Nursing Research最新文献

Background: Older adults with heart failure experience clustered symptoms. However, little is known about how symptom clusters transition over time.

Objectives: This study aimed to (a) identify the longitudinal transition of symptom cluster profiles over 8 years and (b) examine the associations between demographic and clinical factors and the transition between symptom cluster profiles over time.

Methods: We conducted a longitudinal secondary analysis of data from the Health and Retirement Study's 2008, 2012, and 2016 surveys. We included participants with heart failure in the core data sets and their proxy respondents in the exit data sets. We included demographic and clinical variables as well as six symptoms (fatigue, shortness of breath, pain, swelling, depressive symptoms, dizziness) through physical health interviews. We used latent transition analysis and multinominal regressions to determine longitudinal profiles and explored the association between demographic and clinical factors and membership in symptom cluster profiles.

Results: Among 690 participants, we found four symptom cluster profiles (high burden, low burden, distressing, and respiratory-depressive distress). Participants in the low burden at baseline had the highest probability of transitioning to the respiratory-depressive distress profile. Participants in the respiratory-depressive distress at 4 years had the highest probability of transitioning to the high burden profile. Male sex, Black/African American race, smoking, and comorbidities were associated with the increased odds of transiting from the low symptom burden to the high symptom burden profile.

Discussion: Symptom cluster profile memberships were stable over an 8-year period. However, symptom cluster profiles are changeable and deteriorate over time. Identifying predictive factors enables targeted interventions for those at highest risk.

Background: Tongue-tie is associated with nipple pain and early breastfeeding cessation. To date, research has been limited by small sample sizes and a dearth of evidence on the effects of tongue-tie on infant feeding symptoms and physiologic breastfeeding mechanics.

Objectives: In this article, we describe the protocol for our study exploring infant feeding, negative breastfeeding symptoms, maternal anatomy, and physiologic sucking data between infants with and without tongue-tie.

Methods: A prospective cohort study design is being employed. Over 8 weeks, three visits will be conducted with a sample of mothers and their infants without tongue-tie and a sample of mothers and their infants diagnosed with tongue-tie undergoing treatment via frenotomy. The aims of the study are to compare breastfeeding symptoms, breast anatomy, infant feeding symptoms, feeding efficiency, and nutritive sucking parameters between infants with and without tongue-tie, further comparing these metrics pre- and post-treatment via frenotomy with the non-tongue-tied age-matched counterparts.

Results: This study is currently ongoing.

Discussion: Tongue-tie is an everyday problem; clear guidelines are needed to decide whether to treat it. This novel, innovative, and multidisciplinary research study aims to fill critical gaps in understanding the physiological and functional effects of tongue-tie on breastfeeding, offering evidence to inform better clinical decisions and support effective interventions.

Background: Due to significant gaps in knowledge around women's health, Congress commissioned the National Academies of Science, Engineering and Medicine (NASEM) to conduct a consensus study on funding allocation, workforce needs, and priority research areas for the National Institutes of Health (NIH).

Objectives: This manuscript summarizes the key points of the new NASEM report on women's health research for NIH, presents the relevance and importance for nursing research, and briefly discusses the need for increased representation of nurse scientists on NASEM panels.

Methods: Beginning in the Fall of 2023, a multidisciplinary panel of 17 experts was convened by NASEM to address gaps in women's health research at NIH. The committee was tasked to identify research priorities for NIH-funded research with a focus on conditions that are female specific, more common in women, or affect women differently. In addition, the committee was asked to make recommendations on NIH training and education to strengthen the women's health research workforce, changes to NIH structural, systems, and review processes, and allocation of funding to more equitably reflect the burden of disease among women.

Results: The committee found that from 2013-2023, only 8.8% of NIH research dollars focused on women's health research, and that basic knowledge about women's physiological, hormonal fluctuations, and chromosomal differences is lacking. Data are also needed to better understand diseases that are female-specific, more common in women, or affect women differently. The committee made eight recommendations for transformative change at NIH related to women's health research.

Discussion: Overall, the report describes the need for transformative change at NIH to advance the science on women's health research and improve outcomes. This includes a comprehensive approach and recommendations that would double the NIH's investment in women's health research, enhance accountability, and provide rigorous oversight, prioritization, and integration of women's health research across NIH.

Background: While subject coenrollment into multiple trials is desirable, thoughtful consideration is required to avoid compromising each trial's scientific integrity.

