Journal of Nursing Research最新文献

Background: Globally, breast cancer is the most common cancer type in terms of incidence for women. Women with breast cancer endure higher levels of psychological distress than other types of cancer because many lose their identity as a woman, which is an additional characteristic of their psychological distress. Research using phenomenology to explore "the meaning of life" is rare among women with breast cancer.

Purpose: The purpose of this study was to explore the perspectives of women with breast cancer on "the meaning of life."

Methods: A phenomenological approach was used. Twenty-six women living with breast cancer drawn from a cancer treatment hospital in Taiwan participated in this study. A semistructured interview was utilized to collect the data, and Colaizzi's seven steps were used to analyze the data.

Results: Four themes emerged: (a) value of overcoming suffering, (b) value of reciprocal love, (c) value of self-transcendence, and (d) value of spiritual comfort. This means that the participants defined "the meaning of life" through the lens of suffering from cancer, reciprocal love from their families and friends, uncovering and discovering creative pathways that transformed their pain while searching for the value of their existence, and seeking spiritual guidance from religion.

Conclusions: The participants identified the most pivotal aspect of healing as transforming their pain and accepting value for their suffering. They acknowledged they could not change the fact that they had cancer, but they could learn to accept it as part of their lived experience. Healthcare professionals may use these four themes at a clinically appropriate time on women's journeys toward healing to inspire women with breast cancer to process their own unique "meaning of life."

Background: Family caregivers of patients with multiple sclerosis (MS) face many caring-related problems that increase their care burden and decrease their self-efficacy. Evidence-based self-management interventions may be used to improve care processes and resolve caregiver concerns.

Purpose: The aim of this study was to investigate the effect of a self-management program on care burden and self-efficacy in family caregivers of people with MS.

Methods: This study was performed in Iran in 2018-2019. The participants were selected using convenience sampling and assigned to control and intervention groups of 35 participants each using stratified randomization by gender. The intervention group participated in an eight-session self-management program. Data were collected using the Zarit Burden Interview and Scherrer Self-efficacy Questionnaire. Data were analyzed using descriptive and inferential statistics in SPSS Version 16.

Results: No significant difference in care burden scores was found between the two groups at baseline ( p = .953). However, mean scores for care burden in the intervention group were significantly higher ( p < .001) both immediately after completion of the intervention (42.6 ± 3) and at 3 months after completion of the intervention (36 ± 3), with the most significant improvement found immediately after the intervention. Similarly, no significant difference in self-efficacy scores was found between the groups at baseline ( p = .976). However, mean scores for self-efficacy in the intervention group were significantly higher ( p < .001) both immediately after and at 3 months after completion of the intervention (60.6 ± 4.7 and 72.7 ± 4, respectively), with the most significant improvement found at 3 months postintervention.

Conclusions/implications for practice: Providing self-management programs to caregivers of people with MS is an effective approach to reducing their burden of care and increasing their self-efficacy. Enhancing self-management by learning adaptation skills, self-care skills, social support, and spiritual support promote improved self-efficacy and reduce the care burden of these caregivers.

Background: The miserable work conditions faced by many nurses around the world make them particularly prone to work-family conflict.

Purpose: This study was designed to explain from a resource perspective how and when nurses experiencing work-family conflict are more likely to exhibit decreased levels of organizational identification and professional identification.

Methods: A time-separation research design was used, and data were collected from 322 nurses in five hospitals in China. All of the hypotheses were tested using conduct structural equation modeling.

Results: The results showed that work-family conflict had negative effects on organizational identification and professional identification via emotional exhaustion. In addition, job meaningfulness may have a buffering effect on the negative impact of work-family conflict on emotional exhaustion, organizational identification, and professional identification.

Conclusions/implications for practice: The results advance knowledge on how and when work-family conflict damages organizational identification and professional identification. Providing family support, relieving emotional exhaustion, and enhancing job meaningfulness are necessary to support the organizational and professional identification of nurses.

