International Journal of Nursing Sciences最新文献_第2页

Nursing Retrieval-Augmented Generation: Retrieval augmented generation for nursing question answering with large language models 护理检索增强生成：基于大语言模型的护理问题回答的检索增强生成

IF 3.1 3区医学 Q1 NURSING

International Journal of Nursing Sciences

Pub Date : 2025-11-01 DOI: 10.1016/j.ijnss.2025.10.005

Liping Xiong , Qiqiao Zeng , Weixiang Luo , Ronghui Liu

Objective

This study aimed to develop a Nursing Retrieval-Augmented Generation (NurRAG) system based on large language models (LLMs) and to evaluate its accuracy and clinical applicability in nursing question answering.

Methods

A multidisciplinary team consisting of nursing experts, artificial intelligence researchers, and information engineers collaboratively designed the NurRAG framework following the principles of retrieval-augmented generation. The system included four functional modules: 1) construction of a nursing knowledge base through document normalization, embedding, and vector indexing; 2) nursing question filtering using a supervised classifier; 3) semantic retrieval and re-ranking for evidence selection; and 4) evidence-conditioned language model generation to produce citation-based nursing answers. The system was securely deployed on hospital intranet servers using Docker containers. Performance evaluation was conducted with 1,000 expert-verified nursing question–answer pairs. Semantic fidelity was assessed using Recall Oriented Understudy for Gisting Evaluation – Longest Common Subsequence (ROUGE-L), and clinical correctness was measured using Accuracy.

Results

The NurRAG system achieved significant improvements in both semantic fidelity and answer accuracy compared with conventional large language models. For ChatGLM2-6B, ROUGE-L increased from (30.73 ± 1.48) % to (64.27 ± 0.27) %, and accuracy increased from (49.08 ± 0.92) % to (75.83 ± 0.35) %. For LLaMA2-7B, ROUGE-L increased from (28.76 ± 0.89) % to (60.33 ± 0.21) %, and accuracy increased from (43.27 ± 0.83) % to (73.29 ± 0.33) %. All differences were statistically significant (P < 0.001). A quantitative case analysis further demonstrated that NurRAG effectively reduced hallucinated outputs and generated evidence-based, guideline-concordant nursing responses.

Conclusion

The NurRAG system integrates domain-specific retrieval with LLMs generation to provide accurate, reliable, and traceable evidence-based nursing answers. The findings demonstrate the system’s feasibility and potential to improve the accuracy of clinical knowledge access, support evidence-based nursing decision-making, and promote the safe application of artificial intelligence in nursing practice.

目的研究基于大语言模型（LLMs）的护理检索增强生成（NurRAG）系统，并评估其在护理问题回答中的准确性和临床适用性。方法由护理专家、人工智能研究人员和信息工程师组成的多学科团队，按照检索增强生成的原则，共同设计NurRAG框架。该系统包括四个功能模块：1)通过文档规范化、嵌入和向量索引构建护理知识库；2)基于监督分类器的护理问题过滤；3)语义检索和证据重新排序；4)循证语言模型生成，生成基于引用的护理答案。该系统使用Docker容器安全地部署在医院内网服务器上。采用1000对专家验证的护理问答对进行绩效评估。语义保真度采用面向召回的注册评价替代研究-最长公共子序列（ROUGE-L）评估，临床正确性采用准确性评估。结果与传统的大型语言模型相比，NurRAG系统在语义保真度和回答准确率方面都有显著提高。对于ChatGLM2-6B， ROUGE-L从（30.73±1.48）%提高到（64.27±0.27）%，准确率从（49.08±0.92）%提高到（75.83±0.35）%。llama1 - 7b的ROUGE-L准确度由（28.76±0.89）%提高到（60.33±0.21）%，准确度由（43.27±0.83）%提高到（73.29±0.33）%。差异均有统计学意义（P < 0.001）。定量案例分析进一步表明，NurRAG有效地减少了幻觉输出，并产生了循证的、符合指南的护理反应。结论NurRAG系统将特定领域检索与llm生成相结合，可提供准确、可靠、可追溯的循证护理答案。研究结果表明，该系统在提高临床知识获取准确性、支持循证护理决策、促进人工智能在护理实践中的安全应用方面具有可行性和潜力。

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引用次数: 0

Trajectories of cumulative fluid balance and the association with pressure injuries in ICU patients ICU患者累积体液平衡轨迹及其与压力损伤的关系

IF 3.1 3区医学 Q1 NURSING

International Journal of Nursing Sciences

Pub Date : 2025-11-01 DOI: 10.1016/j.ijnss.2025.10.004

Xiangping Chen, Peiqi Liu, Bingyan Zhu, Xiumin Qiu, Wei Yu, Yuewen Lao, Xiaoyan Gong, Yiyu Zhuang

Objective

This study aimed to investigate the longitudinal trajectories of cumulative fluid balance (CFB) in intensive care unit (ICU) patients and analyze the relationship between different trajectory groups and the occurrence of pressure injuries (PIs).

