Practice Nurses Research Articles

Closing gaps in emergency care

Abstract: Current socio, political, and economic events may disproportionately affect those who are identified as vulnerable, as well as their presentation to Canadian emergency departments. The housing crisis, food instability, and concurrent issues with mental health and addictions are a harsh reality for many of these individuals. The emergency department may not be suited to complex health and social issues, but it provides an essential safety net for the vulnerable who cannot access care through traditional primary care routes. Alternative, patient-centered solutions to the problem are necessary, and advanced practice nurses can be the key to appropriately organizing and delivering integrated care innovative models. Raising awareness and influencing public policy to drive meaningful social change and address alarming health inequities is an important consideration for nurses working in emergency departments.

Postpartum Hemorrhage Management in Canadian Emergency Nursing Practice

Background: Postpartum hemorrhage (PPH) remains a leading cause of maternal mortality globally, claiming approximately 70,000 lives annually. Despite preventive efforts, high-income countries, including Canada, have reported increasing rates of PPH. The rising incidence and associated complications indicate improved emergency nursing practices in managing PPH are needed. Methods: PPH guidelines from the Society of Obstetricians and Gynecologists of Canada, Federation of International Gynecologists and Obstetricians, and the Canadian Association of Perinatal, and Women’s Health Nurses were compared to National Emergency Nurses Association guidelines. The competencies, medications, and obstetric maneuvers for PPH that may be relevant to emergency nurses were extracted and categorized for the emergency nursing HIRAID (History & Red flags, Assessment, Interventions, & Diagnosis) framework. Findings/Results: We found 13 discrete skills across the PPH guideline recommendations that are applicable to emergency nurses. There is near perfect overlap in medical recommendations, but gaps exist between FIGO and SOGC guidelines and NENA and CAPWHN guidelines. There are SOGC and FIGO guidelines that apply to emergency nurses that are not addressed in NENA guidelines, Discussion: There was significant overlap on treatment recommendations from maternal health bodies such as uterotonic drugs, hemorrhage control, and hemostatic resuscitation. There were significant gaps in NENA recommendations. Conclusion: The comparison of PPH guidelines highlights where NENA guidelines need further detail. These skills are particularly significant for providing nursing care in rural and remote areas. Standardized protocols for PPH management, interprofessional collaboration, and regular competency assessments are included in most guidelines but are conspicuously absent for emergency nurses. To address the gap, NENA could integrate national emergency nursing PPH competencies standards or develop recommendations for the care of maternal emergencies.

State Full Practice Authority Regulations and Nurse Practitioner Practice Autonomy: Evidence From the 2018 National Sample Survey of Registered Nurses.

State full practice authority (FPA) laws are designed to permit NPs to practice autonomously from physicians. Little is known regarding how FPA laws affect NPs' practice autonomy in daily practice. This study used nationwide survey data from 20,830 NPs to estimate how NPs' practice autonomy differs between NPs in FPA and non-FPA states. NPs in states with FPA laws were more than twice as likely as NPs in non-FPA states to practice in clinic settings with no onsite physicians and were twice as likely to not have a physician collaborator. Associations between FPA laws and four other indicators of practice autonomy were positive but smaller in magnitude. States with FPA laws more than 10 years experienced larger changes in nurse practitioner (NP) autonomy compared with states with FPA laws in effect less than 10 years. FPA laws may promote the development of autonomous NP practice sites, thereby expanding access in underserved populations.

Hemodynamic monitoring- (NOT) anursing task?!

Ensuring adequate and stable hemodynamic conditions is an essential component of patient care in emergency and intensive care units. The assessment of circulatory status is complex and influenced by patient-specific characteristics, medical staff experience, and available equipment. Hemodynamic monitoring encompasses both invasive and noninvasive methods to monitor circulatory parameters. It supports patient management and ensures therapeutic success by alerting healthcare providers to deviations, including critical values. In practice, numerical data often receive more emphasis than comprehensive patient observation, potentially leading to misinterpretation. Advanced practice nurses (APNs) are highly qualified nursing professionals who work largely autonomously due to their advanced training. However, there is currently no uniform legal regulation for these professions in Germany. Clear definitions and nationwide regulations for related academic programs are necessary. Interprofessional collaboration, as well as the qualifications and numbers of nursing staff, significantly impact therapeutic outcomes. Hemodynamics involves the physical principles of blood flow and the assessment of vital parameters to ensure organ perfusion and oxygenation. The competence and knowledge of nursing staff are crucial for safe patient care. Local standard operating procedures (SOPs) should consider interprofessional collaboration and the qualifications of team members.