Objective: We developed a Decision-Making Grid (GRID) to help investigators determine whether a clinical trial is compatible with a second clinical trial, thus allowing coenrollment, or if it should be considered competing, prohibiting coenrollment.

Methods: The GRID evaluates 21 elements across 4 domains: Scientific Integrity, Data Interpretation, Feasibility/Burden, and Additional Considerations. Optimally, each PI shares their protocol, completes the GRID independently, then meets to compare their perspectives, seeking a mutually acceptable agreement.

Results: The GRID has facilitated coenrollment decision-making for the RESTORE and PROSpect pediatric critical care clinical trials. In RESTORE, five trials were reviewed; one was approved for coenrollment; four were deemed competing. In PROSpect, 26 trials have been reviewed; 20 are approved for coenrollment; six were deemed competing. In both RESTORE and PROSpect, the PIs of multiple trials arranged a mutually acceptable sharing agreement.

Discussion: The GRID provides a systematic process to help investigators evaluate the effect of coenrollment in multiple clinical trials.

Background: Double-duty caregivers are health care professionals caring for family members or friends outside the workplace. While they may communicate frequently with colleagues in their professional role, little is known about communication with health care providers in the caregiving role.

Objective: To measure double-duty caregiver satisfaction when communicating with health care providers and to identify correlates and predictors of satisfaction.

Methods: A cross-sectional, nonexperimental, correlational study was used. Participants included registered nurses who were current or former caregivers of a family member or friend aged 50 or older. Correlation and multiple linear regression analyses were performed to examine the associations between double-duty caregivers' personal and professional attributes, factors, and satisfaction with communication.

Results: Double-duty caregivers reported above-average satisfaction with communication. Personal beliefs about caring and trust had the highest influence on satisfaction. Stress was associated with lower satisfaction with communication.

Discussion: This study is the first to examine double-duty caregiver satisfaction when communicating with health care providers and associated factors. Health care providers must implement strategies to maximize their acknowledgment of personal beliefs about caring and foster the building of trusting relationships to support colleagues in this role.

Background: Perceived stigma significantly impedes access to public health resources for women living with HIV/AIDS, highlighting the crucial need for interventions to empower individuals to overcome such barriers.

Objectives: This paper outlines the protocol for a pilot study aimed at evaluating the efficacy of the Helping Overcome PErceived Stigma (HOPES) intervention employing the mixed methods-grounded in narrative transportation-theory in reducing perceived stigma among women living with HIV/AIDS.

Methods: A total of 100 women living with HIV/AIDS will be randomized into two groups: the HOPES group and the control group. Participants in the HOPES group will watch the narrative transportation videos about perceived stigma experiences and coping strategies recorded by peer volunteers and write notes.

Results: The study commenced in September 2023 and concluded data collection in May 2024.

Discussion: Findings from this study will inform effectiveness trials of HOPES, advancing the evidence base for reducing stigma, and improving mental health in women living with HIV/AIDS.

Background: Psychological birth trauma is common among women in labor and has severe implications for maternal and infant health. Although the prevalence and risk factors of psychological birth trauma have been widely reported, these findings have not been systematically synthesized, limiting screening and interventions.

Objective: This study aimed to determine the pooled prevalence of and risk factors for psychological birth trauma.

Methods: The Cochrane Library, Web of Science, PubMed, Embase, and Scopus databases were systematically searched between their inception and October 1, 2023. Pooled prevalence, odds ratio, and 95% confidence intervals were calculated using fixed or random effects models using Stata 15.0.

Result: The pooled prevalence rate of psychological birth trauma was 19%. We performed subgroup analysis based on age, parity, region, and measurement tools. The results showed differences in the prevalence of psychological birth trauma between these subgroups, suggesting the need for clinical personalization in different populations. The pooled odds ratio showed that fear of childbirth, cesarean section, operative vaginal birth, pain during labor, and dissatisfaction with support from midwives were significantly associated with psychological birth trauma.

Discussion: The study found that the pooled prevalence of psychological birth trauma was 19%. PBT risk factors are diverse, and understanding the prevalence and risk factors for psychological birth trauma has important implications for health care and social care systems.

Background: Integration-a hallmark of mixed methods research (MMR)-is crucial throughout the entire research process. Despite its importance, integration remains an elusive concept often inadequately addressed by researchers, with many publications focusing solely on the final stages of data analysis and interpretation.

Objectives: The authors aim to synthesize methodologic discussions of the mixed method research integration process and provide an illustration of integration across all phases of an exemplar explanatory sequential study.

