The Florence Nightingale Foundation (FNF) is a charity organisation in the United Kingdom that provides scholarships to nurses, midwives and other health professionals while serving as a living memorial of the work of Florence Nightingale.
BACKGROUND:Depressive symptoms are common in individuals with inflammatory bowel disease (IBD) and are associated with poor disease outcomes. Transcutaneous electrical acupuncture point stimulation (TEAS) is a noninvasive intervention with potential benefits for inflammation but remains untested in IBD. We developed a smartphone application for home-based TEAS self-administration and evaluated its feasibility, acceptability, and preliminary effects. METHODS:In a randomized feasibility study, IBD patients with Patient Health Questionnaire-9 (PHQ-9) scores ≥ 8 were recruited through Crohn's and Colitis UK. Participants were remotely trained to use the TEAS device, locate acupoints, and self-administer the treatment via the app. Group A completed 30-min daily sessions for 21 days from week 1, while Group B started in week 6. Outcomes [recruitment, retention, acceptability, depression, fatigue, pain, and quality of life (QoL)] were assessed at baseline, week 4, and week 9. RESULTS:Of the 109 individuals of interest, 57 were assessed, 37 were eligible, and 36 were randomized. In Group A, 83% (15/18) completed ≥ 18 sessions, compared to 50% (9/18) in Group B. The questionnaire completion rates were 92% ( n = 33) at baseline, 83% ( n = 30) at 4 weeks, and 67% ( n = 24) at 9 weeks. Most participants (81%) recommended TEAS. Preliminary analysis showed reduced depressive symptoms and improved QoL postintervention and at the follow-up. Postintervention, the mean PHQ-9 score decreased from 13.9 to 7.7 in Group A and from 14.2 to 6.5 in Group B. CONCLUSIONS:Home-based TEAS is feasible, acceptable, and has a clinical potential. A full-scale randomized controlled trial is needed to confirm its efficacy in the treatment of IBD-related depression.
This case study explores the nursing process for a 67-year-old male patient, Mr B. Mr B lives with a stoma following a total colectomy because of ulcerative colitis. The assessment phase identified key issues, including anxiety about lifestyle changes, impaired skin integrity and deficient knowledge regarding stoma care. Nursing diagnoses were formulated based on these findings, emphasising the patient's psychological and physical challenges. Specific, Measurable, Achievable, Relevant and Time-Bound (SMART) goals were established to reduce anxiety, improve skin integrity and enhance the patient's knowledge of stoma management within a 4-week timeframe. Interventions included providing emotional support, comprehensive education on stoma care, appropriate product recommendations and regular monitoring. These interventions were rationalised to ensure holistic and effective care. The evaluation phase confirmed the success of the interventions, with the patient reporting reduced anxiety, improved skin condition and increased confidence in managing their stoma. This case study underscores the importance of a structured nursing process in addressing both the physical and emotional needs of patients living with a stoma, highlighting the role of personalised care plans in promoting patient wellbeing and independence. The study provides a practical framework for nurses to enhance the quality of life for patients facing similar challenges.
Background:Quality of life and care varies between and within the care homes in which almost half a million older people live and over half a million direct care staff (registered nurses and care assistants) work. The reasons are complex, understudied and sometimes oversimplified, but staff and their work are a significant influence. Objective(s):To explore variations in the care home nursing and support workforce; how resident and relatives' needs in care homes are linked to care home staffing; how different staffing models impact on care quality, outcomes and costs; how workforce numbers, skill mix and stability meet residents' needs; the contributions of the care home workforce to enhancing quality of care; staff relationships as a platform for implementation by providers. Design:Mixed-method (QUAL-QUANT) parallel design with five work packages. WP1 - two evidence syntheses (one realist); WP2 - cross-sectional survey of routine staffing and rated quality from care home regulator; WP3 - analysis of longitudinal data from a corporate provider of staffing characteristics and quality indicators, including safety; WP4 - secondary analysis of care home regulator reports; WP5 - social network analysis of networks likely to influence quality innovation. We expressed our synthesised findings as a logic model. Setting:English care homes, with and without nursing, with various ownership structures, size and location, with varying quality ratings. Participants:Managers, residents, families and care home staff. Findings:Staffing's contribution to quality and personalised care requires: managerial and staff stability and consistency; sufficient staff to develop 'familial' relationships between staff and residents, and staff-staff reciprocity, 'knowing' residents, and skills and competence training beyond induction; supported, well-led staff seeing modelled behaviours from supervisors; autonomy to act. Outcome measures that capture the relationship between staffing and quality include: the extent to which resident needs and preferences are met and culturally appropriate; resident and family satisfaction; extent of residents living with purpose; safe care (including clinical outcomes); staff well-being and job satisfaction were important, but underacknowledged. Limitations:Many of our findings stem from self-reported and routine data with known biases - such as under reporting of adverse incidents; our analysis may reflect these biases. COVID-19 required adapting our original protocol to make it feasible. Consequently, the effects of the pandemic are reflected in our research methods and findings. Our findings are based on data from a single care home operator and so may not be generalised to the wider population of care homes. Conclusions:Innovative and multiple methods and theory can successfully highlight the nuanced relationship between staffing and quality in care homes. Modifiable characteristics such as visible philosophies of care and high-quality training, reinforced by behavioural and relational role modelling by leaders can make the difference when sufficient amounts of consistent staff are employed. Greater staffing capacity alone is unlikely to enhance quality in a cost-effective manner. Social network analysis can help identify the right people to aid adoption and spread of quality and innovation. Future research should focus on richer, iterative, evaluative testing and development of our logic model using theoretically and empirically defensible - rather than available - inputs and outcomes. Study registration:This study is registered as PROSPERO CRD42021241066 and Research Registry registration: 1062. Funding:This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 15/144/29) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 8. See the NIHR Funding and Awards website for further award information.
BackgroundSexual dysfunction (SD) in women with diabetes is a multifaceted complication driven by hormonal, neuropathic and psychosocial factors. It has been reported that the prevalence of SD is higher in women with type 1 diabetes compared to both women with type 2 diabetes and women without diabetes. However, prevalence estimates of SD in women with type 1 diabetes are variable, due to the heterogeneity of the conducted studies and the various confounding factors that are associated with SD. AimThis review aimed to estimate the prevalence of SD in premenopausal women with type 1 diabetes compared to women without diabetes; consider current methods for measuring SD; and identify factors associated with SD in women with type 1 diabetes. MethodA systematic review of the literature was conducted. Four electronic databases (Embase, MEDLINE, CINAHL, PsycINFO) were searched between 15 March and 29 April 2022, the search was updated on 4 February 2023 to identify studies that assessed SD in women with type 1 diabetes. FindingsThe search yielded in 1104 articles; of these, 180 were assessed for eligibility. A meta-analysis of eight eligible studies revealed that the odds of experiencing SD is three times higher in women with type 1 diabetes compared to women without diabetes (OR = 3.8 95%CI 1.8-8.0, p < 0.001). The most commonly used measure of SD was the female sexual function index (FSFI); in three studies, this was combined with the female sexual distress scale (FSDS). Factors that have shown significant association with SD are depression, anxiety and duration of diabetes. ConclusionThis review has shown that SD is a significant issue for women with type 1 diabetes. These findings should encourage diabetes professionals and policymakers to give more attention to female SD (FSD) by incorporating it into care pathways and clinical guidelines.
