Journal of Clinical Nursing最新文献

Aim: To combine qualitative and quantitative data to evaluate the feasibility, participant satisfaction and effectiveness of a hybrid pulmonary rehabilitation programme following hospital discharge for an exacerbation of chronic obstructive pulmonary disease (COPD).

Design: Convergent parallel mixed method study nested in a larger ongoing prospective study; this report includes a subset of 21 participants who complete the qualitative and quantitative assessments between May 2023 and January 2024.

Methods: Semi structured interviews using open-ended questions were conducted and analysed using a thematic analysis approach. Participants were interviewed after completing an 8-week hybrid home-based rehabilitation programme, including four face-to-face and four remote sessions. Quantitative assessments-covering disease impact, anxiety and depressive symptoms, and exercise tolerance-were conducted at the beginning and end of the intervention in the same participants who took part in the interviews, and a 10-item satisfaction questionnaire was also completed after the programme.

Data sources: May 2023 to January 2024.

Reporting method: GRAMMS checklist was followed.

Results: 21 people with chronic obstructive pulmonary disease (11 females; mean age 62 ± 7 years; mean FEV₁ 30% ± 10% of predicted) were interviewed. Five major themes were identified: (i) accessibility and adaptation to individual needs; (ii) confidence in the transdisciplinary care manager model, confirmed by high satisfaction score (95/100); (iii) integration of informal carers; (iv) perceived benefits supporting maintenance of health behaviour, consistent with the statistically and clinically significant improvements observed across all quantitative outcomes; and (v) hybrid programme challenges (technical issues and preference for face-to-face visits).

Conclusion: The hybrid programme resulted in significant improvements in physical and psychological outcomes, and participants reported high levels of satisfaction. Qualitative findings highlighted the value of home-based delivery, supervision by a single care manager, informal carer involvement and emotional support in shaping feasibility and satisfaction. However, challenges related to remote sessions indicate that telerehabilitation may not be suitable for all patients and should not be used as a standalone PR option.

Relevance for clinical practice: Given the strong preference of participants for face-to-face visits over remote visits, telerehabilitation should always include a minimum of individual or group face-to-face supervised sessions. The balance between supervision modalities should be personalised according to participants' needs and progress.

Aim: This study aimed to examine the influence of missed nursing care on satisfaction with nursing care and trust in nurses among patients with cancer.

Design: A descriptive and correlational study.

Methods: The study involved 271 patients with cancer hospitalised in the Medical Oncology units of a university-affiliated Oncology Hospital in Türkiye. Data were collected using the Patient Information Form, MISSCARE Survey-Patient (MCSP), Newcastle Satisfaction with Nursing Care Scale (NSNCS) and Trust in Nurses Scale (TNS) between December 26, 2022, and August 30, 2023. Descriptive and inferential statistics were conducted using SPSS 26. The STROBE checklist guided reporting.

Result: Mean scores were 1.71 (SD = 0.77; possible range = 1-5) for the communication subscale of the MCSP, 3.86 (SD = 1.19; possible range = 1-5) for the basic care subscale of the MCSP, 92.93 (SD = 13.80; possible range = 0-100) for NSNCS and 27.64 (SD = 3.21; possible range = 5-30) for TNS. Missed communication was statistically significantly and negatively correlated with both satisfaction and trust, whereas missed basic care was not significantly correlated with either. Regression analyses confirmed that missed communication significantly and negatively predicted satisfaction and trust, whereas missed basic care did not.

Conclusion(s): Missed communication was associated with lower satisfaction with nursing care and reduced trust in nurses among patients with cancer, whereas missed basic care, despite higher levels, did not predict either outcome. These findings highlight the central role of nurse-patient communication in shaping patients' perceptions of nursing care quality in oncology settings.

Implications for the profession and/or patient care: Within oncology care contexts, healthcare institutions and nurse managers should prioritise strategies to reduce missed nursing care, particularly missed communication. Short-term actions include strengthening nurse-patient communication through structured communication training and manageable workloads, while long-term strategies should embed communication and basic care standards into institutional quality frameworks to enhance patient satisfaction and trust.

