Nursing Research最新文献

Background: In sub-Saharan Africa, the risk of obstetric complications remains high throughout the postpartum period.

Objective: We developed and tested a novel, integrated model of group postpartum care titled Focused-Postpartum Care (Focused-PPC) to improve outcomes. In this paper, we report clinical outcomes of participants in the intervention arm and differences in knowledge of post-birth warning signs among those in the intervention and control arms.

Methods: Focused-PPC encompassed recommended clinical assessments, targeted education, and peer support up to 1 year after birth. Focused-PPC was implemented as a parallel randomized controlled trial involving 192 postpartum women across four health centers in Tamale, Ghana, from February 2022 to August 2023. Eligible participants 18 years or older with a live birth were randomly assigned to either the Focused-PPC intervention arm or the control arm at a 1:1 allocation and were not blinded to their allocation. At each health center, 48 participants were allocated to either an intervention or control arm. Focused-PPC groups in the intervention arm consisted of eight participants per group. Participants in the intervention arm received the Focused-PPC integrated group model of care. Participants in the control arm received the standard of postnatal care already administered at each health center.

Results: Baseline analysis included 96 participants from the control arm and 91 participants from the intervention arm. We found that vital signs and clinical outcomes were relatively stable; however, incidences of hypertension substantially decreased among participants in the intervention arm. By 3 months post-birth, most participants in the intervention arm were able to identify all post-birth warning signs and retain this knowledge compared to the control arm. Those in the intervention arm were also knowledgeable of more warning signs at each time point compared to the control arm.

Discussion: An integrated, evidence-based approach to postpartum care, such as Focused-PPC, has potential to increase knowledge and improve clinical outcomes among mothers in Ghana.

Abstract: Background: Self-advocacy plays a crucial role in the mental health and treatment outcomes of oncology patients, particularly those with uterine malignancies. Despite its significance, research on the self-advocacy levels and influencing factors among Chinese patients with uterine malignancies remains limited.Objectives: To assess the self-advocacy levels among Chinese patients with uterine malignancies and identify the demographic, psychological resilience, and decision self-efficacy factors that influence self-advocacy.Methods: This cross-sectional study was conducted from March 1 to September 1, 2023, involving 220 inpatients with uterine malignancies from three tertiary hospitals in Shandong Province, China. Participants were recruited using convenience sampling and completed the General Information Questionnaire, Female Cancer Survivorship Self-advocacy Scale, Connor-Davidson Resilience Scale, and Decision Self-efficacy Scale.Results: The average self-advocacy score among participants was 59.44 ± 10.14. Significant positive correlations were found between self-advocacy, psychological resilience, and decision self-efficacy. The random forest algorithm identified decision self-efficacy, psychological resilience, family average income, type of medical insurance, educational level, and residence as the six most important influencing factors, with the optimal model performance observed when lambda (λ) = 1.191. Multiple linear regression analysis further confirmed that decision self-efficacy, psychologic resilience, family average income, educational level, and residence were significant predictors of self-advocacy.Discussion: The self-advocacy levels of Chinese patients with uterine malignancies were relatively low, with decision self-efficacy, psychological resilience, and socioeconomic factors significantly influencing their self-advocacy abilities. Future targeted interventions should focus on enhancing patients' decision self-efficacy and psychological resilience, thereby guiding them to actively respond and participate in decision-making, ultimately improving self-advocacy among patients with uterine malignancies.

Background: Disrespect and abuse of laboring and child-birthing women in health care is a global problem that violates the universal human rights of childbearing women. There is a lack of reliable and valid tools for measuring these behaviors. One instrument, the Disrespect and Abuse scale, has preliminary data with no established psychometrics in diverse populations. Further analysis is required to ensure the reliability and validity of this tool in diverse populations and health care settings.

Objectives: We examined the psychometric properties of the Disrespect and Abuse scale in diverse international nursing and midwifery populations.

Methods: A cross-sectional descriptive design was used to measure disrespect and abuse toward women during childbirth. Data were collected from 231 nurses and midwives across international labor and delivery units. Exploratory factor analysis was conducted using principal component analysis with oblimin rotation as the factor extraction method.

