Western Journal of Nursing Research最新文献

Background: With population aging, the number of older adults living alone is increasing. Health literacy has an important effect on the health and quality of life of community-dwelling older adults, but the relationship between living alone and health literacy is unclear.

Objective: This study aimed to explore the relationship between living alone and health literacy in community-dwelling older adults.

Methods: A secondary data analysis of health literacy in community-dwelling adults aged ≥65 years was performed using the 2023 Korean National Health and Nutrition Examination Survey data. Health literacy was assessed using a self-reported questionnaire. Multiple linear regression was used to analyze the factors associated with health literacy.

Results: Of 1573 older adults (mean age, 72.2 years; mean health literacy score, 27.6 points), 409 (26.0%) lived alone, of whom 73.1% were women. Health literacy was directly associated with higher educational level (college or higher: β = 0.210, P < .001), being employed (β = 0.080, P = .002), and better subjective health status (good: β = 0.067, P = .038), and inversely associated with living alone (β = -0.064, P = .018), older age (β = -0.062, P = .035), and living in a rural area (β = -0.112, P < .001).

Conclusion: Living alone was associated with a lower level of health literacy. Social support to improve health literacy in older adults should prioritize those living alone, living in rural areas, with lower educational levels, unemployed persons, and those with poor self-perceived health status.

Background: The coronavirus disease 2019 pandemic highlighted vulnerabilities in the nursing workforce needing attention before future crises. Clinical nurse specialists (CNSs) led teams, provided clinical expertise for policies and patient care, and adapted rapidly; however, the pandemic experiences of CNSs are not understood.

Objective: We aimed to explore the lived experiences of Michigan's CNSs throughout the pandemic.

Methods: Using a descriptive phenomenological design, semi-structured, one-on-one interviews were conducted between January and April 2021. Interviews were audio-recorded and transcribed to allow for rigorous analysis.

Results: Nine CNSs participated. Three themes emerged from the data. Within each of those 3 broad themes were 3 to 4 subthemes. Theme 1: nurses adapting to a crisis mindset consists of constant stress and work, rapid and unpredictable change, adapting with the science, and feelings toward the public. Theme 2: CNSs adapting to the crisis in unique ways is comprised of bearing extra emotional weight, losing a sense of control, role representation and clarity, and pride and responsibility. Theme 3: CNSs as holistic beings consists of coping mechanisms, support systems, and persistent life demands.

Conclusions: The stress experienced by CNSs was distinct from the stress felt by other health care professionals as they were expected to lead teams through 3 spheres of impact. The magnitude and uniqueness of their stress identifies a priority for adequate preparation of CNSs and highlights an opportunity for specific areas of improvement prior to any future crises.

Background: COVID-19 affected the ability of minorities to access healthcare services.

Objective: We sought to explore factors associated with perceived usefulness of telehealth, perceived ease of use, attitude toward telehealth, behavioral intention to use telehealth, and actual use of telehealth among minority individuals during the COVID-19 pandemic.

Method: A descriptive exploratory design was used with a sample of 43 minority individuals living in the Midwest United States who used telehealth within the last 12 months. The theoretical framework guiding this study was the technology acceptance model.

Results: Forty-three individuals living in the community completed the survey, with the majority identifying as female and African American. Those with a bachelor's degree or less had lower perceived usefulness of using telehealth than those with a master's degree (t_[41] = -3.01, P < .01). Participants who accessed telehealth through a smartphone or regular cell phone perceived the usefulness of telehealth significantly higher (t_[41] = 2.04, P < .05) than those who used other methods. Older participants reported less perceived of ease of use of telehealth than their younger counterparts (r = -0.33, P < .05). Perceived usefulness, ease of use, attitude, and behavioral intention to use telehealth were positively correlated (P < .001).

Conclusion: Age, educational level, and method of accessing telehealth services were associated with perceived usefulness and ease of use by study participants. Additional research is recommended.

Background: Older adults with cognitive impairment are at increased risk of falls due to impaired judgment, balance, and mobility. The effectiveness of fall prevention interventions in this population remains unclear.

Objective: To investigate the effects of fall prevention interventions on fall incidence in older adults with cognitive impairment.

Methods: A systematic review and meta-analysis were conducted and reported following PRISMA guidelines. Six databases (PubMed, CINAHL, PsycINFO, Embase, Cochrane CENTRAL, and PQDT) were searched for studies published from January 2014 to December 2023, with an updated search in May 2025. Eligible studies were randomized or quasi-experimental trials involving adults aged ≥60 years with cognitive impairment. Of 2342 records identified, 17 studies were included in the review and 10 studies (13 data sets) in the meta-analysis. Study quality was appraised using a modified Scottish Intercollegiate Guidelines Network checklist. A random-effects model was used to synthesize results.

