laparoscopic Roux-en-Y gastric bypass or sleeve gastrectomy. All of them had not attended follow-up with the multidisciplinary healthcare team (including psychological assessment) for at least one year. RWR was calculated with respect to maximal weight loss by the nadir weight achieved after surgery. Patients were divided into two groups: high RWR (≥20%) or low RWR (<20%). At their first visit, we had them complete the Eating Disorder Examination and Repetitive Eating Questionnaires (EDE-Q and Rep(eat)-Q). Patients with high RWR reported higher EDE-Q global, dietary restraint and weight concerns without significant group differences in eating and shape concerns. Compared to those patients with low RWR, these patients also indicated greater Rep(eat)-Q global, compulsive grazing and repetitive eating. Global EDE-Q score, eating concern, shape concern, weight concern and all Rep(eat)-Q indexes were positively associated with higher RWR. Disordered EBs occurred more frequently in the group with high RWR. In these patients, eating behavior symptoms and grazing behavior were both correlated to the RWR, suggesting a possible involvement of both conditions in weight regain.

A Critical Analysis of the Integration of Evidence-Based Practice among Nurses and Nursing Assistants and Its Impact on Patient-Centered Care in Multidisciplinary Healthcare Teams

This article focuses on the implementation of EBP concerning nurses and nursing assistants and studies the effects of that implementation on the properly targeted and patient-specialized healthcare process with the help of MDTs. EBP is critical in today’s healthcare needs since it allows for the basis for decision-making and frames the latest practices influencing patients' health. Nevertheless, there are challenges that nursing assistants face when implementing EBP in clinics because they have no formal training in EBPs. From the literature review and synthesis of this paper, we demonstrate the elements of EBP that improve team communication, patient satisfaction, and decreased medical errors, but what has been left unanswered is the experiences of the nursing assistants in EBP. Future strategies include evidence-based practice specialist schooling and hiring to catalyze increased EBP across multiple discipline teams and promote highly effective patient care.

Artificial intelligence after the bedside: co-design of AI-based clinical informatics workflows to routinely analyse patient-reported experience measures in hospitals

ObjectiveTo co-design artificial intelligence (AI)-based clinical informatics workflows to routinely analyse patient-reported experience measures (PREMs) in hospitals.MethodsThe context was public hospitals (n=114) and health services (n=16) in a large state...

Developing a toolkit to support parents’ involvement in child death review: an experience-based co-design study

BackgroundUnderstanding why children die is important for grieving parents and for informing system improvements aimed at prevention and future care. Many countries have child death review (CDR) process, but little...

Physiotherapists as first-contact practitioners for patients with low back pain in French primary care: a pragmatic cluster randomised controlled trial.

A new model of care enables French physiotherapists (PT) working in collaboration with family physicians (FP) to expand their usual scope of practice for patients with acute low back pain (LBP). The aim of our study is to evaluate the impact of this new first-contact physiotherapy (FCP) advanced practice model compared to usual FP care. A multicentre pragmatic non-inferiority cluster randomised controlled trial (RCT) has been conducted in six multidisciplinary primary healthcare centres in France. Patients from 20 to 55 years old with acute LBP consulted either the PT or the FP. PT independently assessed and managed patients including medication prescription. The primary outcome measure was disability at six weeks (Roland Morris Disability Questionnaire, range 0-24). Secondary outcomes include pain, risk disability prognosis, satisfaction with care, healthcare resources use and wait times. Data were collected at baseline, six and twelve weeks. Outcomes across arms were compared using mixed models regression analysis. Except for non-inferiority analysis of the primary outcome measure, other analyses were performed with a two-sided significance level of 0.05. Sixty patients were recruited (PT: 32, FP: 28). The adjusted mean difference between groups for disability at 6 weeks was 0.39 in favour of the FP group (95%CI: -2.03; 2.81, p = 0.753). Considering a 5 points minimal clinically important difference, the FCP-led model of care was not inferior to usual FP care for the primary outcome. There was no statistically significant difference between groups in disability at 3 months and pain at 6 weeks and 3 months. PTs prescribed significantly less medications than FPs (p < 0.001). No statistically significant difference was found for other healthcare resource use outcomes, patients' satisfaction and wait times. This is the first RCT to evaluate the impact of a FCP advanced practice model of care including medical delegated acts in a primary care setting. Our results suggest that the FCP-led model of care is not inferior to usual FP care regarding disability at 6 weeks. The FCP model could result in possible benefits in terms of healthcare resources use. Further adequate powered studies with larger sample size are needed to draw stronger conclusions. The study has been registered in ClinicalTrials.gov (NCT05200533) on the 20th of January 2022.

