Nursing Research最新文献

Background: Women from diverse socioeconomic status (SES) face a higher risk of preterm birth, increasing their infants' vulnerability to neurodevelopmental and other health disorders; however, the predictive role of maternal ZIP code level SES in these outcomes remains underexplored.

Objectives: To investigate the associations between maternal racial disparity, ZIP code-level SES, and infant breastfeeding, growth, and neurodevelopmental trajectories.

Methods: In this cohort study, preterm infants were recruited from two Connecticut neonatal intensive care units (NICUs). Infant demographic data, feeding regimens, and growth during the NICU stay were documented. Neurodevelopmental outcomes were assessed using the NICU Neonatal Neurobehavioral Scale, the Bayley scale of infant and toddler development (3rd ed.), and the Brief Infant Toddler Social Emotional Assessment. To compare SES differences between infants born to Black and White mothers, both t -tests and Wilcoxon tests were conducted. We used XGBoost to analyze infant health outcomes and SHapley Additive exPlanations (SHAP) values to identify SES-related risk factors associated with feeding, growth during NICU stay, and neurodevelopmental outcomes up to 2 years of age.

Results: In total, 181 preterm infants from eight ZIP code areas were included in the study. The majority of infants were born to mothers who were White and non-Hispanic. Compared with infants born to White mothers, those born to Black mothers had younger birth gestational age (GA), lower birth weights, shorter birth lengths, smaller head circumferences, and higher Score of Neonatal Acute Physiology with Perinatal Extension-II (SNAPPE-II), with all differences being statistically significant. Compared with White mothers, Black mothers were younger, single, and less educated. Black mothers also had lower median household incomes, larger average family sizes, and higher levels of poverty compared with White mothers. Based on SHAP values, the risk factors predicting infants' feeding, growth, and neurodevelopment are ranked as follows: birth weight, birth GA, SNAPPE-II score, average family size, maternal age, median household income, poverty level, and school enrollment.

Discussion: Maternal racial disparity and SES serve as predictors of feeding, growth, and neurodevelopmental outcomes in preterm infants. Understanding these associations can inform health care strategies for vulnerable preterm populations to improve long-term health outcomes.

Background: Gender-based violence (GBV) has profound health effects on survivors, and there is a critical need to identify culturally relevant protective factors that support trauma recovery and healing.

Objectives: To develop and validate the Motivators and Resources for Trauma Recovery (I-MOVE) scale to assess internal and external resources and motivators supporting trauma healing among GBV survivors across different cultural and social contexts.

Methods: We used a structured, multiphase methodology for scale development, incorporating feedback from international experts and survivors. The I-MOVE tool was developed using a three-phase process: (1) identifying core domains through the extraction of relevant concepts from survivor narratives, (2) generating scale items using survivor language, and (3) assessing content and face validity, as well as evaluating acceptability, through a content validity index with experts and cognitive interviews with GBV survivors aged 30-60 from diverse cultural backgrounds.

Results: The I-MOVE scale, consisting of 57 items, assesses resources and motivators crucial to trauma recovery. Expert evaluations and cognitive interviews ensured clarity, relevance, and cultural sensitivity.

Discussion: The I-MOVE scale fills a critical gap by offering a culturally responsive tool to assess internal and external motivators of trauma recovery among GBV survivors. Its development incorporated multicultural survivor input, enhancing clarity and relevance across diverse populations. Unlike existing tools, I-MOVE addresses the full spectrum of healing resources, including legal status, parenting roles, and culturally appropriate services, particularly relevant for immigrants. These findings suggest the scale's strong potential to support survivor-centered care and inform targeted interventions across varied forms of GBV.

Background: While emerging literature has documented worsening staff nurse shortages due to higher prevalence of workplace violence, bullying, discrimination, and burnout among nurses post pandemic, there is limited evidence to identify specific work environment factors that either induce or mitigate nursing turnover intentions in relation to these workforce challenges.

Objectives: This study aimed to evaluate nurses' experiences with workplace violence, bullying, discrimination, and burnout within work environments and examine their associations to determine their subsequent effects on nurses' intentions to leave.

Methods: In 2024, we conducted a quantitative cross-sectional study using online, anonymous surveys with multiple validated instruments to gauge nurses' work environment perceptions, experiences with workplace violence, bullying, discrimination, burnout, and intent to leave. We used descriptive and inferential statistics to analyze the data collected from 222 nurses from New York State.

