SAGE Open Nursing最新文献

Background: Antenatal care (ANC) is a healthcare service designed to ensure a safe pregnancy. The World Health Organization recommends that pregnant women have at least four ANC visits for a healthy pregnancy. However, it is unclear whether this guideline is being followed in Mogadishu, Somalia. Therefore, this study aims to investigate the factors that influence ANC attendance among pregnant women in Mogadishu, Somalia.

Methods: A cross-sectional study was conducted at two hospitals, involving 329 pregnant women in their third trimester. Data were collected using structured questionnaires through face-to-face interviews. Statistical analysis was performed with SPSS 26, using descriptive statistics and logistic regression to assess the association between variables, with a significance level set at a p-value of less than .05.

Results: Only 14% of women met the recommended minimum for ANC visits. Nulliparous women were less likely to attend ANC compared to those with children (adjusted odds ratio [AOR] = 0.1, p = .031). In contrast, women receiving home visits from healthcare workers had higher odds of attending ANC (AOR = 8.3, p < .001). Those who felt their appointments were too short also had lower odds of attending ANC (AOR = 0.3, p = .007).

Conclusion: Many pregnant women do not attend ANC services as the World Health Organization recommends, which suggests at least four visits. Factors influencing attendance include parity, healthcare worker home visits, and perceived appointment quality. Improving these factors, particularly home visits and appointment durations, could enhance ANC attendance.

Aim: To assess the level and determinants of self-care agency (SCA) among patients with Type 1 diabetes mellitus.

Methods: A descriptive cross-sectional design was used to collect data from 128 participants via an online survey. Participants were conveniently recruited from diabetes clinics in two major hospitals (one public, one teaching) in Jordan's largest cities. Data were collected using the Appraisal of Self-Care Agency Scale-Revised (ASAS-R), Diabetes Self-Efficacy Scale, and Diabetes Self-Management Scale. Descriptive statistics, t-tests, ANOVA, and Pearson correlation were used. Data collection occurred from October 2019 to January 2020.

Results: Participants showed a relatively high level of SCA (74.1%, M = 55.5/75, SD = 6.87). Significant differences in the ASAS-R "lacking power" subscale were found based on marital status (t = 2.39, p = .018), with single participants scoring higher (M = 2.84) than married (M = 2.44), and comorbidity status (t = 3.69, p < .001), with those without comorbidities scoring higher (M = 2.96) than those with (M = 2.43). No correlations emerged between ASAS-R scores and continuous demographics, except a negative correlation between "lacking power" and age (r = -.191, p < .05). ASAS-R total scores correlated significantly with diabetes self-efficacy (r = .543, p < .001) and self-management (r = .566, p < .001), but not with demographics.

Conclusion: Participants had high SCA, especially in developing power, though lower scores were seen in "lacking power." Age, marital status, and comorbidities influenced this subscale. Higher SCA was associated with greater self-efficacy and self-management, underscoring its importance in diabetes care.

Introduction: Adoption of digital technologies in midwifery education has been slow. Many barriers challenge implementing digital learning technologies in Africa, limiting access, disrupting learning activities and hindering full engagement and adoption of digital tools.

Methods: A scoping review of original research publications from Africa was performed to explore stakeholder perspectives regarding the adoption and effectiveness of digital learning within midwifery education. The review aimed to examine and document stakeholder experiences, perceptions, attitudes, and challenges in existing literature, providing insights crucial to informing future strategies and policy decisions. Data from each study were collected using a custom-designed extraction form tailored specifically for this review.

Results: After searching nine databases, 233 original manuscripts were located. Specific inclusion and exclusion criteria were applied, and nine studies remained for analysis. Content analysis was used to identify three main themes: (1) perceived benefits of digital learning, (2) facilitating factors, and (3) technical and technological challenges, which identified the experiences, perceptions, attitudes, and challenges of stakeholders who have been exposed to using digital technology in midwifery education in Africa.

Conclusion: There is a growing interest in integrating digital learning into midwifery education in Africa; however, this comes with contextual challenges such as limited infrastructure, access, and low digital literacy. Addressing these through targeted investment, comprehensive training, and other localized strategies is key to successfully implementing and scaling up digital education in preservice midwifery education on the continent. Findings can help guide effective program design and policy development.

Introduction: Prenatal education courses for pregnant women appear to be an effective strategy to facilitate maternal adaptation, especially during labor. Consequently, maintaining high adherence rates to these courses is crucial for improving health outcomes in pregnant women and enhancing their experience during the transition through this stage. However, in Latin America, low adherence to in-person prenatal education courses has consistently been reported. On the other hand, adherence to online courses and the factors associated with permanence have been poorly studied in this context.

Objective: This study aimed to identify factors that predict pregnant women's adherence to an online prenatal education course.