Socio-ecological barriers to behavior change-oriented dementia prevention: a qualitative study of healthcare professionals’ perspectives

Objectives This qualitative study aimed to: (1) identify socio-ecological barriers to behavior change-oriented dementia (AD/ADRD) prevention from the perspectives of healthcare professionals, and (2) propose strategies to address these barriers during a clinical trial for an AD/ADRD prevention program (My Healthy Brain). Method Multidisciplinary healthcare professionals involved in geriatric care (N = 26, M experience > 17 years) from diverse clinics within a medical center participated in focus groups. Using the Socio-Ecological Model (SEM), 5 focus groups were conducted to identify individual, interpersonal, institutional, community, and societal barriers. The Expert Recommendations for Implementing Change (ERIC) framework informed evidence-based strategies to overcome these barriers. Results Healthcare professionals identified barriers, including limited resources, language and technological barriers, provider dismissiveness, competing institutional priorities, underrepresentation of minority groups, and biases towards biomedical treatments. Strategies to address these barriers involved enhancing accessibility, increasing provider training and support, integrating interventions within clinic operations, fostering community partnerships, and addressing societal misconceptions and biases. Conclusion Integrating SEM and ERIC frameworks yielded strategies that will be used in My Healthy Brain trial to enhance equity and responsiveness to diverse older adults. Our results can inform efforts to address multi-level barriers to AD/ADRD prevention and the larger contexts influencing risk factors.

Recounting the untold stories of breast cancer patient experiences: lessons learned from a patient-public involvement and engagement storytelling event.

Breast cancer remains a prevalent disease in women worldwide. Though advancements in breast cancer care have improved patient survival, a breast cancer diagnosis, and subsequent interventions have a lasting impact on patients' lived experiences during the pandemic. We present the collaborative learning process from this patient engagement workshop series as a community-academic partnership. Narrative medicine tools were used to recount patients' lived experiences following diagnosis, where both patients and researchers shared their cancer research activities in each workshop, and the role of the multidisciplinary healthcare team was discussed. We used an iterative approach to cohort building, narrative development, and the use of multiple media formats to capture stories. Over 20 patients with breast cancer shared their stories for the first time since their diagnosis with a wider audience. Here, we present the learning process and considerations from this event. Understanding patients' lived experiences can support researchers and healthcare professionals in developing an empathetic approach to shared healthcare decision making. Moreover, understanding the lived experiences of patients is critical to addressing disparities in healthcare.

Epidemiology of International Patients with Lower-Limb Deficiencies Treated at a United States–Based Pediatric Prosthesis Clinic

ABSTRACT Introduction Limited epidemiological or clinical research exists describing pediatric lower-limb deficiency (LLD) patients born outside the United States (US). Objectives The purpose of this study was to characterize a cohort of international patients treated at a single tertiary care orthopedic hospital. We set out to quantify the prevalence of international patients within a broader cohort of pediatric limb deficiency patients. In addition, we evaluated similarities and differences between adopted and nonadopted internationally born patients as well as their US-born counterparts. Study Design Retrospective chart review was performed on patients born outside the US between 1995 and 2020. Methods Patients were divided into groups based on place of birth, country of residence, and adoption status. Statistical analysis was performed using χ2 and t-test. Results A total of 111/579 (19.2%) patients seen in our limb difference clinic were born outside the US, with 39.6% adopted. Geographically, patients represented 32 countries, and 96.4% were born in low- or middle-income countries (LMICs). The most common causes of LLD were congenital malformations (72.1%), trauma (17.1%), and tumor (5.4%). Syme was the most common amputation level (26.6%), followed by knee disarticulation (23.7%) and transtibial (18.7%). Congenital diagnoses were more frequent in adoptees (93.1% vs. 58.2%), whereas nonadoptees often had trauma (25.4%) or tumor (8.9%) diagnoses leading to amputation (P = 0.0003). A total of 23/60 (38.3%) international patients with preexisting lower-limb amputations had never worn a prosthesis at the time of initial presentation. Conclusions Many pediatric patients with prosthetic needs presenting for care in the US were born in LMIC. Adopted and nonadopted internationally born patients had significant differences in clinical etiologies of their LLD. Clinical Relevance Statement Internationally born patients may constitute a substantial percentage of US-based specialty clinics treating children with lower-limb differences, particularly from low- or middle-income countries where access to orthopedic and prosthetic care may be limited. This study highlights the importance of multidisciplinary health care providers addressing these children’s distinct clinical needs for improved patient-centered care.

