BackgroundPractitioner-level implementation interventions such as audit and feedback, communities of practice, and local opinion leaders have shown potential to change nurses’ behaviour in clinical practice and improve patients’ health. However, their effectiveness remains unclear. Moreover, we have a paucity of data regarding the use of theory in implementation studies with nurses, the causal processes—i.e. mechanisms of action—targeted by interventions to change nurses’ behaviour in clinical practice, and the constituent components—i.e. behaviour change techniques—included in interventions. Thus, our objectives are threefold: (1) to examine the effectiveness of practitioner-level implementation interventions in changing nurses’ behaviour in clinical practice; (2) to identify, in included studies, the type and degree of theory use, the mechanisms of action targeted by interventions and the behaviour change techniques constituting interventions and (3) to examine whether intervention effectiveness is associated with the use of theory or with specific mechanisms of action and behaviour change techniques.MethodsWe will conduct a systematic review based on the Cochrane Effective Practice and Organization of Care (EPOC) Group guidelines. We will search six databases (CINAHL, EMBASE, ERIC, PsycINFO, PubMed and Web of Science) with no time limitation for experimental and quasi-experimental studies that evaluated practitioner-level implementation interventions aiming to change nurses’ behaviour in clinical practice. We will also hand-search reference lists of included studies. We will perform screening, full-text review, risk of bias assessment, and data extraction independently with the Covidence systematic review software. We will assess the quality of evidence using the GRADEpro software. We will code included studies independently for theory use (Theory Coding Scheme), mechanisms of action (coding guidelines from Michie) and behaviour change techniques (Behaviour Change Technique Taxonomy v1) with QSR International’s NVivo qualitative data analysis software. Meta-analyses will be performed using the Review Manager (RevMan) software. Meta-regression analyses will be performed with IBM SPSS Statistics software.DiscussionThis review will inform knowledge users and researchers interested in designing, developing and evaluating implementation interventions to support nurses’ behaviour change in clinical practice. Results will provide key insights regarding which causal processes—i.e. mechanisms of action—should be targeted by these interventions, and which constituent components—i.e. behaviour change techniques—should be included in these interventions to increase their effectiveness.Systematic review registrationThe protocol has been registered at the International Prospective Register of Systematic Reviews (PROSPERO; registration number: CRD42019130446).
Gestational hypertension, preeclampsia, and peripartum cardiomyopathy are among the most common and often severe pregnancy-specific cardiovascular diseases (CVDs) and causes of complications in pregnancy. This clinical review provides nurses with an overview of pregnancyspecific CVDs, outlines their pathophysiology, and discusses risk factors and assessment. It describes management interventions according to timing: the antepartum, intrapartum, and postpartum phases are each addressed.
Background: The use of chemical restraints (CRs) in health care facilities is a complex intervention that raises questions about its effectiveness and whether it is safe and patient oriented. Purpose: This review aims to gather nursing quality standards for the use of CR through an innovative method of knowledge synthesis, the realist review, to support the development of a quality evaluation tool. Methods: A realist review method was chosen. Results: An operational definition of chemical restraint is proposed, a concept seen as synonymous with the management of behavioral symptoms by pharmacological agents with sedative proprieties. Twenty-eight quality standards were identified and presented in a theoretical model. Conclusions: These quality standards will allow the evaluation of practices from a nursing perspective for the use of CR in health care settings.
One hundred and twenty-five consecutive patients with infectious endocarditis were examined by transthoracic (TTE) and transesophageal echocardiography (TEE). They included 91 cases of endocarditis on native valves and 34 cases on prosthetic valves. The detection rate for vegetations was significantly greater (93%) by TEE than by TTE (73%) on native valves, but the rate of detection of vegetations on prosthetic valves was low and not significantly different between the two methods. Out of a total of 20 abscesses, only 8 were detected by TEE as compared with 17 by TEE. TEE gave three false negatives; small anterior abscesses masked by a prosthesis or aortic calcifications. In addition, TEE visualized three perforations and three mycotic aneurysms of the mitral valve. The lesions were confirmed anatomically in 51 cases. Referring to the overall detection of vegetations and complications, TEE had a sensitivity of 94% and a specificity of 84.5%, with a negative predictive value of 87.5%. These results show that TEE is significantly better than TTE for the detection and morphological analysis of vegetations and abscesses.
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