Methods

In this retrospective longitudinal study, we obtained health-related data from the Medical Information Mart for Intensive Care IV database, including sociodemographic, disease-related variables, and ICU treatment variables. The daily CFB adjusted for body weight was calculated, and the occurrence of PIs during the ICU stay was recorded. A group-based trajectory model was used to explore the different CFB trajectories. Binary logistic regression was used to analyze the relationship between the CFB trajectory group and PIs.

Results

Among the 4,294 included participants, we identified four distinct trajectories of CFB in ICU patients: the rapid accumulation group (12.5 %), the slow accumulation group (28.5 %), the neutral balance group (41.7 %), and the negative decrease group (17.3 %). After adjusting for some sociodemographic, disease-related variables, and ICU treatment variables, the rapid accumulation group had an OR of 1.63 (95 %CI: 1.30, 2.04) for all stages of PIs and an OR of 1.36 (95 %CI: 1.08, 1.72) for stage II or higher PIs compared to the neutral balance group.

Conclusions

Four unique trajectories of CFB were identified among patients in the ICU, including rapid accumulation, slow accumulation, neutral balance, and negative decrease. Rapid accumulation independently increased the risk of PIs during ICU stay.

目的探讨重症监护病房（ICU）患者累积体液平衡（CFB）的纵向轨迹，分析不同轨迹组与压伤（pi）发生的关系。方法在这项回顾性纵向研究中，我们从重症监护医学信息市场IV数据库中获得与健康相关的数据，包括社会人口学、疾病相关变量和ICU治疗变量。计算经体重调整后的每日循环流化床（CFB），并记录住院期间pi的发生情况。采用基于群体的轨迹模型对不同的循环流化床运行轨迹进行了研究。采用二元logistic回归分析CFB轨迹组与pi之间的关系。结果在纳入的4294名受试者中，我们确定了ICU患者CFB的四种不同轨迹：快速积累组（12.5%）、缓慢积累组（28.5%）、中性平衡组（41.7%）和负减少组（17.3%）。在对一些社会人口统计学、疾病相关变量和ICU治疗变量进行调整后，与中性平衡组相比，快速积累组所有阶段pi的OR为1.63 (95% CI: 1.30, 2.04)， II期或更高阶段pi的OR为1.36 （95% CI: 1.08, 1.72）。结论ICU患者CFB有快速积累、缓慢积累、中性平衡和负减少4种不同的发展轨迹。快速累积独立增加了ICU住院期间pi的风险。

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引用次数: 0

Trajectory and determinants of family resilience in caregivers of preterm infants: A mixed-methods study 早产儿照顾者家庭弹性的轨迹和决定因素：一项混合方法研究

IF 3.1 3区医学 Q1 NURSING

International Journal of Nursing Sciences

Pub Date : 2025-11-01 DOI: 10.1016/j.ijnss.2025.10.008

Caihui Su , Dun Liu , Shanshan Xu , Yongfen Wang , Yuehua Lin , Qingqing Lian

Objective

To investigate the dynamic trajectory, predictors, and underlying adaptation mechanisms of family resilience (FR) among Chinese families with preterm infants (PIs) from birth to six months.

Methods

Guided by Ecological Systems Theory, a convergent parallel mixed-methods study was conducted in the Neonatal Intensive Care Unit (NICU) of a tertiary hospital in Fujian Province, China, from June 2023 to June 2024. Quantitative data were collected from 202 caregivers selected by convenience sampling at four time points: at birth (T0), 42 days postpartum (T1), 3 months postpartum (T2), and 6 months postpartum (T3). Generalized Estimating Equations (GEE) was used to analyze scale score differences across time points and explore factors influencing FR. Qualitative data were collected through semi-structured interviews with 14 caregivers recruited by maximum variation purposive sampling and analyzed using Colaizzi’s phenomenological approach. After conducting separate data analyses, the findings were integrated through side-by-side comparison and joint display.

Results

Quantitative results revealed a non-linear, “V”-shaped trajectory of FR, significantly influenced by educational level, conception via assisted reproduction, farming occupation, coping style, psychological resilience, family functioning, and social support. Qualitative findings identified four themes: initial uncertainty and emotional distress, post-discharge anxiety, gradual adaptation, and eventual stabilization. Integrated mixed-methods findings revealed that the initial confusion phase demands a comprehensive response to family needs (T0); the post-discharge bottleneck requires addressing the care capability-needs gap (T1); the role adaptation phase is pivotal for enhancing internal family resources (T2); and the family-work transition necessitates enhanced work-family facilitation (T3).