ASSESSMENT OF NURSES' KNOWLEDGE REGARDING PERSONAL PROTECTIVE EQUIPMENT AT TERTIARY CARE HOSPITAL LAHORE

Personal Protective Equipment (PPE) is crucial for protecting healthcare workers from occupational hazards and infections, particularly in high-risk environments such as hospitals. Adequate knowledge and proper use of PPE are essential to ensure the safety of both healthcare workers and patients. This study aimed to assess the knowledge, attitudes, and practices of nurses regarding PPE at a tertiary care hospital in Lahore, Pakistan. Methods: A descriptive cross-sectional study design was utilized. A structured questionnaire was used to collect data from 152 nurses working in various departments of the hospital. Purposive sampling was employed, and the sample size was determined using RaoSoft with a 95% confidence interval and a 0.5% margin of error. The questionnaire comprised sections on demographic information, knowledge assessment, and attitudes and practices evaluation. Data were analyzed using SPSS version 25.0, with descriptive statistics and chi-square tests to identify associations between demographic characteristics and knowledge levels. Results: Of the 152 participants, 77% were female, with a mean age of 36.5 years (SD ± 9.05 years). Most participants held a diploma in nursing (46%), and the majority (93.4%) had less than 12 years of professional experience. The findings revealed that 67% of nurses demonstrated good knowledge of PPE, 20% had average knowledge, and 13% exhibited poor knowledge. While 92% of participants reported being knowledgeable about PPE usage, inconsistencies were noted in the adherence to specific practices, such as glove and mask usage. Additionally, only 34% of participants believed that consistent use of PPE would reduce their risk of infection, indicating a potential gap between perceived and actual knowledge. Conclusion: The study highlights both strengths and gaps in nurses' knowledge and practices regarding PPE at a tertiary care hospital in Lahore. While most nurses demonstrated a satisfactory understanding of PPE, inconsistencies in practical application underscore the need for targeted training and reinforcement of guidelines. Regular training sessions, active monitoring, and continuous professional development are essential to enhance adherence to PPE protocols and safeguard healthcare workers in resource-limited settings like Pakistan.

ISCO-08 Classification and scope of practice of nurses: Survey among WHO-Europe member states

Abstract Background The expansion of nurse’s roles in the delivery of care needs transparent defining of roles, extra education/training opportunities, and complementary legislative regulations. Methods This cross-sectional study was planned to explore status of nursing and midwifery workforce in WHO Europe member states. Data were collected from December 2020 until September 2023. Results ISCO-08 2221 is used to classify for only bachelor prepared-nurses in 2 of countries (Bulgaria and Spain). Besides, it is used only for vocational prepared-nurses in 2 of countries (Kyrgyzstan and Tajikistan). Those countries only have vocational or bachelor education. ISCO-08 2221 is used in 1 of countries which have two entry levels with vocational and bachelor prepared-nurses (Georgia). ISCO-08 3221 is referred to vocational training in 5 (20%) countries (Armenia, Finland, the UK, Croatia, Hungary). ISCO-08 2221 is main classification for all levels prepared nurses in 18 countries including Switzerland, Cyprus, Czechia, Germany, Denmark, Ireland, Israel, Iceland, Kazakhstan, Lithuania Latvia, Malta, Poland, Portugal, Romania, Sweden, Slovakia, Türkiye. Scope of practice of vocational and bachelor prepared nurses is defined by law/legislation in 25 of member states. Scope of practice vocational versus bachelor depends on conduct scientific tasks (Switzerland), being broader (Kazakhstan), competency level (Hungary, Croatia, Portugal) exceptionally there is no difference in Malta. Scope of Registered Nurse, Specialist Nurse and Advanced Nurse Practitioner differ in 22 of countries of those which on activities/practice/roles, expanded authority, working with determined care group. As a result, while scope of practice of professional nurses varies in line with their education level, ISCO-08 2221 is used for nurses’ classification from all education levels in member states. Key messages • There is no classification for postgraduate trained nurses (as is the case for physicians), even though scope of practice is different across education levels. • When revising the ISCO-08 classification, it should be recommended that a common terminology is needed to define postgraduate nurses in region.

