Worldviews on Evidence-Based Nursing最新文献

Background: The characteristics, application, and effectiveness of chatbots in improving the mental health of young people have yet to be confirmed through systematic review and meta-analysis.

Aim: This systematic review aims to evaluate the effectiveness of chatbot-delivered interventions for improving mental health among young people, identify factors influencing effectiveness, and examine feasibility and acceptability.

Methods: To identify eligible interventional studies, we systematically searched 11 databases and search engines covering a publication period of January 2014 to September 2024. Meta-analyses and subgroup analyses were performed on randomized controlled trials to investigate the effectiveness of chatbot-delivered interventions and potential influencing factors. Narrative syntheses were conducted to summarize the feasibility and acceptability of these interventions in all the included studies.

Results: We identified 29 eligible interventional studies, 13 of which were randomized controlled trials. The meta-analysis indicated that chatbot-delivered interventions significantly reduced distress (Hedge's g = -0.28, 95% CI [-0.46, -0.10]), but did not have a significant effect on psychological well-being (Hedge's g = 0.13, 95% CI [-0.16, 0.41]). The observed treatment effects were influenced by factors including sample type, delivery platform, interaction mode, and response generation approach. Overall, this review demonstrates that chatbot-delivered interventions were feasible and acceptable.

Linking evidence to action: This review demonstrated that chatbot-delivered interventions had positive effects on psychological distress among young people. Chatbot-delivered interventions have the potential to supplement existing mental health services provided by multidisciplinary healthcare professionals. Future recommendations include using instant messenger platforms for delivery, enhancing chatbots with multiple communication methods to improve interaction quality, and refining language processing, accuracy, privacy, and security measures.

Background: The teach-back method is an effective approach for reinforcing patient education by clarifying and reviewing misunderstood concepts.

Aim: To examine the effect of discharge training based on the teach-back method on discharge readiness and satisfaction in patients undergoing lumbar disc herniation surgery.

Methods: A randomized controlled trial using a pre-test-post-test design was conducted at two state hospitals in Northern Cyprus from November 2022 to December 2023. A total of 64 patients were randomly assigned to either the intervention group (n = 32) or the control group (n = 32). Data were collected using the Discharge Education Satisfaction Scale, the Readiness for Hospital Discharge Scale, and the Discharge Education Knowledge Test. The CONSORT 2010 flow diagram was followed.

Results: The mean ages of the intervention and control groups were 51.26 ± 11.92 years and 46.50 ± 11.73 years, respectively. Following the intervention, patients who underwent lumbar disc herniation surgery in the intervention group showed significantly higher scores compared to the control group (p < 0.05). These improvements were observed in overall discharge education satisfaction, discharge education knowledge, and all subdimensions of discharge readiness-including personal status, knowledge, and coping ability.

Linking evidence to action: Discharge education delivered using the teach-back method enhances satisfaction, knowledge, and discharge readiness in patients undergoing lumbar disc herniation surgery.

Trial registration: The full research protocol is available at ClinicalTrials.gov (NCT05695014).

Background: Hematological cancers impair patients' quality of life (QoL) due to prolonged and complex treatments. Digital empowerment programs enhance patient engagement by supporting symptom management and psychosocial well-being.

Aims: This study was conducted to examine the effects of patient-centered digital empowerment programs on hematological cancer care.

Methods: As part of this study, a comprehensive search was conducted in nine databases and the gray literature in March 2025. The screening included randomized controlled trials without any time restrictions. This study adhered to the guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. Fixed-effect and random-effect models were used in the meta-analysis. Cochran's Q chi-square test and I² statistic were applied to assess heterogeneity. Data analysis was performed using the Comprehensive Meta-Analysis (CMA) 3 software.

Results: A total of seven studies were included in this meta-analysis. Patient-centered digital empowerment programs were found to have moderate and positive effects on depression (Hedges' g = 0.27, p < 0.001), distress (Hedges' g = 0.28, p < 0.001), self-efficacy, and QoL (Hedges' g = 0.22, p < 0.001). There was no significant effect on fatigue levels in patients with hematological cancers (p = 0.27), suggesting that digital empowerment programs may not be effective in managing fatigue. The results of the sensitivity analysis support the robustness and reliability of the study findings.

