Nursing Research最新文献

Background: Despite growing awareness of the dyadic role in transplant care and a mandate for patient-caregiver dyads for transplant listing, the integration of dyadic science into transplantation research is lacking. Recruiting transplant patient-caregiver dyads has unique challenges that need to be considered when designing and conducting dyadic studies in transplantation.

Objectives: The aim of this study was to present (a) the barriers and facilitators to dyadic recruitment in a patient-caregiver transplant population that we encountered and (b) strategies developed to overcome these challenges.

Methods: We used the social marketing mix framework to guide this methodological report of patient-caregiver dyadic recruitment strategies employed during a post-lung-transplant psychometric study of 50 patient-caregiver dyads.

Results: We identified several facilitators of dyadic recruitment in the lung transplant population, including (a) conducting a study of high relevance to both patients and caregivers, which helped facilitate maximum engagement of participants; (b) using remote recruitment and data collection strategies to improve accessibility to participation and minimize the amount of time or energy required to participate; (c) conducting patient and caregiver study visits independently from one another, which allowed for scheduling flexibility and helped improve participation among dyad members who do not live together; and (d) establishing clinical partnerships and having acquired clinical experience with the target population. We also identified barriers to dyadic recruitment that require careful planning in future studies, including (a) high healthcare utilization, which can delay the recruitment timeline; (b) recruiting patients and caregivers independently within relevant time frames; (c) gatekeeping, when the patient or the caregiver blocks researcher access to the other dyad member; (d) establishing contact with the participant via phone; and (e) limited study staffing that reduced recruitment and study visit scheduling flexibility.

Discussion: To our knowledge, this is the first methodological report to present the barriers and facilitators to dyadic recruitment in a patient-caregiver transplant population. Our experience and lessons learned can be used to inform future research teams to successfully design and conduct much-needed dyadic research in organ transplantation.

Background: Persons with limited English proficiency may receive inequitable care due to the absence of language services. Despite health equity initiatives, knowledge gaps exist regarding how and when language access needs are identified, acted upon, and which methods are being used.

Objective: The purpose of this study was to explore limited English proficient and deaf obstetrical patients and nurses' experiences with language services to improve delivery of culturally competent care.

Methods: This mixed methods study occurred in two phases. In phase 1, demographic and language service data were collected via surveys that were deployed to obstetric patients with limited English proficiency. In phase 2, nurses' experiences with interpretive services were explored via three focus groups to identify facilitators and barriers to care. Quantitative data were analyzed using descriptive analysis methods, while qualitative data were analyzed using grounded theory methods.

Results: Fifty participants receiving obstetric services who had limited English proficiency participated in phase 1. Language services were positively rated with a noted preference for in-person interpreters. Participants identified unique barriers, but felt comfortable discussing concerns, stating nurses listened to them, treated them with courtesy, kindness, and respect. In phase 2, 16 nurse participants identified two major themes: evidence of barriers to accessibility, convenience, and consistency of language access services; and increased need for cultural and linguistic competence.

Discussion: Findings indicate in-person interpreters are most effective and capture cultural nuances often missed when using a phone/iPad during patient encounters. Language service delivery at various points of care requires further consideration to ensure consistent use during patient encounters. Future research should explore digital health language interventions, while nurses' suggestions to decrease language service barriers should be used to develop policies and programs designed to better meet linguistic needs.

Background: Although the benefits of exercise in osteoporosis prevention are well documented, research indicates that women's engagement in physical activity remains suboptimal.

Objectives: The aim of this study was to assess the Health Belief Model constructs and the self-regulation concept derived from Social Cognitive Theory concerning exercise behaviors for osteoporosis prevention.

Methods: The study used a cross-sectional survey of 250 women who were premenopausal (ages 30-49 years). The data collection instruments were comprised of health beliefs, self-regulation, awareness, and exercise behavior questionnaires.

Results: The average score for exercise behavior was notably low. Within the integrated model, exercise behavior was significantly linked to increased levels of perceived benefits, perceived susceptibility, self-efficacy, health motivation, and self-regulation, as well as decreased levels of perceived barriers.

Discussion: In the final model, perceived benefits and self-efficacy emerged as the most influential predictors of exercise behavior. Therefore, implementing strategies to improve effectiveness in practice, such as boosting self-efficacy through motivational counseling and educating individuals on the advantages of the recommended behavior, is likely to result in more successful health promotion initiatives for middle-aged women aimed at preventing osteoporosis.

Background: In a digitalized world, accessing disease information through online platforms has become essential in influencing health-promoting behaviors among patients with heart failure. Patients must possess sufficient digital health literacy to obtain accurate and reliable information from digital platforms; however, there is no known data about the mediating role of digital health literacy in the relationship between health behaviors and symptom burden among persons with heart failure.

Objective: To examine the relationship between digital health literacy, health behaviors, and symptom status (frequency, severity, and level of discomfort) in persons with heart failure and the mediating role of digital health literacy in the relationship between health behaviors and symptom status.

Methods: This cross-sectional, correlational study was conducted between November 2023 and June 2024 with 250 persons diagnosed with heart failure. Data were collected using the Heart Failure Health Behavior Scale, e-Health Literacy Scale, and Heart Failure Symptom Status Scale. Pearson correlation analysis, linear regression, and hierarchical regression analysis with PROCESS Model 4 were used to analyze the continuous variables.