Conclusions

This study systematically identifies the unique “V”-shaped trajectory of FR in Chinese families with PIs and its key influencing factors, and accurately analyzes their dynamic experiences and adaptation across four stages. These findings provide an empirical basis for stage-specific targeted interventions, strongly support the practical advancement of the family-centered care model, and deliver critical guidance for enhancing FR.

目的探讨中国出生至6个月早产儿家庭弹性的动态轨迹、预测因素及适应机制。方法以生态系统理论为指导，于2023年6月至2024年6月在福建省某三级医院新生儿重症监护病房（NICU）开展一项趋同平行混合方法研究。采用方便抽样的方法，选取202名护理人员，在出生时（T0）、产后42天（T1）、产后3个月（T2）和产后6个月（T3）四个时间点进行定量数据采集。采用广义估计方程（Generalized estimingequations， GEE）分析量表得分在时间点上的差异，探讨影响家庭责任的因素。采用最大变异目的抽样方法对14名照顾者进行半结构化访谈，收集定性数据，并采用Colaizzi现象学方法进行分析。在进行单独的数据分析后，通过并排比较和联合展示的方式将研究结果整合在一起。结果受教育程度、辅助生殖受孕、农业职业、应对方式、心理弹性、家庭功能和社会支持等因素的影响，生育生育率呈非线性的“V”型轨迹。定性研究结果确定了四个主题：最初的不确定性和情绪困扰，出院后焦虑，逐渐适应和最终稳定。综合混合方法的调查结果显示，最初的混乱阶段需要对家庭需求做出全面的反应（T0）；出院后瓶颈需要解决护理能力与需求之间的差距（T1）；角色适应阶段是增强家庭内部资源的关键阶段（T2）；家庭与工作的过渡需要加强工作与家庭的促进（T3）。结论本研究系统识别了中国pi家庭FR独特的“V”型轨迹及其关键影响因素，准确分析了pi家庭FR在四个阶段的动态经历和适应。这些发现为针对特定阶段的针对性干预提供了经验基础，有力地支持了以家庭为中心的护理模式的实际推进，并为提高FR提供了重要指导。

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引用次数: 0

Perceptions and recommendations of multiparas and health-related professionals on appropriate birth intervals: A descriptive qualitative study 多产妇和健康相关专业人员对适当生育间隔的看法和建议：一项描述性定性研究

IF 3.1 3区医学 Q1 NURSING

International Journal of Nursing Sciences

Pub Date : 2025-09-01 DOI: 10.1016/j.ijnss.2025.07.001

Hongyan Liu , Xinli Zhu , Zhijing Xu , Shuang Liang , Ya Liu , Xiaojiao Wang , Xu Qian , Chunyi Gu

Objectives

This study aimed to explore the perceptions and recommendations of multiparas and health-related professionals regarding appropriate birth intervals (BIs) and key determinants.

Methods

In-depth semi-structured interviews were conducted between April 1 and June 30, 2022. Nine multiparas and thirteen health-related professionals were purposefully sampled until data saturation was reached. A thematic analysis approach was applied to the interview transcripts, utilizing dual independent coding and consensus validation in NVivo 12.0.

Results

The data generated two overarching categories: 1) balanced decision-making on the appropriate birth intervals and 2) internal and external determinants integrated with health and societal considerations. Four key themes emerged following the two categories: 1) consistency and discrepancy between the actual and recommended birth intervals of multiparas; 2) health- and development-oriented professional recommendations; 3) internal determinants related to individual-level factors; and 4) external determinants related to child-related factors, family support, and social security. Weighing women’s reproductive health and career development, multiparas and health-related professionals perceived a length between 18 and 36 months as the appropriate BI.

Conclusion

Multiparas and health-related professionals shaped their balanced recommendations on a relatively appropriate birth interval ranging from 18 to 36 months, which was influenced by women’s individual-level factors, child-related factors, family support, and social security. Targeted social and healthcare services should be offered to women and their families during the BIs.