A single-blind, randomised control trial on the effectiveness of a structured multi component training module for family caregiver of persons with Parkinson's disease: A study protocol.

Parkinson disease (PD), a neurodegenerative disorder that progresses over time, is steadily growing in number and prevalence worldwide. PD in Malaysia is expected to increase five-fold by 2040 from the existing estimate of 20,000 patients in 2018. Treatment program of PD in Malaysia is rather unstructured, and there is no known comprehensive PD family caregiver training program available to date. To ensure the quality of a program, it must be tested for feasibility, effectiveness and sustainability. This paper describes the protocol of a study that evaluates the effectiveness of a structured, comprehensive training program of family caregiver to persons with PD in comparison to usual care. A total of 60 pairs of persons with PD of stage II and III, and their primary family caregiver will be recruited and allocated into either an experimental or a control group for 12 weeks of intervention. The experimental group will undergo initial training from multi-disciplinary healthcare providers and will be given a physical module containing weekly tasks that must be practised at home. While the control group will receive a usual care. Both groups will be assessed in terms of physical functions, functional mobility, quality of life (QoL), caregiver burden and knowledge using standardised assessment tools namely Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS), Timed Up and Go (TUG) test, Parkinson's Disease Questionnaire (PDQ-39), European Quality of Life five-dimensions (EQ-5D), Malay version of Zarit Burden Interview (MZBI) and Knowledge of Parkinson Disease Questionnaire (KPDQ). In addition, the feasibility and sustainability of the interventions will be evaluated, alongside its cost-effectiveness based on the average and incremental cost effectiveness ratio. All data will be analysed using descriptive and inferential statistics, particularly mixed model ANOVA. There is a significant gap in the literature pertaining family caregiver training programs for people with PD. Documented programs are lacking in term of comprehensiveness of content, application approach and the measurement of training outcomes including the program cost-effectiveness. The feasibility and effectiveness of such training program in a Malaysian setting also requires investigation due to differences in living environment, support system and population's perception. This study will assist to fulfil the existing literature gap and demonstrate the potential benefit of caregiver involvement in mediating the care and therapy for PD in the home setting. Optimum knowledge and skills gained through the training are expected to enhance the confidence and ability of the family caregivers and may possibly reduce their perceived caregiving burden. The protocol of this study is registered in the Australian-New Zealand Clinical Trial Registry (ANZCTR) with a registration number ACTRN12623000336684.

The Collaborative Pulse of Healthcare: a critical analysis of Nursing’s Role in a Holistic Approach to Patient Care Across Medical Specialties

This critical analysis explores nursing's pivotal role in fostering a holistic approach to patient care within multidisciplinary healthcare teams. As healthcare becomes increasingly complex, the integration of collaborative practices across specialties is essential for delivering comprehensive and patient-centered care. Nurses, often serving as the main touchpoint for patients, play a crucial role in coordinating care, advocating for patient needs, and bridging communication among healthcare professionals. This study examines the specific contributions of nurses, identifies challenges in inter-professional collaboration, and highlights enablers that support effective teamwork. Findings suggest that nursing collaboration positively impacts patient outcomes, satisfaction, and care continuity, though challenges such as communication barriers and hierarchical structures remain. By enhancing support for collaborative nursing roles, healthcare institutions can achieve improved quality of care and greater efficiency. Recommendations include promoting interdisciplinary training, clarifying team roles, and implementing policy reforms to empower the nursing workforce in holistic patient care.

Exploring the oral health status of children living with hypoxic ischemic encephalopathy (HIE): A caregiver described self-report.

Hypoxic Ischemic Encephalopathy (HIE) is a birth complication due to loss of oxygen flow, resulting in a wide range of physical and cognitive differences often requiring support from multidisciplinary healthcare teams. Despite this population's increased need, little is known about their oral health status and the role of the dentist as a member of the care team. A 32-item oral health questionnaire was shared to 8700 members within the patient advocacy non-profit, Hope for HIE's, Facebook group. The survey assessed caregiver-reported oral health status and facilitators and barriers to receiving dental care. Two hundred sixty-two individuals responded to the survey. The majority were white (90%, 177/196) parents of children with HIE (99%, 259/262) that lived in the U.S. (76%, 148/195) and cared for children under 3 (42%, 106/251). 36% (85/236) reported cavity experience, 81% (180/223) reported visiting the dentist for a dental check-up, however, 58% (147/255) considered the dentist to be a member of their child's care team. Children diagnosed with HIE likely experience similar oral health status as their peers, however, qualitative developmental work is necessary to assess facilitators and barriers to receiving dental care, and how to integrate the dentist into the care team.

