Multidisciplinary Health Care Team Research Articles

A qualitative study on coping strategies of young women living with breast cancer in Ghana

AimThis study sought to identify ways of coping with breast cancer diagnosis and its treatment challenges among young Ghanaian women living in the Accra metropolis. MethodologyThe study used an exploratory descriptive qualitative approach to recruit twelve participants aged 28–45 years through purposive and snowball sampling methods from three hospitals in the Accra metropolis. Participants were interviewed using a face to face approach and interviews were audio recorded with participants’ permission. Verbatim transcription was done and data were analyzed using content analysis procedures. FindingsParticipants believed God is the ultimate healer. They prayed and read the Bible. Some believed God could replace their breasts, they voided sinful acts and used religious artefacts such as the Rosary, special oil prepared by pastors, pictures of pastors. They obtained physical and emotional support from their families, partners and significant others. They compared themselves with others who had worse health challenges such as those with end-stage breast cancers who were on admission and those who have died. Participants also listened to music, read storybooks, took a walk in flower gardens to cope with breast cancer diagnosis and treatment. ConclusionsYoung women living with breast cancer rely more on God and support from their families, friends and the church in coping with their condition. These young women need to be attended to by multidisciplinary healthcare team the clinical psychologist and a spiritual leader to enable meet their physical, psychosocial and spiritual needs.

Antibiotic Resistance Policy and the Stewardship Role of the Nurse.

Government policy, at all levels, should reflect current scientific evidence to curb the spread of multidrug-resistant organisms (MDROs) and to promote healthier lives for citizens and the global community. The World Health Organization estimates that approximately 63,000 Americans die annually of infections from MDROs. Annual spending in the United States used to combat MDRO infections surpassed $35 billion in 2015. This article is a review of U.S. policy regarding MDROs and focuses on several means with which nurses can implement antibiotic stewardship within their practices to stall the creation and global spread of antibiotic-resistant organisms. Nurses are vital to successfully implementing methods of antibiotic stewardship as they are at the center of multidisciplinary health care teams and have the greatest direct patient contact of all members within the team. Methods of antibiotic stewardship include limiting the use of antibiotics within animal husbandry industries, promotion of health care policy in line with antibiotic stewardship standards, and adopting more stringent clinical prescribing practices of antibiotics used in human therapies. Application of these improvements to U.S. federal, state, and local facility policies is in line with current scientific evidence and will provide a framework for cohesive partnerships with nations and institutions abroad that also struggle with the spread of MDROs in their own communities.

Pharmacy student and pharmacist perceptions of professional socialism and communication in a real-life clinical setting.

To determine the impact of authentic clinical tasks on student confidence in interprofessional communication and assess the perceptions of pharmacists and pharmacy undergraduate students on how their degree prepares them to communicate and integrate with other healthcare professionals. Pharmacists completed a questionnaire regarding how their degree prepared them to communicate with other healthcare professionals. Third- and fourth-year pharmacy undergraduate students completed a modified questionnaire with questions relating to interprofessional learning and their experiences of reflective interprofessional communication tasks whilst on hospital placement. The questionnaires produced a combination of qualitative and quantitative data. Pharmacists (n = 36) and pharmacy students (n = 186) were in agreement that interprofessional training is important for undergraduate pharmacy students. Over 80% of student respondents viewed the interprofessional communication skills task as a useful method to develop communication skills with an increase in confidence following completion of the task. A variety of methods ranging from classroom- to practical-based sessions may be used to develop communication skills and professional socialism. Interprofessional learning has an important role for all working within the multidisciplinary healthcare team and contributes to the development of collaborative working relationships. It should be introduced and reinforced throughout undergraduate studies and continued in the workplace.

Supportive Care of Patients on Mechanical Ventilation.

The paradigm of supportive care of patients who are critically ill has changed significantly over the past 20 years. Patients on mechanical ventilation are no longer heavily sedated; the goal is a comfortable patient who can interact with health-care professionals and with their family members. Systematic, regular assessment of the patient for pain, anxiety, and sleep deprivation allows early recognition of these distressing symptoms. Appropriate treatment of patients' symptoms should be based on a multi-modal pharmacologic and non-pharmacologic approach. Early mobilization and avoidance of physical restraint are additional patient-centered goals. The presence of family members during daily rounds and at the bedside can reduce the distress of the patient and enhance communication with the health-care team. All of these changes have created new challenges and opportunities for the multidisciplinary health-care team. This review aimed to describe the main components of evidence-based supportive care of patients on mechanical ventilation, beyond the specific settings of the ventilator.

