Severe and persistent mental illnesses refer to a group of psychiatric disorders causing severe dysfunction in patients and include diagnoses such as schizophrenia, bipolar disorder, and major depression. Patients with severe and persistent mental illnesses have a complex symptomatology and face complicated medical disparities creating a difficult care process and reduced quality of life. Palliative care, a holistic approach to care that aims to reduce symptoms and stress of illness in persons living with chronic diagnoses, is appropriate within this population to address the complexity of care needs but is currently underutilized. The purpose of this review was to systematically review the literature to determine what is currently known about palliative care utilization in the severe and persistently mentally ill population. The databases systematically searched include PubMed, Cumulative Index for Nursing and Allied Health Literature, PsycINFO, and MEDLINE, to find all articles relevant to the research question. Keywords include "palliative care," "end-of-life care," and "severe and persistent mental illness," including all subsets. Literature was reviewed per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The results of this systematic review helped synthesize current information about this developing topic to inform clinicians on how to best integrate palliative care to this population.

To understand and analyze the concept of "unbearable suffering" using a concept analysis method and to propose a new nursing diagnosis, the Walker and Avant method of concept analysis was used. Following the concept analysis method in 8 steps, a literature search was carried out in the MEDLINE, Dialnet, WOS, and PsycINFO databases between 2016 and 2020. Articles of theoretical or empirical nature, written in English, with the abstract available were included. As a result, 11 articles (4 theoretical and 7 empirical) were included. In addition, 2 cases were developed. The proposed new diagnosis, "unbearable suffering," refers to the situation of an individual who, because of a variety of factors, regardless of the cause, feels that he/she is unable to bear the suffering he/she is experiencing. The diagnosis is proposed for inclusion in "Domain 9: Coping/Stress Tolerance" and "Class 2: Coping Responses" of the North American Nursing Diagnosis Association taxonomy. Recognition of a nursing diagnosis for unbearable suffering could be key in identifying this type of suffering and facilitating interventions to reduce or mitigate it. Nurses play a fundamental role in situations of high levels of end-of-life suffering.

Objectives
To examine the effectiveness of group cognitive behavioural therapy (CBT) for postpartum depression (PPD) delivered by public health nurses with little to no previous psychiatric training at improving depression, worry, social support and the mother-infant relationship.

Methods
Mothers (n = 141) living in Ontario, Canada with Edinburgh Postnatal Depression Scale Scores ≥10 and an infant <12 months of age were randomized to receive nine weekly 2-h sessions of in-person group CBT for PPD delivered by two public health nurses plus treatment as usual (TAU; experimental group) or TAU alone (control group). Primary outcomes were change in EPDS score and current major depressive disorder (Mini International Neuropsychiatric Interview) assessed immediately post-treatment (T2). Secondary outcomes included maternal worry, social support, and quality of the mother-infant relationship. All outcomes were assessed again six months post-treatment (T3).

Results
Participants in the experimental group had statistically significantly greater reductions in PPD symptoms immediately post-treatment (T2) (B = -5.35, p < 0.01), were more likely to manifest a clinically significant improvement in EPDS scores (≥4 points; OR = 3.44, 95%CI: 1.49–7.94), and no longer have symptoms consistent with current MDD (OR = 5.31, 95% CI: 1.78–15.83). Six months post-treatment (T3), experimental group participants had higher odds of clinically significant PPD improvement (OR = 5.10, 95%CI: 1.89–13.78), while 25% of the experimental group and 70% of remaining control group participants reported current MDD (p < 0.01). Statistically significant improvements in worry and the mother-infant relationship were also observed, decreases maintained at six months post-treatment.

Conclusions
Public health nurses with little to no previous psychiatric training can be trained to deliver effective group CBT for PPD to improve depression, worry, and the mother-infant relationship. Task shifting PPD treatment with group CBT to public health nurses could improve treatment uptake and lead to better outcomes for mothers, families, and the healthcare system.

(Trial Registration NCT03039530)

L’apparition d’une plaie a un fort retentissement sur le plan somatique, fonctionnel et psycho-social chez la personne âgée. Elle peut altérer significativement sa qualité de vie. Le rôle de l’infirmière spécialiste clinique, en partenariat avec l’équipe pluridisciplinaire, est fondamental pour une prise en charge globale individualisée. La construction du projet thérapeutique se définit à partir d’une évaluation multidimensionnelle du patient et de sa plaie.

Background: Prolonged exposure to work-related stress can lead to nurse burnout, potentiating clinical and medication errors and low-quality patient care. Holistic approaches (such as mindfulness training, "zen rooms," and massage chairs, among others) have been shown to reduce nurses' anxiety, stress, and burnout.

Purpose: To evaluate the use of "serenity lounges" (dedicated rooms where nurses can take workday breaks for the purposes of relaxation and rejuvenation) and massage chairs on nurses' anxiety, stress, and burnout.