目的本研究旨在探讨多产妇和健康相关专业人员对适当生育间隔（BIs）和关键决定因素的看法和建议。方法于2022年4月1日至6月30日进行深度半结构化访谈。有目的地对9名多段落和13名与健康有关的专业人员进行抽样，直到达到数据饱和。在NVivo 12.0中使用双重独立编码和共识验证，采用主题分析方法对访谈记录进行分析。结果数据产生了两个总体类别：1)关于适当生育间隔的平衡决策；2)综合考虑健康和社会因素的内部和外部决定因素。以下两类出现了四个关键主题：1)实际和建议生育间隔之间的一致性和差异；2)以健康和发展为导向的专业建议；3)与个体层面因素相关的内部决定因素；4)与儿童相关因素、家庭支持和社会保障相关的外部决定因素。在权衡妇女的生殖健康和职业发展后，多产妇和健康相关专业人员认为18至36个月是适当的基本健康期。结论妇产科专业人员和健康相关专业人员对18 ~ 36个月生育间隔的均衡建议受妇女个人因素、儿童相关因素、家庭支持和社会保障等因素的影响。在生育期间，应向妇女及其家庭提供有针对性的社会和保健服务。

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引用次数: 0

Time series analysis of outpatient blood collection visits: Fluctuation patterns and nursing staff allocation optimization 门诊采血次数时间序列分析：波动模式及护理人员配置优化

IF 3.1 3区医学 Q1 NURSING

International Journal of Nursing Sciences

Pub Date : 2025-09-01 DOI: 10.1016/j.ijnss.2025.08.007

Shuangshuang Xing , Xiarong Du , Yan Hu , Yiqin Pu

Objectives

This study aimed to explore the characteristics of outpatient blood collection center visit fluctuation and nursing workforce allocation based on a time series model, and the application effect was evaluated.

Methods

To enhance the efficiency of phlebotomy at the hospital outpatient window and improve patient satisfaction, the First Affiliated Hospital with Nanjing Medical University implemented a time series analysis model in 2024 to optimize nursing staff allocation. The management team was led by a head nurse of the outpatient blood collection department with extensive experience. It included one director of the nursing department, six senior clinical nurses, one informatics expert, and one nursing master’s degree holder. Retrospective time-series data from the hospital’s smart blood collection system (including hourly blood collection volumes and waiting times) were extracted between January 2020 and December 2023. Time series analysis was used to identify annual, seasonal, monthly, and hourly variation patterns in blood collection volumes. Seasonal decomposition and the Autoregressive Integrated Moving Average Model (ARIMA) were employed to forecast blood collection fluctuations for 2024 and facilitate dynamic scheduling. A comparison was conducted to evaluate differences in blood collection efficiency and patient satisfaction before (January–June 2023) and after (January–June 2024) implementing the dynamic scheduling model based on the time series analysis and forecasting.

Results

Visit volumes showed periodicity and slow growth, peaking every second and third quarter of the year and daily at 8:00–9:00 a.m. and 2:00–3:00 p.m. The ARIMA model demonstrated a good fit (R² = 0.692, mean absolute percentage error = 8.28 %). After adjusting the nursing staff allocation based on the fluctuation characteristics of the number of phlebotomy per hour in the time series analysis model, at the peak period of the blood collection window, at least three nurses, one mobile nurse and two volunteers were added. The number of phlebotomy per hour increased from 289.74 ± 54.55 to 327.53 ± 37.84 person-time (t = -10.041, P < 0.01), waiting time decreased from 5.79 ± 2.68 to 4.01 ± 0.46 min (t = 11.531, P < 0.01), and satisfaction rose from 92.7 % to 97.3 % (χ² = 6.877, P < 0.05).

Conclusions

Based on the time series analysis method, it is helpful for nursing managers to accurately allocate human resources and optimize the efficiency of outpatient service resources by mining the special change rule of the outpatient blood collection window and predicting the future fluctuation trend.

目的基于时间序列模型，探讨门诊采血中心访问量波动及护理人员配置特点，并对应用效果进行评价。方法为提高医院门诊窗口放血效率，提高患者满意度，南京医科大学附属第一医院于2024年实施时间序列分析模型，优化护理人员配置。管理团队由一位经验丰富的门诊采血科护士长带领。其中护理部主任1人，高级临床护士6人，信息学专家1人，护理硕士1人。从医院的智能采血系统（包括每小时采血量和等待时间）中提取2020年1月至2023年12月的回顾性时间序列数据。时间序列分析用于确定血液采集量的年度、季节性、月度和小时变化模式。采用季节分解和自回归综合移动平均模型（ARIMA）预测2024年采血波动，便于动态调度。比较基于时间序列分析预测的动态调度模型实施前（2023年1月- 6月）与实施后（2024年1月- 6月）采血效率和患者满意度的差异。结果访客量呈周期性缓慢增长，在每年第二季度和第三季度达到高峰，每日在上午8:00-9:00和下午2:00-3:00达到高峰。ARIMA模型拟合良好（R2 = 0.692，平均绝对百分比误差= 8.28%）。根据时间序列分析模型中每小时采血次数的波动特征，调整护理人员配置后，在采血窗口高峰期，至少增加3名护士、1名流动护士和2名志愿者。每小时放血次数由289.74±54.55人次增加到327.53±37.84人次（t = -10.041, P < 0.01），等待时间由5.79±2.68分钟减少到4.01±0.46分钟（t = 11.531, P < 0.01），满意度由92.7%提高到97.3% （χ2 = 6.877, P < 0.05）。结论基于时间序列分析方法，挖掘门诊采血窗口的特殊变化规律，预测未来波动趋势，有助于护理管理者准确配置人力资源，优化门诊资源效率。