Antibiotic consumption and healthcare-associated infections in a tertiary hospital in Belgrade, Serbia from 2011 to 2016.

Healthcare-associated infections (HAIs) and irrational use of antibiotics in healthcare settings are major global public health concerns. Surveillance of HAIs in intensive care units (ICU), surgical-site infections (SSIs), and Clostridium difficile infections (CDIs), together with implementation of antibiotic stewardship, are cornerstones of hospital infection prevention programs. The aim of this study was to evaluate antibiotic consumption, especially of broad spectrum antibiotics, in relation to HAI incidence density (ID). The study was conducted from 2011 to 2016 in a tertiary hospital, the Military Medical Academy (MMA), in Belgrade, Serbia. Through regular hospital surveillance we identified all patients with a new HAI. Data on consumption of antibacterials for systemic use were expressed as defined daily dose per 100 bed days (DDD/100 BD). The highest incidence density (ID) of HAI was observed among patients in surgical ICUs (47.2 per 1000 patient-days), while the highest incidence rate among SSI was 3.7%. Moreover, the highest ID of CDI in medical patients was 6.2 per 10,000 patient-days, while in surgical patients it was 4.3 per 10,000 patient-days. The most frequently used antibiotics were cephalosporins, aminoglycosides and carbapenems (16.0 ± 2.3, 4.8 ± 0.7, 4.3 ± 0.7 DDD/100 BD, respectively). There was no significant correlation between consumption of any groups of antibiotics and ID of CDI in medical and surgical patients. The multidisciplinary healthcare team would have crucial importance in the implementation of the antibiotic stewardship program in order to decrease unnecessary exposures of patients treated in healthcare settings.

Multidisciplinary views towards the clinical pharmacist: a hospital palliative cancer care team perspective in Malta

To explore the views of the multidisciplinary healthcare team towards the role of the clinical pharmacist within the palliative care unit of an oncology hospital in Malta. At present, in Malta, clinical pharmacists are not routinely involved in care provision with palliative cancer care teams and there is a need to consider their role. Three 60 min audio-recorded heterogeneous focus groups were conducted with eligible healthcare providers at Sir Anthony Mamo Oncology Centre in Mater Dei Hospital. The topic guide was based on literature and was assessed for face and content validity by an expert panel. The transcripts were analysed using the framework method whereby emerging categories and themes were devised. A total of four doctors, ten ward nurses, two Hospice community nurses, three nursing aides, one psychologist and six allied healthcare professionals consented to participate. The framework analysis resulted in four main categories namely: (1) pharmacists as the expert reference point; (2) availability of clinical pharmacists in providing clinical services on ward level; (3) attitudes towards potential clinical services provided by clinical pharmacists; and (4) clinical pharmacists as a link with the community on pharmaceutical matters. The general view of healthcare providers on the clinical pharmacist's role in palliative cancer care was largely supportive and positive. This should encourage policy makers to introduce clinical pharmacy services within this setting.

