INTRODUCTION:Obesity is a significant health issue associated with chronic conditions such as cardiovascular disease and type 2 diabetes. Bariatric surgery is the most effective weight loss treatment for obesity. This systematic review aimed to examine factors influencing individuals' decisions to undergo bariatric surgery. METHODS:This systematic review was guided by the JBI Manual for Evidence Synthesis for Qualitative Reviews and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. Literature searches were conducted in CINAHL, PubMed, Cochrane Library, APA PsycINFO, and APA PsycArticles. Results were analysed using a meta-aggregative approach. Quality appraisal was conducted using the JBI Checklist for Qualitative Research. RESULTS:Thirteen studies were included. Health concerns, fears of obesity-related comorbidities, and a desire to improve physical health and quality of life emerged as key motivators to undergoing bariatric surgery. Support from healthcare professionals and family played a crucial role in motivating individuals to consider surgery. Women particularly noted concerns about fertility as a motivator to undergo bariatric surgery. Disclosure of surgery, financial concerns, transport, family and work commitments, and perceived risks of surgery were identified as barriers to undergoing bariatric surgery. CONCLUSION:Findings highlight the need for healthcare professionals to adopt empathetic, patient-centred approaches when discussing bariatric surgery. Addressing financial, insurance, and logistical barriers, alongside stigma and family resistance, is essential. Improving patient education, strengthening provider relationships, and offering tailored support can enhance decision-making, access, and long-term outcomes for those considering bariatric surgery.

AIM:To explore the social context of violence for hospital-based and community nurses from different ethnic groups, the types of violence experienced or witnessed both in and outside the workplace, and its impact on mental and physical health. DESIGN:Cross-sectional, qualitative study using semi-structured interviews. METHODS:Semi-structured interviews were conducted online with 12 hospital-based and community nurses recruited from London, England, between May and August 2021. Data were analysed using reflexive thematic analysis. RESULTS:The sample comprised seven hospital nurses and five community nurses. Four themes were identified: (i) the social context in which nurses from different ethnic groups are exposed to community violence; (ii) types of workplace violence experienced or witnessed by hospital-based and community nurses from different ethnic groups; (iii) perceptions of the factors contributing to workplace violence; (iv) impacts of violence on mental and physical health outcomes. Using the social ecological framework and sociological theory of stress, these findings informed a conceptual stress process model of violence exposure for nurses. CONCLUSION:Nurses from different ethnic groups are exposed to violence both in and outside the workplace which negatively affects their mental and physical health. Effective violence prevention requires a multi-factorial approach that addresses the social and institutional factors contributing to violence, shifting the focus from individual measures to systemic organisational changes. IMPACT:The NHS workforce is currently more diverse than ever, and healthcare leaders must improve access to mental health and well-being resources for staff affected by workplace violence, particularly for those who hold multiple social identities at the intersection of ethnicity, gender and age. Prioritising this support is essential not only to safeguard against negative health outcomes but also to improve the recruitment and retention of healthcare professionals. PATIENT OR PUBLIC CONTRIBUTION:No patient or public contribution.

AimsTo evaluate the effects of the organisational environment on hospital discharge readiness during public health emergencies.DesignAn observational study.MethodsA regression-discontinuity design approach was employed to assess the impact of the organisational environment on hospital discharge readiness. Adult patients diagnosed with acute myocardial infarction and discharged from the Cardiac Critical Care Unit of a tertiary hospital in Shanghai, China, were recruited. Spearman correlation analysis was conducted to examine the associations between multiple factors at individual and organisational levels and hospital discharge readiness across three stages of pandemic policy changes.ResultsA total of 411 patients were included in the analysis. The regression-discontinuity analysis revealed a significant discontinuity at the cut-off, indicating that policy-driven changes in the organisational environment during public health emergencies were associated with a 21.61% reduction in hospital discharge readiness. Additionally, family functioning and the quality of nursing discharge education were significantly associated with discharge readiness across all three pandemic stages.ConclusionsThese findings demonstrate that patient-perceived hospital discharge readiness is significantly influenced by changes in the organisational environment during public health emergencies. Future research should focus on developing targeted discharge preparation programmes that allow for organisational adaptation in response to emergencies, such as pandemics or natural disasters.Implications for Patient CareOrganisational responses to public health emergencies need to prioritise enhancing discharge preparedness. This includes bolstering family involvement and ensuring that nurses are adequately trained to provide effective discharge education, especially when healthcare resources are strained.ImpactThe findings underscore the importance of adaptable and resilient discharge planning and transitional care, particularly in public health emergencies. Fostering an organisational environment that supports seamless discharge processes can significantly improve patient readiness for post-hospital care.Reporting MethodsStrengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement.Patient or Public ContributionNo patient or Public Contributions.