Patient or public contribution: Patients contributed by completing questionnaires.

Aims: To identify symptom clusters in haematological malignancy patients during chemotherapy and determine the factors associated with different symptom clusters.

Design: A cross-sectional study.

Method: Convenience sampling was used to investigate haematological malignancy patients hospitalised for chemotherapy at a tertiary teaching hospital in Chengdu, China, from January 2021 to December 2023. Participants completed the Chinese version of the Condensed Memorial Symptom Assessment Scale. Hierarchical cluster analysis was used to identify symptom clusters; univariate analyses and logistic regression analyses were used to determine their related factors. This study was reported following the STROBE checklist.

Results: A total of 600 participants were included in the study. We have identified the psychological, sleep, pain-fatigue, gastrointestinal-asthenia symptom clusters in haematological malignancy patients during chemotherapy. Binary logistic regression analysis indicated that being female and having lactate dehydrogenase levels of 220 IU/L or higher are associated with an increased risk for the psychological symptom cluster. The sleep symptom cluster is more likely to occur in females, those with a prognostic nutritional index < 45, lactate dehydrogenase ≥ 220 IU/L and platelet-to-lymphocyte ratio ≥ 107.85. Female, the prognostic nutritional index < 45 and age ≥ 60 years are correlated with the pain-fatigue symptom cluster. The gastrointestinal-asthenia symptom cluster is related to female, a diagnosis of acute leukaemia or lymphoma, lactate dehydrogenase ≥ 220 IU/L and prognostic nutritional index < 45.

Conclusion: Adult haematological malignancy patients undergoing chemotherapy experience multiple symptoms that can be further divided into four symptom clusters. The occurrence of symptom clusters is influenced by a combination of patient sociodemographic characteristics, disease conditions and biochemical indicators.

Relevance to clinical practice: The symptom burden is a major issue for haematological malignancy patients during chemotherapy. Health caregivers should focus on the connection between symptoms rather than individual symptoms when developing and providing interventions. Identifying the factors influencing symptom clusters in haematological malignancy patients should be the basis for accurate, efficient and cost-effective interventions.

Patient or public contribution: The patients completed the questionnaires during the data collection in this study.

Background: Surrogates make decisions for critically ill patients in intensive care units (ICUs). Because such decisions are critical, many surrogates experience decisional conflict, which can lead to long-term regret and psychological distress. Understanding surrogates' needs during decision-making, particularly when invasive procedures are involved, is essential to improving patient outcomes.

Aim: To identify and analyse the needs of surrogates and the decisional conflict they experience during the decision-making process for invasive procedures in ICUs.

Methods: This convergent, parallel, mixed-methods study was conducted at a tertiary medical centre in southern Taiwan. Eligible participants were surrogates aged 20 years or older. The patients represented by these surrogates had a Glasgow Coma Scale (GCS) score of < 12 and were expected to undergo at least one invasive procedure. Quantitative data were collected from 100 surrogates using a structured questionnaire assessing decisional conflict and needs, and qualitative data were obtained through in-depth interviews with 13 surrogates.

Results: The following factors were significantly associated with decisional conflict: lower education level (β = -6.24, p = 0.042), lower family income (β = -9.91, p = 0.027), and resuscitative types of invasive procedure (β = -6.40, p = 0.045). Information needs were the most critical because information is often overwhelming without a medical background. Meeting surrogates' support needs, including the need for support from family members, can help reduce isolation in decision-making. The findings also indicate that internal resources played a key role in alleviating decisional conflict in surrogates.

Conclusion: The informational, support, and resource needs of surrogates play a critical role in decision-making for invasive procedures. Their informational needs primarily indicate difficulties in comprehending and integrating complex medical information within a limited timeframe. Clear, structured communication and emotional support may reduce decisional conflict and long-term regret.