A DISCHARGE CARE BUNDLE REDUCES READMISSIONS IN PATIENTS WITH ACUTE EXACERBATION OF COPD

SESSION TITLE: Late Breaking Abstracts SESSION TYPE: Original Investigations PRESENTED ON: 10/08/2018 04:30 PM - 05:30 PM PURPOSE: Chronic obstructive pulmonary disease (COPD) remains the third most common cause of readmission among Medicare beneficiaries, occurring in 60% of patients within one year of hospital discharge and in 30% within 3 months of discharge. Decreasing readmissions in this patient population improves patient health and decreases healthcare utilization of resources. The purpose of this study was to determine if a COPD care bundle delivered by a multidisciplinary health care team will reduce hospital readmission rates for acute exacerbations of COPD (AECOPD). METHODS: A prospective cohort design study with pre and post intervention arms was conducted. From April to September of 2016, patients admitted with AECOPD at Morristown Medical Center (MMC) were enrolled in the pre-intervention group. Subsequently an evidence-based COPD care bundle was developed with three primary objectives: (1) Patient education on COPD by healthcare providers prior to discharge; (2) Completion of an individualized self-management COPD action plan to be used by patients after hospital discharge; and (3) Timely outpatient follow-up with a pulmonologist. After this COPD care bundle was implemented in April of 2017, patients admitted with AECOPD at MMC from April to September of 2017 were enrolled in the post-intervention group. Patient characteristics, hospital length of stay (LOS), discharge location, and readmission rates for both groups were collected. Statistical analysis were carried out using Pearson chi-square test or Fisher exact test for categorical variables and 2-sample t-test or Mann Whitney test for continuous variables. The primary outcome was 30-day readmission rates. Secondary outcome was hospital LOS. RESULTS: 150 patients were enrolled in the pre-intervention group and 221 patients were enrolled in the post-intervention group. The two groups were similar in clinically relevant patient characteristics. 30-day readmission rate was lower in the post-intervention group, 22.2% vs. 32.7% (p=0.024). 60-day and 90-day readmission rates were also lower in the post-intervention group, 30.3% vs. 56.0% (p< 0.001) and 35.3% vs. 62.6% (p<0.001), respectively. Hospital length of stay was similar between the two groups, 8 days vs. 7 days (p=0.322). CONCLUSIONS: Implementation of a discharge care bundle in patients admitted with AECOPD significantly and consistently reduced 30 day hospital readmission rates in our patient population without increasing hospital length of stay. This reduction in readmissions was sustained through 60 and 90 days. CLINICAL IMPLICATIONS: A multidisciplinary discharge program can be easily implemented and can improve patient outcomes in those admitted with AECOPD. Such a program should be considered in all hospitals. DISCLOSURES: No relevant relationships by Federico Cerrone, source=Web Response No relevant relationships by Stephanie Chiu, source=Web Response No relevant relationships by Joan Corasaniti, source=Web Response No relevant relationships by Krystal Fitzpatrick, source=Web Response No relevant relationships by Moira Kendra, source=Web Response No relevant relationships by Lisa Landry, source=Web Response No relevant relationships by Beverly Natale, source=Web Response No relevant relationships by Natalie Reyes, source=Web Response No relevant relationships by Chirag Shah, source=Web Response

A2187 Effectiveness of the community pharmacists interventions in improving blood pressure levels in patients with hypertension with a view to improving patient self- management

Objectives: of this study is to evaluate if a pharmaceutical care Methods: This project evaluates the pharmacist's interventions during a prospective randomized controlled trial, from November 2015 to May 2016. Patients with an established diagnosis of hypertension, regular customers of the pharmacy were allocated in a random way either to a control group (no pharmaceutical care) or to an intervention group (followed-up by a community pharmacist during a 6- month period). The pharmacist interventions, tried to increase medication adherence and lower blood pressure in these patients, involved education sessions and counseling directed to the patient. Results: A total of 120 patients with an established diagnosis of hypertension were randomly assigned to the study (60 in the control group and 60 in the intervention group). Although there were no significant differences in both groups concerning mean age, gender, body mass index, and antihypertensive pharmacotherapy, at the end of the study, blood pressure control was higher in the intervention group (P = 0.005) Also in the intervention group at the end of the study significantly improved blood glucose values, BMI values and waist circumference. Medication adherence was also higher in the intervention group at the end of the study. There was also a decrease in the lipid levels in the intervention group Conclusion: Pharmacist intervention can significantly improve medication adherence and blood pressure control in patients with hypertension• Community pharmacists are valuable members of multidisciplinary health care teams in the management of patients with hypertension• Pharmacist interventions can improve medication adherence and reduce blood pressure• Community pharmacists can participate in health education and promotion campaigns to improve hypertension control.

The next step: a strategic focus on physical activity and sedentary behaviour in Irish mental health care.

People with severe mental illnesses have dramatically reduced life expectancy compared with the general population, which is largely attributed to physical comorbidity. Physical activity and sedentary behaviour interventions offer a safe and viable therapeutic resource for multi-disciplinary mental health care teams. The accumulating evidence supporting the role of these interventions has changed the focus of mental health strategy in some countries, with new developing roles for certain mental health professionals in this field. However, in Ireland the absence of specialised exercise practitioners places a leadership role for mental health nurses in this regard. National mental health strategy in Ireland should prioritise physical activity and sedentary behaviour interventions, make recommendations for the integration of specialised exercise practitioners in all mental health multidisciplinary teams, and recommend the provision of training and awareness for mental health nurses and other multidisciplinary professionals who are already well placed to address this issue.