Update on Practical Management of Early-Stage Non-Small Cell Lung Cancer (NSCLC): A Report from the Ontario Forum.

Therapeutic strategies for early-stage non-small cell lung cancer (NSCLC) are advancing, with immune checkpoint inhibitors (ICIs) and targeted therapies making their way into neoadjuvant and adjuvant settings. With recent advances, there was a need for multidisciplinary lung cancer healthcare providers from across Ontario to convene and review recent data from practical and implementation standpoints. The focus was on the following questions: (1) To what extent do patient (e.g., history of smoking) and disease (e.g., histology, tumor burden, nodal involvement) characteristics influence treatment approaches? (2) What are the surgical considerations in early-stage NSCLC? (3) What is the role of radiation therapy in the context of recent evidence? (4) What is the impact of biomarker testing on treatment planning? Ongoing challenges, treatment gaps, outstanding questions, and controversies with the data were assessed through a pre-meeting survey, interactive cases, and polling questions. By reviewing practice patterns across Ontario cancer centers in the context of evolving clinical data, Health Canada indications, and provincial (Cancer Care Ontario [CCO]) funding approvals, physicians treating lung cancer voiced their opinions on how new approaches should be integrated into provincial treatment algorithms. This report summarizes the forum outcomes, including pre-meeting survey and polling question results, as well as agreements on treatment approaches based on specific patient scenarios.

Effectiveness and Persistence of Anti-TNFα Treatment in Patients with Rheumatoid Arthritis - A 7 Years Real-World Cohort Study.

To describe the effectiveness and persistence of treatment with three anti-TNFα drugs, Infliximab, Etanercept, and Adalimumab, in patients with Rheumatoid Arthritis (RA) in a rheumatology center. A longitudinal, retrospective cohort study was conducted. Data were obtained from the health records of patients with RA who were followed up in a rheumatology center between 2011 and 2019 under a multidisciplinary healthcare model (MCM). The drugs used in this study were indicated according to the treatment guidelines for prescription. In order to follow-up of disease activity, at least three DAS28 reports for every analyzed year were used. The chi-square test and Fisher's exact test were used for statistical analyses of categorical variables. For the analysis of treatment persistence, the Kaplan-Meier method was used based on the recorded follow-up time of disease activity. One hundred and eighty-three RA patients included (80% women, median age 60 years), who received adalimumab (n = 56) (30.6%), etanercept (n = 64) (34.9%), or infliximab (n = 63) (34.4%) during the 7-year study period. A higher proportion of patients had moderate or high disease activity for all three anti-TNFα. In first-year treatment, 67% to 87% of the cohort achieved disease activity control and disease response to treatment. For the first three years, 95% to 98% of patients continued with the medications. In years 5th and 7th, the proportion of patients on medication was 80% to 90% and 42% to 54%, respectively. The efficacy and persistence of anti-TNF-α were similar among the three molecules. These findings regarding long-term persistence in treatment may be useful for therapeutic decision-making based on real-life cohort results.

18 Past and current care practices for neonates with complex medical needs: A scoping review to support clinical program evaluation