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引用次数: 0

Advance care planning among stroke patients: A scoping review 脑卒中患者的预先护理计划：一项范围综述

IF 3.1 3区医学 Q1 NURSING

International Journal of Nursing Sciences

Pub Date : 2025-09-01 DOI: 10.1016/j.ijnss.2025.08.009

Margareta Hesti Rahayu , Sri Sutarni , Heny Suseani Pangastuti , Eva Marti

Objective

This study aimed to describe the implementation of advance care planning (ACP) in patients with stroke.

Methods

A scoping review was conducted according to the Arksey and O’Malley framework. Accordingly, we searched for articles published in ScienceDirect, PubMed, Scopus, ProQuest, and Medline. The inclusion criteria were original research on ACP among adult or elderly stroke patients, hospital- or community-based studies, and those published in English or Indonesian. Qualitative analysis was then used to identify keywords, categories, and themes.

Results

Among the 1,050 articles identified, only 8 satisfied the inclusion criteria, indicating that limited studies were available for ACP interventions among stroke patients. Four themes were ultimately identified: the strategy implementation of ACP, the challenges of ACP implementation, the benefits of ACP, and the factors influencing ACP. Strategy ACP implementation included the ACP method, the communication style, participation role, media used, and ACP documentation. Lack of information about ACP, facilities, incapacitated patients, and reluctance to implement have become challenges to implementation in stroke. The benefits of ACP, particularly the outcomes of the ACP program, included awareness of ACP engagement, patients can express their wishes, and increased advance directive (AD) documentation. The factors influencing ACP included patient condition, knowledge, and appropriate ACP methods.

Conclusion

ACP has not been widely used when providing interventions for stroke patients. The implementation of ACP in stroke patients is full of challenges due to various patient conditions. Effective strategies are needed to improve ACP in stroke patients. It is necessary to develop an ACP for stroke patients’ method that involves interprofessional collaboration, and studies on ACP in stroke patients need to be further conducted through interprofessional collaboration.

目的探讨脑卒中患者提前护理计划（ACP）的实施情况。方法根据Arksey和O 'Malley框架进行范围综述。因此，我们搜索了在ScienceDirect、PubMed、Scopus、ProQuest和Medline上发表的文章。纳入标准为成人或老年脑卒中患者ACP的原始研究、医院或社区研究以及以英语或印尼语发表的研究。然后使用定性分析来确定关键词、类别和主题。结果在1050篇文献中，只有8篇符合纳入标准，表明ACP干预脑卒中患者的研究有限。最终确定了四个主题：非加太战略的实施、非加太实施的挑战、非加太的好处以及影响非加太的因素。ACP策略的实施包括ACP方法、沟通方式、参与角色、使用的媒体和ACP文件。缺乏ACP的相关信息、设施、丧失行为能力的患者以及不愿实施ACP已成为中风患者实施ACP的挑战。ACP的好处，特别是ACP项目的结果，包括对ACP参与的认识，患者可以表达他们的愿望，以及增加预先指示（AD）文件。影响ACP的因素包括患者的病情、知识和合适的ACP方法。结论acp尚未广泛应用于脑卒中患者的干预。由于脑卒中患者的病情不同，ACP的实施充满了挑战。需要有效的策略来改善脑卒中患者的ACP。有必要开发一种跨专业合作的脑卒中患者ACP方法，对脑卒中患者ACP的研究需要通过跨专业合作进一步开展。

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引用次数: 0

The role and value of self-employed nurses in the allocation of nursing human resources: A scoping review 自雇护士在护理人力资源配置中的作用和价值：范围审查

IF 3.1 3区医学 Q1 NURSING

International Journal of Nursing Sciences

Pub Date : 2025-09-01 DOI: 10.1016/j.ijnss.2025.08.005

Nianqi Cui , Wei Yang , Yulin Lu , Jingfen Jin

Objective

This study aimed to conduct a scoping review to determine the role and value of self-employed nurses in the allocation of nursing human resources.