Linking evidence to action: Digital empowerment programs may serve as a moderately effective tool in improving depression, distress, self-efficacy, and QoL among patients with hematological cancers. However, they exhibit limited effects on physical symptoms, particularly in fatigue management. Therefore, more comprehensive and multidisciplinary interventions are needed to address the management of physical symptoms effectively. Patient-centered digital empowerment programs enable early intervention by assisting healthcare professionals in symptom tracking. Digital solutions enhance care processes by improving patient education, psychosocial support, and self-management skills.

Background: Home-based exercise offers a cost-effective way to receive thorough rehabilitation without the requirement of costly supervised treatment.

Aim: To investigate the effects of home-based exercise on the balance ability in post-stroke patients.

Methods: A thorough search was carried out on various databases, such as Cochrane Library, Web of Science, PubMed, Embase, and China National Knowledge Infrastructure Library, until October 2024. The inclusion criteria were limited to randomized controlled trials that evaluated the impact of home-based exercise interventions.

Results: The meta-analysis indicated that home-based exercise significantly improved static balance ability (Berg Balance Scale [BBS]: MD = 3.45, 95% CI [1.43, 5.47], I² = 71%, p = 0.0008, random-effects model). Conversely, the analysis revealed that the home-based exercise group did not exhibit a statistically significant improvement in the Time up and Go Test (TUG) when compared to the control group (TUG: MD = -0.34, 95% CI [-4.30, 3.61], I² = 96%, p = 0.86, random effects model). The subgroup analysis revealed that home-based exercise significantly enhanced balance ability in patients with subacute stroke (BBS: p < 0.0001; TUG: Overall effect p = 0.02). However, no significant improvement was observed in patients with chronic stroke (BBS: p = 0.39). Regarding the duration of intervention, both short-term and long-term interventions were effective on the BBS (p < 0.0001 and p = 0.0008, respectively), although no significant difference was found for the TUG. Participants engaging in exercise for more than 90 min per week demonstrated greater improvements in balance ability (BBS: p < 0.0001; TUG: p = 0.02). When considering national economic levels, significant effects on the BBS were observed in both developed and developing countries (p = 0.0001 and p < 0.0001, respectively), while significant effects on the TUG were noted only in developing countries (p = 0.04).

Linking evidence to action: Home-based exercise interventions showed significant results in improving static balance in patients with subacute stroke, especially home-based exercise that lasted longer than 12 weeks and lasted at least 90 min per week. However, more methodologically rigorous randomized controlled trials are needed to validate these results. In addition, the optimal exercise program and type to optimize the balance ability of stroke patients also need further research.

Background: The global population is aging, and it is becoming increasingly common for older people to suffer from multiple diseases. The development of digital health technologies has assisted the self-management of multimorbid older patients. Currently, there is a lack of qualitative review that synthesizes the needs and experiences of multimorbid older patients using digital health technologies for self-management.

Aims: To synthesize the needs and experiences of multimorbid older adults using digital health technologies for self-management.

Methods: The following six electronic databases were searched: PubMed, Embase, Web of Science, Scopus, Cochrane Library, and CINAHL. The search timeframe was from construction to November 4, 2024. Thematic synthesis by Thomas and Harden was used for meta-synthesis. Study selection and data extraction were conducted independently by two researchers, and quality was evaluated using the 10-item Critical Appraisal Skills Programme tool.

Results: Ten studies were included. Three themes and seven subthemes were synthesized: (1) different impressions and perceptions, (2) challenges of use, and (3) conveniences and benefits. Older adults with multiple medical conditions have positive or negative impressions and perceptions of digital health technologies and experience multiple challenges in their use (lack of expertise, technical and equipment barriers, need support), while at the same time, digital health technologies offer huge benefits for their self-management (improved communication with healthcare professionals, enhanced self-management skills).

Linking evidence to action: This review provides support for healthcare professionals to understand the experiences of multimorbid older adults using digital health technologies for self-management. Healthcare professionals and technology developers should establish collaborative relationships to design comprehensive, usable, and less burdensome digital health technologies for older adults with multiple morbidities. Additionally, comprehensive technical support services should be provided to ensure the effective utilization of these technologies by older adults.