Simulation learning: exploring its transformative influence on nursing practice.

Simulation in nursing education enables nursing students to develop and practise their clinical, critical thinking and decision-making skills within the safety of a realistic learning environment. Evidence suggests that this method of learning can enhance nursing students' confidence, enabling them to navigate the current challenges in healthcare and consider new ways of working. This article outlines the benefits and challenges of simulation and discusses the implications of the use of this learning technique in nurse education for future nursing practice.

Primary care nurses’ readiness to promote digital health technology use among patients

Abstract Background Digital health technologies (DHTs) aim to optimise resource allocation and improve public health outcomes as care supplements. However, many patients do not access them independently. Nurses, as central contacts for primary care patients, can integrate digital health assessments, patient portals, remote monitoring, and teleconsultations into practice. Insight into their readiness to promote patients’ use of DHTs is important for efficient dissemination strategies. We examined nurses’ referral of patients to use DHTs and whether digital dedication (enthusiasm, inspiration, and pride for DHTs) and service guidance skills were associated with referral behaviour. Methods In spring 2023, the national ‘2023 survey on information systems for registered nurses’ gathered data from 549 nurses in Finnish primary care, comprising registered nurses (62%) and public health nurses (38%). The outcome, frequency of nurses’ DHT referrals, was assessed on a scale ranging from never to daily. We used multivariable ordinal logistic regression to examine associations, adjusted for career length, unit, and location. Results Among the nurses, 31% never or seldom referred patients to DHTs, while 19% did so monthly, 32% weekly, and 18% daily. Multivariable model showed that with each one-point increase in digital dedication (scale 1-5), the odds of referring patients to DHTs more frequently increased by 43% (OR = 1.43, 95% CI 1.21-1.70). Nurses who rated their service guidance skills as good (OR = 1.76, 1.01-3.05) or excellent (OR = 2.89, 1.28-6.62) had greater odds of referring patients to DHTs more frequently compared to those with less advanced skills. Conclusions Referring patients to DHTs is not a common practice for primary care nurses and can undermine care equity. Nurses’ motivation and knowledge about DHTs should be fostered, which may enhance patient referrals. Developing guidelines to assess patients’ digital capability and needs for effective service coordination is paramount. Key messages • Digitally committed and service-aware primary care nurses may refer patients to use DHTs more often than their peers, but we could not consider if suitable DHTs were available for patients encountered. • Nurses should be motivated to use digital tools and provided with instructions for proficiently coordinating services in order to address patients’ underutilisation of DHTs and promote equitable care.

Factors influencing an advanced nursing practice service for people with intellectual disabilities

Abstract Background People with intellectual disabilities (PWID) have less access to preventive healthcare services and are therefore more likely to suffer from certain chronic diseases. Advanced Practice Nursing (APN) can be a suitable approach for this group. However, APN is not yet widespread in all European countries. This intervention focuses on PWID in Hamburg, Germany, who receive case management and prevention focusing on stress, nutrition, mobility and addiction through community-based APN to improve their health status. We aimed to explore the facilitators, barriers and experiences of stakeholders in the context of the APN intervention. Methods We conducted 90 semi-structured problem-centered interviews with PWID, family members, professional caregivers and prevention service providers in 2023 and 2024. We employed convenience sampling. Data were analyzed by qualitative content analysis with mixed inductive-deductive coding using MAXQDA. Results Overall interviewees were satisfied with the intervention. It was reported that the clients exercised more, ate healthier, learned techniques to reduce stress and coped better with addiction. In addition, barriers to preventive services were reduced. We identified factors that positively influenced the success of the intervention: good interprofessional collaboration, successful relationship building with clients, concise goal setting and target group-specific work materials. Barriers were: neglect of the professional care network, difussion of agreements, lack of available prevention services, and communication problems. The results are preliminary. Conclusions This is one of the first evaluation studies of an APN intervention for PWID in Germany. The results show that this new form of care can be implemented if the relevant stakeholders work together and good relationships with the clients are established. Specific goals should be defined and the professional carergivers should develop a community network. Key messages • APN is a suitable approach for disease prevention and health promotion for people with intellectual disabilities, given interprofessional collaboration and a well-established relationship with clients. • Preventive healthcare for the target group is difficult to implement if the stakeholders do not work together and if there are insufficient suitable preventive services available in the community.