Methods

Following the scoping review methodological framework proposed by Arksey and O’Malley, China National Knowledge Infrastructure (CNKI), WanFang, CINAHL, PubMed, Web of Science, and Scopus databases were searched from inception to February 2025 on self-employed nurses in the nursing field. Thematic content analysis was used to collate, summarize, and narratively report themes and subthemes on nursing data practices.

Results

A total of 60 articles were ultimately included. Four themes emerged from the scoping review. Among them, 14 articles focused on the qualification certification and competency requirements of self-employed nurses, 24 articles delved into the roles and responsibilities, 24 articles focused on the value, and the remaining four articles focused on the registration and legalization. Self-employed nurses must have a bachelor’s degree in nursing and pass relevant exams, while specialist nurses need even more skills. They offer personalized care through clinics or home visits, providing a flexible and autonomous career path, reducing healthcare costs, and encouraging interdisciplinary collaboration.

Conclusions

This study highlights the various roles and values of self-employed nurses. However, self-employed nurses face challenges, including nonuniform regulations, practice risks, a lack of medical insurance policies, shortages in remote areas, and inadequate educational support. Key strategies for enabling effective contributions to the healthcare system include the standardization of entry requirements, the strengthening of certification processes, the enhancement of safety measures, the development of medical insurance policies, the attraction of talent, and the reinforcement of educational frameworks.

目的探讨个体护士在护理人力资源配置中的作用和价值。方法按照Arksey和O 'Malley提出的范围综述方法框架，检索中国知网（CNKI）、万方、中国医学信息学会（CINAHL）、PubMed、Web of Science和Scopus数据库，检索自成立至2025年2月护理领域的个体执业护士。主题内容分析用于整理、总结和叙述性报告护理数据实践的主题和次主题。结果最终共纳入60篇文献。范围审查产生了四个主题。其中，自主执业护士资格认证与胜任力要求14篇，角色职责24篇，价值24篇，注册与合法化4篇。自雇护士必须拥有护理学士学位并通过相关考试，而专科护士则需要更多的技能。他们通过诊所或家访提供个性化护理，提供灵活自主的职业道路，降低医疗成本，并鼓励跨学科合作。结论本研究突出了个体护士的多种角色和价值。然而，自雇护士面临挑战，包括不统一的法规、执业风险、缺乏医疗保险政策、偏远地区短缺以及教育支持不足。促进对医疗保健系统作出有效贡献的关键策略包括标准化入职要求、加强认证程序、加强安全措施、制定医疗保险政策、吸引人才和加强教育框架。

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引用次数: 0

Depression and related factors among public health nurses engaged in cases of child neglect-related abuse 参与儿童忽视相关虐待案件的公共卫生护士的抑郁及相关因素

IF 3.1 3区医学 Q1 NURSING

International Journal of Nursing Sciences

Pub Date : 2025-09-01 DOI: 10.1016/j.ijnss.2025.08.006

Ayano Ogata , Ayako Ide-Okochi

Objectives

To evaluate the occurrence of depression and its related factors among public health nurses (PHNs) engaged in child neglect-related abuse cases.

Methods

A cross-sectional study of PHNs involved in maternal and child health or child and family welfare, and engaged in cases of child neglect-related abuse was conducted from January to March 2023 in all municipalities of 13 prefectures selected from Japan’s seven regions, considering geographic diversity and major urban areas. The Patient Health Questionnaire-2 was used to screen for depression. Statistical analyses included the Chi-square test, Mann–Whitney U test, and logistic regression analysis.

Results

A total of 359 provided valid responses. Among them, 11.4 % screened positive for depression. Significant individual factors related depression were management-stage nurses (OR = 6.27, 95 %CI: 1.63–24.18), no disability welfare experience (OR = 3.49, 95 %CI: 1.05–11.55), being assignment of high-risk cases within the past year (OR = 8.28, 95 %CI: 2.07–33.08), and lower work control (OR = 0.53, 95 %CI: 0.32–0.86). Workplace environment factors were lower perceptions and relationships within the workplace (OR = 0.43, 95 %CI: 0.29–0.65) and perceiving manpower as not secured (OR = 9.07, 95 %CI: 1.17–70.40).

Conclusions

Mental health measures for PHNs should include workload management and reduced burdens through workforce enhancement, attention to burdens on managerial PHNs, promoting communication and mutual support, and opportunities to engage in disability welfare work.

