Western Journal of Nursing Research最新文献

Objective: Our aim in this study was to evaluate the effects of education provided to family caregivers of patients with heart failure (HF) on the caregiver's contribution to the patient's self-care and on the patient's quality of life and symptoms.

Methods: This study utilized a pretest-posttest intervention design and was conducted with 380 patients and family caregivers. Data were collected using the Caregiver Information Form, Patient Information Form, Caregiver Contribution to Heart Failure Self-Care Index (CC-SCHFI), Memorial Symptom Assessment Scale-Heart Failure (MSAS-HF), and the Minnesota Living with Heart Failure Questionnaire (MLWHFQ). After the preliminary interview, a pretest was administered to the patients and their caregivers. Then, caregivers were trained on HF. After the end of the education, the posttest was administered to the patients and their caregivers.

Results: The difference between the mean (± SD) CC-SCHFI pretest (53.37 ± 1.73) and posttest (72.84 ± 1.08) scores was statistically significant (p < .001). The differences between patients' MSAS-HF pretest (1.08 ± 0.39) and posttest (0.53 ± 0.25) and MLWHFQ pretest (49.00 ± 12.69) and posttest (39.00 ± 14.06) scores were statistically significant (p < .001). There was no significant correlation between the CC-SCHFI pretest scores of caregivers and the MLWHFQ and MSAS-HF pretest scores of patients, whereas a weak and significant correlation was found between the CC-SCHFI posttest scores of caregivers and the MSAS-HF posttest scores of patients (r = 0.161, p = .002).

Conclusion: Supporting caregivers in HF through educational program may increase their contribution to patient care and improve patient outcomes.

Background: Any form of discrimination directly opposes the ethical principles and values of the nursing profession. Discriminatory care is a major moral challenge to healthcare systems around the world.

Objective: This study aimed to explore clinical nurses' experiences of discrimination against patients.

Methods: This qualitative study used a conventional content analysis approach. Thirteen nurses were selected through purposive sampling from various clinical units at public and private hospitals in Iran. Data collection was conducted through semi-structured interviews, and data analysis was performed using Granheim and Lundman's 5-step method.

Results: The study identified 3 main themes and 6 subthemes. These include "duplicity in the application of organizational rules" (comprising differences in providing hospitalization and patient accommodation services and ignoring organizational regulations in providing welfare services), "inequality in relationship with patients" (encompassing disregard for ethical considerations in patient relationships and differential physical presence at the patient's bedside), and "differences in the delivery of care and treatment services" (involving neglecting patients' needs in care provision and expediting the provision of interdisciplinary services).

Conclusion: This study underscores that discrimination in health care extends beyond direct patient care, infiltrating physical, material, and even intangible aspects such as communication style and patient attention. To combat this pervasive issue, nurses must receive comprehensive education about the various forms of discrimination. By implementing both immediate and long-term strategies, including policies and programs, we can work toward creating a more inclusive and respectful healthcare environment for all.

Introduction: Advanced practice nursing is well established in many countries. However, in Mexico the role has not been implemented. The aim of this paper was to establish consensus, via expert stakeholder engagement, on the priorities to develop advanced practice nurse (APN) roles nationally in Mexico.

Methods: A 2-round Delphi technique was employed. Along with using data from in-depth interviews with health care professionals in Mexico, a review of the published literature was also undertaken. A total of 25 statements using a Likert scale from not important (1) to very important (4) were developed for round 1. Those working in positions with an interest in advanced practice nursing were invited to participate. A context index validity of 0.8 was applied for round 1, and those that scored above 0.8 were used for round 2 where participants were asked to rank the statements in order of priority.

Results: Thirty-one experts participated in round 1 and 14 in round 2. A total of 12 statements were scored with a content validity index above 0.8, and these were ranked for round 2. The statements reflected key areas around advanced practice nursing from workforce issues to regulation, education, and career progression. The key priorities were the need for a national regulatory framework and clear definition of APN roles.

Conclusions: These statements will now be used to support the case for how advanced practice nursing should be developed in Mexico at a national level addressing the health care needs of the population and help toward building a strong APN workforce.

Background: New nurse turnover remains a significant issue. Studies demonstrate that when nurses think their patients' safety is threatened, they are more likely to question their job commitment.

