Nursing Research最新文献

Background: Chronic stress causes harmful physiological responses that yield increased inflammation and subsequent health conditions. Stress is an important measure among minoritized populations who face social situations that predispose risk to developing mental health problems. Hair and fingernail cortisol have been studied as retrospective measures of chronic stress and to demonstrate biological response to social situations.

Objectives: The objective of this study was to compare the Perceived Stress Scale (PSS) with hair and nail cortisol concentrations and assess the risk factors associated with stress levels among heterosexual and sexual and gender-minoritized adolescent males.

Methods: We recruited a cohort of adolescents who were assigned male sex at birth. Approximately half of our cohort consisted of sexual and gender-minoritized people, and half consisted of heterosexual cisgender males. Participants provided hair and nail samples and completed a survey that included demographic and hair hygiene questions and the PSS. Hair and nail samples were processed in a laboratory, and survey results were analyzed descriptively.

Results: Several samples were not provided or received, and some survey data were missing. Hair and nail cortisol values were significantly associated. There was no significant relationship between the PSS and hair and nail cortisol values. No significant differences were found between the heterosexual and sexual minoritized groups. Black participants reported lower perceived stress scores compared to White participants. Participants whose gender was nonbinary or genderqueer had higher hair cortisol values compared to those who identified as male. Older participants had higher hair cortisol values compared to younger participants.

Discussion: Previous researchers have similarly found no correlation between self-report stress scales and cortisol values, increased stress experience among nonbinary or genderqueer individuals compared to cisgender individuals, and a positive correlation between aging and stress. Yet, our finding that Black participants reported lower stress levels than White participants is unexpected. Our study demonstrates a high correlation between hair and nail cortisol values, suggesting the potential to substitute these markers as needed.

Background: Fear of childbirth affects women worldwide and can have adverse consequences. Midwives have implemented a number of interventions, autonomously or as part of a professional team. However, midwives have been unable to identify the most appropriate intervention for ensuring the reduction or alleviation of this fear to provide the best perinatal outcomes.

Objective: This study aimed to evaluate the effectiveness of a prenatal educational intervention followed by specific support during childbirth, designed and delivered exclusively by midwives for women with a high fear of childbirth.

Method: This randomized controlled trial was performed with two arms in two phases: an online prenatal education phase followed by a support phase during childbirth. Participating women with a high fear of childbirth, which was determined using the Wijma Delivery Expectancy Questionnaire A-Spanish version, were assigned to the experimental group or the usual care control group at a 1:1 ratio.

Results: Women showed a reduction in fear of childbirth in both phases of the study. According to the intention-to-treat analysis, a significant mean difference was observed in the prenatal stage in favor of the intervention group, and a nonsignificant difference was observed in favor of this same group after delivery.

Discussion: The effectiveness of continuous specific prenatal education with preferential support during childbirth by midwives was indicated by improvements in the level of fear of childbirth.

Background: Saudi Arabia has one of the highest childhood obesity rates worldwide. The primary factor associated with the high prevalence of obesity among adolescents is a lack of physical activity (PA). Compared to male adolescents, very few Saudi female adolescents meet the World Health Organization recommendation of achieving 60 minutes of moderate-to-vigorous PA per day, putting them at a higher risk of overweight and obesity.

Objective: This cross-sectional study aimed to examine the relationship between the theory of planned behavior and psychosocial factors, including attitude toward PA, subjective norms, perceived behavioral control (PBC), PA intention, and self-reported PA among Saudi female adolescents.

Methods: A convenience sample of 329 Saudi female adolescents was recruited from all-female public intermediate and high schools in the Eastern Region of Saudi Arabia. Data were collected using online self-administered questionnaires. The theoretical model was examined using structural equation modeling.

Results: The findings revealed a higher prevalence of overweight compared to obesity among participants. About half the participants were from families with a medium monthly income. The mean PA score indicated a low level of PA. The model demonstrated significant explanatory power for both PA intention and PA behavior, respectively. The strongest predictor of adolescents' intention was attitude, followed by PBC.Moreover, the female adolescents' attitudes and PBC had significant indirect effects on self-reported PA through intention, whereas intention had a direct effect on PA. The model did not support a direct or indirect relationship between subjective norms and PA.