Methods: This retrospective cohort study included pregnant women who voluntarily enrolled in an open-access online prenatal education course between 2020 and 2025. The main outcome was adherence to the course. Sociodemographic variables and pregnancy-related characteristics were considered potential predictors. Population characteristics were summarized using descriptive statistics. A logistic regression model was constructed to identify independent predictors of adherence.

Results: A total of 1,624 pregnant women were included, 43.59% completed the course. Enrolling in the course between 2023 and 2025 (OR = 1.95, 95% CI = 1.57 to 2.41), having a planned pregnancy (OR = 1.81, 95% CI = 1.34 to 2.47), having an educational level higher than primary school (OR = 1.58, 95% CI = 1.21 to 2.06) and attending more prenatal visits (OR = 1.05, 95% CI = 1.00 to 1.09) were independent predictors of course completion.

Conclusion: Fewer than half of the enrolled pregnant women completed the online prenatal education course. Strategies need to be implemented to improve adherence, especially among pregnant women who report unplanned pregnancies, lower educational levels, and fewer prenatal visits.

Introduction: The hospital-to-home care transition poses significant challenges for older adults due to factors such as physical/cognitive decline, limited support, low health literacy, socioeconomic barriers, and poor care coordination. These challenges include readaptation to daily life and negative feelings such as uncertainty, worry, loneliness, and fear of dealing with adverse events at home. A tailored nursing process can potentially improve this transition. This scoping review mapped evidence on the nursing process for older adults during hospital-to-home transitions. Method: A scoping review following Joanna Briggs Institute methodology was conducted. Searches included Embase, Lilacs, Livivo, PubMed, Scopus, Web of Science, and gray literature sources (Google Scholar, CAPES Catalog), performed in 2023 and updated in March 2025. Eligible sources (original articles, reports, theses/dissertations) addressed nursing process development for this transition. Evidence was synthesized using descriptive analysis. Results: Eleven sources were included. Six (54.5%) used nursing taxonomies, primarily NANDA-I (five sources, 45.4%). Two sources (18.2%) used theoretical frameworks (Self-Regulation Theory, Gottlieb's Strength-Based Care Theory). Six sources (54.5%) used instruments assessing demographics, function (cognitive, physical, mental), dependencies, adherence, self-management, caregiver readiness, and discharge/learning needs. Five sources (45.4%) listed 54 diagnoses, primarily related to safety/protection, activity/rest, and elimination/exchange domains. Two sources (18.2%) used nursing outcomes classification taxonomy for outcome planning. Interventions focused mainly on health education. A gap regarding the implementation phase was noted. Four sources (36.4%) addressed evaluation. Conclusion: These findings can guide clinical nurses in developing the nursing process for older adults transitioning home. The review identifies population needs, common assessment tools, frequent diagnoses/interventions, and evaluation methods, aiding nurses in tailoring care during this critical transition.

[This retracts the article DOI: 10.1177/23779608251349403.].

Introduction: The increasing cost of long-term care is an issue faced by older care recipients and their families. The financial burden of long-term care for older adults may reduce the well-being of family caregivers. However, it remains unclear how family caregivers experiencing financial strain adapt to both caregiving and daily life.

Objective: This cross-sectional study examined the caregiver characteristics and financial burden associated with the cost of utilizing long-term care services for an older relative among 427 family caregivers.

Methods: Potential influencing factors were compared among three categories of financial burden and their impact on the lives of family caregivers. The chi-square test was used for categorical data (e.g., sex, marital status, employment status), and the Kruskal-Wallis test for continuous or ordinal data (e.g., age, self-rated health, annual household income).

Results: The proportion of family caregivers experiencing financial burden was statistically significantly higher among those living with an older relative compared with those whose older relative was in a care facility (68.2% vs. 57.3%, respectively; p = .049). Among 198 family caregivers living with an older relative, a greater severity of functional disability in an older relative was statistically significantly associated with financial burden and its impact on their lives (p = .004). On the other hand, among 229 family caregivers of an older relative utilizing institutional care, those bearing the costs of long-term care were statistically significantly more likely to experience financial burden and its impact on their lives (p < .001).

Conclusion: A financial shortage among older relatives was found to have a negative impact on the work, private life, and care choices of family caregivers. These findings may inform the development of support measures tailored to caregivers with a limited household income.

Introduction: Scenario-based training (SBT) is a modern, innovative teaching approach that facilitates structured discussions among nurse interns. Well-crafted scenarios are vital for educators to effectively incorporate learning objectives into the training experiences of nurse interns.

Objective: This study examined the impact of scenario-based training on nurse interns' critical thinking dispositions.

Methods: A true experimental design, including the study & control groups, was utilized. The study included 120 nurse interns who were selected randomly and classified into two groups: a study group (60 NIs) and a control group (60 NIs). Data were collected using three instruments: a scenario-based knowledge instrument, a critical thinking dispositions scale, and a satisfaction tool.