Results: The psychometric assessment yielded a two-factor structure. Factor 1 consisted of 13 items characterizing physical and verbal abuse. Factor 2 contained nine items reflecting disrespectful behaviors. The Cronbach's alpha coefficients reflected high internal consistency.

Discussion: The scale was shown to be reliable and valid in assessing self-reported disrespectful and abusive behaviors among nurses and midwives in a diverse international sample. Use could assist in the assessment of these behaviors in maternal health care facilities. Further research is warranted to confirm the scale's robustness and applicability across various populations and settings and use the Disrespect and Abuse scale to identify the burden and predictors of mistreatment of women in different health care settings.

Background: The analysis of health diary data has long relied on inferential statistical methods focusing on sample means and ad hoc methods to calculate each individual's variation in health outcomes.

Objectives: In this paper, an advanced statistical model is applied to daily diary self-reported health outcomes to simultaneously study an individual's likeliness to report an outcome, daily mean intensity level, and variability in daily measures.

Methods: Using observational, secondary data from 782 adults, we analyzed self-report daily fatigue symptoms, distinguishing between whether an individual reported fatigue and its severity when reported. Self-reported depressed affect and participant characteristics were used as predictors of daily fatigue symptoms.

Results: A higher likeliness to report fatigue correlated with higher mean fatigue severity and greater stability in severity ratings. Higher mean severity correlated with greater stability in severity ratings. Females and those with high depressed affect were more likely to report fatigue. Females and those with high depressed affect reported greater mean severity.

Discussion: The model applied to daily measures allowed for the simultaneous study of an individual's likeliness to report a symptom, daily mean symptom severity, and variability in severity across days. An individual's daily variation in symptom severity was represented as a model parameter that did not contain measurement error that is present in ad hoc methods.

Background: People with type 2 diabetes mellitus (T2DM) commonly report a higher fatigue intensity than the general population. However, effective fatigue management is lacking because little is known about other fatigue characteristics, including timing, distress, and quality, as well as the potential fatigue subtypes experienced in people with T2DM.

Objective: To describe fatigue intensity, timing, distress, and quality, and identify fatigue subtypes in people with T2DM.

Methods: This cross-sectional, descriptive study included a sample of 150 participants with T2DM recruited from two diabetes outpatient clinics in Taiwan. Fatigue intensity, timing, and distress were measured using the Fatigue Symptom Inventory. Fatigue quality was measured using the Multidimensional Fatigue Inventory. Fatigue subtypes were identified using a latent profile analysis.

Results: Participants reported a mild fatigue intensity, experiencing fatigue for about 22% of the day with worse fatigue in the afternoon and evening and having mild disturbances. Three fatigue subtypes were identified. The "high/persistent fatigue with mild distress" subtype was characterized by high fatigue intensity and duration with severe general, physical, and mental fatigue that mildly interfered with functioning. The "moderate/frequent fatigue with minimal distress" group showed moderate levels of fatigue intensity and duration levels with intermediate of general, physical, and mental fatigue and minimal fatigue disturbances. The "no fatigue and distress" subtype was characterized by overall low fatigue scores.

Discussion: We identified fatigue characteristics and subtypes in people with T2DM, providing insights into better fatigue management. People with T2DM reported having mild but persistent fatigue. The latent profile analysis revealed that fatigue is likely composed of a mixture of physical and mental components. Nurses should assess both the physical and mental aspects of fatigue while addressing features of the fatigue characteristics in tailored management strategies to alleviate all aspects of fatigue in people with T2DM.

Background: The COVID-19 pandemic prompted researchers to develop new ways to design and launch studies and recruit and retain participants. Pregnant women and infants are considered vulnerable populations in research, and families affected by substance use are particularly difficult to recruit and retain. Recruitment for studies involving medical technologies such as MRI can also be difficult due to misconceptions and fear of the technologies.

Objectives: To describe "lessons learned" during the launch of the Outcomes of Babies with Opioid Exposure (OBOE) study, including successes and challenges when working with high-risk infants and families and the importance of engaging participants through recruitment materials and retention efforts.