Discussion: The findings provide essential support for targeting attitude and perceived behavior control of female adolescents in order to enhance their PA intention. This theoretical understanding can help design effective theory-based interventions that promote PA among Saudi female adolescents.

Background: Measuring and assessing the relationship between inpatient nurse staffing and workload across a national health system is difficult because of challenges in systematically observing inpatient workload at the unit level.

Objective: The objective of this study was to apply a novel measure of inpatient nurse workload to estimate the relationship between inpatient nurse staffing and nurse workload at the unit level during a key nursing activity: the peak-time medication pass.

Methods: A retrospective observational study was conducted in the Veterans Health Administration, the largest employer of nurses in the United States. The sample included all patients ( n = 1,578,399 patient days) admitted to 311 non-intensive care unit inpatient acute care units in 112 hospitals in 2019 (104,588 unit days). Staffing was measured as the unit-level, nurse-to-patient ratio, and workload was measured using average time (duration) for RNs to complete the peak-time medication pass.

Results: We found a negative relationship between the RN-to-patient ratio and average peak-time medication pass duration after adjusting for unit-level patient volume and average patient severity of illness and other unit-level factors. This relationship was nonlinear: The marginal effect of staffing on workload decreased as staffing increased.

Discussion: As unit-level nurse staffing increased, average RN workload decreased. This result suggests that interventions to improve nurse staffing may have larger nonlinear effects for units with lower staffing levels. Understanding the effect of differing staffing decisions on variations in nursing workload is critical for adopting models of care that effectively use scarce staffing resources and contribute to retaining nurses in the inpatient workforce. This work provides evidence that peak-time medication pass duration is a valid process-based measure of workload and highlights the potential diminishing returns to increasing staffing.

Background: The pandemic profoundly stressed practicing nurses and could have thereby affected trends in nursing-sensitive quality indicators (NSIs), measures that detect changes in patient health status directly affected by nursing care.

Objectives: The aim of the study was to determine if NSIs have worsened in response to the pandemic and then returned to prepandemic levels using data from 2019 through 2022.

Methods: We conducted a cross-sectional descriptive study of annual trends, examining unit data from the National Database of Nursing Quality Indicators (NDNQI) from 2019 through 2022 for five indicators: rates of falls, central line-associated bloodstream infections (CLABSI), catheter-associated urinary tract infections (CAUTI), hospital-acquired pressure injuries (HAPI), and ventilator-associated events (VAE). The NDNQI is the largest repository of nursing quality indicators, which are derived from patient-level events, reported at the nursing unit level, and submitted quarterly by over 2,000 member hospitals. Adult medical-surgical or critical care inpatient nursing units with complete data for the 4 years were included, with samples ranging from 456 to 5,818 nursing units in 2,346 hospitals. Analysis of variance was conducted by comparing the 2019 rates to each subsequent year.

Results: In decreasing order of prevalence, the mean prepandemic rates were 6.58 VAE per 1,000 ventilator days (critical care only), 2.41 HAPI per 1,000 device days, 2.20 falls per 1,000 patient days, 0.96 CAUTI per 1,000 catheter days, and 0.68 CLABSI per 1,000 central line days for medical-surgical and critical care units combined. The rates for all five nurse-sensitive indicators increased significantly beginning in 2020 and have begun to decline but have not returned to baseline by 2022. The maximum rate was observed in 2020 for falls and 2021 for the remaining indicators. These increases to the maximum ranged from a 12% increase in CAUTI to 49% for CLABSI.

Discussion: NSIs increased during the pandemic and are now returning to baseline. The pandemic underscored the importance of nursing practice. The pandemic's enduring negative effects on the nursing workforce must be addressed to preserve patient safety.

Background: Most of the research and care in fertility focuses on women, whereas men's perspectives and expectations are often overlooked.

Objectives: The aim of the study was to explore the experiences and expectations of men with primary infertility regarding fertility clinics and to provide implications for personalized and inclusive care.