Results: The study results showed that there was statistically significant improvement among the study group, as 13.3% of them had a satisfactory knowledge level at preprogram (χ² = 0.323, p = .389; Cramér's V = 0.052, negligible effect). However, a very strong and statistically significant association was found both immediately after the program at 100% (χ² = 101.538, p < .001; Cramér's V = 0.920) and at the follow-up program at 98.3% (χ² = 97.634, p < .001; Cramér's V = 0.902), reflecting a large intervention effect on knowledge level. There was significant improvement postprogram in enhancing critical thinking dispositions, ranging from medium to large (Cramér's V: 0.321-0.527), as well as higher satisfaction with a percentage of 93.3%, whereas the control group did not exhibit similar increases. These gains were evident immediately after the training and were sustained at follow up, highlighting the effectiveness of SBT.

Conclusion: The study determined that there was a positive correlation between SBT and the development of critical thinking dispositions in the study group postprogram implementation. The study recommended continuous assessment of teaching strategies to increase the effectiveness and efficiency of nursing education.

Introduction: Insecure attachment styles among people with schizophrenia may exacerbate psychiatric symptoms and emotional distress, complicating recovery.

Objectives: This study aimed to assess attachment styles among individuals with schizophrenia and explore their relationship to symptomatology and emotional distress.

Methods: A cross-sectional descriptive correlational design was employed, involving 220 patients diagnosed with schizophrenia. Participants were assessed using the Psychosis Attachment Measure (PAM) to determine attachment styles, the Robertson Emotional Distress Scale (REDS) to evaluate emotional distress, and the Positive and Negative Syndrome Scale (PANSS) to assess psychiatric symptoms.

Results: The study found that 72.5% of participants exhibited high levels of avoidant attachment, while 61.7% displayed significant anxious attachment tendencies. Emotional distress was prevalent, with a mean REDS score of 43.48 ± 3.54, indicating high emotional distress levels. Positive correlations were identified between emotional distress and both avoidant (r = .378, p = .008) and anxious attachment (r = .644, p < .01). Additionally, psychiatric symptoms correlated positively with avoidant (r = .434, p = .018) and anxious attachment (r = .474, p < .01). Multiple regression analysis indicated that anxious attachment was a stronger predictor of psychiatric symptoms (B = 0.72, p < .001) and emotional distress (B = 0.82, p < .001) compared to avoidant attachment.

Conclusion: This study highlights the relationship between attachment styles, emotional distress, and psychiatric symptoms in schizophrenia. Participants exhibited avoidant and anxious attachment, linked to heightened emotional distress and severe symptoms. Avoidant attachment was characterized by emotional withdrawal and self-reliance, while anxious attachment involved dependency and relational anxiety. These insecure patterns predicted the severity of psychiatric symptoms, emotional distress, and anxious attachment. The findings emphasize the importance of addressing attachment dynamics in therapeutic nursing for schizophrenia, as these factors may worsen symptoms and emotional challenges. Using attachment-focused approaches can enable mental health nurses to better support symptom management and enhance well-being.

Introduction: The Strong Black Woman (SBW) schema, deeply embedded in sociocultural and historical narratives, portrays Black women as inherently resilient, self-sacrificing, and emotionally restrained. While it can serve as a source of pride and survival, the schema often imposes psychological, emotional, and physical burdens-particularly in academic nursing, where systemic inequities intersect with racialized and gendered expectations. This paper examines how the SBW schema operates in nursing education and leadership and advocates for a redefinition of strength that embraces vulnerability, wellness, and collective care.

Methods: This narrative review synthesizes research on the SBW schema with a focus on its historical origins, cultural significance, and psychological impacts. Peer-reviewed publications in English from 2000 to 2024 were identified through searches in CINAHL, PubMed, ERIC, EBSCO, and Google Scholar using terms related to the SBW schema and nursing contexts. Although few nursing-specific studies exist, key articles by Jefferies, and Parks and Hayman informed the discussion. Additional insights were drawn from psychology, sociology, public health, and Black feminist theory to contextualize its implications for nursing education and leadership.

Results: The schema contributes to emotional suppression, delayed help-seeking, and heightened risk of burnout. In predominantly white institutions, Black women in nursing experience amplified pressures to overperform, serve as cultural representatives, and navigate professional isolation. These expectations are reinforced by intergenerational and media-driven narratives. While the schema can foster pride and perseverance, its glorification masks its long-term mental health consequences. Emerging literature calls for a paradigm shift that integrates emotional authenticity and systemic support into nursing leadership and education.

Conclusion: Redefining strength in nursing requires dismantling individualistic ideals of resilience and affirming vulnerability as a culturally grounded act of care and resistance. Structural change must include equity-focused policies, antiracist leadership development, and emotionally safe environments that validate the full humanity of Black women in academic nursing.