BACKGROUND: The accuracy of colonoscopy results is significantly affected by the quality of bowel preparation. Identifying and understanding the factors that contribute to effective bowel preparation are crucial for opti...BACKGROUND: The accuracy of colonoscopy results is significantly affected by the quality of bowel preparation. Identifying and understanding the factors that contribute to effective bowel preparation are crucial for optimizing patient outcomes. PURPOSE: The aim of this meta-analysis was to systematically evaluate the variables influencing bowel preparation efficacy in order to inform the development of improved clinical protocols and patient care strategies. METHODS: We conducted a literature search of several databases to find studies that investigated factors affecting the quality of bowel preparation over a period ranging from the inception of each database to November 5, 2024. Studies were independently screened based on preestablished inclusion and exclusion criteria. The meta-analysis was conducted using RevMan 5.4 software. RESULTS: The meta-analysis included 27 articles containing data from 30,716 patients who underwent bowel preparation for colonoscopy. Eight factors were identified that were significantly associated with suboptimal bowel preparation: older age (odds ratio [OR], 1.28; 95% CI, 1.12-1.68; P = 0.019), male gender (OR, 1.33; 95% CI, 1.16-1.53; P < 0.001), chronic constipation (OR, 3.46; 95% CI, 2.65-4.09; P < 0.001), diabetes (OR, 4.72; 95% CI, 2.18-10.22; P < 0.001), use of opioids (OR, 1.62; 95% CI, 1.24-2.45; P = 0.006), a preprocedure high-fiber diet (OR, 2.94; 95% CI, 1.65-5.22; P < 0.001), an interval exceeding five hours between the final administration of the bowel cleansing agent and the procedure (OR, 2.82; 95% CI, 1.79-4.45; P < 0.001), and a last bowel movement that is not watery (OR, 4.78; 95% CI, 2.35-9.71; P < 0.001). CONCLUSION: Health care providers, including nurses, should consider these determinants of bowel preparation effectiveness and implement appropriate interventions in a timely manner to enhance patient education and care.
Editor's note: This is the 30th article in a series on clinical research by nurses coordinated by the Heilbrunn Family Center for Research Nursing at Rockefeller University. The series is designed to be used as a resourc...Editor's note: This is the 30th article in a series on clinical research by nurses coordinated by the Heilbrunn Family Center for Research Nursing at Rockefeller University. The series is designed to be used as a resource for nurses to understand the concepts and principles essential to research. Each column will present the concepts that underpin evidence-based practice-from research design to data interpretation-and most can be read without knowledge of the preceding articles. To see all the articles in the series, go to https://links.lww.com/AJN/A204.
BACKGROUND: Children with medical complexity (CMC) have a high risk of readmission and encounter numerous barriers to care after hospital discharge. Several programs have attempted to mitigate these challenges, with vari...BACKGROUND: Children with medical complexity (CMC) have a high risk of readmission and encounter numerous barriers to care after hospital discharge. Several programs have attempted to mitigate these challenges, with variable impact on readmission rates and care fragmentation. PURPOSE: We implemented a novel telehealth program utilizing the full scope of nursing practice to support hospital-to-home transitions and reduce readmission rates for CMC. The aim of our program was to achieve a 10% reduction in the baseline 30-day readmission rate for this population. METHODS: Eligible inpatients were those with one or more home health orders, a hospital stay of at least seven days, and a previous hospitalization/ED visit in the past year or an intensive care admission during the current hospitalization. The intervention consisted of a virtual nurse visit three to seven days after discharge, with additional follow-up as needed, and handoff to the outpatient team within 30 days to reduce care fragmentation. Our primary outcome was 30-day readmission rates compared to the historical baseline for similar patients. Secondary outcomes included the identification and resolution of care barriers and 30-day ED revisit rates. RESULTS: From January 2020 to June 2024, 974 patients were enrolled in the program, and nurses completed 1,377 telehealth encounters. The 30-day readmission rate decreased from 17.6% to 10.1% over four years. We identified care barriers in 51% of encounters, primarily related to scheduling follow-up appointments (28.5%) and obtaining medical supplies (21.1%). The 30-day ED revisit rate declined from the preintervention baseline of 12.4% to 10.3%. CONCLUSIONS: By utilizing nurses working at the top of their license, readmission rates were reduced for a diverse, high-risk patient population. Novel features of the program included minimal exclusion criteria; bridging inpatient and outpatient care teams; and the ability to address clinical questions, care coordination, and social determinants of health needs through a single point of contact. Successful implementation at a second hospital suggests that the model to reduce readmission rates in complex patients could be replicated elsewhere.