Perioperative Care During Deep Brain Stimulation Surgery.

Deep brain stimulation (DBS) is a life-changing surgical treatment. More than 150,000 patients worldwide have been treated with DBS, primarily for Parkinson disease and medically refractory tremor and dystonia. However, the use of DBS has recently expanded beyond traditional movement disorders to include the treatment of obsessive compulsive disorder, epilepsy, and other neurological and psychological diseases. Considering this expanded use of DBS, it is essential to understand the role that each member of the multidisciplinary health care team plays and how to avoid possible complications during this procedure. Proper patient selection, precise anatomical placement of the electrode, and proper programming of the implanted device are key aspects of DBS treatment. It also is valuable to understand how the deep brain stimulator is implanted and functions. Accurate lead placement that results in positive outcomes for patients relies on collaboration from an experienced perioperative team led by the neurosurgeon.

Psychological and Emotional Aspects in Living Donor Kidney Transplantation

BackgroundThe decision to resort to living donor transplantation determines a particular condition characterized by a strong mental and emotional anguish, both for the patients and their families.The purpose of the study was to correlate the relational dynamics between donor-recipient, donor/recipient couple with the health team, and the family support perceived by the couple with the quality of life 6 months before transplant and 12 months after transplant and compare the data between the 2 time points after participating in the psychotherapy program of counseling about behavioral change. Patients and MethodsTwenty-seven donor and recipient pairs consented to participate. The quality of life was studied through the Complete Form Health Survey (SF-36). All subjects completed a questionnaire that investigated the 3 types of fundamental relationships (donor-recipient, donor/recipient with the health team, and family support perceived by the couple). All participants were involved in an 18-month psychotherapy program in the pre- and post-transplant phase. ResultsThe quality of the donor-recipient relationship significantly positively influences the subjective perception of psychophysical well-being before and after transplant. Post-transplant family support is crucial in ensuring a good perception of psychological and emotional health in donors and recipients. The relationship with the health team is important in ensuring a good perception of psychophysical health only in recipients after transplant. ConclusionsThis study suggests that patients should be assisted by a multidisciplinary health care team and receive continuous support from relatives during the post-transplant adaptation process. This facilitates the donor and recipient postoperative quality of life.

Co-management of tuberculosis and diabetes: an integrative reviewManejo integrado de la tuberculosis y la diabetes: revisión integrativa

RESUMOObjetivo.Identificar as evidências sobre manejo integrado de tuberculose e diabetes disponíveis na literatura para o contexto latino-americano.Métodos.Foi realizada uma revisão integrativa da literatura com busca nas bases de dados LILACS, Web of Science e PubMed. A estratégia utilizou como termos de busca “tuberculose”, “diabetes mellitus” e “manejo integrado”. Foram incluídos artigos científicos sobre estudos realizados na América Latina, publicados de 2011 a 2017, com acesso livre ao texto integral e publicação em inglês, espanhol ou português. Foram coletados dados relativo aos autores, delineamento, amostra, principais resultados, país e ano da publicação. Finalmente, os estudos foram classificados em níveis de evidência.Resultados.Foram incluídos 20 estudos, dos quais 60% apresentaram baixa evidência científica (nível IV). Conforme esses estudos, os pacientes com diabetes possuem maior risco de desenvolver tuberculose, especialmente aqueles com controle glicêmico ineficaz. Além disso, pacientes com tuberculose-diabetes apresentam atraso na conversão do escarro e maior probabilidade de falha terapêutica e morte. Há maior prevalência da associação tuberculose-diabetes no sexo masculino. Em relação aos registros de tuberculose e diabetes em prontuários ou fichas eletrônicas de informação nos serviços de saúde, há falhas ou ausência de anotações. Foi identificado alto custo financeiro do manejo clínico em indivíduos com a comorbidade. A equipe multidisciplinar possui papel imprescindível na prevenção e promoção em saúde, nos três níveis de atenção.Conclusão.O rastreamento bidirecional de tuberculose-diabetes poderá implicar em melhor controle desses agravos, principalmente em países em desenvolvimento e em áreas endêmicas para tuberculose.