Advanced nursing practise as a preventive approach for adults with intellectual disabilities

Abstract Background Various barriers impede access to preventive health services for people with intellectual disabilities in Germany. As a result, they are more likely to suffer from certain chronic diseases. Internationally, Advanced Nursing Practice (ANP) has proven to be a suitable approach to care for this group. In Germany, ANP is not yet widespread. The aim of this study is to improve healthcare for people with intellectual disabilities through ANP-led case management. Methods A randomized controlled trial was conducted in an urban community setting. Inclusion criteria were: ICD-10 diagnosis F70-F79, age ≥18 and care level ≤3. The intervention group (IG) received four outreach home visits focused on prevention and health promotion. The control group (CG) received usual care. Allocation was done using computer-assisted, permuted block randomization. Researchers were blinded during data collection and analysis. The primary outcome was health status after 12 months (t2) (WHODAS). Secondary outcomes were health status after 6 months (t1), health-related quality of life (HQOL) after 6 and 12 months (EQ5D-VAS), and resilience after 6 and 12 months (RS-11). Analysis was performed via ANCOVA with Bonferroni correction at a significance level of 0.025. Results 214 participants were randomized. At t2, 176 participants remained (IG: n = 85, CG: n = 91). Health status at t2 showed a mean difference (MD) of -4.58 points in favor of the IG (p = 0.01). For resilience, a MD of + 1.95 (t2) points in favor of the IG was obtained (p = 0.05). We measured a MD for HQOL of -1.19 (p = 0.72) in favor of the CG. Conclusions A clinically relevant effect of ANP-led case management was achieved on the health status, but not on resilience and HQOL. ANP for people with intellectual disabilities can contribute to health promotion and thereby improve the community health. Therefore, ANP can be used as an innovative approach in the course of reorganization of healthcare for vulnerable populations in Germany. Key messages • ANP-led case management can have a clinically relevant effect on the heal status of people with intellectual disabilities over the course of one year. • ANP-led case management can be seen as a new approach to health promotion and disease prevention in Germany.

The Effect of Perceptions of Evidence-Based Practice on Endotracheal Cuff Pressure Management in Critical Care Nurses: A Correlational Cross-Sectional Multicentre Study.

This correlational cross-sectional multicentre study aims to achieve two objectives. Firstly, to assess nurses' knowledge and practice of endotracheal cuff pressure management. Secondly, to examine the relationship between endotracheal cuff pressure management knowledge and evidence-based practice leadership and work environment. A correlational cross-sectional multicentre study design. This study was conducted among 144 intensive care nurses in Turkey. Data collection included descriptive characteristics and cuff pressure management of nurses, the Evidence-Based Practice Leadership Scale and Evidence-Based Practice Work Environment Scale. Descriptive statistics, chi-square test, Pearson correlation and receiver operating characteristics analysis were conducted. A STROBE checklist was the reporting guide for this study. The success status of nurses in terms of knowledge related to cuff pressure was found significantly different according to the type of intensive care unit working in and the status of receiving training on evidence-based practice. A positive, strong relationship was found between nurses' mean scores on the Evidence-Based Practice Leadership Scale and the Work Environment Scale. There was a very weak positive correlation between the mean scores of the Evidence-Based Practice Leadership Scale and the cuff pressure management. Adherence by nurses to current evidence-based practice for cuff pressure monitoring is essential for safe patient care and improved quality of care. It is recommended to provide both a supportive working environment and training programmes for intensive care nurses to perform cuff pressure management in line with evidence-based practice. Providing educational programs, an appropriate clinical environment, support from health managers and access to appropriate tools are important considerations in increasing the knowledge and skills of intensive care nurses to effectively monitor and manage cuff pressure. Our study complies with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Checklist: cross-sectional studies. No patient or public contribution.