People undergoing ostomy surgery face an extended physiologic and psychosocial recovery. It is not uncommon to experience interruptions in work, pursuing life goals, relationships, physical activity, and social life. Eve...People undergoing ostomy surgery face an extended physiologic and psychosocial recovery. It is not uncommon to experience interruptions in work, pursuing life goals, relationships, physical activity, and social life. Even those with previous travel experience may feel inhibited by their new ostomy. Nurses, including those experienced in wound and ostomy continence, provide essential care to patients recovering from surgery and adjusting to their stoma. With counseling, education, and experience, patients can develop increasing competence and autonomy. This, in turn, helps an ostomate look forward to social activities-including traveling. However, there may be concerns related to stoma management; worry about packing essential appliances; and fear of leaking, odor, and embarrassment from loud stoma noises. This article provides focused information and resources to guide nurses in preparing people living with stomas for safe and enjoyable travel within the parameters of their special health condition and needs.
BACKGROUND: As the largest part of the health care workforce, nurses are vital to efforts to meet the social and environmental needs of individuals' health. Food insecurity is a growing problem globally and contributes t...BACKGROUND: As the largest part of the health care workforce, nurses are vital to efforts to meet the social and environmental needs of individuals' health. Food insecurity is a growing problem globally and contributes to disproportionally higher mortality and morbidity rates, particularly within communities that have been intentionally and historically disinvested. However, literature that examines research related to food insecurity where nurses are involved as researchers, clinicians, or authors is scant. PURPOSE: The purpose of this integrative review was to systematically synthesize and critically analyze findings of nurse-involved studies that address food insecurity, identifying key interventions and outcomes across diverse health care and community settings. METHODS: A systematic search was conducted of multiple databases for peer-reviewed literature from database inception through December 4, 2023. Databases searched were Web of Science, Embase (Ovid), CINAHL, Ovid MEDLINE, Academic Search Complete (EBSCO), and CABI (Centre for Agriculture and Biosciences International) Digital Library. The search used a combination of keywords and controlled vocabulary related to the concepts food insecurity and nursing. The quality of the evidence was evaluated using the scoring system of Olsen and Baisch, which rates articles according to study type, sampling method, details of data collection, and analysis. Articles are scored on a scale of 2 to 13, with higher scores indicating higher-quality evidence. The contributions of nurses to each article as researchers, clinicians, and/or authors were also recorded. RESULTS: Fifty-three articles met the inclusion criteria and were included in the in-depth analysis. Article types included one randomized controlled trial, 18 nonrandomized experimental studies, nine mixed-methods studies, eight cross-sectional studies, 10 qualitative studies, five quality improvement projects, one cohort study, and one program evaluation. The mean score for the quality of evidence was 9.1, indicating reasonable rigor. Four themes emerged from the analysis: health outcomes, health behaviors, building capacity, and building belonging. Across the articles, nurses were shown to have contributed in various roles to the alleviation of food insecurity and to improvements in the health and well-being of individuals and communities. CONCLUSIONS: In this integrative review, many positive changes were found in food insecurity and health (including mental health) outcomes. Nurses added to the state of the science of food insecurity as researchers, clinicians, and/or authors, although it is likely that many nurse-driven actions were not captured in the articles. This integrative review adds to the body of knowledge of methods being studied to alleviate this global problem and nurses' contributions to improvements in health outcomes, health behaviors, community capacity, and community members' sense of belonging.
BACKGROUND: Discharge readiness is a critical determinant of patient outcomes, particularly for patients with aortic dissection, a highly lethal cardiovascular disease. PURPOSE: This study aimed to assess the level of di...BACKGROUND: Discharge readiness is a critical determinant of patient outcomes, particularly for patients with aortic dissection, a highly lethal cardiovascular disease. PURPOSE: This study aimed to assess the level of discharge readiness in patients with acute aortic dissection, and to analyze the influencing factors in order to better support patients' postdischarge recovery and improve their long-term prognoses. METHODS: Patients who underwent surgery for aortic dissection at our hospital and were in the process of recovery and preparing for discharge were included in the study. Discharge readiness was assessed with a widely used, validated discharge readiness scale. Multiple linear regression analysis was performed to identify influencing factors. RESULTS: A total of 218 patients with aortic dissection were enrolled. The mean (SD) total discharge readiness score for these patients was 160.75 (21.38), and the mean (SD) score per item was 7.38 (1.02). Correlation analysis revealed that age, education level, place of residence, family monthly income, and recurrent aortic dissection were each significantly correlated with discharge readiness. Multiple linear regression analysis identified age, education level, place of residence, family monthly income, and recurrent aortic dissection as significant independent predictors of discharge readiness in patients with aortic dissection. CONCLUSIONS: This study revealed that patients with aortic dissection generally had discharge readiness scores at the lower end of the moderate range, indicating the need for improvement. It's imperative that health care providers emphasize patient education prior to discharge and develop and implement personalized discharge plans for these patients in order to improve not only their discharge readiness but also their postdischarge quality of life and long-term prognoses.