Nursing Research最新文献

Background: Inappropriate dietary, exercise, and medication self-care behaviors among persons with diabetes can easily trigger hypoglycemia. Clinically, it is necessary to quickly identify high-risk groups for hypoglycemic events to provide targeted hypoglycemia education. However, there is currently a lack of precise tools to assess self-care behaviors related to hypoglycemia.

Objectives: The aim of the study was to develop and validate a hypoglycemia self-care behavior scale for evaluating the behaviors of persons with diabetes in handling and preventing hypoglycemic events.

Methods: A cross-sectional study with purposive sampling was conducted to recruit 300 persons with Type 2 diabetes who had experienced hypoglycemic events from a medical center and a primary care clinic in southern Taiwan. Data were collected using a structured questionnaire from December 2021 to September 2023.

Results: The original Hypoglycemia Self-Care Behavior Scale, comprising 26 items, was reduced to 17 items, measuring six factors after exploratory factor analysis. Subsequently, the scale was further refined to 10 items covering four factors through structural equation modeling. Validity and reliability were assessed during this process, and the developed scale was subsequently verified for both. Factor loadings ranged from .50-.97, explaining 76% of the total variance. The four factors included "hypoglycemia recognition and carbohydrate supplementation," "prevention of hypoglycemia during exercise," "carbohydrate assessment," and "seeking medical assistance." The Hypoglycemia Self-Care Behavior Scale-developed and validated through structural equation modeling-demonstrates satisfactory model fit, convergent validity, and discriminant validity. Internal consistency was within the range of .73-.94, indicating strong reliability.

Discussion: The Hypoglycemia Self-Care Behavior Scale not only functions as a tool for the rapid assessment of self-care behaviors during hypoglycemic events by clinical healthcare professionals but can also serve as reference for hypoglycemia-related health education.

Background: Rural populations in the United States face a diabetes mortality penalty. Self-management is a core component of treatment for Type 2 diabetes, but there is low uptake of self-management education and support interventions in rural areas. Rural structural barriers to diabetes self-management have been described, yet the role of rural culture has not been extensively explored.

Objective: The purpose was to examine the relationships among rural culture, diabetes beliefs, self-management behaviors, and health outcomes.

Methods: A stratified random sample of 500 adults with Type 2 diabetes were recruited from a rural integrated healthcare system and invited to participate in this nonexperimental cross-sectional study. Participants completed a survey that included validated measures of rural identity, self-reliance, perceived diabetes threat, and diabetes self-management behaviors. The most recent A1c was collected from the medical record. Descriptive, bivariate, multivariate, and moderation analyses were conducted.

Results: One hundred twenty-eight participants returned completed surveys. Having an A1c <8% was associated with better diabetes self-management behaviors, lower perceived threat, being female, and older age. Better diabetes self-management behaviors were associated with lower self-reliance, lower perceived threat, and older age. The combined moderation effect of both self-reliance and rural identity on the relationship between perceived threat and self-management behaviors was significant.

Discussion: Findings highlight the complex relationship between diabetes beliefs and behavior in rural populations and demonstrate that components of the rural culture have both direct and moderating effects on diabetes beliefs and self-management behaviors. These findings have important ramifications for nurses practicing in rural settings.

Background: People with type 2 diabetes mellitus (T2DM) commonly report a higher fatigue intensity than the general population. However, effective fatigue management is lacking because little is known about other fatigue characteristics, including timing, distress, and quality, as well as the potential fatigue subtypes experienced in people with T2DM.

Objective: This study aims to describe fatigue intensity, timing, distress, and quality and to identify fatigue subtypes in people with T2DM.

Methods: This cross-sectional, descriptive study included a sample of 150 participants with T2DM recruited from two diabetes outpatient clinics in Taiwan. Fatigue intensity, timing, and distress were measured using the Fatigue Symptom Inventory. Fatigue quality was measured using the Multidimensional Fatigue Inventory. Fatigue subtypes were identified using a latent profile analysis.

Results: Participants reported a mild fatigue intensity, experiencing fatigue for about 22% of the day with worse fatigue in the afternoon and evening and having mild disturbances. Three fatigue subtypes were identified. The "high/persistent fatigue with mild distress" subtype was characterized by high fatigue intensity and duration with severe general, physical, and mental fatigue that mildly interfered with functioning. The "moderate/frequent fatigue with minimal distress" group showed moderate levels of fatigue intensity and duration levels with intermediate of general, physical, and mental fatigue and minimal fatigue disturbances. The "no fatigue and distress" subtype was characterized by overall low fatigue scores.

