SAGE Open Nursing最新文献

Background: Ethical decision-making was a major challenge for healthcare professionals during the COVID-19 pandemic, particularly in contexts where religion and law strongly influence clinical practice. Both deontological and consequentialist ethical frameworks guide medical decisions; however, balancing these approaches is especially difficult during crises.

Objective: This study aimed to explore the ethical decision-making experiences of intensive care nurses during the COVID-19 pandemic within a Muslim community in Iran.

Materials and methods: A qualitative content analysis was conducted based on in-depth, semi-structured interviews with 14 intensive care nurses.

Results: Three main themes emerged: (a) Humanitarian commitment involving actions beyond formal duties; (b) Nursing practice influenced by legal and organizational frameworks; and (c) Application of a consequentialist perspective in decision-making. Nurses described acting ethically under legal constraints, sometimes prioritizing patients' welfare when physicians were unavailable, and balancing religious, ethical, and legal considerations in their practice.

Conclusion: Nurses' ethical decision-making was shaped by both professional and contextual factors, including law, religion, and cultural values. Their actions reflected a balance between deontological and consequentialist ethics rather than strict adherence to rigid legal or institutional rules. The findings highlight the need for context-sensitive ethical guidelines and support systems for nurses working under crisis conditions.

The Sickle Cell Data Collection program reported maternal death rates in California (2004-2014) of 629 per 100,000 for Black women with SCD, 12 per 100,000 for Black women without SCD, and 6 per 100,000 in the general population. Yet little is known about the lived experiences of pregnant Black women with SCD, or their perceptions of nurses as advocates. To explore how social structures shape maternal health, the complexities of pregnancy while living with SCD, and nursing's role in care and advocacy, a qualitative study using semi-structured interviews was conducted. An interpretive framework centered participants' voices and revealed key themes: (1) Trauma During Childbirth; (2) Dismissal, Disbelief, and Inadequate Pain Management; (3) Self-advocacy; and (4) Emotional and Psychological Impact. Together, these themes highlight the intersecting challenges of pregnancy faced by Black women with SCD and the transformative potential of compassionate, informed, and equitable care.

Introduction: Psychological first aid is an essential framework for delivering immediate emotional and psychological support to individuals affected by crises and traumatic events. Emergency nurses must possess adequate knowledge and preparedness to provide effective psychological first aid during emergencies.

Objective: This study aimed to assess the levels of knowledge and preparedness to provide Psychological First Aid (PFA) among emergency nurses working in hospitals across the West Bank, Palestine between February and April 2024.

Methods: A descriptive cross-sectional study was conducted between February and April 2024 among 164 emergency nurses working in 19 governmental and nongovernmental hospitals across nine cities in the West Bank, Palestine. Data were collected using an online structured questionnaire assessing nurses' knowledge of and preparedness for psychological first aid. Statistical analyses were performed using descriptive and inferential statistics to describe study variables.

Results: Most nurses had moderate knowledge of psychological first aid (71.3%), 14.6% had low knowledge, and 14.0% had high knowledge. In terms of preparedness, 51.2% reported being prepared, 31.7% were unprepared, and 17.1% were uncertain. Preparedness was significantly influenced by sex, workplace setting, and professional roles (p < .05).

Conclusion: Despite moderate knowledge levels, over half of the emergency nurses reported adequate preparedness to deliver psychological first aid, suggesting a readiness to respond but with insufficient theoretical grounding. The findings highlight the urgent need to integrate psychological first aid modules into emergency nursing curricula, conduct periodic simulation-based training, and develop standardized institutional protocols to ensure consistent and evidence-based PFA delivery across Palestinian hospitals.

Background: Virtual reality (VR) is increasingly recognized as a valuable adjunct in cancer supportive care, but evidence for its efficacy in reducing psychological distress during chemotherapy in Middle Eastern settings remains limited.

Objectives: To evaluate the effectiveness of immersive virtual reality as an engaging distraction on stress and anxiety among cancer patients during chemotherapy in Palestine.

Methods: Between June and September 2023, 150 cancer patients were randomly assigned to an intervention group (n = 75) receiving VR during chemotherapy or a control group (n = 75) receiving standard care. Outcomes were measured using the Generalized Anxiety Disorder scale (GAD-7) and Perceived Stress Scale (PSS-10) before and after intervention.

Results: Postintervention analysis revealed potential benefits with significantly lower stress levels in the experimental group (M = 17.7 ± 2.8) compared to controls (M = 19.2 ± 2.5; mean difference: 1.5 points, 95% CI 0.6, 2.4, p < .05, Cohen's d = 0.58, 95% CI 0.25, 0.91). Mean GAD-7 scores were significantly lower in the VR group (M = 6.2 ± 3.1) versus controls (M = 10.8 ± 4.2; mean difference: 4.6 points, 95% CI 3.3, 5.9, p < .001). 54.7% of VR participants (n = 41) achieved minimal anxiety compared to 26.7% of controls (n = 20) (Risk Ratio=2.05, 95% CI 1.35, 3.12). Effect sizes were moderate to large for both outcomes. The observed stress reduction of 1.5 points exceeds the established minimal clinically important difference (MCID) of approximately 1.0-1.5 points for the PSS-10, while the anxiety reduction of 4.6 points meets the MCID threshold of 4 points for the GAD-7.