Knowledge, Attitude and Practice of Nurses and Midwives towards Hepatitis B Infection and Control Measures in Alban Gaded Hospital, Khartoum, Sudan

Purpose: Infection with the hepatitis B virus (HBV) causes severe morbidity and death, burdening world health. Nurses and midwives, among other healthcare professionals, are more likely to contract the illness. Few studies have looked at the knowledge, attitude, and practices (KAP) of healthcare professionals in Sudan with regard to HBV infection, despite the fact that diverse components of KAP have an impact on health-related behaviors. This study's objective was to assess the knowledge, attitude, and practice (KAP) level of nurses and midwives concerning HBV viral infection in, Khartoum, Sudan.  Methods: In the Sudanese state of Khartoum, a public hospital (Alban Gaded Hospital) underwent a cross-sectional descriptive hospital-based study. To assess KAP's understanding of nurses and midwives about HBV infection. Self-administered questionnaires were used and approved by the supervisor for distribution to the population chosen for the study. The data was handed over to the Medical Director whom personally ensured the questionnaires were signed and filled by the Healthcare workers (HCWs) of the chosen criteria at the field. A member of group (23:B) took care of the supervision aside with the medical director, and made sure the data was collected as needed. The data at hand were subjected to statistical analysis using SPSS version 24.0 (Statistical Package for Social Sciences).  Results: 95 samples out of 99 were collected. According to participants’ knowledge: 67.95% have good knowledge about HBV, while 32.05% lack basic knowledge about it. The participants’ attitude towards HBV is above average showing 60.3% safe attitude. Lastly, the study shows excellent practice of the participants’ behavior towards HBV safety measures with a score of 92.3% safe practice. From the hospital, a total of 95 out of 99 nurses and midwives took part in the study. Two thirds of the respondents practiced safety, and the majority of respondents had a positive attitude about HBV preventative measures. More than half of the respondents (58.2%) had an average level of understanding. A minor but serious score of (12.6%) was noticed of the individuals, dealing with patients without wearing gloves. More over half of the nurses and midwives were not vaccinated against HBV; more than 50% of participants had incorrect ideas regarding the symptoms and route of HBV infection and all 95 participants voted (NO) for ever being infected by HBV.  Conclusion: In Alban Gaded hospital, the majority of the nurses and midwives were aware of HBV infection. But a sizeable majority of the participants lacked the necessary understanding of early immunization after birth. The study found a probability of high risk infection due to exposure under the poor level of HBV vaccine coverage rate. Moreover a clear point of limitation was noticed in Table 4 third question, where it asks whether you are or ever was infected by HBV. All the participants denied, showing a sense of partiality. Further occupational exposure prevention measures, training programs on HBV infection, including post-exposure prophylaxis, and increasing the vaccination rate of all HCWS are also strongly encouraged.

"Who You Are and Where You Live Matters": Hospice Care in New York City During COVID-19 Perspectives on Hospice and Social Determinants: A Rapid Qualitative Analysis.

Context: Social determinants of health (SDOH) impacted the quality of home hospice care provided during the COVID-19 pandemic. Perspectives from professionals who provided care identify challenges and lessons learned from their experience. Objective: To examine hospice professionals' perspectives of how SDOH affected the delivery of high-quality home hospice care in New York City (NYC) during the COVID-19 pandemic. Methods: We conducted semistructured interviews with 30 hospice professionals who delivered care to home hospice patients during the COVID-19 pandemic in NYC using a qualitative descriptive design. Purposive sampling was used to recruit professionals from a range of disciplines including physicians, advanced practice providers, nurses, social workers, chaplains, and hospice administration and management. Participants worked for one of two large NYC metro hospices and one outpatient palliative care practice serving the five boroughs of NYC and the surrounding suburbs. Rapid qualitative analysis was used to identify themes. Results: Thirty hospice professionals were interviewed, spanning a variety of clinical and administrative roles. Most (21 out of 30) reported that social determinants affected access and/or delivery of equitable hospice care. Two key themes emerged from interviews: (1) SDOH exist and affect the delivery of high-quality care and (2) disparities were exacerbated during the COVID-19 pandemic resulting in barriers to care. Subthemes outline barriers described by hospice professionals: decreased hospice enrollment, telehealth challenges, resulting in deficient patient/family education, shortages of nursing assistants in some neighborhoods, and diminished overall quality of hospice care for some patients. SDOH created barriers to hospice care through neighborhood factors, resource barriers, and system challenges. Conclusion: SDOH provide a context to understand disparity in the provision of hospice care. COVID-19 exacerbated these conditions. Addressing multidimensional barriers created by SDOH is key in creating high-quality and equitable hospice care, particularly during a crisis.