Results: Of the 194 eligible nurses who completed our survey, most respondents had high exposure to negative acts or bullying and endorsed an intention to leave their jobs. Burnout, bullying, and discrimination experiences emerged as significant predictors of intention to leave. While workplace violence was reported to adversely affect personal well-being and mental health, it was not significantly associated with burnout or intention to leave. Nurses reported that their work environments need improvement, particularly in terms of staffing and leadership. Appropriate staffing has a significant association with workplace violence and reduces discrimination, bullying, and intention to leave perceptions. Although authentic leadership has substantial associations with workplace violence, bullying, and discrimination, it showed a lack of statistical significance on nurses' intention to leave. Notably, burnout was not significantly associated with the six essential standards for a healthy work environment.

Discussion: The complex interplay among workplace violence, bullying, discrimination, and burnout highlights the importance of various work environment factors, such as appropriate staffing, meaningful recognition, and authentic leadership, in effectively shaping nurses' intentions to remain in or leave their jobs. Study results provide a foundation for health care organizations to conduct future research that centers on building more supportive and inclusive work environments to holistically sustain an efficient nursing workforce.

Background: Women commonly experience lower urinary tract symptoms (LUTS), such as frequent urination, urgent urination, and urinary incontinence. Health education for women rarely focuses on LUTS prevention and promotion of bladder health. The Theory of Reasoned Action and the Theory of Planned Behavior have been used to explain and change a variety of health behaviors. Missing from the literature is an explicit test of whether constructs of these theories are associated with LUTS and bladder health, and whether toileting habits explain this association.

Objectives: To inform prevention strategies, this investigation tested whether the Theory of Reasoned Action and Theory of Planned Behavior constructs (attitudes toward, perceived norms of, and perceived control over specific toileting behaviors) are associated with women's toileting habits, and whether these habits mediate associations of theoretical constructs and women's LUTS and bladder health.

Methods: The Prevention of Lower Urinary Tract Symptoms Research Consortium developed theoretical constructs to match four toileting behavior domains (delayed voiding, straining, crouching/hovering over toilets when away from home, and avoiding public toilets) assessed by the validated Toileting Behaviors: Women's Elimination Behaviors scale. Using a population-based survey, data were then collected from women at nine sites in the United States. Cross-sectional regression analyses tested whether toileting habits in a given domain mediated associations of corresponding theoretical constructs with reported LUTS, bladder health, and bladder function.

Results: The overall analytic sample included 1,472 women with a mean age of 48 years. Associations of norms favoring delayed voiding and low perceived control over timing of voiding with more frequent LUTS and poorer bladder health and function were partially mediated by delayed voiding habits. Favorable attitudes toward and norms of straining (i.e., pushing down to urinate) and avoiding public toilets were associated with more frequent LUTS through corresponding toileting habits.

Discussion: Longitudinal research is needed to confirm study findings. Future prevention intervention research may include nursing and public health messaging designed to shape attitudes toward and perceived norms of specific toileting behaviors, as well as policies to enhance control over healthy toileting practices in public spaces, including schools and workplaces.

Background: Organizational climate affects patient, clinician, and healthcare organization outcomes. The 29-item Nurse Practitioner Primary Care Organizational Climate Questionnaire (NP-PCOCQ) has been a valuable research tool for measuring four domains of NP organizational climate in primary care settings: Professional Visibility, Independent Practice and Support, NP-Administration Relations, and NP-Physician Relations. It can benefit from shortening to reduce survey burden and improve response rates.

Objectives: To design a shortened NP-PCOCQ-2 and assess the psychometric reliability and validity.

Methods: To shorten the NP-PCOCQ, in Phase 1, we used data from 1,212 NPs collected in a cross-sectional survey of primary care NPs in 2018-2019. We used quantitative data and expert content review to select the items to retain in the NP-PCOCQ-2, based on data from half the sample. With the other half of the sample data, we evaluated the NP-PCOCQ-2's reliability, factor analytic structure, and correlation with the original scores and two key NP job outcomes, job satisfaction and intention to leave. In Phase 2, we used data from a new sample of 915 NPs to further evaluate the reliability, factor analytic structure, and correlation to job satisfaction and intention to leave, and compared the categorical classification of the organizational climate of NP practices of the NP-PCOCQ-2 to the original NP-PCOCQ.

