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Nurses’ perceptions, experiences and involvement in the provision of end-of-life care in acute hospitals: A mapping review of research output, quality and effectiveness
International Journal of Nursing Studies ( IF 8.1 ) Pub Date : 2021-06-25 , DOI: 10.1016/j.ijnurstu.2021.104007
Jan Shepherd 1 , Amy Waller 1 , Rob Sanson-Fisher 2 , Katherine Clark 3
Affiliation  

Background

Safe and high-quality end of life care is not always achieved in acute care hospitals. Nurses represent a key source of information about current practice, and active participants in interventions to improve end of life care in these settings. Examining the volume, type and quality of publications in this field can help to determine whether research is following a natural scientific progression to inform best-practice end of life care.

Aims

To systematically review:

(i) whether the volume and type of publications (i.e. measurement, descriptive or interventions studies) examining nurses’ perceptions of, and involvement in, end-of-life care delivered in acute hospitals changed over time (i.e. since 2000);

(ii) the proportion of intervention studies involving nurses that meet Risk of Bias research design criteria; and

(iii) the effectiveness of intervention studies that met minimum Risk of Bias criteria.

Methods

MEDLINE, Embase, CINAHL, and PsychInfo were searched for data-based papers published in English between Jan 2000 and Dec 2020. Studies were included if they focused on nurses’ perceptions of, or role in, the provision of end-of-life care in hospitals. Eligible papers were classified as descriptive, measurement or intervention studies. Intervention studies were assessed against the Risk of Bias methodological criteria for research design, and their effectiveness examined.

Results

A total of 131 papers met eligibility criteria for inclusion in the review. The number increased by 31% in each time period (p < 0.0001). Most studies were descriptive (n = 70; 53%), 11 were measurement studies (8%), and the remainder were intervention studies (n = 50; 38%). Thirteen intervention studies (26%) met eligibility criteria. Methodological quality of the eligible intervention studies was variable. Randomisation and blinding of outcome assessors were the domains of greatest concern. Results were variable, with larger, system-wide interventions that incorporated the expertise of the multidisciplinary healthcare team showing the most promise.

Conclusion

There is an increasing number of studies examining nurses’ perceptions of, and involvement in, end-of-life care delivered in acute hospitals. The difficulties of conducting intervention research in this field mean that many studies are descriptive in nature. Given the importance of intervention research in establishing causal relationships, larger-scale intervention studies are essential to improving the quality of end-of-life care provided to patients dying in hospital.



中文翻译:

护士在急诊医院提供临终关怀方面的看法、经验和参与:研究成果、质量和有效性的映射审查

背景

急症护理医院并不总能实现安全和高质量的临终关怀。护士是有关当前实践的重要信息来源,并且是干预措施的积极参与者,以改善这些环境中的临终关怀。检查该领域出版物的数量、类型和质量有助于确定研究是否遵循自然的科学进展,从而为临终关怀的最佳实践提供信息。

目标

系统地回顾:

(i) 检查护士对急诊医院临终关怀的看法和参与的出版物的数量和类型(即测量、描述或干预研究)是否随时间而变化(即自 2000 年以来);

(ii) 涉及符合偏倚风险研究设计标准的护士的干预研究的比例;和

(iii) 符合最低偏倚风险标准的干预研究的有效性。

方法

在 MEDLINE、Embase、CINAHL 和 PsychInfo 中搜索了 2000 年 1 月至 2020 年 12 月期间以英文发表的基于数据的论文。如果研究侧重于护士对提供临终关怀的看法或在提供临终关怀中的作用,则纳入研究在医院。符合条件的论文被归类为描述性研究、测量研究或干预研究。干预研究根据研究设计的偏倚风险方法标准进行评估,并检查其有效性。

结果

共有 131 篇论文符合纳入审查的资格标准。这个数字在每个时间段内增加了 31%(p  < 0.0001)。大多数研究是描述性的(n  = 70;53%),11 项是测量研究(8%),其余的是干预研究(n  = 50;38%)。13 项干预研究 (26%) 符合资格标准。符合条件的干预研究的方法学质量参差不齐。结果评估者的随机化和盲法是最受关注的领域。结果是多变的,更大的、全系统的干预措施结合了多学科医疗团队的专业知识,显示出最大的希望。

结论

越来越多的研究调查了护士对急诊医院临终关怀的看法和参与情况。在该领域进行干预研究的困难意味着许多研究本质上是描述性的。鉴于干预研究在建立因果关系中的重要性,更大规模的干预研究对于提高为在医院死亡的患者提供的临终关怀的质量至关重要。

更新日期:2021-07-20
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