Background: Previous studies have evaluated the competency of newly graduated nurses and nurses. However, most of the instruments used include a large number of items that make completing them a time-consuming process. A brief instrument may be more acceptable and feasible for use in these evaluations.

Purpose: This study was designed to develop the brief capstone core competency (CCC or 3C) scale and validate its effectiveness in evaluating the academic and practical performance of nursing students enrolled in a bachelor's degree program.

Methods: A cross-sectional study was conducted. The 3C scale was developed in two phases. In Phase I, the items were summed from literature reviews, an expert panel, known-groups validity, test-retest reliability, internal consistency reliability, and exploratory factor analysis. In Phase II, the efficacy of the instrument was confirmed using confirmative factor analysis. Five hundred ninety-six participants participated in the first phase, and 520 participants participated in the second phase. The study period was 2016-2017.

Results: The 3C scale includes 24 items distinguished into a three-component structure that accounts for 67.85% of the total variance. The three components include nursing intelligence, nursing humanity, and nursing career. The 3C scale was found to have high levels of internal consistency reliability (.97) and test-retest stability reliability ( r = .97). A significant statistical difference in the performance level was examined between senior and junior nursing students. The hypothesized three-factor model fit index showed χ 2 / df = 1338.25/249, p < .001, goodness-of-fit index = .82, comparative fit index = .90, root mean square error of approximation = .09, and standardized root mean square residual = .06. The participants were found to have excellent nursing humanity competency.

Conclusions: The developed 3C scale exhibited satisfactory reliability and validity for use with nursing students. The 3C scale may be used to evaluate the performance of nursing students during their learning process, and the results may be used to evaluate changes in educational outcomes.

Background: Environmental design in palliative and end-of-life care is known to improve care outcomes, service-user satisfaction, and the continuation of service uptake. No study in the literature has investigated the influence of the environment on palliative and end-of-life care in Nigeria or other African contexts.

Purpose: This study was designed to explore the impact of the physical environment (i.e., place and people) on staff and service users and how these influence the experiences of providing and using palliative and end-of-life care in a Nigerian hospital context.

Methods: Ethnographic methodology was employed because this approach facilitates understanding of environmental realities. This study is part of a larger ethnographic research project developed to uncover aspects of organizational complexities related to the provision and use of palliative and end-of-life care in the Nigerian context. Three hundred fifty hours of participant observation was achieved, and semistructured interviews were used to gather data from 26 participants, including 10 patients, 11 members of a palliative care team, and five hospital managers. Informal chats and photographic capture were additional methods used in data collection. Thematic analysis was conducted to identify and analyze patterns within the collected data.

Results: Physical space, equipment, and placing staff were the three primary themes identified. The physical environment was untidy, and the ward layout prevented privacy, dignity, or comfort for patients and families. The equipment was old and inadequate, and the context of care was worsened by insufficient staffing and neglect of the environmental needs of the staff.

Conclusions: Hospital design for palliative and end-of-life care in Nigeria is "autoinhibitory" (a negative feedback mechanism whereby hospital design detracts rather than promote quality of care), and a physical environment that supports the provision and utilization of care must be implemented to promote palliative and end-of-life care success. Urgent policy action is needed to improve environmental and staffing conditions to advance palliative and end-of-life care in Nigeria.

Background: Infectious diseases are a major threat to healthcare workers and patients alike. Standard precautions (SPs) are a pivotal element in controlling their spread. However, worldwide reported compliance with SP guidelines is suboptimal among workers and students in the healthcare field.

Purpose: The objective of this study was to identify the knowledge and behavioral intent patterns of students in the healthcare field as well as the relationship of these patterns to the students' study program, clinical exposure, and attitudes.

Methods: This cross-sectional study employed a web-based structured questionnaire. Participants were students of nursing, emergency medicine for paramedics, physiotherapy, and medicine studying at a public university in Israel. The questionnaire assessed SP-related knowledge and behavioral intent, perceptions of personal responsibility, and the presence of mentors as role models. The K -means clustering method was used.

