Nursing Research最新文献

Background: The American Heart Association's Life's Essential 8 (LE8) metrics of blood pressure, body mass index, glucose, cholesterol, smoking, diet, sleep, and physical activity are measurable outcomes to gauge cardiovascular health in individuals and populations.

Objective: The aim of this study was to determine the utility of using the National Institutes of Health All of Us Research Program data to quantify LE8 contemporary in a United States cohort.

Methods: This was a cross-sectional observational study of primary (participant-reported and researcher-measured) and secondary (electronic health records) data from Version 7 All of Us data. Adults aged 20-100 years were included. Our primary outcome was percentage of participants with complete data for all LE8 cardiovascular health indicators within 1 year of enrollment. We used All of Us researcher-measured blood pressure and body mass index, health record serum glycosylated hemoglobin (HbA1c), total and non-high-density lipoprotein cholesterol, and participant-reported cigarette use, age, race, and sex data. We described the availability of LE8 in the dataset and then calculated sex differences in LE8 using independent samples t -tests with equal variance, Wilcoxon rank sum test, or chi-square tests.

Results: There were no data for diet, sleep, or physical activity. The final sample with complete data was 56,565 primarily middle-aged adults, and over half were female. Overall, the sample had higher mean systolic blood pressure, high mean body mass index indicating obesity, and average to high HbA1c, indicating few participants meet the definition of ideal cardiovascular health. Nearly half of participants reported lifetime cigarette use of ≥100 cigarettes. Data for non-high-density cholesterol were missing in half of participants. Compared to males, females were younger by 4.2 years and had lower average systolic and diastolic blood pressure, higher mean body mass index, higher total cholesterol, and lower median HbA1c, and fewer reported lifetime cigarette use.

Discussion: Important data for modifiable lifestyle factors of diet, physical activity, and sleep are missing from the All of Us dataset. We recommend adding these missing variables to future surveys. Nevertheless, this snapshot of cardiovascular health shows that, on average, adults in the United States had poorer than recommended cardiovascular health for cardiovascular disease risk.

Background: Psychosocial stigma represents a significant burden in persons with lung cancer-particularly among those undergoing chemotherapy-yet the heterogeneity of stigma experiences remains understudied. While prior research has explored stigma in cancer populations, factors such as psychological resilience, social support, and clinical characteristics (e.g., smoking history, comorbidities) in shaping distinct stigma profiles have not been comprehensively examined. Latent profile analysis-a statistical method to identify unobserved subgroups-offers a novel approach to understanding stigma variability and its predictors in this population.

Objectives: This study aimed to (a) characterize sociodemographic and clinical profiles of persons with lung cancer receiving chemotherapy, (b) identify latent stigma subgroups based on psychosocial burden, and (c) examine factors associated with subgroup membership, including psychological resilience, social support, and health-related covariates.

Methods: A cross-sectional analysis of 273 persons with lung cancer was conducted using validated instruments (Chinese Lung Cancer Stigma Scale, Connor-Davidson Resilience Scale, Multidimensional Scale of Perceived Social Support). Latent profile analysis and multivariate logistic regression were employed to classify stigma subgroups and determine predictors.

Results: Three latent subgroups emerged: low stigma-positive coping, moderate stigma, and high stigma-excessive anxiety. Lower psychological resilience and social support significantly predicted membership in moderate and high stigma subgroups. Smoking history and chronic comorbidities uniquely distinguished the high stigma subgroup. Higher education and stronger social support were protective against severe stigma.

Discussion: Stigma heterogeneity in persons with lung cancer underscores the need for tailored psychosocial interventions. Enhancing psychological resilience and social support may mitigate stigma burden-particularly in high-risk subgroups. Clinical strategies for persons receiving chemotherapy should integrate stigma assessment and target modifiable predictors to improve mental health outcomes. This study highlights the clinical complexity of stigma management in oncology palliative care.

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 to 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 to 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: Self-regulated fatigue (SRF) can seriously damage the physical and mental health of persons with colorectal cancer (CRC) undergoing chemotherapy. Understanding how to improve self-regulation ability is of crucial importance.

Objectives: To investigate the status of potential profiles of SRF in persons with CRC treated with chemotherapy and the factors associated with these profiles.

Methods: A convenience sampling method was used to conduct a questionnaire survey with 322 hospitalized persons with CRC who were undergoing chemotherapy at three tertiary-grade A hospitals in China. Data were collected through the General Information, Self-Regulatory Fatigue Scale, Family Health Scale, the 10-item Kessler Psychological Distress Scale, and cancer information overload scale. Latent profile analysis and multiple logistic regression were used to analyze the data.

Results: SRF among persons undergoing chemotherapy for CRC could be divided into three potential profiles: low SRF-extensive social profile (53.1%), moderate SRF profile (32.3%), and high SRF-low mood profile (14.6%). Gender, per capita family monthly income, family health, psychological distress, and cancer information overload were predictive factors for different profiles of SRF.

