Valerie Danesh

Objective: This study examined a novel method to differentiate between mental and physical stress using Baevsky’s Enhanced Stress Technique. Background: Occupational stress events, whether mental or physical, are handled by the sympathetic and parasympathetic nervous systems, which have been shown to be associated with heart rate variability (HRV), but have not been previously differentiated. Method: Naturalistic HRV and accelerometer data were measured continuously using wrist-worn sensors during a typical 12-h direct-care nursing shift (28 ICU nurses). Physical and mental stress events were calculated using the Baevsky’s Stress Index, and Activity Index was used to investigate their differences between mental and combined mental and physical stress. Results: Root mean square of successive differences between heartbeats (RMSSD), which is associated with the parasympathetic nervous system activity as well as low-frequency power/high-frequency power (LF/HF ratio), and the alpha value of detrended fluctuation analysis (DFA a2), which are associated with the balance between sympathetic and parasympathetic nervous system activity, were the most predictive features of stress events (accounting for AUC of 85.46). Conclusion: Baevsky’s Enhanced Stress Technique shows promise in assessing occupational mental stress among ICU nurses. There were more persistent and significant physiological changes in HRV associated with combined mental and physical stress events. Application: Findings suggest a new stress measurement method for classifying occupational mental stress. Measurement using wrist-worn accelerometer and HRV data sources has pragmatic relevance to the design of real-time, noninvasive, and cost-efficient stress monitoring tools relevant to applications in high-stress work environments.

Aim: Analyse the concept of expertise among practicing clinical nurses in hospital settings. Background: The generational loss of expert clinical nurses was exacerbated globally by the novel coronavirus. This ongoing loss combined with the increased complexity of hospitalised patients has prompted an urgent need to understand expertise among clinical nurses who practice in hospital settings. Methods: Walker and Avant's concept analysis method was used. PubMed, Medline, CINAHL and Access Medicine were searched (1982–2025) for research studies and literature reviews published in English that addressed clinical nursing expertise in hospitals. Results: Expertise is the knowledge and skills that are enculturated from immersion in a domain. Common attributes include obtaining salient information from different sources , interpreting patient situations rapidly and holistically , and performing actions that are individualised, immediate and appear instinctive . Common antecedents include deliberate accumulation of relevant experience and contextual connections within the hospital . Facilitating improved outcomes and facilitating improved outcomes are common consequences. Conclusion: The attributes, antecedents and consequences of clinical nursing expertise are complementary and cross specialties. Experts' apparently instinctive actions are not intuitive but rather related to relevant past experiences, pattern recognition and skilled know‐how. The requirements to develop expertise have evolved with the increased volume of available knowledge. Implications for the Profession: Expertise requires cultivating relevant experiences through active engagement with patients and creating contextual connections with others regarding hospital systems and processes. Experts should be formally included when developing processes and guidelines. Low‐fidelity proxy measures like years of experience should be replaced with psychometrically validated instruments to measure expertise. Impact: This concept analysis addresses the ambiguity of clinical nursing expertise by synthesising over 40 years of literature and provides insights for clinical nurses and researchers regarding the importance of context and the growing complexity of care delivery. Patient or Public Contribution: No patient or public involvement.

Improvements in critical care treatments have led to an increased number of survivors of critical illness and an enhanced recognition of the problems which these patients encounter. Despite this, the ideal strategies to both prevent and manage the problems which people face are yet to be fully elucidated. This review explores the current methods employed to help mitigate problems encountered by survivors of critical illnesses and current barriers that limit their implementation. We will explore the effect of these issues on under-represented communities and the feasibility of delivering these strategies globally, as well as recent advances in mechanistic research and methodological innovation as promising areas for further work. In doing so, it summarises the potential avenues for future research with a view to advancing clinical care and outcomes in survivors of critical illness.

Background Family members of critically ill patients are known to experience short and longer term challenges, including emotional and social problems. To undertake robust future interventional research to support this cohort, we undertook a comprehensive evaluation of the measures used in family outcome research to date. Design Scoping review. We searched Medline, PsycINFO, Scopus, CINAHL, and Web of Science (core collection) for articles published between 2000 and 2024 which examined the outcomes of family members of critically ill patients. Data on outcome measures, study design, and population characteristics were extracted from eligible studies. Results We reviewed 9873 abstracts and identified 388 eligible unique family member cohorts. Across these studies, there were 59 (15.2%) randomised control trials, 287 (74.0%) observational cohorts, 8 (2.1%) quality improvement programmes, and 34 (8.8%) non-randomised controlled interventional studies. Most research was undertaken in USA, Canada, and Europe (n = 264, 67.5%). A total of 218 different outcomes measures were used across the studies included. In this review, 345 (89%) studies measured emotional or psychological outcomes, 85 (22%) measured family experience outcomes, 65 (17%) measured general functional status, quality of life or well-being outcomes, 35 (9%) measured environmental or social outcomes, and 10 (3%) measured cognitive outcomes. Conclusions We identified 388 studies which reported the outcomes of family members of critically ill patients. Over 200 different outcomes measures were utilised, exploring conceptual domains such as quality of life as well as psychological and social outcomes. The majority of studies were observational in nature with variable follow-up timelines. This review has highlighted that a core outcome measure set is essential to enable reliable, robust, and comparable interventional research in this area.

Background: To determine methods of FOBT de-implementation in acute care practice while summarizing the reasons and contraindications for inappropriate FOBT in acute care settings. Fecal occult blood testing is valuable for colorectal cancer screening in ambulatory settings but is not valuable for diagnostics in acute care with consistent indications for discontinuation as a tradition-based practice. Methods: We included all English language prospective and retrospective evaluation studies of FOBT use in acute care settings with or without de-implementation interventions and published as original research articles in peer-reviewed journals. A meta-analysis of FOBT positivity was conducted using a random effects model. Quality was assessed using Critical Appraisals Skills Programme criteria. Results: Of 2471 abstract/titles screened, 157 full-text articles were reviewed, and 22 articles met inclusion criteria of measuring prevalence or de-implementation of FOBT use in acute care settings. All 22 studies evaluated either FOBT use or de-implementation. Twenty articles reported FOBT positivity, with some illustrating that FOBT results were inconsequential to subsequent endoscopy decisions (n = 7, 32%). The included studies represent a publication date range spanning 32 years, with limited documentation of de-implementation strategies. Four published studies described system-level disinvestment to administratively eliminate access to inpatient FOBT orders. Conclusion: Overall, all studies endorse that the use of FOBTs in acute care settings results in increased workload and/or cost without diagnostic benefit. Critical appraisal of low-value tradition-based practices such as FOBT use in acute care settings are essential for deploying deliberate and effective de-implementation strategies.