Results: The 259 students (33% response rate) who completed the questionnaire were enrolled as participants and divided into two knowledge and behavioral intent clusters. Cluster 1 ( n = 156) had a higher proportion of nursing students and a lower proportion of medical students than Cluster 2 ( n = 103). Emergency medicine for paramedics and physiotherapy students were more evenly distributed between the clusters. Participants who were classified in Cluster 1 reported higher intent with regard to proper hand hygiene, use of personal protective equipment, and decontamination practices. In multivariable analysis, only three variables predicted belonging to Cluster 1: nursing students, perception of their mentors as role models, and perception of having higher personal responsibility for microbiological safety.

Conclusions: We observed clear patterns of knowledge and behavior among the students in the healthcare field examined in this study. These patterns were influenced by profession, role mentoring, and sense of responsibility. This use of cluster analysis may contribute to the development of better SP educational endeavors. The patterns identified highlight the need for improved training and the importance of role modeling for healthcare students in all areas of specialization.

Background: Working conditions in public hospitals in Mexico City are highly demanding. The need for healthcare is pressing, materials and instruments are scarce, and exposure to pain and suffering is constant. These adverse conditions have an adverse impact on the physical and mental health of healthcare professionals. The nursing staffs are among those who are most affected, and they frequently experience burnout syndrome or one of its several dimensions, including emotional exhaustion, depersonalization, and reduced personal accomplishment.

Purpose: The aim of this research was to analyze the relationship among working conditions, related stress, and the dimensions of burnout syndrome in a tertiary care public hospital in Mexico City.

Methods: A cross-sectional design was applied on a random sample of 190 nurses in a public hospital in Mexico City. Working conditions and burnout syndrome were evaluated using standardized instruments. Adjusted prevalence ratios were calculated. Three clusters, one for each burnout dimension, were generated and then evaluated using a correspondence analysis with labor characteristics.

Results: One quarter (25%) of the participants self-reported a sense of personal accomplishment, and 12% reported emotional exhaustion and depersonalization. The labor variables that were found to be associated with the dimensions of burnout were workload, performing potentially hazardous work, and conducting tedious tasks. Positive conditions were shown to decrease the prevalence of burnout in all three dimensions.

Conclusions/implications for practice: Working conditions for nursing staff impact the mental health of nurses and affect the quality of the healthcare they provide. The set of work demands and stressors to which they are exposed should be controlled and modified to ensure a healthy work environment.

Background: Differences in short-term cognitive function between mechanically ventilated patients treated with multicomponent interventions and those receiving routine nursing care have not been established because of the lack of follow-up in previous studies.

Purpose: This study was designed to evaluate the effects of the pain, agitation, and delirium (PAD) care bundle on delirium occurrence and clinical outcomes, specifically in terms of short-term cognitive function, in mechanically ventilated patients.

Methods: Data on 243 patients with mechanical ventilation were analyzed from January 2017 to February 2019. The eligible patients were divided randomly into two groups. The control group ( n = 120) received usual care, whereas the intervention group ( n = 123) received the PAD bundle, including pain monitoring and management, light sedation and daily awakening, early mobility, sleep promotion, and delirium monitoring. The incidence and duration of delirium, ventilator time, and intensive care unit (ICU) length of stay were compared between the two groups. Upon discharge from the ICU and at 3 and 6 months after discharge, cognitive function was assessed using the Montreal Cognitive Assessment scale and compared between the two groups.

Results: The incidence of delirium was reduced significantly in the intervention group, and significant decreases in the duration of delirium, ventilator time, and ICU length of stay were found. Cognitive impairment in the intervention group was significantly lower at the 3-month follow-up assessment.

Conclusions/implications for practice: The PAD bundle was shown to be associated with a lower incidence of delirium and improved clinical outcomes. Short-term cognitive impairment occurred in fewer patients who were managed with the PAD bundle after ICU discharge. Our findings indicate that the PAD bundle has the potential to improve clinical outcomes. The administrative staff of ICUs should use strategies, such as interdisciplinary teamwork, to facilitate the buy-in and implementation of interventions.