Leveraging Web & EHR Technology to Bring Evidence-based Care to the Bedside and Reduce Variation

Background: Reduction in unnecessary care variation can be achieved by front line providers by designing and implementing clinical pathways. The internet and clinical decision support (CDS) tools can be used to effectively operationalize and integrate recommendations and best practices provided through clinical pathways directly into front line clinical workflow. Aims: Our Clinical Pathways Program, comprising a portfolio of 100+ pediatric clinical pathways, aims to create shared mental models of care that can be used by the multidisciplinary healthcare team to deliver high quality medical care …

Synergizing Non‐technical Skill Development in Medical Education: From Anatomy Classroom to the In‐Hospital Patient Setting and Back

Medical professionalism is a multifaceted concept that includes maintenance of knowledge, interpersonal skills, teamwork, privacy and honesty. While non‐technical skills are often under‐emphasized in the medical student learning environment these skills are directly associated with providing professional medical care. There is an increasing trend however, for basic science courses such as Anatomy to introduce medical students early onto the concept of professionalism and highlight the importance of non‐technical skill development to patient care. To reinforce these competencies as well as develop an authentic curriculum for non‐technical skill development, anatomists and internists at Mayo Clinic, College of Medicine aligned objectives within medical school and residency programs. Strategies were designed to evaluate (1) teamwork, (2) communication and (3) self‐reflection. The aim of this presentation is to demonstrate how each of these core competencies can be promoted in both residency and medical student curricula and how trainee and student progress may be measured by educational approaches within their learning environments. Strategies include the use of a team charter, self‐reflection/reflective diaries and communication exercises that target patients and the multidisciplinary health care team. Through educational design (1) trainee and student's ability to acknowledge self‐limitation and develop critical thinking skills appeared to evolve and (2) trainee and student appreciation of the importance of communication skills when interacting with different groups as well as ability to translate medical/anatomical terminology to lay language were evident. In addition, the use of reflection and team charters promoted understanding team dynamics and facilitation of effective teamwork. The current multi‐disciplinary health care environment places strong emphasis on team‐work, confidentiality of protected health information and the role of communication in preventing medical errors and improving patient outcome. Anatomy courses designed on team‐based approaches with use of body donors provide a useful simulated learning environment. Medical students may be assessed through a variety of activities targeting team‐work, communication skills and clinical reasoning at different levels. Use of reflective exercises assessing team interaction, evolution of critical thinking skills and course challenges have found an important place in the evolving anatomy curriculum. Early exposure to these critical skills helps prepare for clinical rotations where milestones for these skills will need to be reached. This presentation will demonstrate the translational approach in synergizing non‐technical skill development between anatomy and residency curricula.This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Compounding medications in a rural setting: an interprofessional perspective.

BackgroundInterprofessional learning (IPL) which focuses on the pharmacist’s role in specialty practices as part of a multidisciplinary health care team has not been explored. This study aimed to determine health care students’ understanding of the role of the pharmacist in compounding medications to optimize health outcomes for patients in rural and remote health care services.MethodsFour workshops followed by focus group interviews were conducted with undergraduate pharmacy, medical, nursing, physiotherapy, dentistry, Aboriginal public health, and speech pathology students (n=15). After an introductory lecture, students working in multidisciplinary teams undertook to compound three products. Focus groups were held at the end of the compounding workshops to explore students’ understanding and perceptions of these compounding activities. Thematic analysis was undertaken on the qualitative data obtained from the focus groups.ResultsStudent participants responded positively both to the opportunity to undertake a compounding exercise and being part of an interprofessional team, perceiving benefit for their future rural and remote health practice. Four major themes emerged from the qualitative analysis: improved knowledge and understanding; application to practice; interprofessional collaboration; and rural, remote, and Indigenous context. Students acknowledged that the workshops improved their understanding of the role of the pharmacist in compounding and how they, as part of a multidisciplinary team, could deliver better health outcomes for patients with special needs, especially in a rural and remote context.ConclusionThis study highlights that workshops of this nature have a role to play in developing collaborative interprofessional practice and increasing awareness of pharmaceutical services among undergraduate health students. However, further evidence is needed to assess whether positive perceptions of specialty practice IPL workshops will translate into improved patient outcomes in practice.