Results: Interventions included exercise programs (eg, Tai Chi, resistance training), technology-enhanced training, and environmental or cognitive strategies. They were delivered 1 to 4 times/week over 4 to 52 weeks. Meta-analysis showed a significant reduction in fall rates in intervention groups compared to controls (pooled incidence rate ratio = 0.82; 95% confidence interval: 0.69-0.98). Moderate heterogeneity was observed (I² = 73.7%; p < .001).

Conclusions: Fall prevention interventions can effectively reduce fall rates among older adults with cognitive impairment. Implementing tailored, evidence-based strategies is essential to supporting this high-risk population.

Background: Interstitial cystitis is a complex, highly challenging chronic inflammatory condition that is most predominant in women. It is characterised by persistent pain in the bladder and pelvis area and an urgent and frequent need to urinate during the day and at night. Despite the chronic and burdensome nature of interstitial cystitis, the lived experiences of women suffering from it have been inadequately explored.

Objective: We sought to acquire in-depth knowledge and insights into the experiences of Norwegian women living with interstitial cystitis.

Methods: A qualitative approach was used with an exploratory descriptive design, using the participants' own written stories of living with interstitial cystitis. The data were analysed using a reflective thematic analytic method.

Results: Three main themes came to the fore: (1) interstitial cystitis impacts every aspect of life, (2) struggling to be believed and heard, and (3) struggling to access personalised treatment for symptom alleviation.

Conclusions: Interstitial cystitis is a complex condition that negatively impacts women's physical, mental, and sexual health. Women with interstitial cystitis may face disbelief and medical gaslighting compounded by a lack of awareness about the condition, which hinders their access to tailored treatment and care. The findings emphasise the need for competence and empathy among healthcare professionals and underscore the importance of an increased focus on conditions predominantly affecting women.

Background: Early identification of suicidal ideation (SI) in older adults with chronic pain is critical for improving mental health outcomes. However, methods for SI risk identification and stratification remain limited. Furthermore, traditional statistical methods often fail to capture the complex relationships among risk factors, making machine learning approaches particularly valuable.

Purpose: To develop explainable machine learning models to identify SI risk in older adults with chronic pain.

Methods: This cross-sectional study recruited 516 inpatients from a tertiary hospital in China, all of whom were older adults (aged ≥60 years) with chronic pain (duration ≥3 months) and a visual analog scale (VAS) score of ≥3. Participants completed a general data questionnaire, Beck Suicidal Ideation Scale, VAS, Pain Catastrophizing Scale, and Perceived Social Support Scale. Data were preprocessed using Min-Max Normalization and SMOTETomek. Variables were selected based on univariate analysis, Support Vector Machine-Recursive Feature Elimination, and LASSO regression. Machine learning models were developed and interpreted using the Shapley Additive Explanations method.

Results: History of suicide, history of depression, suicidal behavior exposure, number of pain sites, pain duration, pain level, pain catastrophizing, and perceived social support were associated with SI. The Random Forest (RF) model, which exhibited the best performance, achieved an accuracy of 0.85 and an area under the curve of 0.89. Pain level, perceived social support, and pain catastrophizing were the 3 most influential contributors to SI risk.

Conclusions: The explainable machine learning models facilitate early detection and risk stratification of SI for nurses. By identifying key SI risk factors, these findings support targeted interventions and routine clinical screening.

Background: (Pre-)frailty is a state of heightened multidimensional vulnerability. Therein, (pre-)social frailty and (pre-)physical frailty are common subtypes, often coexisting and synergistically increasing risks of adverse outcomes.

Objective: We aimed to compare the effectiveness of an exercise intervention among community-dwelling (pre-)physically frail older adults by baseline (pre-)social frailty status.

Methods: This was a secondary analysis of a stepped-wedge cluster randomized trial evaluating a 12-week exercise intervention among 149 community-dwelling (pre-)physically frail older adults, with 3 follow-up visits at the 0-week, 12-week, and 24-week postintervention. Intervention effectiveness was examined within subgroups by baseline (pre-)social frailty status (non-[pre-]social frailty: n = 47; [pre-]social frailty: n = 102) using multilevel linear regression.

Results: The non-(pre-)social frailty group exhibited immediate and persistent treatment responses across most outcomes. The (pre-)social frailty group showed improvements in physical frailty (all time points), cognitive function (0-week postintervention), depressive symptoms (all time points), social frailty (score: 0-week and 12-week postintervention; status: all time points), and quality of life (physical: all time points, mental: 0-week and 12-week postintervention). The (pre-)social frailty group had greater immediate improvements in fear of falling, depressive symptoms, and social frailty scores and status than the non-(pre-)social frailty group, but their improvements in social frailty score were less persistent at the 24-week postintervention.

Conclusions: Older adults with (pre-)physical frailty who had comorbid (pre-)social frailty experienced effective improvements in fewer outcomes and less persistent gains in certain outcomes than their counterparts. Interventions should incorporate social support components to ensure comprehensive and lasting effectiveness for this population.