Discussion: There were three latent profiles of SRF in persons with CRC. Family health, psychological distress, and information overload were significant predictors of SRF. Health care providers should adopt individualized interventions to help patients improve disease coping, reduce SRF, and provide support through family care, information filtering, and psychological support.

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 Theory of Planned Behavior has 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 towards, 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 towards 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 towards 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: 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.

Objective: 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: (a) identifying core domains through the extraction of relevant concepts from survivor narratives; (b) generating scale items using survivor language; (c) assessing content and face validity, as well as evaluating acceptability, via a content validity index with experts and cognitive interviews with GBV survivors aged 30 to 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: Positive deviance (PD) methods, initially used to improve health in low-income countries, are now being applied across U.S. health sectors. "Positive deviants" are persons who maintain good outcomes despite facing the same adversity as their neighbors. One strength of PD in intervention development is building on successful local solutions.

Objective: The purpose of this study was to illustrate a quantitative approach to conducting a positive deviant analysis of postpartum coping strategies that were associated with good maternal health when stress was high.

Method: We described the process for identifying positive deviants and a normative group with high stress in a cross-sectional survey of 427 persons between 2 and 22 months postpartum. Measures included postpartum stress, physical and mental health, and postpartum coping strategies: self-regulation, spiritual care, self-care, use and seek support, internal and external resources, and health promotion. We used the Mann-Whitney U statistic to compare coping strategies of positive deviants and a normative group.

Results: Among 163 individuals with high stress, we identified 52 positive deviants with good physical health and 21 with good mental health. Positive deviants with good physical health more often used self-regulation and health promotion than the normative group, but those with good mental health used all coping strategies more often. Positive deviants did not differ significantly from the normative group in terms of demographic variables.

Discussion: Use of a quantitative PD approach resulted in identifying potentially efficacious coping content for interventions to promote postpartum health during high stress. In community and clinical interventions, use of PD to identify existing beneficial coping practices could aid populations facing health-related problems.

Background: Caregivers of home care patients with stroke cope with physical, psychological, social, and economic problems. In addition, their inexperience in patient care affects patient outcomes.

Objectives: This study aimed to evaluate the effect of a training program based on the PRECEDE-PROCEED Model on caregivers of home care of persons with stroke on caregivers' caregiving responses, perceived social support levels, and patient outcomes.

Methods: The study was conducted with 70 stroke patients and 70 caregivers using a quasi-experimental design between July and December 2023. Caregivers were assessed using the "Caregiver Personal Information Form," "Caregiver Reaction Rating Scale," and "Multidimensional Perceived Social Support Scale." Home care patients with stroke were evaluated using the "Patient Personal Information Form," "Braden Pressure Injury Risk Assessment Scale," and "Hospital Admission Follow-up Form".

Results: The caregivers who participated in the study had a mean age of 53 years, and 76% were female. Additionally, 84% received care support. Many caregivers simultaneously had a chronic disease, were first-degree relatives of the patient, and required assistance in providing patient care. Over time, a significant improvement was observed in caregivers' responsiveness and perceived social support. Regarding patient outcomes following the intervention, notable improvements were found in the incidence of aspiration/pneumonia, incontinence, constipation, diarrhea, and falls. The risk of pressure injury significantly decreased over time. Furthermore, hospitalization rates showed a marked reduction after the intervention.

Discussion: The training program based on the PRECEDE-PROCEED Model led to positive changes in caregiving responses and the perceived social support of caregivers of stroke patients. The training program was also associated with improvedpatient outcomes. These findings suggest that the PRECEDE-PROCEED Model can be effectively utilized for caregivers of home care patients with stroke.

Background: As the negative effects of climate change on health increase, interest in responding to the climate crisis within the health care community is rising. Nurses, who comprise the majority of health care professionals, have significant potential to mitigate the health effects of climate change and can play a key role in addressing this global challenge.

Objectives: This study aimed to explore nurses' perspectives on climate change and propose strategies to enhance their ability to respond to climate issues based on the results.

Methods: Q methodology-which combines qualitative and quantitative research methods-was used. Thirty-seven Q statements were selected from 197 statements derived from literature reviews, newspaper articles, books, and interviews. Forty-four nurses in South Korea, who were expected to hold diverse perspectives on climate change, were purposively recruited and participated in Q sorting. The data were collected in July and August 2024 and analyzed using principal component analysis with varimax rotation in PQMethod software.

Results: Four perspectives of climate change were identified among the nurses: being crisis-conscious and solidarity response-oriented, emphasizing the irrelevance to nursing and being corporate response-oriented, recognizing the relevance to nursing and having a strong will to act, and being critically indifferent and passive response-oriented.

Discussion: The findings reveal that nurses' perspectives on climate change can be categorized based on the presence of a professional perspective in viewing the climate issue and the level of climate change response considered desirable. To encourage nurses' active participation in responding to climate change, it is necessary to develop appropriate strategies according to their various perspectives on this issue. The results of this study could be used to formulate solutions that enable nurses to contribute positively to climate change in countries with similar backgrounds to South Korea and those that have achieved rapid economic growth.