Methods: This quality improvement project analyzed 67 paired responses to surveys filled out by nurses before and after their use of serenity lounges at a medical center in Los Angeles between November 2020 and May 2021. Following successful implementation of a serenity lounge on a pilot unit, this project was expanded to a total of 10 units, including COVID-19 cohort units. As part of this expansion, massage chairs were added to 10 serenity lounges, along with items such as wipes, gloves, and shoe covers to enable nurses to adhere to infection control protocols.

Results: Analysis of the 67 paired responses to pre- and post-lounge-use surveys revealed a significant reduction in feelings of emotional exhaustion, burnout, frustration, being worn out, stress, and anxiety after use of the serenity lounge. Improvements in feelings of emotional exhaustion, being worn out, and being anxious were also noted after using the massage chair for at least 10 to 20 minutes.

Conclusions: These results highlight the importance of providing a holistic approach, including a serene space, massage equipment, and other amenities, to help nurses reduce feelings of anxiety, stress, and burnout, particularly during challenging times such as the COVID-19 pandemic.

OBJECTIVE: To investigate the scales used in the diagnosis of incontinence-associated dermatitis (IAD), including the risk factors included in the scales, their reliability and validity, and in which patient groups the scales have been applied.

DATA SOURCES: The relevant studies were screened retrospectively using five MeSH (Medical Subject Headings) keywords in various combinations. Seven international databases were screened between March and July 2019. In total, 2,908 studies published between 2009 and 2019 were evaluated.

STUDY SELECTION: Inclusion criteria for studies were as follows: written in English, published between 2009 and 2019, and investigated a scale developed to diagnose IAD (quantitative studies, randomized controlled studies, or meta-analyses). Studies were excluded if they did not examine scales for diagnosing IAD or were not in English. Nine studies were included in this review: five studies on scale development, one scale revision, one scale reliability study, and two Turkish validity and reliability studies.

DATA EXTRACTION: The study methods, sample characteristics, interventions, validity and reliability analyses, risk factors in the scales, and subdimensions of the scales were examined for each of the nine included studies.

DATA SYNTHESIS: Study samples were composed of nurses, healthcare professionals, patients, or individuals living in a nursing home and ranged in size from 9 to 823 participants. Most data were collected from hospital-wide clinics. The scales used investigated redness, rash, skin loss, incontinence type, infection symptoms, skin color, edema, patient experience, pain, and perineal care habits. Both validity and reliability of the scales were examined in eight of the studies; in one study, only reliability was examined because the scale validity was shown in previous research. Moreover, sensitivity and specificity were indicated in one study.

CONCLUSIONS: There are several competent scales in the literature with proven validity and reliability that can be used to diagnose IAD.

Purpose: The aim of this study was to explore associations between social support, sense of control, and attributed dignity in persons aged 65 years and older who self-manage multiple chronic conditions while living in the community.

Design: A descriptive, nonexperimental, correlational design was used in this study.

Methods: Eighty-nine participants completed telephone surveys that measured social support, sense of control and attributed dignity. Regression analysis was used to identify associations.

Results: Participants were independent in seven of the eight instrumental activities of daily living, with participants having an average of 11 (+/-4) chronic conditions. Significant positive relationships between social support, perceived sense of control, and attributed dignity were identified.

Conclusions: Positive social support is strongly associated with perceived sense of control and attributed dignity.

Clinical Relevance: Healthcare professionals, especially rehabilitation nurses, can assess social support and offer ways to improve social support, thus enhancing sense of control and attributed dignity. These concepts enhance older individuals' ability to manage multiple chronic conditions.

Primary caregivers face constant challenges because of changes in the clinical situation of the person receiving palliative home care. These changes can alter the health-related quality of life and all its dimensions. This study aimed to describe the health-related quality of life of 137 primary caregivers of people enrolled in a palliative home care program in Bogota, Colombia, applying a quantitative, descriptive, and cross-sectional research design. The Caregiver's Quality of Life Instrument, initially developed by Ferrell, and the sociodemographic characteristics form for caregivers of people with chronic disease, both previously validated in the Colombian population, were used. The results showed that the primary caregivers have a good and adequate overall health-related quality of life; however, they presented some alterations in the physical, psychological, and social dimensions. Therefore, nursing and interdisciplinary palliative care teams should aim their interventions not only at patients but also at primary caregivers during palliative home care.

Patients with cancer are living longer, and many experience pain secondary to tumor invasion or as a consequence of cancer-directed therapies. Opioid use disorders and associated morbidity and mortality have increased with dramatic rise during the SARS-CoV-2 pandemic. National and international stakeholders have developed clinical practice guidelines in an effort to curb opioid misuse and overdose-related death. However, to ensure that patients with cancer do not experience barriers to adequate pain management, most of these guidelines are not intended for patients with cancer-related pain or for those receiving palliative or hospice care. Oncology, palliative, and hospice care providers are increasingly tasked with the management of severe disease-related pain in the setting of coexisting opioid use disorder without research on the most effective risk and harm reduction strategies to guide care.