Trial registration: Chinese Clinical Trial Registry (ChiCTR2100041981).

Background: The Self-Efficacy in Palliative Care (SEPC) scale assesses the perceived competence of palliative care professionals. There is no validated version of this scale in Ecuador.

Aim: We sought to culturally adapt and validate the SEPC scale in nursing professionals and students in Ecuador, examine their levels of self-efficacy, and explore influencing factors.

Methods: Thirteen experts participated in a Delphi panel for cultural adaptation. For validation, 421 undergraduate students and 497 nursing professionals participated, providing sociodemographic information along with formative, professional, and personal experience in palliative care, followed by the SEPC scale, the Bugen Coping with Death scale, and the Palliative Care Difficulties scale. Twenty percent completed the instruments at the 6th month for intra-observer validity. A confirmatory factor analysis (CFA) of the original structure was performed.

Results: The SEPC scale showed adequate 3-factor structure and excellent internal consistency reliability (Cronbach's α = 0.98). Construct validity, assessed via CFA, showed a root mean square error of approximation of 0.053, indicating good model fit, with a comparative fit index of 0.984 and a Tucker-Lewis Index of 0.976. Nursing professionals demonstrated higher SEPC scores than students. Moreover, people with personal end-of-life experience and older people had higher SEPC scores. Higher self-efficacy is associated with better coping with death, but not with greater perceived difficulties in palliative care. This finding provides partial support for the convergent validity of the measure.

Conclusion: The SEPC scale can be used in Ecuador and other similar contexts to assess self-efficacy perceived by nursing professionals and students.

Background: Psychological distress, including anxiety, depression, and suicidality, may be influenced by environmental exposures such as pesticides. However, whether pesticide exposure is a significant risk factor for these mental health outcomes remains unclear.

Objective: We sought to systematically evaluate whether pesticide exposure is a risk factor for anxiety, depression, and suicide among agricultural populations.

Methods: We conducted a systematic search of PubMed, Web of Science, and Scopus through December 2024. Observational studies assessing the association between pesticide exposure and psychological distress outcomes were included. Separate meta-analyses were performed for studies with retrospective and prospective exposure assessments using random-effects models to calculate pooled odds ratios (ORs) or risk ratios (RRs). Subgroup analyses and meta-regression explored potential moderators. Publication bias and sensitivity analyses were conducted.

Results: Twenty-one studies met the inclusion criteria. Among retrospective studies, pesticide exposure was associated with increased odds of psychological distress (pooled OR = 1.77; 95% confidence interval [CI]: 1.37-2.31). Among prospective studies, pesticide exposure was associated with increased risk (pooled RR = 1.99, 95% CI: 1.23-3.21). Subgroup analyses indicated stronger associations for depression compared to suicide. Meta-regression identified outcome type and sample size as significant moderators. Despite evidence of small-study effects, sensitivity analyses confirmed the robustness of the results.

Conclusion: This systematic review and meta-analysis support pesticide exposure as a potential risk factor for anxiety, depression, and suicide, underscoring the need for preventive strategies and further longitudinal research.PROSPERO Registration Number:CRD42024502004.

Background: Patient-centered communication (PCC) has been recognized as a key factor in improving health outcomes, yet little is known about the role of PCC in preventing risky health behaviors.

Objective: This study investigated associations between PCC and health-risk behaviors (ie, traditional cigarette use, electronic cigarette use, alcohol consumption above recommended levels) among U.S. adults with and without cancer history.

Methods: The nationally representative data used in this study came from the 2020 Health Information National Trends Survey. The sample included 2529 adults (aged ≥18 years), including 421 with a self-reported cancer history and 2108 without a self-reported cancer history. Descriptive statistics and multivariable logistic regression analyses were performed.

Results: Overall, 13.2% reported current traditional cigarette use, 6.1% e-cigarette use, and 31.4% alcohol use above recommended levels. Although cancer survivors were less likely to report e-cigarette use (2.2% vs 6.5%, P = .004), no group differences in cigarette smoking and alcohol drinking were established. Better PCC was associated with lower odds of reporting ≥1 health-risk behavior among cancer survivors (adjusted odds ratio [AOR] = 0.97; 95% confidence interval [CI], 0.95-0.99; P = .005). Among those without cancer, older age (AOR = 0.44; 95% CI, 0.27-0.73; P = .002), higher education (AOR = 0.60; 95% CI, 0.37-0.98; P = .040), and having health insurance (AOR = 0.41; 95% CI, 0.19-0.89; P = .025) were associated with lower odds of engaging in ≥1 health-risk behavior.

Conclusion: Study findings showed significant associations between PCC and health-risk behaviors among cancer survivors. Promoting PCC among providers is needed for better patient outcomes. PCC, that is, responsive to patients' needs and expectations can prevent engagement in risky health behaviors.