Conclusion: Engaging distraction via virtual reality demonstrates potential benefit in reducing stress and anxiety among cancer patients during chemotherapy. However, this study design cannot isolate VR-specific immersive effects from general distraction. Future research with active control conditions is needed to establish VR's unique value proposition.

Introduction: Critical thinking, defined as the purposeful, self-regulatory judgment involving interpretation, analysis, evaluation, and inference, is a fundamental requirement for education in the healthcare field. Reflection, a metacognitive process that promotes self-awareness and deeper understanding of experiences, is regarded as one of the key strategies that enhances critical thinking disposition by fostering motivation and habitual application of these skills.

Objective: This study aimed to evaluate the effects of daily versus weekly reflection on the critical thinking disposition of nursing students, including its dimensions of engagement, innovativeness, and cognitive maturity.

Methods: This quasi-experimental study with a pretest-posttest design was undertaken at Birjand University of Medical Sciences, Birjand, Iran in 2023. Participants (n = 48; 24 per group) were recruited via census sampling method and randomly assigned into two daily and weekly reflection groups. The intervention was conducted during four weeks of clinical training. Data were collected through a demographic information questionnaire and Ricketts' critical thinking disposition questionnaire.

Results: No statistically significant differences were observed between the two groups concerning the mean scores for overall disposition towards critical thinking (p = 0.673, Cohen's d = 0.12) and for each of its dimensions: engagement (p = 0.740, Cohen's d = 0.08), innovativeness (p = 0.281, Cohen's d = 0.22), and maturity (p = 0.652, Cohen's d = 0.10) both before and after the intervention. Mean scores slightly increased in both groups post-intervention (daily: +3.2, 95% CI [1.5, 4.9] ; weekly: +2.8, 95% CI [1.0, 4.6]), though not significantly.

Conclusion: Considering that the mean score of critical thinking disposition and each of its dimensions after the 4-week intervention in the two groups had no statistically significant difference, therefore, it is suggested to investigate the long-term effect of daily and weekly reflection in future studies.

Background: Electronic Medical Records (EMRs) have become essential tools in modern healthcare, enhancing efficiency, safety, and quality of care. However, multiple factors influence nurses' satisfaction with EMR use.

Aim: To assess nurses' work satisfaction with EMR use and identify associated facilitators and barriers among nurses in Palestinian governmental hospitals.

Methods: A cross-sectional quantitative design was employed. A convenience sample of 190 nurses from medical and surgical wards was recruited. Data were collected using a self-administered questionnaire covering demographics, work environment variables, and an adapted version of the Nursing Work Satisfaction Questionnaire (NWSQ). Sample size was determined using G*Power software. Data were analyzed using SPSS.

Results: Among 190 nurses, 51.1% were aged 20-30 years, with nearly equal gender distribution. Most (63.1%) had received EMR training, and 53.2% perceived the system as user-friendly. 52.1% were satisfied with their work using EMRs. Regression analysis demonstrated that ease of system use (β = 0.274, p < .001), EMR training (β = 0.230, p = .020), technical support satisfaction (β = 0.148, p = .012), and age (β = 0.194, p = .045) remained significant predictors of nurses' work satisfaction after adjustment. The regression model explained 23.4% of the variance in work satisfaction (R ² = .234).

Conclusion: Nurses in Palestinian governmental hospitals reported moderate satisfaction with EMR use. Factors such as training, system usability, technical support, and age significantly contributed to satisfaction. Strengthening these areas may enhance the integration and effectiveness of EMRs in nursing practice.

Background: Objective structured clinical examinations (OSCEs) are widely used to assess nursing students' clinical skills. However, ensuring consistent scoring between examiners remains difficult, particularly for subjective areas such as communication.

Purpose: This study aimed to evaluate inter-rater agreement between two faculty examiners in a pre-graduation OSCE recommended for final-year pre-registration nursing students in Japan, comparing technical skill stations with communication-focused stations.

Methods: A total of 90 final-year nursing students completed two OSCE stations: one assessing technical procedures, the other assessing communication and patient education. Two examiners independently scored each aspect of performance using binary checklists. Inter-rater agreement was calculated using Cohen's kappa and prevalence- and bias-adjusted kappa.

Results: Higher inter-rater agreement was found for psychomotor items (e.g., auscultation) than for verbal or empathy-based items. In the technical station, agreement improved across successive circuits, suggesting examiner calibration. In contrast, in the communication station, agreement remained consistently low. Empathy-related items showed the greatest discrepancy between kappa and prevalence- and bias-adjusted kappa, highlighting challenges in evaluating subjective skills.