Clinicians should be familiar with addiction medicine and chronic pain literature and be able to incorporate some of these best practices. This case study reviews the management of severe cancer-related pain in a patient with co-occurring opioid use disorder, utilizing many of the best practices in available clinical practice guidelines for the management of chronic non-cancer-related pain.

Purpose: The aim of this study was to examine a fatigue model for older individuals based on the theory of unpleasant symptoms.

Research Design: The research design used was a secondary data analysis of the "Patient-Reported Outcomes Measurement Information System Profiles-Health Utilities Index" data set.

Methods: Multiple regression analysis and path analyses were used to examine hypothesized model paths.

Results: A number of comorbidities, pain, sleep, depression, anxiety, education, and sensory impairment were significant predictors of fatigue. Higher fatigue scores predicted lower physical, social, and cognitive performances, as well as worse perceived health and quality of life (QOL). In addition, the identified fatigue outcomes mediated the relationship between fatigue and QOL.

Conclusions: Future research should be directed toward exploring other risk factors of fatigue and examining feedback loops depicted in the theory of unpleasant symptoms.

Clinical Relevance to the Practice of Rehabilitation Nursing: Rehabilitation nurses should closely monitor and manage the identified fatigue-influencing factors to improve older individuals' performance, perceived health, and QOL.

Background: Family-centered care is a philosophy and healthcare delivery model adopted by many neonatal intensive care units (NICUs) worldwide, yet practice varies widely.

Purpose: The aim of this study was to synthesize recommendations from frontline NICU healthcare professionals regarding family-centered care.

Methods: Data were obtained from the baseline phase of a multicenter quasi-experimental study comparing usual family-centered NICU care (baseline) with mobile-enhanced family integrated care (intervention). Members of the NICU clinical care team completed a family-centered care survey and provided free-text comments regarding practice of family-centered care in their NICU and recommendations for improvement. The comments were analyzed using a directed content analysis approach by a research team that included NICU nurses and parents.

Results: Of the 382 NICU healthcare providers from 6 NICUs who completed the survey, 68 (18%) provided 89 free-text comments/recommendations about family-centered care. Almost all comments were provided by nurses (91%). Six main themes were identified: language translation; communication between staff and families; staffing and workflow; team culture and leadership; education; and NICU environment. The need for greater resources for staffing, education, and environmental supports was prominent among the comments, as was team culture and staff-parent communications.

Implications for Practice: The NICU healthcare professionals identified a range of issues that support or impede delivery of family-centered care and provided actionable recommendations for improvement.

Implications for Research: Future research should include economic analyses that will enable determination of the return on investment so that NICUs can better justify the human and capital resources needed to implement high-quality family-centered care.

Alliant la théorie de l'enseignement à la pratique centrée sur la prise en charge globale des patients, les cahiers infirmiers sont pensés pour faciliter l'acquisition des connaissances indispensables à l'exercice du métier au quotidien.

Cet ouvrage est composé de 4 parties :
Partie I - Les bases en anatomie et physiologie
Partie II - Les explorations, examens cliniques et principaux examens complémentaires
Partie III - Les principaux syndromes
Partie IV - Les pathologies

La compréhension et l'acquisition des connaissances sont facilitées par une présentation tout en couleurs, de nombreux tableaux, illustrations, photographies et une série d'encadrés :
- Protocole de soin,
- Protocole d'examen,
- Démarche clinique infirmière,
- Raisonnement clinique partagé,
- Pour la pratique, on retiendra,
- La pharmacologie avec les modalités d'administration des médicaments et de surveillance.

Des exemples de cibles prévalentes en lien avec chaque pathologie sont proposés afin d'initier le futur professionnel aux transmissions ciblées et des situations cliniques mettent en valeur l'aspect pratique de la collection.

La table des matières remaniée, du général au plus pointu, permettra de découvrir la profession de manière graduelle. Bénéficiez d’abord du portrait actuel de la profession et des fondements théoriques de la discipline. Plongez ensuite au coeur de la pratique infirmière avec la démarche de soins et le jugement clinique. Apprenez à les appliquer dans le reste de l’ouvrage et dans toutes sortes de contextes. Grâce à la couleur et à des pastilles qui marquent les étapes, repérez et suivez facilement la démarche. Mettez-vous dans la peau de l’infirmière avec les mises en situation et vous comprendrez ainsi comment appliquer cette méthode de pensée. Enfin, réviser devient un jeu d’enfants avec les schémas qui résument les contenus théoriques et pratiques.