Using Mortality and Morbidity Conferences in Advanced Practice Nurse Education to Enhance Student Self-Efficacy.

The integration of morbidity and mortality (M and M) conferences into advanced practice nurse (APN) nursing curricula is a novel approach aimed at enhancing education, reflective learning, and continuous improvement. M and M conferences have traditionally been a standard practice for medical specialties, yet a gap exists in their utilization within APN education. A quasiexperimental pilot study with 20 student registered nurse anesthetists was conducted at a large urban academic center. The General Self-Efficacy Scale was utilized to evaluate student self-efficacy and confidence in managing adverse events. Significant improvement in self-efficacy scores (p = .003) postintervention indicated the educational benefits of M and M conferences. All participants reported increased confidence in navigating unexpected events. The M and M conference is a valuable tool within APN education for cultivating self-efficacy and confidence in navigating adverse events. [J Nurs Educ. 2024;63(X):XXX-XXX.].

The effect of listening to music and drawing on coping with dysmenorrhea complaints in nursing students: randomized controlled trial

AimTo examine the effect of listening to music and drawing on coping with dysmenorrhea complaints of nursing students.MethodsThe study was a double-blind, three parallel-group randomized controlled trial conducted between August 2023 and May 2024 at Bartın University, Faculty of Health Sciences, Department of Nursing. Ninety-six dysmenorrheic nursing students with regular menstrual cycles were included in the study and randomly assigned to three groups as drawing, music and control groups. Visual Analog Scale (100mmVAS of pain), Perceived Stress Scale (PSS) and Menstrual Symptoms Scale (MSS) were applied to the students at baseline, 1st and 2nd months. The interventions were as follows: the music group listened to a 29-minute and 32-second song three days before menstruation and on the first day of menstruation in the third month composed by Juan Sebastian Martin-Saavedra, while the drawing group created art for the same duration. The pain scores, perceived stress, and menstrual symptoms were measured in all groups after the interventions.ResultsPretest, 1st and 2nd months 100mmVAS of pain score averages were 7.16 ± 1.99, 7.16 ± 1.99 and 7.50 ± 1.98 for the control group, 7.22 ± 1.64, 4.84 ± 1.80 and 2.13 ± 1.45 for the music group and 6.69 ± 1.80, 5.09 ± 1.55 and 2.91 ± 1.33 for the drawing group, respectively. Pretest, 1st and 2nd months PSS score averages were 28.75 ± 3.71, 29.09 ± 3.87 and 30.03 ± 4.16 for the control group, 29.91 ± 3.98, 14.06 ± 4.06 and 3.59 ± 3.82 for the music group and 27.38 ± 3.63, 18.13 ± 5.60 and 8.34 ± 5.46 for the drawing group, respectively. Pretest, 1st and 2nd months MSS score averages were 79.25 ± 15.41, 88.00 ± 20.08 and 90.66 ± 19.13 for the control group, 85.41 ± 10.77, 62.41 ± 15.23 and 34.00 ± 12.62 for the music group and 80.69 ± 11.07, 65.53 ± 15.37 and 47.31 ± 15.11 for the drawing group, respectively. Mean menstrual pain intensity, mean perceived stress level, and mean menstrual symptoms level in the art and music group decreased significantly at 1st and 2nd months post-intervention (p < .001). A significant increase in score levels was observed in the control group.ConclusionsBoth art and music practices are effective in significantly reducing menstrual pain, perceived stress, and menstrual symptoms in nursing students with dysmenorrhea. It is important to include listening to music and drawing on women’s health and disease nursing practices to control menstrual pain, perceived stress, and menstrual symptoms in dysmenorrhea.Clinical trials registration numberhttps://clinicaltrials.gov identifier NCT06027489; registered August 30, 2023.