Conclusions: OSCE inter-rater reliability was higher for objective technical skills than for subjective communication skills and empathy-related behaviors, among pre-registration nursing students.

Implications for practice: Improving checklist clarity and providing targeted examiner training for communication and empathy-related items may enhance the reliability of OSCE scoring in nursing education.

Introduction: Nursing students are future healthcare leaders who play a significant role in promoting community health. A deeper understanding of obesity and related lifestyle factors enables them to develop better awareness regarding the prevention and management of obesity among individuals.

Objective: This study aimed to determine the prevalence of overweight and obesity and to assess the association with lifestyle practices among undergraduate nursing students.

Method: A descriptive cross-sectional study was conducted at RAKCON University, from February to April 2024. Using convenience sampling, 187 undergraduate nursing students were recruited from a total population of 357. Data were collected using a semistructured questionnaire, including sociodemographic characteristics and lifestyle practices. The researchers measured the height and weight of the students initially to calculate the Body Mass Index. Statistical analyses included chi-square tests or Fisher's exact tests to examine associations between variables. Multiple linear regression was used to explore the predictors.

Results: More than half of the participants (54%) were aged 20 or younger; 67.9% were females. The majority (94.1%) were Arab. More than half (51.3%) had a normal BMI, while 15.5% were obese. There were statistically significant associations in weight change over the last 6 months (X2 = 8.69, p = .03), fast-food consumption (FET = 19.1, p = .01), consumption of soft/sugar-sweetened drinks (FET = 18.4, p = .02), and exercise habits (X2 = 13.90, p = .03). The regression analysis, the model explained 4.3% of BMI variance (R² = .043) and was not statistically significant, F (4, 182) = 2.03, p = .092; no individual predictor reached p < .05.

Conclusion: Overweight and obesity were present among nursing students and associated with selected lifestyle practices, particularly fast-food and carbonated drinks/sweetened drinks, and exercise habits. Targeted health-promotion strategies and educational programs are needed to improve healthy lifestyle behaviors and reduce future obesity-related risks.

Introduction: As healthcare evolves due to demographic changes and new technologies, there is a pressing need for nursing education to emphasize reflective practices. Despite its importance, students often struggle with integrating reflection into their learning due to inconsistent guidance and a lack of structured support.

Objective: This study explored nursing students' experiences and understanding of reflection, and how they engaged with it as a skill.

Method: A qualitative exploratory design was employed, involving 22 1st- and 3rd-year nursing students. Data was collected through in-depth and focus group interviews, allowing for rich data collection through both interaction and individual insights. The data were analyzed using a six-step thematic process. The reporting followed the COREQ guidelines.

Results: The analysis revealed two main themes, namely factors that support the reflection process and challenges of the reflection process with four subthemes: understanding the concept and purpose of reflection, educational structures and facilitation, lack of tools and structure in education, and power imbalances in relationships. Both 1st- and 3rd-year students found the concept of reflection broad and vague; however, 3rd-year students emphasized its practical applications. Both groups stressed the need for clear guidance and peer learning models to foster a supportive environment for reflection.

Conclusion: This study identifies a gap between the ideal and actual experiences of reflection among nursing students. Both 1st- and 3rd-year students struggled to understand and apply reflection due to limited guidance. Education programs should introduce structured reflection training throughout the coursework, including consistent support from educators and supervisors. Addressing power imbalances could help establish a safe learning environment, enabling students to analyze their experiences both retrospectively and in real time. The findings offer insights that can enhance nursing education globally and contribute to the international knowledge base.

Background: Young people encounter numerous health challenges, including sexual and reproductive health (SRH) problems. Poor SRH literacy plays a key role in young people's risky sexual behavior, which can lead to untoward SRH-related health outcomes.

Objectives: This study assessed the level of SRH literacy and SRH service utilization among in-school and out-of-school young people in Osun state, southwest Nigeria.

Methods: A descriptive cross-sectional study among 1,096 young people aged 15-24 in two universities and one community in Osun state. Respondents were selected using a multi-stage sampling process. A structured questionnaire incorporating the health literacy questionnaire (HLQ) was used to collect data, which was analyzed using descriptive and inferential statistics.

Results: The mean age was 19.0 ± 2.6 years; about half (56.5%) were females, while about one-third (35.2%) were sexually experienced. The mean literacy score was 56.6 ± 17.2, and 79.5% had low SRH literacy levels. Only 12.9% utilized any SRH-related care or service. SRH information and counselling were the most utilized services (78.7%), while the least was cervical cancer screening (11,4%). A lower SRH literacy score was significantly associated with being out of school (P < .001) and non-use of SRH services (P < .001). Respondents with good literacy levels were three times more likely to have accessed and utilized SRH care and services (OR: 3.08, 95% CI: 1.99-4.76).

Conclusion: The respondents had a low SRH literacy level, which was associated with poor utilization of SRH services. Appropriate interventions are required to improve SRH literacy levels in the study setting.