AIM:To establish research priorities for Australian Nurse Practitioners and develop a robust research agenda. DESIGN:A descriptive, exploratory approach was used and conducted in two stages. METHODS:Data were collected over two stages. Data for Stage 1 were collected from 14 December 2023 to 16 February 2024. For the Delphi rounds (Stage 2), data were collected from 11 March to 24 March 2024 for Delphi Round 1 and from 12 June to 26 June 2024 for Delphi Round 2. An exploratory survey was used in Stage 1 to identify clinical challenges and research themes perceived as important for Australian Nurse Practitioners. In Stage 2, a two-phased modified Delphi survey was conducted to prioritise the research themes identified in Stage 1. RESULTS:A total of 315 participants responded to the exploratory survey, with a majority being female (77%), aged between 30 and 75 years. Participants were primarily employed in the public healthcare sector (60%), the private sector (23%), while 17% practised across both sectors. A total of 1335 challenges facing Australian Nurse Practitioners were identified. Sixty-nine participants completed the first Delphi round, and 33 the second, giving response rates of 21% (69/315) and 48% (33/69), respectively. The first Delphi round yielded 11 research themes. Seven of these yielded Content Validity Indices of < 0.90. Four research priority areas remained and were ranked in order of importance. CONCLUSION:The identified Australian Nurse Practitioner research priorities will play a pivotal role in shaping policies, fostering the efficient integration of Nurse Practitioners into the healthcare system and advancing research capacity. IMPACT:Nurse Practitioners are established providers of high-quality care internationally; however, they face persistent integration challenges in Australia. This study delivers a nationally relevant, consensus-based research agenda that identifies key priorities across clinical, educational and leadership domains. PATIENT OR PUBLIC CONTRIBUTION:No patient or public contribution.

INTRODUCTION:Advanced practice nursing is well established in many countries. However, in Mexico the role has not been implemented. The aim of this paper was to establish consensus, via expert stakeholder engagement, on the priorities to develop advanced practice nurse (APN) roles nationally in Mexico. METHODS:A 2-round Delphi technique was employed. Along with using data from in-depth interviews with health care professionals in Mexico, a review of the published literature was also undertaken. A total of 25 statements using a Likert scale from not important (1) to very important (4) were developed for round 1. Those working in positions with an interest in advanced practice nursing were invited to participate. A context index validity of 0.8 was applied for round 1, and those that scored above 0.8 were used for round 2 where participants were asked to rank the statements in order of priority. RESULTS:Thirty-one experts participated in round 1 and 14 in round 2. A total of 12 statements were scored with a content validity index above 0.8, and these were ranked for round 2. The statements reflected key areas around advanced practice nursing from workforce issues to regulation, education, and career progression. The key priorities were the need for a national regulatory framework and clear definition of APN roles. CONCLUSIONS:These statements will now be used to support the case for how advanced practice nursing should be developed in Mexico at a national level addressing the health care needs of the population and help toward building a strong APN workforce.

The use of respectful communication is essential to establishing a good therapeutic relationship between the healthcare professional (HCP) and the patient. Negative language can adversely affect interactions between the public and HCPs. Person-centred care is advocated in cardiovascular care, but there is lack of information regarding on how communication and respectful language can be applied. The aim of this statement is to explore the concept of respectful language in the delivery of person-centred cardiovascular care and present a working definition of respectful language in the context of healthcare and HCPs. This paper outlines of the role of communication in the delivery of cardiovascular care with critical analysis of the relevant literature. Factors influencing respectful language including ethnicity and culture and the move from the term 'patient' to 'person' are explored. Digital technologies (such as remote monitoring) now play a key role in delivering healthcare and HCPs need to be mindful on how it affects communication. Another important consideration is artificial intelligence and its potential impact on respectful language. Many healthcare providers and organizations have developed plain language documents, and non-technical lay summaries are available for evidence-based guidelines and research. This paper offers suggestions for ensuring best practice in the use of respectful language. Undoubtedly, respectful language is central to delivering person centred care. Every individual HCP involved in providing cardiovascular care can make some changes to their communication. Further education and training in the use of respectful language is needed along with evidence highlighting patient-reported outcomes and experience.