Methods: A qualitative study was conducted in Iran between November 2022 and October 2023. Thirteen men with primary infertility were interviewed in-depth using a semistructured approach. Data were analyzed using the inductive content analysis method.

Results: The central theme, "Therapy Environment: Private and Interactive," was identified. The theme comprises four categories: Effective Interaction-A Key to Therapy Success; Infertility Treatment-A Joint Effort; Personal and Stress-Free Environment-Essential for Treatment; and Treatment Plan-Vital for Successful Outcome.

Discussions: Study findings underscore the importance of tailored approaches to male infertility care. Healthcare providers should prioritize personalized, stress-free environments for male infertility patients and encourage effective communication and joint participation with partners to achieve successful outcomes. Tailored approaches and therapeutic settings should be created to cater to male patients' unique needs.

Background: Firearm or gun violence has become a significant and ongoing public health crisis in the United States. There is little evidence of the current practices of nurses in assessing, screening, and counseling patients and families on firearm ownership and safety.

Objectives: The purpose of this exploratory qualitative study was to explore the attitudes, perceptions, and current practices in assessing, screening, and counseling gun ownership and safety among registered nurses, with a secondary aim of identifying the facilitators and barriers to implementing the practice.

Method: An exploratory qualitative research study design was used. We recruited focus group participants via e-mail, social media blasts, referrals, and personal contact requests. Participants were interviewed using structured focus group questions via Zoom. Five focus groups included 32 registered and advanced practice nurses. The audio-recorded and transcribed data were analyzed using Braun and Clarke's approach to thematic analysis.

Results: We identified four key themes. First, there was a significant need to educate and train nurses in the assessment, screening, and counseling about firearm safety. Second, there was a need to extend this education to patients, families, and the community. Third, there was a need to advocate for the creation and implementation of policies. Fourth, there was a need to implement mental health assessment as a standard practice before owning a gun, which emerged as a potential solution. Additionally, we found a need to address barriers to assessment and counseling on gun use. The creation of state laws and organizational policies, along with the provision of current data, emerged as other facilitators for assessment, screening, and counseling among nurses about firearms use and safety.

Discussion: Ours is one of the first studies to explore attitudes and perceptions about gun ownership and current practices in gun safety assessment, screening, and counseling among registered nurses. The findings lay some foundation for a focused, multifaceted approach and interventions to address gun violence and safety concerns.

Background: Emerging adults with type 1 diabetes are at risk of poorer diabetes-related health outcomes than other age groups. Several factors affecting the health and experiences of the emerging adults are culture and healthcare specific.

Objectives: The aim of this study was to explore the experience of emerging adults living with type 1 diabetes in Lebanon, describe their diabetes self-care and diabetes-related health outcomes (HbA1c and diabetes distress), and identify the predictors of these outcomes.

Methods: A convergent mixed methods design was used with 90 participants aged 18-29 years. Sociodemographic, clinical data, and measures of diabetes distress, social support, and self-care were collected. Fifteen emerging adults participated in individual semi-structured interviews. Multiple linear regression was used to determine predictors of diabetes outcomes. Thematic analysis was used to analyze qualitative data. Data integration was used to present the mixed methods findings.

Results: The study sample had a mean HbA1c of 7.7% (SD = 1.36) and 81.1 % reported moderate to severe diabetes distress levels. The participants had good levels of diabetes self-care and high levels of social support. HbA1c was predicted by insulin treatment type, age at diagnosis, and diabetes self-care; while diabetes distress was predicted by diabetes knowledge, blood glucose monitoring approach, and diabetes self-care. "Living with type 1 diabetes during emerging adulthood: the complex balance of a chemical reaction" was the overarching theme of the qualitative data, with three underlying themes: "Breaking of bonds: changes and taking ownership of their diabetes", "The reactants: factors affecting the diabetes experience", and "Aiming for equilibrium". The integrated mixed methods results revealed one divergence between the qualitative and quantitative findings related to the complexity of the effect of received social support.

Discussion: The suboptimal health of the emerging adults despite good self-care highlights the importance of addressing cultural and healthcare specific factors such as diabetes knowledge and public awareness, social support, and availability of technology to improve diabetes health. Findings of this study can guide future research, practice, and policy development.