Objective: The objective of this study was to explore the question "How do new nurses' perceptions of safety affect their intention to leave their first job?"

Methods: We used reflexive thematic analysis, a qualitative analytic method. Participants were recruited as part of a subset of a larger nationwide survey on transition to practice of RNs who were newly licensed in 2021. Thirteen nurses from 7 states were included in the sample.

Results: Four of the 13 nurses were in their first positions at the time of the interview. When asked to describe their first year in practice, an overarching finding was "It felt unsafe." The subthemes derived from this main theme were Entering a Precarious Environment and Questioning Their Readiness for Practice. Environmental and nurse-related factors contributed to this feeling.

Conclusion: Helping new nurses feel safe requires the development of a supportive clinical culture. Improving staffing alone will not ensure that new nurses feel supported. When the nurses in this study felt that they were not alone and that they could count on other staff to be helpful, they thrived even in the face of high patient acuity and stressful situations. This support helps them to develop their nursing judgment and learn to care for themselves so they can deliver optimal patient care.

Background: Few interventions have been culturally and linguistically adapted to address Latino family caregivers' unique needs for support in providing dementia care.

Objective: We sought to pilot test the Aprendiendo Juntos/Learning Together intervention in increasing self-efficacy for care provision among Latino caregivers.

Methods: Using a randomized waitlist controlled design, 50 Latino family caregivers were assigned to either the immediate intervention group (IIG) or waitlist control group (WLG). The intervention was a 6-week psychoeducational program, delivered weekly via a video-conferencing platform, addressing topics around care provision such as communication, home safety, and medication management. Caregivers were assessed at baseline, 12, and 24 weeks. The primary outcome was caregiver self-efficacy at 12 weeks, with secondary outcomes including caregiver confidence, global health, and appraisal of behavioral symptoms of dementia. Between-group differences were examined using independent t-tests and multivariable linear regression, controlling for potential confounders.

Results: Caregiver self-efficacy significantly improved in the IIG compared with the WLG (P = .042) with a moderate effect size (d = 0.64). Confidence in providing complex care also increased significantly in the IIG (P = .002), demonstrating a strong effect size (d = 1.00). In addition, 2 of the 4 subscales of the Caregiver Confidence in Medical Sign/Symptom Management scale-managing cognitive signs/symptoms and general medical management/responsiveness-showed significant improvements (d = 0.95, P = .004 and d = 0.99, P = .003, respectively). Sustainability of intervention effects at 24 weeks was observed in the IIG.

Conclusions: The findings support the efficacy of the intervention in increasing self-efficacy in providing complex care to their family members with dementia among Latino caregivers.

Background: Childhood obesity has emerged as a significant public health issue globally, with one-quarter of obese children living in Africa. Maternal factors have been linked with childhood obesity, yet there is limited research in Ghana.

Objective: This scoping review examined maternal factors associated with childhood obesity in Ghana.

Methods: This review was conducted using the framework by Arksey and O'Malley. The strategy involved searching electronic databases (PubMed, Web of Science, and Embase) and reference lists of relevant literature. Additional searches were performed using Google Scholar. Keywords, including maternal factors, childhood obesity, and Ghana, with their synonyms and related Medical Subject Headings (MeSH) terms, were combined using Boolean operators. Peer-reviewed articles investigating maternal factors in relation to obesity in children in Ghana were included.

Results: The scoping review included 11 studies conducted between 2012 and 2022 with 8101 children between 4 and 17 years old. The prevalence of childhood obesity was between 2.3% and 21.2%. Higher socioeconomic status was consistently associated with a higher risk of childhood obesity. Several studies also found a positive association between maternal education and childhood obesity. Other maternal factors, including BMI and empowerment, have been less frequently studied.

Conclusion: Contrary to results from the developed countries, Ghanaian children from higher socioeconomic backgrounds and with more educated mothers are more prone to obesity, highlighting the need to specifically target these families in obesity prevention and intervention strategies.

Background: Emerging adulthood (aged 18-29 years) is a critical period marked by social, academic, and work transitions. During this life stage, sleep patterns are easily changed, especially for those who live with type 1 diabetes mellitus, which increases the likelihood of sleep disorders.