Results: In Phase 1, the NP-PCOCQ-2 subscales were all reliable, demonstrated a four-factor Confirmatory Factor Analysis (CFA) fit, and were highly correlated with scores on the 29-item NP-PCOCQ. All subscales were significantly positively correlated with job satisfaction and negatively correlated with intention to leave. In Phase 2, we found the same patterns: the NP-PCOCQ-2 subscales were all reliable, demonstrated a four-factor CFA fit, and were highly correlated with scores on the 29-item NP-PCOCQ. All subscales were significantly positively correlated with job satisfaction and negatively correlated with intention to leave. Additionally, each NP-PCOCQ-2 subscale classified greater than 75% of NP's practices the same as the NP-PCOCQ.

Discussion: The 17-item NP-PCOCQ-2 demonstrated reliability, maintenance of the constructs measured by the original scale, and convergent validity. Researchers can use the NP-PCOCQ-2 to measure the four domains of NP's organizational climate in primary care.

Background: Fibromyalgia (FM) is a widespread chronic pain condition affecting 3 - 6% of the world's population. Research suggests psychological resilience, defined as the ability to rebound from adversity and adapt while retaining self-determination and a positive outlook, may play a role in reducing FM severity, managing symptom burden, and improving physical function. A thorough understanding of how resilience relates to coping with the adverse consequences of FM may enable nurses to develop interventions that assist patients in coping with the disorder and living a meaningful life.

Objective: The aim of this study was to examine factors associated with psychological resilience and physical function among adults with FM.

Methods: A cross-sectional survey study was conducted on a purposive sample of 200 participants recruited from the Autoimmune Registry Inc. Online survey data were collected on socio-demographic variables, resilience, physical function, comorbidities, pain intensity and depression. Structural equation modeling was used to test the central hypothesis that age, sex, race, education, work status, comorbidities, resilience, depression and pain intensity were directly related to physical function.

Results: The model explained 14.9% of the variance in psychological resilience, 25.3% of the variance in pain intensity, 18.6% of the variance in depression, and 38.2% of the variance in physical function. Age and comorbidities were indirectly associated with physical function through psychological resilience, whereas age, comorbidities, psychological resilience, and pain intensity were directly associated with physical function. Depression had neither a direct nor indirect association with physical function but did have a significant direct association with resilience.

Discussion: Nurses caring for persons with FM ideally are positioned to provide evidence-based care that fosters resilience and ultimately improves physical function. Since resilience was found to be directly related to physical function, nurses need to evaluate resilience and utilize interventions that strengthen resilience, thereby enhancing physical function among adults living with FM. This will allow adults living with FM to manage their symptoms and experience improvements in overall functioning.

Background: Acceptance and Commitment Therapy (ACT), a third-generation cognitive behavioral therapy, has been increasingly applied in smoking cessation. However, the progress of ACT in smoking cessation, the scope of existing research, and its findings and limitations require further investigation.

Objectives: To investigate the application of ACT in smoking cessation, analyze the current state of research, and provide theoretical insights and solutions for addressing the smoking issue in the future.

Methods: Ten databases (PubMed, Web of Science, Embase, Cochrane Library, CINAHL, PsycINFO, China Biology Medicine Disc, China National Knowledge Infrastructure, Wanfang Database, and China Science and Technology Journal Database) were systematically searched. The search covered publications from the inception of each database up to March 20, 2024. Following the search, two researchers independently screened the literature, extracted relevant data, and summarized and analyzed the included studies.

Results: A total of 35 articles from eight countries were included in the review. Participants included both general smokers and those from special populations, such as smokers with anxiety, depression, or severe mental illness. Interventions were delivered either face-to-face or online. Follow-up durations ranged from 1 to 13 months. The content primarily focused on the six core aspects of ACT. Outcome measures included the evaluation of smokers' smoking cessation outcomes, feasibility of the research design, participants' acceptability and satisfaction, and the acceptance of cravings to smoke.

Discussion: ACT-based intervention provides a reasonable and safe strategy to assist health care professionals in guiding patients to quit smoking, particularly those with mental health conditions. The findings indicate that further research is necessary to optimize the quality and efficacy of ACT interventions for smoking cessation.

Background: Identifying effective methods to recruit and retain participants in research is imperative to maximize generalizability of findings and reduce bias in interventional studies. Historically, studies of hopelessness, defined as a negative outlook and sense of helplessness about the future, have struggled with both recruitment and retention.

Objective: The purpose of this paper is to describe strategies utilized for recruitment and retention, and quantify their results, in a randomized controlled trial (RCT) (Heart Up!) that enrolled participants with ischemic heart disease (IHD) who reported moderate to severe hopelessness.