The Effect of Cognitive Behavioural Therapy-Based Psychoeducation on Medication Adherence and Aggression in Individuals Diagnosed With Schizophrenia: An Experimental Study.

It is known that treatment compliance is low and aggression is higher in individuals diagnosed with schizophrenia compared to the normal population. Cognitive behavioural therapy (CBT) is known to reduce relapse and hospitalisation and increase well-being in individuals diagnosed with schizophrenia. However, there are almost no studies on increasing treatment compliance and decreasing aggression. This study was conducted to determine how CBT-based psychoeducation affects medication adherence and aggression in individuals diagnosed with schizophrenia. The study was conducted as a quasi-experimental model with the pre-test-post-test control group with 73 schizophrenic patients (33 experimental, 40 control) between June 2022 and July 2023. Data were collected using the Descriptive Characteristics Form, Morisky Medication Adherence Scale (MMAS) and Buss-Perry Aggression Questionnaire (BPSQ). The schizophrenic patients in the experimental group were given eight sessions of CBT-based psychoeducation, while the schizophrenic patients in the control group were not given any training. The data were analysed using mean, standard deviation, chi-squared test, dependent samples t-test and independent samples t-test. It was determined that the aggression level of the experimental group before the training was 80.51 ± 19.38, and after the CBT-based psychoeducation, it was 73.12 ± 15.28. It was determined that the aggression level of the control group before the training was 84.22 ± 12.13, and after the post-test, it was 85.60 ± 11.72. It was determined that the medication adherence level of the experimental group before the training was 2.75 ± 1.25, and after the CBT-based psychoeducation, it was 3.57 ± 0.67. It was determined that the medication adherence level of the control group before the training was 2.05 ± 1.33, and after the post-test, it was 2.17 ± 1.36. The psychoeducation based on CBT caused a statistically significant difference (p = 0.001) in medication adherence and aggression levels in the experimental group. It was determined that CBT applied to individuals diagnosed with schizophrenia was effective on increasing their medication adherence and reducing their aggression. It is recommended for psychiatric nurses to include CBT-based psychoeducation in their nursing practices in order to increase medication adherence and reduce aggression in individuals with schizophrenia. The findings emphasise that CBT-based psychoeducation increases treatment adherence and significantly decreases the level of aggression in individuals diagnosed with schizophrenia. Psychiatric nurses should include CBT-based psychoeducation in their treatments.

Organizational evidence-based practice culture, implementation leadership, and nurses: A bidirectional mediation model.

This study aimed to explore 1) factors that influenced the evidence-based practice competencies and behaviors of clinical nurses and 2) the interaction between the organizational evidence-based practice culture, head nurses' implementation leadership, and nurses' evidence-based practice competencies and behaviors. The significance of organizational evidence-based practice culture and head nurses' implementation leadership in enhancing nurses' evidence-based practice competencies and behavior is widely recognized in healthcare settings. However, there is limited knowledge of how these factors influence nurses' evidence-based practice competencies and behavior. A cross-sectional survey was conducted at 10 hospitals in China. Data were collected via online questionnaires from October to December 2020, utilizing social characteristic questionnaires, the Evidence-Based Practice Questionnaire, the Organizational Culture and Readiness Scale for System-wide Implementation ofEvidence-Based Practice, and the Implementation Leadership Scale. All data were imported into the IBM Statistical Program for the Social Sciences (SPSS) 27.0 and PROCESS version 4.1 macro on SPSS for statistical analysis. The design and reporting of our study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Checklist. We received 1047 (99.15%) valid questionnaires. The multiple linear regression analysis showed that significant factors were organizational evidence-based practice culture, implementation leadership, and years of experience in nursing. After controlling for the impact of the covariate (years of experience in nursing), it was found that organizational evidence-based practice culture partially mediated the relationship between head nurses' implementation leadership and nurses' evidence-based practice competencies and behaviors. Additionally, head nurses' implementation leadership partially mediated the relationship between organizational evidence-based practice culture and nurses' evidence-based practice competencies and behaviors. Organizational evidence-based practice culture, head nurses' implementation leadership, and years of experience in nursing significantly predict nurses' evidence-based practice competencies and behaviors. Organizational evidence-based practice culture and head nurses' implementation leadership mutually mediated their influence on nurses' implementation of evidence-based practice. Head nurses should proactively seek opportunities to enhance their implementation leadership, such as participating in training programs (e.g., mentoring and coaching programs) and attending conferences, workshops, or seminars on implementation leadership. Policymakers should also consider providing more policy support for implementing leadership development and cultivating a positive evidence-based practice culture.