Results: Digital health literacy was positively but weakly correlated with health behavior and negatively correlated with symptom status. The mediation analysis revealed that part of the effect of health behaviors on symptom status was mediated by digital health literacy.

Discussion: Health behaviors directly affected symptom status and indirectly affected symptom status through digital health literacy. Strategies developed by nurses to enhance digital health literacy could play a critical role in improving the health of persons with heart failure by reducing symptom burden and promoting health behaviors. Research is needed on the influence of various predictors on symptom burden and assessing whether interventions to enhance digital health literacy can improve health outcomes among those with heart failure.

Background: A structurally fluent workforce is essential to demonstrate structural competency-the ability to recognize and address how social, political, and economic structures affect health. Such a workforce understands the role of external factors and social determinants in health inequities. Evidence shows that minority patients receive better care from a diverse workforce. The racial composition of hospital nurses and its correlation to patients remains unreported.

Objective: The aim of this study was to evaluate patient-nurse racial concordance at the hospital level in a large geographically representative hospital sample.

Methods: A cross-sectional descriptive study design was employed using the 2015 Annual Registered Nurse Survey of the National Database of Nursing Quality Indicators and 2019 Medicare patient data. Concordance was measured by subtracting the hospital nurse percentage from the patient percentage. We defined Black-serving hospital (BSH) status by classifying hospitals into categories (25/50/25) by low, medium, and high representation of Black patients. Descriptive and correlation statistics were calculated on nurse and patient race and their concordance at the hospital and BSH levels.

Results: Among 574 hospitals, the proportion of Black nurses was significantly lower than that of Black patients, with considerable variation across hospitals. The representation of Black nurses and patients was strongly associated with hospitals that served more Black patients and generally employed more Black nurses. When grouped into low, medium, and high BSHs, the percentage of Black nurses differed considerably across the categories. High BSH had the greatest discordance.

Discussion: Although Black nurses and Black patients are often clustered in the same hospitals, there are relatively few Black nurses in hospitals where Black patients primarily receive care. This study underscores the urgent need for healthcare institutions and policymakers to prioritize building structural competency and diversifying the nursing workforce, particularly in hospitals serving higher Black patient populations. Future research is warranted on whether patient-nurse racial concordance or a nursing workforce more reflective of the patient population it serves reduces disparities.

Background: The inaugural "Cancer Symptom Science Expert Meeting," held in Lausanne, Switzerland, on October 11-12, 2023, brought together 40 nurse scientists from seven countries to enhance collaboration across the global symptom science community; identify common research interests, gaps in knowledge, and opportunities for research; and develop strategies to address challenges and accelerate symptom science research internationally.

Objectives: The aim of this white paper were to summarize the discussions and recommendations deliberated during the meeting and introduce the Global Research Alliance in Symptom Science (GRASS).

Methods: This 2-day meeting featured presentations that highlighted critical issues and unanswered questions in cancer symptom science and other chronic conditions. Attendees identified four core topic areas based on the knowledge gaps reflected throughout the presentations. Four working groups (WGs) were formed to identify gaps and opportunities associated with each topic and to outline strategic directions and essential actions to advance symptom science.

Results: The WGs developed recommendations on four core topic areas. WG1 explored optimal approaches to collect, analyze, and use symptom data for research and clinical purposes. WG2 addressed the development of a minimum dataset or common data model for symptom science research. WG3 focused on enhancement of best practices in implementation science strategies to improve uptake of evidence-based symptom management strategies in routine clinical care. WG4 addressed the questions of capacity building and infrastructure for the creation of a global alliance in symptom science (GRASS).

Discussion: WGs' recommendations underscore the commitment of an international coalition of scientists to advance symptom science. The symposium established the groundwork for the group to constitute GRASS, a global research alliance dedicated to symptom science in cancer and other chronic conditions. Future directions include establishing regular scientific meetings, fostering interdisciplinary collaboration, and engaging with symptom scientists.

Background: Despite experiencing an increased incidence in stroke, minority groups have the lowest reported knowledge of stroke signs and symptoms and are less likely to receive time-sensitive interventions. There is a need to explore the relationship between social determinants of health and stroke awareness and severity within at-risk communities.

Objectives: The aim of this study was to explore relationships between social determinants of health and stroke awareness and severity in an underserved area located in a city borough in Northeastern United States.

Methods: We used an exploratory descriptive retrospective design and existing data. Data from 1,162 patients discharged with a principal diagnosis of stroke (ischemic stroke, subarachnoid hemorrhage, or intracerebral hemorrhage) were analyzed to explore the relationship between social determinants of health (age, sex, race, ethnicity, payer status, zip code) and stroke awareness and severity.

Results: Age group, race, and hospital arrival method were all significant indicators of time to arrival at the hospital. When holding all other factors in the model constant, being 65 years of age or older was associated with a decrease in time to reach the hospital compared to those under 65 years of age. Those who traveled by private transport had longer discovery to arrival times when holding all other factors constant, as compared to those who arrived by emergency medical services. Compared to persons who were White, persons who were Black or Asian saw increased times to hospital arrival.

Discussion: This study found that social determinants of health including age, race, sex, and insurance type significantly influenced stroke awareness and/or severity. These study findings can be used by stroke program leadership and community nurses to direct community-centered stroke awareness outreach.