Nursing Research最新文献

Background: Adolescents with type 1 diabetes (T1D) often experience heightened levels of diabetes distress and struggle with maintaining effective self-management behavior. Resilience-both at the family and individual levels-is a crucial psychological capacity for coping with challenges. However, limited research has explored how diabetes distress, family resilience, self-resilience, and self-management behavior are interrelated in adolescents with T1D.

Objectives: The purpose of this study was to examine whether family resilience and self-resilience mediate the association between diabetes distress and self-management behavior in adolescents with T1D.

Methods: A cross-sectional study was conducted in a children's hospital in China, involving 143 adolescents with T1D (mean age=13.05 y) and their caregivers. Participants completed the Diabetes Behavior Rating Scale, Problem Areas in Diabetes Scale, Diabetes Strengths and Resilience measure for adolescents, and Family Resilience Assessment Scale. Structural equation modeling was employed for data analysis.

Results: Diabetes distress was negatively associated with family resilience, self-resilience, and self-management behavior. Family resilience, self-resilience, and self-management behavior were positively correlated. Both family resilience and self-resilience significantly and partially mediated the association between diabetes distress and self-management behavior.

Discussion: These findings highlight that family and individual resilience partly buffer the adverse effects of diabetes distress on self-management. Interventions should support families in recognizing and leveraging their strengths, while incorporating resilience-enhancing strategies to promote both psychological well-being and self-management in adolescents with T1D.

Background: Nurse practitioners (NPs) are a growing segment of the acute care hospital workforce, yet little is known about how organizational factors, such as Magnet designation, influence their workplace experiences.

Objectives: We examined whether employment in a Magnet hospital was associated with NPs' strong recommendation of their hospital and whether this relationship was explained by NPs' assessments of care quality, patient safety, and care transitions.

Methods: In this cross-sectional study we analyzed data from 774 NPs across 425 U.S. hospitals using the 2024 Nurses4All Survey and the American Hospital Association Annual Survey. The independent variable was employment in a Magnet hospital versus a non-Magnet hospital. The dependent variable was NPs' strong recommendation of their hospital to family and friends. Mediating variables included NPs' assessments of nursing care quality, patient safety, and confidence in patient care transitions. Mediation analysis using weighting estimators was conducted to adjust for confounding variables and to evaluate the extent to which the hypothesized mediators explained the relationship between Magnet status and hospital recommendation.

Results: NPs employed in Magnet hospitals were 15% more likely to strongly recommend their hospital compared to those in non-Magnet hospitals. The natural indirect associations through stronger quality of nursing care, patient safety grade, and confidence in care transitions accounted for approximately 13.3%, 26.6%, and 40% of the total association, respectively. The natural direct association remained positive and significant, suggesting that Magnet employment is associated with hospital recommendation among NPs independently of quality and safety assessments.

Discussion: NPs in Magnet hospitals are more likely to endorse their hospital, partially due to more favorable assessments of care quality and safety. This supports Magnet's aim to attract and retain registered nurses and suggests the benefit extends to NPs. Healthcare leaders should apply Magnet principles to strengthen NP engagement, development, and retention.

Background: Sustained implementation of evidence-based practices and interventions in clinical settings is essential to ensure patients receive the best evidence-informed care. Information to guide sustainment of complex, multicomponent interventions in routine clinical practice after grant funding ends has had limited attention in the literature.

Objectives: The purpose of this article is to describe the efforts of our multidisciplinary trial team to foster sustainment of key components of a complex electronic health record (EHR)-facilitated symptom surveillance and management intervention for people receiving cancer care at a Midwestern quaternary medical center or community practice settings.

Methods: The parent Enhanced EHR-Facilitated Cancer Symptom Control (E2C2) hybrid Type II effectiveness-implementation pragmatic trial assessed the effectiveness of a multicomponent EHR-facilitated, collaborative care model-based intervention for management of SPPADE symptoms (sleep interference, pain, impaired physical function, anxiety, depression, and energy deficit/fatigue) and its implementation in medical oncology and community practice settings. The dynamic sustainability framework (DSF) posits the need for on-going efforts to continuously optimize the fit of an intervention within dynamic and evolving delivery contexts. This brief report uses the DSF to describe our team's efforts to optimize the fit of the core E2C2 intervention components to the practice setting and broader ecological system during the conduct of the trial. These activities were designed to achieve sustained implementation of the intervention in routine care delivery as the funded research activities concluded.

Results: Core intervention components to be sustained were symptom surveillance using electronic patient-reported outcome measures, clinician alerts for severe symptoms, access to a registered nurse symptom care manager (RN SCM) for severe symptoms, patient education materials to support symptom self-management, access to a website of cancer-related materials, and the training and supervision of the RN SCMs.