Methods: The OBOE study is a multisite prospective longitudinal cohort study comparing infants with antenatal opioid exposure to unexposed controls from birth to 2 years of age. Chi-square tests were used to examine refusal reasons among caregivers of eligible infants by exposure group and differences in 6-month retention among subgroups based on social determinants of health.

Results: Four factors were essential in establishing the Consortium, implementing the study, and retaining participants: (a) creating venues for collaboration, (b) pivoting from in-person to virtual training, (c) anticipating potential enrollment barriers and addressing them directly, and (d) engaging participants through recruitment materials and retention efforts. With these factors in place, only 5% of caregivers of eligible opioid-exposed infants and 8% of control infants declined to participate in the study because of MRIs. Of 310 enrolled infants, 234 infants had attended the 6-month visit. Subgroups of enrolled infants were similar in retention at 6 months.

Discussion: Reporting our successes and challenges in setting up a nationwide consortium during the pandemic may help other consortia that need to be set up virtually. We anticipated that the serial MRIs would be a barrier to participation; however, few indicated they refused to participate because of MRIs, suggesting our efforts to address this potential barrier to enrollment were successful.

Background: Inappropriate dietary, exercise, and medication self-care behaviors among persons with diabetes can easily trigger hypoglycemia. Clinically, it is necessary to quickly identify high-risk groups for hypoglycemic events to provide targeted hypoglycemia education. However, there is currently a lack of precise tools to assess self-care behaviors related to hypoglycemia.

Objectives: To develop and validate a hypoglycemia self-care behavior scale for evaluating the behaviors of persons with diabetes in handling and preventing hypoglycemic events.

Methods: A cross-sectional study with purposive sampling was conducted to recruit 300 persons with type 2 diabetes who had experienced hypoglycemic events from a medical center and a primary care clinic in southern Taiwan. Data were collected using a structured questionnaire from December 2021 to September 2023.

Results: The original hypoglycemia self-care behavior scale, comprising 26 items, was reduced to 17 items, measuring six factors after exploratory factor analysis. Subsequently, the scale was further refined to 10 items covering four factors through structural equation modeling. The validity and reliability were assessed during this process, and the developed scale was subsequently verified for both. Factor loadings ranged from .50-.97, explaining 76% of the total variance. The four factors included "hypoglycemia recognition and carbohydrate supplementation," "prevention of hypoglycemia during exercise," "carbohydrate assessment," and "seeking medical assistance." The hypoglycemia self-care behavior scale-developed and validated through structural equation modeling-demonstrates satisfactory model fit, convergent validity, and discriminant validity. Internal consistency was within the range of .73-.94, indicating strong reliability.

Discussion: The hypoglycemia self-care behavior scale not only functions as a tool for the rapid assessment of self-care behaviors during hypoglycemic events by clinical health care professionals but can also serve as reference for hypoglycemia-related health education.

Background: Rural populations in the United States face a diabetes mortality penalty. Self-management is a core component of treatment for type 2 diabetes, but there is low uptake of self-management education and support interventions in rural areas. Rural structural barriers to diabetes self-management have been described, yet the role of rural culture has not been extensively explored.

Objective: The purpose was to examine the relationships among rural culture, diabetes beliefs, self-management behaviors and health outcomes.

Methods: A stratified random sample of 500 adults with type 2 diabetes were recruited from a rural integrated health care system and invited to participate in this non-experimental cross-sectional study. Participants completed a survey that included validated measures of rural identity, self-reliance, perceived diabetes threat, and diabetes self-management behaviors. The most recent A1c was collected from the medical record. Descriptive, bivariate, multivariate and moderation analyses were conducted.

Results: 128 participants returned completed surveys. Having an A1c < 8% was associated with better diabetes self-management behaviors, lower perceived threat, being female, and older age. Better diabetes self-management behaviors were associated with lower self-reliance, lower perceived threat, and older age. The combined moderation effect of both self-reliance and rural identity on the relationship between perceived threat and self-management behaviors was significant.

