Nursing-Sensitive Outcomes among Patients Cared for in Paediatric Intensive Care Units: A Scoping Review

Measuring the effectiveness of nursing interventions in intensive care units has been established as a priority. However, little is reported about the paediatric population. The aims of this study were (a) to map the state of the art of the science in the field of nursing-sensitive outcomes (NSOs) in paediatric intensive care units (PICUs) and (b) to identify all reported NSOs documented to date in PICUs by also describing their metrics. A scoping review was conducted by following the framework proposed by Arksey and O’Malley. Fifty-eight articles were included. Publications were mainly authored in the United States and Canada (n = 28, 48.3%), and the majority (n = 30, 51.7%) had an observational design. A total of 46 NSOs were documented. The most reported were related to the clinical (n = 83), followed by safety (n = 41) and functional (n = 18) domains. Regarding their metrics, the majority of NSOs were measured in their occurrence using quantitative single measures, and a few validated tools were used to a lesser extent. No NSOs were reported in the perceptual domain. Nursing care of critically ill children encompasses three levels: improvement in clinical performance, as measured by clinical outcomes; assurance of patient care safety, as measured by safety outcomes; and promotion of fundamental care needs, as measured by functional outcomes. Perceptual outcomes deserve to be explored.

A Pilot One Group Feasibility, Acceptability, and Initial Efficacy Trial of LISTEN for Loneliness in Lonely Stroke Survivors

Introduction Loneliness is a prevalent problem for adult stroke survivors, and a known contributor to hypertension, secondary stroke, functional decline, poorer quality of life, and mortality in older adults. LISTEN (Loneliness Intervention using Story Theory to Enhance Nursing-sensitive outcomes), a theoretically based behavioral health intervention designed to target loneliness, in a sample of lonely survivors of ischemic stroke. Objectives: To assess the feasibility and acceptability of LISTEN (Loneliness Intervention using Story Theory to Enhance Nursing-sensitive outcomes) in lonely stroke survivors and to evaluate the initial efficacy of LISTEN for loneliness, depressive symptoms, neurological quality of life, and blood pressure in a sample of lonely survivors of ischemic stroke. Methods: The study design was framed using the psychoneuroimmunology paradigm and employed a prospective non-randomized one group design. Six adult stroke survivors were recruited from a Neurology outpatient clinic. Once consented and enrolled, participants attended 5 sequential weekly group sessions of LISTEN. Evaluations, field notes, and video recordings of each session were used to assess feasibility and acceptability of LISTEN. Quantitative data was collected at enrollment and at 1, 6, and 12 weeks post last LISTEN session to assess initial efficacy on loneliness (revised UCLA loneliness scale), depressive symptoms (PHQ-9), neurological quality of life (NeuroQoL), and blood pressure. SPSS was used for descriptive and comparative data analysis to examine within subject changes. Results: LISTEN was feasible to deliver in the selected clinical setting and participants rated LISTEN as highly useful, organized, and clear with an overall rating as excellent for loneliness. Participants reported significant decline in loneliness and improved scores on three subscales of the NeuroQoL; executive function, positive affect and well-being, and satisfaction with social roles. Recruiting stroke survivors for the trial was time intensive for the study team. Conclusions: Larger randomized trials of LISTEN in stroke survivors are needed to build evidence for the longer term effectiveness of LISTEN on loneliness, depressive symptoms, and quality of life. Future study designs will include planning to diminish barriers to recruitment.

Measuring Nursing Sensitive Outcomes in Patient with Acute Myocardial Infarction: Tool Development and Validation

Context: The outcomes movement is a young science, improving care by determining the outcomes of nursing interventions will give scientific validity to strategies that are used by nursing in a variety of venues. Cardiovascular nurses contribute significantly to health outcomes and frequently assume responsibility for the clinical and organizational processes to ensure positive outcomes for patients and families Aims: The aims of this study were to identify nursing-sensitive outcomes in patients with acute myocardial infarction, to develop a tool to measure nursing-sensitive outcomes of caring patients with myocardial infarction, and to evaluate the content, face validity, reliability and nursing sensitivity of 46 nursing sensitive-outcomes concerning bio-psycho-socio- educational aspects of care for patients with myocardial infarction from the Nursing Outcomes Classification (NOC). Methods: A survey research design was used in this study to assess the content and face validity of the designed instrument and inter-rater reliability was utilized to assure its reliability. Thirty patients with acute myocardial infarction subjected to measuring their nursing-sensitive outcomes during their stay in the CCUs or intermediate units. Fifty-nine experts were invited to participate in this study. Nursing-Sensitive Outcomes Measuring Scale was developed and subjected to testing reliability, validity, and sensitivity Results: Most of the studied outcomes showed a high degree of consistency as indicated by ICC that was above 0.900. 100% of the experts rated 14 out of 46 outcomes as very important; the remaining outcomes were assessed by more than 75% of the experts as important. Also, 18 out of 46 outcomes were rated by the 100% experts as very sensitive to the contribution of nursing intervention; no one outcome was rated as not important or not sensitive for nursing contribution. Conclusions: The study provided evidence of outcomes content validity, reliability, and nursing sensitivity of the studied outcomes. The study recommended the testing of NOC outcomes in various clinical settings with appropriate training for nurses, and the inclusion of NOC into nursing curricula to utilized in clinical education as a continuum for nursing diagno- ses classification.