Current perspectives on the role of the pharmacist in heart failure management

Pharmacists play an important role within a multidisciplinary health care team in the care of patients with heart failure (HF). It has been evaluated and documented that pharmacists providing medication reconciliation especially during transition of care, educating patients on their medications, and providing collaborative medication management lead to positive changes in the patient outcomes, including but not limited to decreasing in hospitalizations and read-missions. It is foreseeable that pharmacist roles will continue to expand as new treatment and innovative care are developed for HF patients. I reviewed published role of pharmacists in the care of HF patients. MEDLINE and Current Content database (both from 1966 – December 31, 2017) were utilized to identify peer-reviewed clinical trials, descriptive studies, and review articles published in English using the following search terms: pharmacists, clinical pharmacy, HF, and cardiomyopathy. Citations from available articles were also reviewed for additional references. Preliminary search revealed 31 studies and 55 reviews. They were further reviewed by title and abstract as well as full text to remove irrelevant articles. At the end, 24 of these clinical trials and systematic reviews are described in the following text and Table 1 summarizes 16 pertinent clinical trials. Some roles that are currently being explored include medication management in patients with mechanical circulatory support for end-stage HF, where pharmacokinetics and pharmacodynamics of medications can change, medication management in ambulatory intravenous diuretic clinics, and comprehensive medication management in patients’ home settings. Pharmacists should continue to explore and prospectively evaluate their role in the care of this patient population, including documenting their interventions, and impact to economic and patient outcomes.

ANGINA AS A SEQUELA OF A CONGENITAL HEART DEFECT

In 2000, an estimated 800,000 adults with congenital heart disease lived in the United States. Medical care for this growing population of individuals often requires a coordinated multidisciplinary healthcare team. We present a case of atypical angina in a young female from suspected subclavian

Severe bicuspid aortic stenosis in pregnancy: balancing the risk of prematurity and maternal mortality.

We report a case of combined severe aortic stenosis and regurgitation in a pregnant patient with a history of congenital bicuspid aortic valve. The patient presented at 22 weeks of gestation with angina and pre-syncopal symptoms. During her admission, she experienced intermittent episodes of non-sustained ventricular tachycardia and hypotension. A multi-disciplinary healthcare team was assembled to decide on the appropriate medical and surgical treatment options. At 28 weeks of gestation, the patient underwent a caesarean delivery immediately followed by a mechanical aortic valve replacement.

Clinical care pathway strenghens interprofessional collaboration and quality of health service: a literature review

To review the effectiveness of a clinical care pathway on interprofessional collaboration and quality of health service. A review was performed of literature published from 2000 to 2015, with the following keywords: clinical pathway, care pathway, and interprofessional collaboration. Evidence depicted the positive results of nursing care for clients, health care professionals and facilities. The research results were implemented at different facilities using several research designs, from descriptive to experimental. A clinical pathway was used as a tool in various clinical situations including in emergency, elective surgery, and pre-post-surgery, as well as in common clinical cases. It was administered by the health care professionals in providing care, encompassing the comprehensive process from diagnosis to clinical audit. Health care professionals should engage in active collaboration during the implementation of a clinical care pathway. In implementing the standard of input, process, and outcome of care to clients, health care professionals should emphasize the process and outcome of care and eliminate unnecessary or inefficient treatments. A clinical care pathway could reduce the average length of stay for patients, increase cost effectiveness, and, consequently, improve the quality of service. To optimize the care process, the pathway should be implemented of multidisciplinary health care team.

What does hope mean when working with suicidal prisoners?

Instances of fatal suicide in prison continue to rise. A loss of hope has been linked to suicide risk, yet the concept of hope in prison is not well understood. The aim of this study was to gain an insight into a multidisciplinary health care team's understanding of the concept of hope when working with suicidal prisoners. Semi-structured interviews were carried out with 13 members of a multidisciplinary health care team at a category B male prison, and 7 participants additionally attended a focus group. The data was then thematically analysed. Three themes emerged from the analysis: a diverse understanding of the concept of hope, hope as a protective factor from suicide, and prison is a unique environment. These insights acknowledge hope as a key factor in prisoners' recovery and the reduction of suicide risk; however, the multidisciplinary team did not share an understanding of the concept of hope. Theoretical development in this area, for example through concept analysis, will bring consistency to future research and enable the development of evidence-based interventions which may reduce the high rate of prison suicide and subsequently have a positive effect on staff stress and burnout.