A qualitative study on the field experience of genetic counseling in Korea.

In Korea, genetic counseling services began with the opening of genetic clinics in the early 1990s; in recent years, demand for these services has increased. However, genetic counseling is not an officially recognized healthcare service under the Korean national health insurance system; further, its certification is not recognized as a medical qualification. To clarify the role and significance of genetic counselors, this study examined their field experiences. To this end, we conducted focus group interviews with 11 certified genetic counselors, six advanced practice nurses, and four regular nurses. The interviews were transcribed verbatim and examined using thematic analysis. We found that even though Korea did not recognize their roles, the participants met their responsibilities and primary duties. In addition, they faced challenges during counseling due to a lack of formal education in genetics and genomics. Moreover, they encountered dilemmas related to the legal and ethical aspects of decision support for family testing or prenatal diagnosis due to the complexity of rare genetic disorders. However, they attempted to acquire the specialized knowledge needed to support patients with rare genetic disorders and their families, gradually developing practical experience and specialized knowledge. Therefore, it is necessary to develop manuals, establish systems, and improve working environments to provide high-quality and specialized genetic counseling. Additionally, there is a need for national support, such as establishing set wages for genetic counselors, developing a national qualification certification system, and securing dedicated personnel.

KNOWLEDGE AND PRACTICE OF NURSES REGARDING TRACHEOSTOMY CARE

Tracheostomy is a common procedure in critical care settings for patients requiring prolonged ventilation or airway management. Nurses play a crucial role in tracheostomy care, which demands comprehensive knowledge and adherence to evidence-based practices to prevent complications. Objective: This study aimed to assess the knowledge and practices of nurses regarding tracheostomy care at Jinnah Hospital Lahore. Methods: A descriptive cross-sectional study was conducted from January 2024 to July 2024 at Jinnah Hospital Lahore. A total of [specify sample size, e.g., 150] registered nurses working in different wards and intensive care units (ICUs) were selected through simple random sampling. Data were collected using a structured questionnaire, which included sections on demographic information, knowledge, and practices. Knowledge and practice scores were categorized as good, moderate, or poor. Data analysis was performed using SPSS version 25.0, employing descriptive statistics and chi-square tests to identify associations between variables. Results: The study revealed that 60% of the nurses had moderate knowledge regarding tracheostomy care, while 25% demonstrated good knowledge, and 15% had poor knowledge. In terms of practice, 54.7% of nurses reported moderate adherence to tracheostomy care protocols, 30% had good practices, and 15.3% demonstrated poor practices. A significant association was found between formal training in tracheostomy care and higher knowledge and practice scores (p &lt; 0.05). Conclusion: The findings indicate that most nurses possess moderate knowledge and practices concerning tracheostomy care, with notable gaps in training and adherence to standardized protocols. The study highlights the need for structured training programs and continuous professional development to enhance nurses' competency in tracheostomy care and improve patient outcomes.

Bloodstream: notes towards an anthropology of digital logistics in healthcare.

Based on ethnographic research in northern Ghana, this article explores the complex logistics of blood and the ways in which the availability of blood has been transformed through the introduction of drones. We explore how drone services affect this ecosystem of supply and contribute to reshaping the practices of physicians, nurses, facility pharmacists and stock managers, as well as the expectations and experiences of patients and their families. Situated at the interface of medical anthropology, critical studies of infrastructure and anthropological studies of digital innovations in healthcare, our paper attends to the emerging anthropological research on medical logistics as a means of connecting people with medical resources. It demonstrates the fundamentally ambivalent nature of technological innovation: on the one hand, drones have fueled health workers' hopes and transformed access to blood. On the other hand, their introduction has also led to connectivity without stock. In line with STS scholarship, we highlight the important role of the physical properties of objects such as blood in shaping their circulation.