The complexity of atrial fibrillation (AF) requires an integrated, multifaceted, multidisciplinary, and holistic team approach to optimize the management of AF patients. Active engagement of patients and involvement of nurses and various allied professionals (AP) and a strong collaboration with physicians is crucial in this respect as indicated by the 2024 European Society of Cardiology Guidelines on the management of AF. This is also reflected in these latest guidelines by the concept of AF-CARE, which emphasizes the importance of including the patient, carers, and various healthcare professionals. In this Clinical Consensus Statement, the role of nurses and APs is highlighted and includes optimal approaches on their involvement in the implementation and execution for these guideline recommendations in daily clinical practice. Moreover, additional detail will be provided to the key components and their requirements to allow this integrated multidisciplinary care to be implemented alongside the perspective of the patient. This Statement also examines the challenges and opportunities in relation to their application to clinical practice and how optimal multidisciplinary care can be implemented.

BACKGROUND:Hospital discharge readiness is a crucial concept, influenced by various individual, interpersonal, and institutional factors in populations experiencing acute myocardial infarction. However, there is a gap in the exploration of these interactive variables, particularly regarding integrated configurations that facilitate readiness for hospital discharge. OBJECTIVE:This study aimed to explore the complex determinants affecting hospital discharge readiness from an integrated perspective, based on the Middle-Range Theory of Adaptation to Chronic Illness. METHODS:A cross-sectional observational study was conducted from July 2021 to March 2024 at a tertiary hospital in Shanghai, China. The study assessed individual demographics, family dynamics, quality of discharge teaching, adaptive capacity, and hospital discharge readiness among post-acute myocardial infarction patients. Fuzzy-set qualitative comparative analysis was employed by performing necessity and sufficiency analyses of discharge readiness. RESULTS:A total of 240 patients participated in this study. The findings indicated that no single determinant independently achieved hospital discharge readiness. Six configurations or pathways leading to high readiness were identified, classified into three patient types: (i) hospital-driven, (ii) family-hospital-driven, and (iii) individual-family-hospital joint-driven. Among these, the most significant configuration involved high family dynamics, high quality of teaching prior to discharge, high adaptive capacity, and low-income levels. Substitutability was observed between income levels and family functions across two configurations. CONCLUSION:Hospital discharge readiness among post-acute myocardial infarction patients arises from interactions of multiple determinants spanning individual, interpersonal, and institutional levels. These insights can inform healthcare providers to prioritize identifying these factors and developing personalized interventions that enhance adaptive capacity, family dynamics, and teaching quality during transitional care.

The Hospital at Home (HaH) service has developed and evolved over the past few years with the Covid-19 pandemic and improved the integration of care in the community from acute hospital settings. Despite these advancements, there remains a limited understanding of patients’ lived experiences with the HaH service. This study aims to explore the experiences and perceptions of older adults who have received HaH services to inform future quality improvement initiatives. A qualitative approach utilizing semi-structured interviews was employed to comprehensively understand how patients and family caregivers individually interpreted and made sense of their interactions with the HaH service in the context of an urban setting in the United Kingdom. Purposive sampling was used to select key informants (n = 7) who had previously utilized the HaH service in early 2023. Using an interpretive phenomenological analysis, approaches of interpretive interviews, initial data review, segmentation of data into coherent units, and condensation into cohesive themes were involved. Reporting of findings adhered to the Standards for Reporting Qualitative Research (SRQR) Guidelines. Four distinct themes, each accompanied by its own set of interpretive practices and subordinate themes, emerged: [1] positive experiences of using HaH service [2], supporting family-centred care within HaH service [3], perceived challenges faced by individuals and caregivers in HaH [4], messages for quality improvement of HaH service. The study’s findings provide insight into the experiences and interpretations of users within an integrated HaH service. The positive aspects of the service, its encouragement of family-centred care, identified challenges, and suggested improvements collectively contribute to advancing the quality enhancement of future HaH endeavours.

Nurses are the “heart of patient care” and in the forefront of the health care delivery for cardio-oncology patients. Nurses play a critical central role in maximizing longitudinal health of cancer patients and survivors through the prevention of cardiovascular complications throughout the patient’s cancer care journey. Nurses function in a variety of roles such as nurse clinicians, advanced practice nurses (APNs)or nurse practitioners (NPs), patient educators, managers, nurse navigators or nurse researchers. The role of nurses, particularly the advanced practice nurses as key members in delivering cardio-oncology care is evolving. However, despite the rapidly increasing growth of cardio oncology programs globally, a pivotal need remains to develop and provide formalized training programs for nurses, NPs and APNs. At present, no formal academic cardio-oncology nurse training program or certification exists. There is clearly more work to be done on the role of nurses in cardio-oncology care. As cardio-oncology evolves to become a key specialty with dedicated services being established across the globe, the role of the nurse in delivering this service is critical and a concerted collaborative approach between the two distinct specialties of cardiology and oncology needs to ensure the nursing workforce is educationally prepared and confident to treat and manage cardio-oncology patients.