Discussion: Findings highlight the complex relationship between diabetes beliefs and behavior in rural populations and demonstrate that components of the rural culture have both direct and moderating effects on diabetes beliefs and self-management behaviors. These findings have important ramifications for nurses practicing in rural settings.

Background: Excessive daytime sleepiness is a prevalent and sustained symptom that contributes to untoward physiological and psychological outcomes among stroke survivors. Mechanisms of excessive daytime sleepiness poststroke are not fully understood. Chronic systemic inflammation may contribute to impaired mitochondrial functioning and thereby reduce cellular energy metabolism, which may contribute to symptoms of excessive daytime sleepiness in stroke survivors.

Objectives: This pilot study aimed to assess the relationship between systemic inflammation and cellular energy metabolism to poststroke excessive daytime sleepiness.

Methods: This descriptive pilot study explored the relationship between excessive daytime sleepiness, systemic inflammation, and aerobic energy metabolism of platelets in 22 chronic stroke survivors. The Epworth Sleepiness Scale was used to measure excessive daytime sleepiness. Systemic inflammation was measured by assessing pro-inflammatory cytokines interleukin-6, interleukin-1β, and tumor necrosis factor-alpha and the inflammatory marker C-reactive protein. Aerobic energy metabolism was measured by assessing oxygen consumption rates of platelets. Simple linear regression was used to test the influence of oxygen consumption rates and inflammation on excessive daytime sleepiness. Correlations were analyzed using Spearman rho correlation coefficients.

Results: Excessive daytime sleepiness was recognized in 27.3% of the sample. Systemic inflammation was associated with excessive daytime sleepiness in women but not men. We found no significant relationship between excessive daytime sleepiness and energy metabolism of platelets. However, all oxygen consumption rates were numerically higher in persons with excessive daytime sleepiness.

Discussion: Systemic inflammation may be related to excessive daytime sleepiness symptoms with a notable effect among women. Future larger studies are needed to further explore the sexually dimorphic relationship of poststroke excessive daytime sleepiness to systemic inflammation. Numerically higher platelet oxygen consumption rates may indicate higher energy demands for stroke survivors with excessive daytime sleepiness.

Background: There is a dearth of research inclusive of African American adults living with obstructive sleep apnea (OSA) despite differences in symptom presentations compared to non-Hispanic White patient populations. Less is known regarding the potential effect of comorbidities, including hypertension, on commonly reported symptoms, such as fatigue, and their association with inflammatory biomarkers.

Objective: This longitudinal pilot study aimed to characterize fatigue symptom presentations among African American adults newly diagnosed with OSA and discern peripheral blood analytes linked to symptoms while accounting for co-occurring hypertension.

Methods: African American adults newly diagnosed with OSA with and without co-occurring hypertension were approached by study staff and recruited following their diagnostic visit with sleep medicine clinicians at two health systems and followed over 6 months after commencing continuous positive airway pressure treatment. Patient-Reported Outcomes Measurement Information System Fatigue surveys and plasma were collected every 3 months from 29 participants. Mixed-effects models examined changes in fatigue symptom presentations over time while accounting for plasma-based analytes and hypertension status.

Results: Despite higher fatigue symptom severity upon diagnosis, participants with co-occurring hypertension reported greater improvements in fatigue scores after commencing continuous positive airway pressure treatment for up to 6 months than those without hypertension. Inverse correlations were observed between fatigue scores, C-reactive protein, matrix metalloproteinase-8, and osteoprotegerin analyte levels among participants with/without hypertension. Across all participants, changes in interleukin-6 were associated with changes in fatigue scores in the first 3 months after diagnosis.

Discussion: Findings indicate that hypertension is linked to increased fatigue upon diagnosis of OSA in this sample of African American adults. Fatigue in persons with hypertension improved after treatment in this sample. These hypothesis-generating findings can inform future interventional studies aimed at improving fatigue among persons with OSA while leveraging markers linked to fatigue symptom severity as potential objective markers of improvements. Further research on the role of inflammatory markers, such as IL-6, on fatigue symptom presentations is warranted in persons with OSA.