Trial registration: PROSPERO number: CRD42024599433.

Background: A call for action has been issued nationwide to prevent suicide among nurses. An increased understanding of contributing and protective factors associated with suicidal ideation in nurses is needed to implement preventive measures. Factors needing exploration include nurses' burnout, mental well-being, physical health, and workplace characteristics.

Aims: This study aimed to determine factors associated with suicidal ideation in 501 moderate-to-high-risk nurses, including their mental health, level of burnout, health-related personal beliefs, healthy lifestyle behaviors, and workplace characteristics.

Methods: A descriptive, cross-sectional correlational study was conducted on baseline survey data that was completed before the nurses were randomized to one of two interventions as part of their participation in a randomized controlled trial investigating the efficacy of a combined mental health screening program and cognitive-behavioral skills building intervention versus a screening program alone. Nurses were recruited from across the United States via email. Only nurses identified with moderate-to-high-risk adverse mental health outcomes, including suicidal ideation, were included. The survey used valid and reliable measures to assess burnout, anxiety, depression, suicidal ideation, post-traumatic stress, healthy lifestyle behaviors, health-related personal beliefs, resilience, job satisfaction, self-perceived mattering to the workplace, and intent to leave. Bivariate tests were performed.

Results: Burnout, anxiety, depression, and post-traumatic stress were individually correlated with increased odds of suicidal ideation, as were nurses working 12-h shifts and those who reported an intent to leave their jobs. Protective factors against suicidal ideation included resilience, positive health-related personal beliefs, healthy lifestyle behaviors, job satisfaction, and workplace mattering.

Linking action to evidence: There is an urgent need for policies and implementation of evidence-based interventions to address mental health issues in nurses to ultimately prevent suicide. Burnout should be considered as a possible precursor to serious adverse mental health problems and not just an operational retention issue. Leaders need to invest in resources to enhance nurses' mental health, fix system problems that are at the root cause of burnout, routinely recognize employees for their excellent work, and communicate that they matter. Leaders should listen carefully to their nurses, prioritize their ideas for impactful change, and appreciate those who contribute to improving culture and caring practices.

Background: Cardiovascular disease (CVD) is a leading cause of mortality and disability worldwide, posing significant challenges to the quality of healthcare services. Social Cognitive Theory (SCT) provides a framework for understanding individual behaviors and guides the development of intervention programs aimed at promoting health-enhancing behaviors.

Aims: To evaluate the effectiveness of interventions based on SCT in improving health outcomes among patients with CVD.

Methods: From the creation of the databases until September 2024, we searched six databases and manually searched the references included in the study. The outcomes included cardiovascular risk factors (weight, blood pressure, blood lipids), physical capacity (6-min walk test, physical activity, daily steps, exercise self-efficacy), psychological states (anxiety, depression), and health behaviors (self-management, self-efficacy, quality of life). The quality of randomized controlled trials was evaluated with the Cochrane RoB 2 tool, and quasi-experimental studies were assessed using the JBI critical appraisal tool.

Results: A total of 10 studies, involving 1140 participants, were included in the review. Compared to conventional cardiovascular care, interventions based on SCT were able to lower systolic blood pressure (MD = -6.36; 95% CI [-11.30, -1.41]; p = 0.012), total cholesterol (MD = -0.29; 95% CI [-0.49, -0.09]; p = 0.004), and low-density lipoprotein levels (MD = -0.21; 95% CI [-0.38, -0.04]; p = 0.015) in CVD patients. They also increased the 6-min walk test distance (MD = 33.87, 95% CI [5.40, 62.34], p = 0.02) and daily steps (SMD = 0.77; 95% CI [0.46, 1.09]; p < 0.001), improved physical activity (SMD = 0.65; 95% CI [0.25, 1.06]; p = 0.002) and exercise self-efficacy (SMD = 1.23, 95% CI [0.23, 2.23], p = 0.016), and enhanced quality of life (SMD = 0.75, 95% CI [0.06, 1.43], p = 0.032).

Link evidence to action: Social cognitive theory-based interventions hold promise for improving health outcomes in patients with cardiovascular disease. This study provides further insights into the application of SCT in clinical practice. However, given the limited number of included studies and the potential risk of bias, further high-quality research is required to validate these findings.