In heart failure, cardiac cachexia often presents in people as weight loss accompanied by muscle wastage, loss of appetite and reduced quality of life. Such people often have a poor prognosis. However, the impact of these symptoms on Thai patients’ quality of life is unknown. Therefore, this study aimed to explore cardiac cachexia, its symptoms, and its effect on quality of life using a mixed-method sequential explanatory design. Data for this study were collected from a specific cardiac failure clinic in a large hospital in Bangkok, Thailand, from August 2022 to January 2023. Forty-two patients with heart failure were screened for cardiac cachexia using cachexia consensus criteria and bioelectrical impedance vector analysis. They also completed the Simplified Nutritional Appetite Questionnaire, the Thirst Distress Scale for Heart Failure and the Kansas City Cardiomyopathy Questionnaire to assess appetite, thirst, and quality of life, respectively. Thirty-eight participants were included for statistical analysis and divided into two groups: those with confirmed or suspected cardiac cachexia (n = 7) and those without (n = 31). The former group reported low appetite scores; however, no significant differences were observed between the two groups’ appetite, thirst, or quality of life. After identifying patients with cardiac cachexia, six semi-structured interviews were conducted using an interview guide and analyzed through thematic analysis. The interviews revealed two common themes: Changes in diet and thirst and a Reduction in physical activity levels. Both themes complement the quantitative results. This study initiates a significant step in the understanding of cardiac cachexia in the Thai population with heart failure. Nurses can play a crucial role in identifying and managing patients with or at risk of cardiac cachexia.

AIM:To elucidate strategies for improving organisational adaptation during public health emergencies from the perspectives of nurse managers. DESIGN:This study utilised a qualitative approach, incorporating complex adaptive system theory within a phenomenological tradition. METHODS:Semi-structured interviews were conducted from May 2022 to June 2022. Participants included core members of the Shanghai Public Health Emergency Teams-Nursing from 12 tertiary hospitals in Shanghai, all of whom had substantial experience as nurse leaders impacting health systems. Data obtained were coded and analysed using interpretative phenomenological analysis. RESULTS:Seventeen frontline nurse managers participated, leading to the emergence of three key themes related to complex organisational adaptation: seeking institutional support for environmental adaptation, building intrateam support for structural adaptation and activating individual support for behavioural adaptation. A conceptual framework of organisational adaptation was proposed, displaying the interconnections among these themes. CONCLUSIONS:The study provides valuable insights into managing nursing teams involved in public health emergency preparedness and response as an adaptive system. Identified managerial strategies offer guidance to ensure effective organisational assembly and optimal utilisation of the nursing workforce within the healthcare system. IMPLICATIONS FOR THE PROFESSION:Recognising the crucial role of nurses in managerial positions, who leverage leadership, adaptability and decision-making skills to coordinate frontline teams, is vital for effective public health emergency response. Their involvement in administrative roles underscores the importance of nursing perspectives in strategic planning, organisational adaptation and enhancing health system resilience during crises. IMPACT:The organisational adaptation strategies effectively adopted by nurse managers provide a reference for international scholars seeking to enhance the function and performance of nursing staff in healthcare system during public health emergencies. REPORTING METHOD:Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist. PATIENT OR PUBLIC CONTRIBUTIONS:No Patient or Public Contributions.

Background Sex-specific outcomes following AF ablation(CA) have reported conflicting findings. Objectives We report the impact of female sex on outcomes in patients with persistent AF from the CAPLA randomized trial. Methods 338 patients with PsAF were randomized to pulmonary vein isolation(PVI) or PVI with posterior wall isolation(PWI).The primary outcome was arrhythmia recurrence at 12 months.Clinical and electroanatomical characteristics,arrhythmia recurrence and quality of life were compared in women and men. Results Seventy-nine(23.4%) women(PVI 37;PVI+PWI 42) and 259(76.6%) men(PVI 131,PVI+PWI 128)underwent AF ablation.Women were older (median age 70.4(IQR 64.8-74.6) vs 64.0(IQR 56.7-69.7)years,p<0.001) and had more advanced left atrial electroanatomical remodeling.At 12 months, arrhythmia-free survival was lower among women(44.3% vs 56.8% in men,HR 1.44,95% CI 1.02-2.04, LogRank p=0.036).PWI did not improve3 arrhythmia-free survival at 12 months(HR 1.02,95% CI 0.74-1.40, LogRank p=0.711).Median AF burden was 0% in both groups(women:IQR 0.0-2.2% vs men:IQR 0.0-2.8%,p=0.804).Healthcare utilisation was comparable in women(36.7%) and men(30.1%,p=0.241),however women were more likely to undergo a repeat procedure(17.7% vs 6.9%,p=0.007).Women reported more severe baseline anxiety(average HADS anxiety score 7.5±4.9 vs 6.3±4.3 in men,p=0.035) and AF-related symptoms (baseline AFEQT 46.7±20.7 vs 55.9±23.0 in men,p=0.002),with comparable improvements in psychological symptoms(ΔHADS anxiety score: -3.8±4.6 vs -3.0±4.5, p=0.152(ΔHADS depression score: -2.9±5.0 vs -2.6±4.0,p=0.542) and greater improvement in AFEQT compared to men at 12 months(ΔAFEQT +45.9±23.1 vs +39.2±24.8,p=0.048). Conclusion Women undergoing CA for PsAF report more significant symptoms and poorer quality of life than men.Despite higher arrhythmia recurrence and repeat procedures among women,AF burden was comparably low, resulting in significant improvements in quality of life and psychological wellbeing following CA in both sexes.