目的了解从事儿童忽视相关虐待案件的公共卫生护士抑郁的发生情况及其相关因素。方法考虑到地理多样性和主要城市地区，于2023年1月至3月在日本7个地区中选择的13个县的所有市对从事妇幼保健或儿童和家庭福利并从事与儿童忽视有关的虐待案件的初级保健护士进行了横断面研究。患者健康问卷-2用于筛查抑郁症。统计分析包括卡方检验、Mann-Whitney U检验和logistic回归分析。结果共有359人提供有效回复。其中，11.4%的人患有抑郁症。与抑郁相关的显著个体因素为管理阶段护士（OR = 6.27, 95% CI: 1.63 ~ 24.18）、无残疾福利经历（OR = 3.49, 95% CI: 1.05 ~ 11.55）、过去一年内被分配为高危病例（OR = 8.28, 95% CI: 2.07 ~ 33.08）和较低的工作控制（OR = 0.53, 95% CI: 0.32 ~ 0.86）。工作场所环境因素是较低的感知和工作场所内的关系（OR = 0.43, 95% CI: 0.29-0.65）和感知人力不安全（OR = 9.07, 95% CI: 1.17-70.40）。结论护理人员的心理健康措施应包括：加强工作负荷管理和减轻负担，重视管理护理人员的负担，促进沟通和相互支持，并提供从事残疾人福利工作的机会。

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引用次数: 0

Prevalence of workplace violence against nurses in Saudi Arabia: A systematic review and meta-analysis 沙特阿拉伯对护士的工作场所暴力的普遍性：系统回顾和荟萃分析

IF 3.1 3区医学 Q1 NURSING

International Journal of Nursing Sciences

Pub Date : 2025-09-01 DOI: 10.1016/j.ijnss.2025.08.002

Mohammed Abdelmalik , Atallah Alenezi , Mohamed Abdallah , Ibrahim Ibrahim , Mohammed Ahmed , Mohammead O. Mohammead , Almoez M. Mohammed , Abdalrahman Saeed , Fahad M. Alhowaymel , Abdulaziz F. Abaoud , Binyameen Sambu , Ibraheem A. Alhowaymel

Objectives

Workplace violence is a serious issue in healthcare settings. Nurses are particularly vulnerable, and such violence significantly impacts their professional lives, leading to decreased productivity and care quality. We aimed to estimate the pooled prevalence of workplace violence against nurses through systematic review and meta-analysis in Saudi Arabia.

Methods

Databases were searched for articles published in English from 2013 to 2023, including PubMed, Web of Science, Science Direct, Medline, Emerald, Wiley, and ProQuest. The quality of the included studies was rigorously assessed using the Joanna Briggs Institute (JBI) critical appraisal tools. Meta-analysis was conducted using Comprehensive Meta-Analysis software. Subgroup analysis, meta-regression, and publication bias tests were performed.

Results

The pooled prevalence of workplace violence among nurses in Saudi Arabia was 61.8 % (95 %CI: 45.8 %–75.6 %). Subgroup analysis showed the highest prevalence of workplace violence in studies conducted before 2020 at 69.7 % (95 %CI: 42.0 %–88.0 %) and 2020-2023 at 57.0% (95 %CI: 35.6 %–76.1 %); in the western region at 90.2 % (95 %CI: 70.2 %–97.3 %); among female nurses at 81.8 % (95 %CI: 66.9 %–90.9 %); with patient relatives as perpetrators at 70.8 % (95 %CI: 46.4 %–87.2 %); during afternoon shifts at 78.5 % (95 %CI: 64.4 %–88.1 %); for verbal abuse at 54.9 % (95 %CI: 31.3 %–76.6 %); and in the intensive care unit at 68.1 % (95 %CI: 28.1 %–92.1 %). Meta-regression analysis revealed that the night shift significantly contributed to heterogeneity. The funnel plot and Egger’s regression test (P = 0.647) indicated no significant publication bias.

Conclusions

This meta-analysis showed the estimate of workplace violence against nurses in Saudi Arabia is 61.8 %. Nursing managers and health policymakers should implement targeted interventions to prevent workplace violence, especially among female nurses, during afternoon shifts, in intensive care units, and in the western region of Saudi Arabia.