Background: Stress, anxiety, and depression during pregnancy can adversely affect maternal, fetal, and child health. To alleviate these symptoms, nonpharmacological interventions have been increasingly utilized as supportive approaches.

Aim: To compare nonpharmacological interventions and determine their effectiveness in reducing stress, anxiety, and depression levels during pregnancy.

Methods: This systematic review adheres to the network meta-analysis extension for the Preferred Reporting Items for Systematic Review and Meta-analysis 2015 statement for design and reporting. The included studies were comprised of quasi-randomized and randomized controlled trials that aimed to assess the effectiveness of nonpharmacological interventions on stress, anxiety, and depression in pregnant women. The methodological quality of the included studies was assessed using the Cochrane Collaboration Risk of Bias Tool. Statistical analysis was conducted using the "mvmeta" package in Stata/SE 15. PubMed, APA PsycNET, Web of Science, The Cochrane Library, and Scopus were searched for randomized controlled trials up to December 2021.

Results: This star network meta-analysis included 38 trials with 3555 pregnant women and eight nonpharmacological interventions for stress, anxiety, and depression. The findings indicate that spiritual meditation was the most effective intervention in reducing stress, anxiety, and depression during pregnancy. Mindfulness-based stress reduction was identified as another effective intervention specifically for reducing stress. Furthermore, during pregnancy, mindfulness-based cognitive therapy was found to be the second most effective intervention in reducing depression.

Linking evidence to action: Our research showed that spiritual meditation might be the most effective intervention for reducing stress, anxiety, and depression in pregnant women. Health professionals could consider recommending spiritual meditation as a complementary therapy to pregnant women to reduce stress, anxiety, and depression.

Trial registration: PROSPERO International Prospective Register of Systematic Reviews: CRD42021261089.

Background: Optimal glycemic control is known to be challenging for people with type 2 diabetes (T2D) due to the maintenance of long-term self-management behavior. Incorporating the transtheoretical model (TTM) components into motivational interviewing (MI) has been applied to promote self-management behaviors such as physical activity in T2D patients. However, the effectiveness of the TTM-based MI intervention in improving glycemic control, self-management, and self-efficacy in adults with T2D remains unclear.

Aim: This systematic review and meta-analysis of randomized controlled trials aimed to estimate the effect of a TTM-based MI intervention on glycemic control, self-management, and self-efficacy in adults with T2D patients.

Methods: We searched five electronic databases up to September 13, 2023. Two researchers independently screened records, extracted data, and assessed study quality using the Cochrane Risk of Bias Tool 2.0. Pooled effects were estimated in standardized mean differences (SMDs) or mean differences (MDs) using fixed- and random-effects models. Sensitivity analysis and meta-regression explored the reasons for heterogeneity.

Results: Thirty trials with 4214 participants were identified. The TTM-based MI intervention significantly reduced HbA1c (MD = -0.92, 95% CI [-1.08, -0.75], p < 0.001, I² = 65%), FPG (SMD = -1.06, 95% CI [-1.38, -0.73], p < 0.001, I² = 93%), and 2hPG (MD = -1.42 mmol/L, 95% CI [-1.83, -1.00], p < 0.001, I² = 89%), with high, moderate, and low certainty of evidence, respectively. The intervention also improved self-management (SMD = 1.47, 95% CI [1.16, 1.78], p < 0.001, I² = 80%) and self-efficacy (SMD = 1.53, 95% CI [1.04, 2.02], p < 0.001, I² = 92%). Meta-analysis revealed that MI treatment dose and initial glycemic status contributed to the high heterogeneity.

Linking evidence to action: The TTM-based MI intervention can be a promising intervention for understanding patients' stage of change with tailored strategies and MI techniques to facilitate behavior change, resulting in improved glycemic control, self-management, and self-efficacy in T2D patients. Nevertheless, given the moderate to high risk of bias in the included studies, further rigorous randomized controlled trials should be conducted to examine the effectiveness of TTM-based MI interventions. Short and multiple sessions that comply with the fidelity of MI in the intervention plans are suggested in daily nursing routine for diabetes self-management education.