Background: Heart failure (HF) patients can experience poor appetite and intense thirst. The Thirst Distress Scale for HF (TDS-HF) and the Simplified Nutritional Appetite Questionnaire (SNAQ) are tools used to assess these symptoms. However, these questionnaires are not currently available in Thai.Aims: To translate the TDS-HF and SNAQ into the Thai language and to evaluate the reliability and validity of these translated instruments.Methods: The TDS-HF and the SNAQ were translated from English to Thai using a forward-backward method. Their face and content validity, their internal consistency and test-retest reliability, were assessed with a sample of 20 HF patients recruited from a single supra-tertiary hospital in Thailand.Results: Participants reported that the TDS-HF and the SNAQ had face validity. The content validity was assessed as adequate by the expert panel. The Cronbach's alphas of the TDS-HF and the SNAQ were 0.91 and 0.71, respectively. The intraclass correlation coefficients of the TDS-HF and the SNAQ were 0.91 and 0.91, respectively.Conclusions: The Thai versions of the TDS-HF and the SNAQ demonstrate adequate validity and reliability. These tools hold significant potential for supporting clinical practice, particularly for nurses involved in HF management by helping to assess thirst and appetite effectively.

Journal Article Corrected proof Hypertension: the silent killer in a vulnerable population Get access Geraldine Lee Geraldine Lee Nursing and Health Service Research, Catherine McAuley School of Nursing & Midwifery, Brookfield Health Sciences Complex, University College Cork, Cork T12 AK54, Ireland Corresponding author. Email: glee@ucc.ie https://orcid.org/0000-0001-6385-8600 Search for other works by this author on: Oxford Academic Google Scholar European Journal of Cardiovascular Nursing, zvae004, https://doi.org/10.1093/eurjcn/zvae004 Published: 22 January 2024 Article history Received: 09 January 2024 Accepted: 10 January 2024 Corrected and typeset: 22 January 2024 Published: 22 January 2024

BACKGROUND:While Cardiac Rehabilitation (CR) programs have shown effectiveness in improving cardiac outcomes, there is limited understanding of how patients perceive and adapt to these interventions. Furthermore, alternative modes of delivering CR that have received positive evaluations from participants remain underexplored, yet they have the potential to enhance CR uptake.OBJECTIVES:To explore the patient experience in CR programmes following Acute Myocardial Infarction (AMI) and describe their adaptive processing.PATIENTS AND METHODS:This qualitative study was conducted at a nationally certified centre in China between July 2021 and September 2022, encompassing three stages: in-hospital, centre-based, and home-based CR programs. Purposive sampling was used to select eligible AMI patients for in-depth semi-structured interviews. The interview outline and analytical framework were aligned with the key concepts derived from the middle-range theory of adaptation to chronic illness and the normalization process theory. The findings were reported following the Consolidated Criteria for Reporting Qualitative Research checklist.RESULTS:Forty AMI patients were recruited. Four main themes describing the process of AMI patients normalizing CR intervention were identified, including (1) experiencing CR service driving by role's responsibilities, (2) engaging in collaborative relationship based on interpersonal trust, (3) exploring a personalized rehabilitation plan by complex integration, and (4) expecting a promised outcome to shape decision-making.CONCLUSION:Integrated care interventions for AMI patients could benefit from a collaborative co-designed approach to ensure that CR interventions are normalized and fit into patients' daily lives. Organizational-level CR services should align with the rehabilitation needs and expectations of patients.