Discussion: Sustainability is dynamic and multidimensional, and emphasizes the importance of optimizing the fit of key intervention components to the care delivery context as it evolves time. Investigators are advised to plan sustainability efforts early, embrace change inherent in dynamic settings, and carefully track adaptations of intervention components to maximize intervention fit in real-world clinical practice to ensure patients continue to derive benefit from evidence-informed care.

Background: Existing research fails to address the complex nature of nonspecific chronic lower back pain (cLBP) despite its detrimental effect on economic, societal, and medical expenditures.

Objectives: We developed a nurse-led, mobile-delivered self-management intervention-Problem-Solving Pain to Enhance Living Well (PROPEL-M)-and evaluated its usability, feasibility, and initial efficacy for South Korean adults with nonspecific cLBP.

Methods: This study was composed of two phases: (a) lab and field usability testing for a gamified mobile device application and (b) a pilot study employing a one-arm pretest-and-posttest design among adults aged 18-60 years with nonspecific cLBP. During the 2-week PROPEL-M intervention, participants used the gamified PROPEL application to watch 12 educational videos, engage in pain-relief activities and record daily pain and interference scores, and also participate in weekly yoga sessions and nurse consultations. In addition, participants wore a Fitbit for activity tracking, completed surveys, and underwent a quantitative sensory test to assess pain sensitivity. Blood samples were obtained for RNA sequencing.

Results: The PROPEL gamified mobile application was refined during two-stage usability testing. In a pilot trial, 19 participants were recruited, all of whom completed the study. Satisfaction with the PROPEL-M, encompassing the application, yoga sessions, and nurse consultations, was rated as excellent. No adverse events were reported. Moreover, significant reductions were observed in the worst pain, average pain, current pain, and pain interference between baseline and the 2-week follow-up. We also found an increase in the heat-pain threshold at the pain site, measured by increasing thermal stimuli from 32°C until pain was rated 50 on a 0-100 scale.

Discussion: The feasibility of the PROPEL-M was favorable despite concerns about the participants' burden associated with multidimensional data collection and diverse study-related activities. In the short term, the PROPEL-M demonstrated beneficial effects on pain intensity, interference, and heat-pain threshold, suggesting reduced sensitivity to heat stimuli. Comprehensive data on pain phenotypes and physical activity patterns collected through the PROPEL-M can support nurses in developing individualized self-management strategies, which may be further enhanced through nurse-led consultations.

Background: Working-age individuals with mild traumatic brain injury (mTBI) often experience persistent postconcussion symptoms (PCSs) that significantly impair their quality of life (QoL). Posttraumatic stress disorder (PTSD) may act as a psychological mechanism linking PCSs to a poorer QoL, whereas illness perception may influence the extent to which PCSs lead to PTSD; these relationships have not been tested. Establishing this moderated mediation pathway is critical for identifying patients at a heightened psychological risk and informing early intervention strategies to optimize postacute rehabilitation outcomes.

Objective: This study examined the mediating role of PTSD in the relationship between PCSs and QoL, as well as the moderating effect of illness perception on these associations.

Methods: A longitudinal study was conducted among 120 working-age individuals with mTBI in Indonesia. PCSs and illness perception were assessed at discharge, PTSD was measured at 1 month, and QoL was measured at 3 months postdischarge. A moderated mediation analysis was performed using Hayes' macro, PROCESS Model 7.

Results: PCSs at discharge were associated with poorer QoL at 3 months, with PTSD fully mediating this relationship. Illness perception moderated the effect of PCSs on PTSD, with more negative perceptions intensifying symptoms. The indirect effect of PCSs on QoL through PTSD was stronger among individuals prone to negative illness perception.

Discussion: PTSD plays a critical role in mediating the relationship between PCSs and QoL, whereas negative illness perception further amplifies this indirect effect, leading to a poorer QoL 3 months postinjury. These findings confirm the presence of a moderated mediation pathway, highlighting the need for early psychological screening and targeted interventions that address both PTSD and negative illness perception. Integrating these strategies into postacute rehabilitation may improve long-term recovery outcomes in working-age individuals with mTBI.

Background: Older adults often experience declines in physical fitness, which can lead to difficulties with mobility and daily routines. The Healthy Beat Acupunch (HBA) regimen-a novel exercise approach that combines traditional Chinese medicine and exercise-holds promise for enhancing physical fitness in this population. However, its effectiveness in maintaining or improving physical fitness among older adults-particularly within the Thai population-has not yet been examined.

Objectives: This study aims to examine the effects of the 6-month HBA regimen on physical fitness of Thai older adults in residential homes.

Methods: A quasi-experimental, two-group pre-post study was conducted with 92 participants from two residential homes, randomly allocated to either the experimental or control group. The experimental group participated in instructor-led HBA sessions lasting 40 minutes, three times per week for the first 3 months, followed by video-guided HBA regimen for the remaining 3 months. The control group continued their usual daily activities in the residential home. Physical fitness assessments were conducted at baseline, 3 months, and 6 months. Data were analyzed using generalized estimating equations to examine interaction effects between groups and time, as well as within-group changes.