Abstract Background Neonates with complex medical needs (NCMN) are a rapidly growing patient population internationally. Although NCMN are a relatively small proportion of all Neonatal Intensive Care Unit (NICU) admissions, they are high healthcare utilizers. Since 2018, a dedicated Neonatal Complex Care Team (NCCT) has cared for NCMN at a large quaternary care center. The NCCT cares for NCMN in a dedicated, single-family room, patient area within the NICU. This model of care has yet to be evaluated for its potential impact on healthcare outcomes. Objectives The objective of the scoping review is to determine the breadth of available literature on the care practices for the management of NCMN and to collate the available evidence to define outcome measures to be used in a formal program evaluation. Design/Methods The review followed the PRISMA extension for scoping reviews and utilized resources from the Joanna Briggs Institute. The two databases that were utilized include Medline via OVID and CINAHL. The dates for included publications are January 1st 1993, until July 15th 2023. Only studies published in English and primary research were included. Two independent reviewers performed the initial title and abstract screening, and the full text review. The data extraction was completed by one independent reviewer. Results 102 articles were included in the title and abstract screen, and 12 were considered for full text review. Four articles were included. Interventions discussed in the included articles ranged from discharge conferences with patient’s caregivers, to the implementation of an entirely new model of care. Multidisciplinary health care teams appear to be integral to the in-hospital care and smooth discharge of NCMN. We identified that caregiver involvement and satisfaction are important to the discharge process as they are primarily responsible for their infant’s care after discharge, and so it is important that the specifics of care are communicated and taught effectively. The outcomes of interest identified as most useful for clinical program evaluation were length of stay and readmission rate. Additionally there was limited data reported on long-term health outcomes of this patient population. Conclusion This scoping review identified few articles that reported new models of care, a lack of consistent outcomes used in evaluating existing care models and overall a gap in research in this rapidly growing patient population. There is more work to be done to improve care of NCMN and our findings will be used in designing future studies that evaluate care models.

Telehealth-delivered physical activity interventions provided by maternal healthcare services influence postpartum women’s engagement in physical activity: a systematic review

The benefits of physical activity in the postpartum population are well documented, and regarded as being vitally important to the recovery process. Psychological health, musculoskeletal conditions, cardiorespiratory fitness and weight retention are among the postpartum health issues that physical activity can positively influence. Although international guidelines for physical activity postpartum have been published, there is a lack of current research into the effectiveness of, and patient compliance with, physical activity programmes in this population. Physiotherapists are well placed to deliver physical activity interventions for these women because of the multidisciplinary maternal healthcare services that are provided for them. The focus of this paper is to examine the available evidence regarding how the delivery and accessibility of physical activity programmes have changed with the exponential growth of telehealth. A detailed systematic literature search limited to randomized controlled trials published in English was performed for the period from 2014 to 2022. Four relevant publications were identified that utilized an element of telehealth physical activity in the postpartum population, although the timescale and definition of postpartum was not standardized across the papers. The findings of this literature review indicate that there is tentative support for the use of remote intervention as a means of improving physical activity in postpartum patients. The literature does not provide a consensus on the most appropriate length, type or duration of telehealth-delivered postpartum physical activity intervention for this population. There is a need for future high-quality research to investigate the effect of remote physical activity delivery on cost-effectiveness and patient satisfaction.

Identifying the need for a nurse-driven palliative care intervention for American Indian and rural family caregivers.

The purpose of this qualitative study was to understand the needs of family caregivers (FCGs) from the perspectives of health care professionals delivering cancer care to American Indian and rural populations. A descriptive content analysis of 18 interviews with multidisciplinary health care professionals delivering cancer care at a rural cancer institute in the Great Plains region was conducted. We identified three themes: access, support, and awareness with six subthemes. Consideration of these core needs, coupled with the individual cultural circumstance, is critical in addressing disparities faced by American Indian/Alaska Native and rural FCGs. The availability of specialized health care services, like palliative care, can positively impact the experience of FCGs providing care. However, access is limited. The needs and challenges faced by American Indian/Alaska Native and rural FCGs described in this study can inform the development of a culturally responsive palliative care intervention. Nurses are well positioned to develop and lead this intervention, which will be the first of its kind. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Nurse-Led Medication Management for Older People in Home Care: A Systematic Review of Evolving Nurse Responsibilities in Technology-assisted Care

Technology-assisted care is transforming the home care landscape for older people requiring medication management. With evolving roles and responsibilities, nurse-led interventions are shaping the future of nursing practice in home care. This review aimed to identify and describe nurse-led roles in medication management in home care for older people within the context of technology-assisted care. A systematic review employing an integrative approach was conducted on the PubMed (covering MEDLINE), Scopus, CINAHL, ProQuest, and Embase, targeting studies published in English over the past decade, from 2014 to 2024. The initial database search identified 1629 studies, which were subsequently narrowed down to 20 studies selected for data analysis and narrative research synthesis. The review findings were classified into 3 categories: “fundamental principles,” “nurses and their role identities,” and “enhanced care quality and medication safety.” Given the effectiveness of nurses as leaders in technology-assisted home care for enhancing medication management safety, it is essential to implement policies that support and improve their involvement in multidisciplinary healthcare teams. Additionally, continuous education and training focused on technology-assisted care competencies are necessary to ensure nurses are well-prepared to enhance patient safety in home care.