工作场所暴力是医疗机构中的一个严重问题。护士尤其脆弱，这种暴力严重影响了她们的职业生活，导致生产力和护理质量下降。我们旨在通过系统回顾和荟萃分析来估计沙特阿拉伯针对护士的工作场所暴力的总体发生率。方法检索PubMed、Web of Science、Science Direct、Medline、Emerald、Wiley、ProQuest等数据库2013 - 2023年发表的英文论文。使用乔安娜布里格斯研究所（JBI）关键评估工具严格评估纳入研究的质量。采用综合meta分析软件进行meta分析。进行亚组分析、meta回归和发表偏倚检验。结果沙特阿拉伯护士工作场所暴力总发生率为61.8% （95% CI: 45.8% ~ 75.6%）。亚组分析显示，在2020年之前进行的研究中，工作场所暴力的发生率最高，为69.7% (95% CI: 42.0% - 88.0%)， 2020-2023年为57.0% (95% CI: 35.6% - 76.1%)；西部地区为90.2% (95% CI: 70.2% - 97.3%)；女护士占81.8% (95% CI: 66.9% - 90.9%)；患者亲属为肇事者占70.8% (95% CI: 46.4% - 87.2%)；下午班为78.5%(95%置信区间：64.4% - 88.1%)；言语虐待占54.9% (95% CI: 31.3% - 76.6%)；重症监护病房为68.1% （95% CI: 28.1% - 92.1%）。元回归分析显示，夜班对异质性有显著影响。漏斗图和Egger回归检验（P = 0.647）显示无显著发表偏倚。本荟萃分析显示，在沙特阿拉伯，针对护士的工作场所暴力估计为61.8%。护理管理人员和卫生政策制定者应实施有针对性的干预措施，以防止工作场所暴力，特别是在女护士、下午班、重症监护病房和沙特阿拉伯西部地区。

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引用次数: 0

The role of ethical leadership in promoting internal whistleblowing among nurses: A dual-mediation model analysis of psychological safety and reporting attitudes 伦理领导在促进护士内部举报中的作用：心理安全和报告态度的双重中介模型分析

IF 3.1 3区医学 Q1 NURSING

International Journal of Nursing Sciences

Pub Date : 2025-09-01 DOI: 10.1016/j.ijnss.2025.08.004

Ibrahim Abdullatif Ibrahim , Indrajit Doddanavar , Samah Mohamed Abdelrahim , Mennat Allah G. Abou Zeid

Objectives

This study aimed to investigate the dual mediating roles of psychological safety and reporting attitudes in the association between ethics-centered leadership and internal whistleblowing among nurses.

Methods

A multicenter, cross-sectional study design was employed, involving a convenience sample of 273 nurses among five university hospitals from August to October 2024. Data were collected using a demographic questionnaire, Ethical Leadership Scale, Psychological Safety Scale, Positive Attitudes Toward Whistleblowing Scale, and Internal Whistleblowing Scale. Pearson correlation and structural equation model were conducted to test the hypothesized dual mediation model.

Results

The average score of nurses for ethical leadership was 4.14 ± 0.57, psychological safety was 3.80 ± 0.64, reporting attitudes was 4.12 ± 0.67, internal whistleblowing was 3.93 ± 0.52. Ethical leadership had a significant effect on psychological safety (β = 0.38, P < 0.001), reporting attitudes (β = 0.44, P < 0.001), and internal whistleblowing (β = 0.21, P = 0.009). Furthermore, psychological safety (β = 0.26, P < 0.001) and reporting attitudes (β = 0.27, P < 0.001) significantly influenced internal whistleblowing among the nurses. The indirect effect of ethics-centered leadership on internal whistleblowing intermediated by psychological safety was significant (β = 0.10, P < 0.001). Similarly, reporting attitudes demonstrated a significant mediating effect (β = 0.12, P = 0.003).

Conclusions

Ethical leadership encourages internal whistleblowing among nurses by fostering psychological safety and positive reporting attitudes. Therefore, healthcare managers should prioritize ethical leadership development, enhance psychological safety, and foster constructive reporting attitudes that enable nurses to report ethical violations confidently, without apprehension.

目的探讨心理安全和报告态度在护士伦理中心领导与内部举报的关系中的双重中介作用。方法采用多中心横断面研究设计，于2024年8月~ 10月选取5所大学附属医院的273名护士作为方便样本。采用人口统计问卷、道德领导量表、心理安全量表、举报积极态度量表和内部举报量表收集数据。采用Pearson相关和结构方程模型对假设的双重中介模型进行检验。结果护士伦理领导平均得分为4.14±0.57分，心理安全平均得分为3.80±0.64分，报告态度平均得分为4.12±0.67分，内部举报平均得分为3.93±0.52分。伦理型领导对心理安全感（β = 0.38, P < 0.001）、报告态度（β = 0.44, P < 0.001）和内部举报（β = 0.21, P = 0.009）有显著影响。此外，心理安全感（β = 0.26, P < 0.001）和报告态度（β = 0.27, P < 0.001）显著影响护士内部举报行为。以伦理为中心的领导在心理安全中介下对内部举报的间接影响显著（β = 0.10, P < 0.001）。同样，报告态度表现出显著的中介效应（β = 0.12, P = 0.003）。结论伦理领导通过培养心理安全感和积极的举报态度，促进护士内部举报。因此，医疗管理人员应优先考虑道德领导的发展，加强心理安全，并培养建设性的报告态度，使护士能够自信地报告违反道德的行为，而不必担心。

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引用次数: 0