Methods: Integration in MMR includes four distinct dimensions encompassing philosophical assumptions and paradigms, methodological methods, and dissemination of integrated study findings. This paper presents our integrated study findings, illustrated by a research study conducted to investigate sleep health among women with breast cancer.

Results: Integration of quantitative and qualitative data analyses is demonstrated through consistently matching the guiding paradigm with design choice, meta-inferences, and visual joint displays. The connecting displays linking quantitative and qualitative data, compare sleep characteristics scores, and the relationship between anxiety and vasomotor symptoms. The results highlight the significance of visual tools in enhancing the analytic processes and providing a comprehensive understanding of complex clinical phenomena.

Discussion: Integrating across all stages of mixed method research studies presents many challenges. The proposed four-dimension model of integration contributes to understanding the unique value of fully integrated mixed methods results. The exemplary study findings confirm the value of integration in achieving a nuanced and comprehensive understanding of a significant clinical problem.

Background: Older adults with heart failure often exhibit poor self-care maintenance. Frailty could exacerbate self-care, leading to deteriorating health. Social support and depression may play a role in self-care maintenance in older adults with heart failure combined with frailty. Confirming this potential mechanistic relationship could provide valuable reference for nurses to formulate and improve the targeted intervention strategies and health education programs for older adults with heart failure.

Objectives: This study analyze the relationship between frailty and self-care maintenance in older adults with heart failure and determined the sequential mediation effect of social support and depression. Its goal was to provide valuable theoretical insights for formulating targeted clinical nursing interventions for older adults with heart failure.

Methods: A cross-sectional study was conducted from July 2023 to February 2024, during which older adults with heart failure were recruited using a convenience sampling method from the cardiovascular department of a tertiary class A hospital in Qingdao, China. A total of 241 completed the Tilburg Frailty Indicator, the Self-Care of Heart Failure Index, the Social Support Rating Scale, and the Patient Health Questionnaire-9. T-tests and one-way analysis of variance were used to examine differences in self-care maintenance among participants with distinct characteristics; correlation analysis was used to ​identify variable relationships within the study. The mediation model was tested using the SPSS PROCESS macro and the bootstrap method.

Results: Frailty was negatively correlated with self-care maintenance, and both social support and depression were significantly related to frailty and self-care maintenance. Social support and depression not only independently mediated the relationship between frailty and self-care maintenance but also exhibited a significant sequential mediation effect.

Discussion: The frailty of older adults with heart failure and its correlation with self-care maintenance is a complex and multidimensional phenomenon. Frailty not only directly influenced self-care maintenance in participants but also indirectly affected it through the mediating factors of social support and depression. Future research should emphasize innovative, targeted interventions to enhance social support quality and accessibility and alleviate depression, ultimately boosting patients' self-care capabilities and elevating their quality of life.

Background: Heart failure is a debilitating condition affecting over 6.7 million adults in the United States. Social risks and complexity, or personal, social, and clinical aspects of persons' experiences, have been found to influence health care utilization and hospitalizations in persons with HF. Low-value utilization, or irregular outpatient visits with frequent emergency room use, or hospitalization is common among persons with complex conditions and social risk and requires further investigation in the heart failure population.

Objective: The purpose of this research was to assess the influence of complexity and social risk on low-value utilization in persons with heart failure using machine learning approaches.

Methods: Supervised machine learning, tree-based predictive modeling was conducted on an existing data set of adults with heart failure in the eight-county region of Western New York for the year 2022. Decision tree and random forest models were validated using a 70/30 training/testing data set and k-fold cross-validation. The models were compared for accuracy and interpretability using the area under the curve, Matthew's correlation coefficient, sensitivity, specificity, precision, and negative predictive value.

Results: Area deprivation index, a proxy for social risk, number of chronic conditions, age, and substance use disorders were predictors of low-value utilization in both the decision tree and random forest models. The decision tree model performed moderately, while the random forest model performed excellently and added hardship as an additional important variable.

Discussion: This is the first known study to look at the outcome of low-value utilization, targeting individuals who are underutilizing outpatient services. The random forest model performed better than the decision tree; however, features were similar in both models, with area deprivation index as the key variable in predicting low-value utilization. The decision tree was able to produce specific cutoff points, making it more interpretable and useful for clinical application. Both models can be used to create clinical tools for identifying and targeting individuals for intervention and follow-up.