Results: Participants in the experimental group showed significant improvements in all physical fitness parameters over time compared to the control group. Additionally, significant improvements were observed within the experimental group in all parameters when compared to baseline, 3 months, and 6 months.

Discussion: The improvements in all physical fitness parameters are consistent with the principles of the meridian theory and the effects of acupoint stimulation. The combination of instructor-led and video-guided sessions helped participants consistently perform the HBA regimen. This two-phase approach aligns with previous studies supporting supervised-to-video transitions and addresses practical challenges, including healthcare worker shortages. Compared to the control group-which maintained routine activities with limited fitness gains-the HBA regimen demonstrated a more comprehensive and efficient approach for enhancing physical fitness.

Background: Inferential statistics are foundational tools in health and nursing research. However, their misuse-particularly when applied to nonrandomized samples-is widespread and has serious implications for the integrity of science and evidence-based nursing practice.

Objectives: The aims of this study were to examine the consequences of performing inferential statistical analysis on nonrandomized samples and provide guidance on alternative approaches when random sampling is not feasible.

Methods: This paper synthesizes evidence from statistical theory, research methodology, and nursing literature to describe the assumptions of inferential statistics and the biases introduced by nonrandomized sampling. Alternatives such as nonparametric tests, bootstrapping, and descriptive statistics are also described.

Results: Violating statistical test assumptions, such as random sampling and independence, can lead to misleading p -values, invalid confidence intervals, and incorrect generalizations. Systemic factors contributing to misuse include institutional pressures, growing publication options, and insufficient statistical training.

Discussion: Inferential statistics must be grounded in proper sampling methods. Researchers should avoid overgeneralization from biased samples, use alternative analytical approaches where appropriate, and clearly disclose methodological limitations. Reform in nursing education and publication standards is critical to maintaining the validity and trustworthiness of nursing science.

Background: Substance use disorder (SUD) research has shifted to focus on strength-based approaches and resilience. The Connor-Davidson Resilience Scale-25 (CD-RISC-25) has been widely used to measure resilience in the general population, individuals with SUD, and individuals with mental health conditions. However, there is no globally accepted standard measure of resilience, and the lack of a consistent conceptual definition and limited psychometric information for instruments in SUD research publications contribute to methodological challenges.

Objectives: The purpose of this study was to appraise the psychometric properties of the CD-RISC-25 and evaluate the scale's performance in SUD research using the Psychometric Reliability & Investigation of Research Instruments (PRIORI) rubric.

Methods: Cochrane Rapid Review criteria were used to synthesize and evaluate 48 published peer-reviewed articles that used the CD-RISC-25 to measure resilience in individuals with SUD. The PRIORI rubric was used to appraise the articles for the conceptual definition of resilience, reliability, validity, results related to resilience, and performance of the CD-RISC-25.

Results: Cronbach's alpha for the CD-RISC-25 in populations with SUD provided support for use of the measure among different populations with SUD. Most authors reported face validity; however, sufficient data were available in most publications to also support criterion and construct validity. Appraisal scores for the CD-RISC-25 used in populations with SUD suggested the CD-RISC-25 scale was a good measure of resilience.

Discussion: The PRIORI rubric allowed researchers to critically appraise the performance of the CD-RISC-25 in the reviewed SUD research articles. Findings suggest the CD-RISC-25 was valid and reliable when used to measure resilience in diverse populations with SUD. Adopting the CD-RISC-25 as the gold standard measure of resilience could help address the methodological challenges identified in SUD research.

Background: Weight stigma-a social phenomenon in which individuals can be treated differently due to their weight and physical appearance-can be associated with stress-related conditions and poor health. Sexual minority women (SMW) have an increased prevalence of obesity and overweight compared to heterosexual women, potentially making them more susceptible to experiencing weight stigma.

Objectives: No studies have examined weight stigma in a national sample of SMW. Therefore, the purpose of this study was to examine the prevalence of external weight stigma and internal weight stigma in a sample of SMW and in relevant subgroups defined by demographic data.

Methods: This study used online survey methods to determine the prevalence of external and internal weight stigma in a national sample of adult SMW ( n = 459).

Results: Most participants identified as non-Hispanic White, more than half identified as bisexual, and the sample ranged in age from 18 to 76 years. The prevalence of external weight stigma ranged from 26% to 65% depending on type (e.g., discrimination vs. mistreatment), and the prevalence of internal weight stigma was 57%. All body mass index categories were positively correlated with some forms of weight stigma, with the obese category associated with all forms of weight stigma.

Discussion: To address weight stigma, including eliminating discrimination based on weight and establishing caring and empathetic relationships, healthcare providers should support an individualized and holistic approach to weight management with attention to marginalized identities and other social determinants of health.

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.