Discussion: We identified fatigue characteristics and subtypes in people with T2DM, providing insights into better fatigue management. People with T2DM reported having mild but persistent fatigue. The latent profile analysis revealed that fatigue is likely composed of a mixture of physical and mental components. Nurses should assess both the physical and the mental aspects of fatigue while addressing features of the fatigue characteristics in tailored management strategies to alleviate all aspects of fatigue in people with T2DM.

Background: Double-duty caregivers are healthcare professionals caring for family members or friends outside the workplace. Although they may communicate frequently with colleagues in their professional role, little is known about communication with healthcare providers in the caregiving role.

Objectives: The aims of this study were to measure double-duty caregiver satisfaction when communicating with healthcare providers and to identify correlates and predictors of satisfaction.

Methods: A cross-sectional, nonexperimental, correlational study was used. Participants included registered nurses who were current or former caregivers of a family member or friend aged 50 or older. Correlation and multiple linear regression analyses were performed to examine the associations between double-duty caregivers' personal and professional attributes, factors, and satisfaction with communication.

Results: Double-duty caregivers reported above-average satisfaction with communication. Personal beliefs about caring and trust had the highest influence on satisfaction. Stress was associated with lower satisfaction with communication.

Discussion: This study is the first to examine double-duty caregiver satisfaction when communicating with healthcare providers and associated factors. Healthcare providers must implement strategies to maximize their acknowledgment of personal beliefs about caring and foster the building of trusting relationships to support colleagues in this role.

Background: The analysis of health diary data has long relied on inferential statistical methods focusing on sample means and ad hoc methods to calculate each individual's variation in health outcomes.

Objectives: In this paper, an advanced statistical model is applied to daily diary self-reported health outcomes to simultaneously study an individual's likeliness to report an outcome, daily mean intensity level, and variability in daily measures.

Methods: Using observational, secondary data from 782 adults, we analyzed self-report daily fatigue symptoms, distinguishing between whether an individual reported fatigue and its severity when reported. Self-reported depressed affect and participant characteristics were used as predictors of daily fatigue symptoms.

Results: A higher likeliness to report fatigue correlated with higher mean fatigue severity and greater stability in severity ratings. Higher mean severity correlated with greater stability in severity ratings. Females and those with high depressed affect were more likely to report fatigue. Females and those with high depressed affect reported greater mean severity.

Discussion: The model applied to daily measures allowed for the simultaneous study of an individual's likeliness to report a symptom, daily mean symptom severity, and variability in severity across days. An individual's daily variation in symptom severity was represented as a model parameter that did not contain measurement error that is present in ad hoc methods.

Background: Infants with developmental risk factors are more likely to have feeding problems and develop chronic feeding disorders. Early detection and understanding of the progression of problematic feeding and its relationship with a child's biological functioning and the family feeding environment will enhance effective symptom management and development of interventions to prevent pediatric feeding disorders.

Objectives: The New Through Two (NewThru2) feeding study protocol is described. Study aims are to (a) characterize symptoms of problematic feeding and trajectories of symptoms from predischarge from neonatal intensive care through 24 months of age, (b) determine the relationship of child biological function at discharge with symptom characteristics and trajectories, (c) describe the child's feeding environment and its relationship to symptoms from discharge through 24 months, and (d) determine the relationship between problematic feeding symptoms and growth and developmental outcomes.

Methods: NewThru2 is a prospective, longitudinal, mixed-method study following over 200 infants who received care in a neonatal intensive care unit and were identified as at risk for compromised development. The study follows enrolled infants through 24 months of age. Symptoms of problematic feeding are measured predischarge by clinical observation and medical record review and postdischarge by parent report. Biological function is measured by medical history and cardiorespiratory and autonomic nervous system function during feeding prior to discharge. Child feeding environment is measured by strategies parents use to manage feeding, the effect of feeding on the parent and family, and the use of feeding services. A subset of parents is interviewed to achieve a contextual understanding of the family feeding environment. Child outcome measures include parent-reported feeding skills and clinician-reported growth and neurodevelopment.

Discussion: The results of this study will improve understanding of pediatric feeding disorders during a time of development sensitive to adequate nutrition and with infants at risk for developmental delays or impairments.

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 semistructured 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.