Methods: At a single U.S. hospital, 681 patients with IHD were screened for state hopelessness using the Dunn State-Trait Hopelessness Scale. Of the 279 eligible for the study, 224 participants chose to enroll (80.2%) into the RCT. Analysis for this paper focused on recruitment and retention results and associated strategies.

Results: Of the 224 enrolled, 66 reconsidered study participation before baseline data collection and 27 of the remaining 158 dropped out between the baseline and final 6-month follow-up timepoint.

Discussion: Successful recruitment strategies included regularly meeting with study recruiters to promote fidelity of enrollment strategies, discussing progress towards goals, and identifying the optimal time frame to meet with hospitalized patients to discuss the study. Successful retention strategies included building rapport with both participants and research staff, responding quickly and thoroughly to participant feedback, and consistently meeting with interventionists and data collectors to ensure study fidelity, troubleshoot challenges, and provide encouragement. The results reinforce that individuals reporting moderate to severe hopelessness require ample time from study staff at enrollment and throughout the study. Future researchers should consider expanding the recruitment timeline to reduce attrition between enrollment and first data collection visit.

Background: Cardiometabolic disease disproportionately affects rural communities, but early behavioral and physiological risk indicators are understudied in these populations.

Objectives: This aim of this study was to characterize cardiometabolic health in a rural southeastern U.S. community. Primary objectives included assessing the prevalence of blood pressure and glycemic alterations and examining associations between modifiable factors such as sleep, nutrition, and educational attainment. A secondary objective was to assess community interest in future hypertension research.

Methods: A cross-sectional study was conducted during a nurse-led community health screening event at a rural street festival. Participants were recruited using non-probability convenience sampling and completed structured surveys and clinical screenings. Regression models evaluated relationships between predictors and blood pressure outcomes. Moderation analyses evaluated the role of sex.

Results: Participants with high school education had significantly higher SBP and MAP readings compared to those with bachelor's degrees. Sleeping ≤ 6 hours predicted higher SBP, MAP, and glucose. Younger adults exhibited significantly higher BP levels across all models The effects of education and sleep on BP were considerably stronger among men, but women exhibited higher BP across models, which was a reversal of typical epidemiological patterns.

Discussion: Modifiable factors such as education and sleep were associated with early cardiometabolic risk in rural communities. Findings support biobehavioral models integrating metabolic, inflammatory, and behavioral indicators for early risk detection, especially in younger ages. Nurses are well-positioned to lead interdisciplinary initiatives addressing cardiometabolic risk in rural communities. Future studies should prioritize scalable prevention strategies targeting young adults before clinical disease emerges.

Background: Sexual and gender minorities (SGMs) remain disproportionately affected by HIV and bacterial sexually transmitted infections (STIs). Despite the efficacy of pre-exposure prophylaxis (PrEP) for HIV prevention and the emerging promise of doxycycline post-exposure prophylaxis (doxy-PEP) for STI prevention, awareness, uptake and persistence remain limited.

Objective: In this qualitative, we study explored client perspectives on barriers and facilitators influencing the use of same-day PrEP and doxy-PEP to inform strategies for broader implementation in primary care. Informed by the stages of the PrEP Care Continuum and the levels of the SGM Health Disparities Framework, we sought to better understand the barriers and facilitators at each stage of the clinical continuum (i.e., awareness, uptake, and persistence) and at various levels of influence (i.e., individual, interpersonal, community and societal).

Methods: Four virtual focus groups with 26 SGM clients with experience using PrEP and/or doxy-PEP were conducted. Data were analyzed using deductive thematic analysis guided by the PrEP Care Continuum and the SGM Framework.

Results: Consistent barriers to uptake and persistence exist, including healthcare access, cost, stigma, and discriminatory clinical encounters. Participants highlighted the burden of the current medical model, which involves multiple procedural steps and frequent healthcare visits. Facilitators included community support, targeted social media messaging, and affirming providers. Notably, participants drew motivation from historical and communal narratives, including the legacy of the HIV/AIDS epidemic, and emphasized the need for visible public and political support for biomedical prevention.

Discussion: The results underscore the importance of integrating client-informed approaches to improve biomedical prevention delivery. To advance HIV and STI prevention among SGMs, there is a critical need for culturally tailored education to support increasing awareness and flexible clinical models to support the uptake and persistence in care. PrEP and doxy-PEP are vital, synergistic tools that require coordinated strategies in primary care, to expand access and address persistent health disparities and end the HIV and STI epidemics.