Objectives: We sought to (1) describe sleep characteristics in emerging adults with type 1 diabetes mellitus in Andalusia, Spain; (2) determine the prevalence of insomnia and hypersomnolence using Diagnostic and Statistical Manual of Mental Disorders (DSM-5) diagnostic criteria; and (3) examine the relationship between sociodemographic factors and diabetes-related factors with sleep satisfaction and symptoms of insomnia and hypersomnolence while controlling for potential confounders such as coexisting health conditions and the use of sleep aids.

Methods: We conducted a cross-sectional study in Andalusia, Spain, from October 2021 to July 2022, involving 362 emerging adults aged 18 to 29 (67.4% female) with type 1 diabetes mellitus. Participants completed online forms for sociodemographic questions and the Oviedo Sleep Questionnaire.

Results: The average sleep duration was 6.8 hours, with half of the participants expressing dissatisfaction. Sleep duration and biological sex predicted insomnia and hypersomnolence, while only sleep duration predicted sleep satisfaction. Common nocturnal awakenings were due to urination, noise, and hyper/hypoglycemia. Notably, 47.5% met DSM-5 criteria for insomnia and 6.9% for hypersomnolence.

Conclusions: Emerging adults with type 1 diabetes mellitus in Andalusia frequently faced significant sleep challenges, including sleep dissatisfaction, insufficient sleep duration, insomnia, and hypersomnolence. These findings highlight the need for comprehensive sleep assessments in diabetes care, using DSM-5 criteria that can guide interventions to improve sleep quality and glycemic stability.

Background: Maintaining a good quality of life improves treatment outcomes and overall survival rate among patients with hepatobiliary and pancreatic cancers. However, known factors influencing the quality of life are fragmented and require a comprehensive investigation of influencing factors to improve the quality of life among patients with hepatobiliary and pancreatic cancers during treatment periods.

Objective: We aimed to comprehensively identify the factors influencing the quality of life among patients with hepatobiliary or pancreatic cancer during illness and treatment periods.

Methods: Patients with hepatobiliary or pancreatic cancer were recruited from a university hospital between September 2022 and November 2023. Along with collecting medical and treatment information, pain, depression and anxiety, and quality of life were assessed using the Numeric Rating Scale, Hospital Anxiety and Depression Scale, and Functional Assessment Cancer Therapy-General Scale, respectively. Multiple regression analysis was performed to identify factors influencing the quality of life using SPSS 26.0.

Results: Among the 204 participants, 141 (69.1%) were male and 141 (69.1%) were diagnosed with hepatobiliary cancers. The mean (±SD) age was 66.7 ± 8.5, and the mean quality of life was 72.5 ± 15.8. Depression, anxiety, pain, and serum albumin significantly influenced the quality of life, which explained 67.8% of the variance.

Conclusions: To improve the quality of life of patients with hepatobiliary and pancreatic cancers, we suggest providing appropriate psychosocial support, pain control, and nutritional management during the cancer treatment.

Background: The presence of health care workplace violence (WPV) significantly impacts victims, patients, and the organization. Registered nurses' experience of vertical WPV is not well understood, in part because the extant literature uses inconsistent and ambiguous terminology or focuses on bullying or incivility, excluding other violent behaviors.

Objective: This critical ethnography study explored the perceptions and experiences of registered nurses who have been victims of vertical violence in the health care workplace.

Methods: Eight registered nurses who self-identified as victims of vertical violence were recruited via purposive and snowball sampling. Data analysis used the constant comparative method described by Glaser and Strauss. Beck's criteria for rigor in qualitative studies was used to enhance the credibility of findings.

Results: Data analysis revealed 4 categories of the registered nurses' victim experience of vertical violence: (1) encountering vertical violence, (2) understanding vertical violence, (3) struggling with vertical violence, and (4) reflecting on the experience of vertical violence.

Conclusions: The use of power, influence, and organizational mechanisms to commit vertical violence has the potential to harm nurses and suppress the nurses' willingness to advocate for others. Despite widespread attempts to prevent WPV, vertical violence continues and poses a significant threat to health care organizations' core values, culture, reputation, and patient care outcomes. Health care organizations must prioritize the well-being of nurses, create effective systems that support nurses, and foster a culture of accountability to adequately address vertical violence and reduce the detrimental impacts on nurses, patients, and the organization.