Journal of Clinical Nursing最新文献

Aim: To cross-culturally adapt a framework for person-centred leadership in residential care for older people in Sweden.

Design: This study has an exploratory and descriptive design.

Methods: The translation procedure followed a cyclic process of translation into Swedish and back-translation into English by two independent bilingual linguists. An evaluation of conceptual and semantic equivalence and comprehensiveness between the original English version and the translated Swedish version was performed by an expert committee. The translated version of the framework was validated by leaders (n = 34) in residential care, who assessed its relevance through a web form. The adaptation of the framework followed recommended guidelines for cross-cultural adaptation.

Results: The translation procedure resulted in two minor changes related to the wording in two descriptors. The results of the validation procedure showed that the framework is relevant for leaders in Swedish residential care for older people.

Conclusion: The cross-culturally adapted framework is useful and suitable for leaders in Swedish residential care for older people. The framework clarifies the leader's role and identifies leadership attributes and requirements for person-centred leadership in residential care, thereby providing support to leaders by framing person-centred leadership.

Implications for the profession and/or patient care: The framework can be used as a guide for leadership training and/or development initiatives in residential care. It can be further extended to nursing curriculums, leadership development programs, and organisational performance and development processes. It may also provide a foundation for policy and guidelines by establishing the activities required for leaders to promote person-centredness in the care of older people.

Reporting method: This study followed the STROBE checklist for cross-sectional studies.

Patient and public contribution: There was no patient or public contribution.

Background: Health care workers (HCW) with post-COVID condition (PCC) are frequently reported to suffer from mental health impairment. Given HCW above-average risk for mental health, research is necessary and risk factors need to be assessed.

Aim: To compare mental health and health of German HCW with and without PCC and to identify associated psychological and social factors.

Design: Cross-sectional study.

Method: Overall, 2816 German HCW participated (332 reported PCC). Measures were post-COVID condition symptom sum score (PCSS), symptoms of depression (Patient Health Questionnaire-2), anxiety (Generalised Anxiety Disorder-2) and post-traumatic stress disorder (PTSD) symptoms (Impact of Event Scale-6), work-family conflict (Work-Family Conflict Scale), social support (ENRICHD Social Support Inventory), sense of coherence (Sense Of Coherence-3 Scale) and working conditions. Group differences of HCW with and without PCC were investigated. Multiple linear regression analysis was performed for HCW with PCC. PCSS was the dependent variable. Independent variables were a.m. measures and age, gender, occupational group and migration background.

Results: HCW with PCC exhibited higher values, with medium effect sizes, for symptoms of depression, anxiety and PTSD. Small effect sizes were observed for work-family conflict, social support, sense of coherence and working conditions. Higher PCSS scores were associated with higher depression, anxiety, PTSD and work-family conflict levels, lower social support and sense of coherence and migration background. Being a physician was associated with lower PCSS.

Conclusion: Lower mental health, social factors and resources may play a role in reporting severe post-COVID symptoms. Further research is necessary to investigate these interactions using the biopsychosocial theory.

Implication for the profession: This study can help to understand PCC in HCW to design adjusted treatments and protect HCW from PCC and minimise their risk of PCC.

Reporting method: This study complies with the Journal article reporting standards for quantitative research in psychology: The APA Publications and Communications Board task force report (Data S1).

Public contribution: Caregivers are the sample group.

Aims: To identify whether there are differences in knowledge regarding the management of patients with respiratory stomas among nurses working in hospitals with an advanced practice tracheostomy service compared to those without it.

Design: Descriptive, cross-sectional, comparative, analytical survey study.

Method: The study was conducted from January to March 2023 in four tertiary care hospitals, two of which have an advanced practice tracheostomy service. A self-administered questionnaire was designed, consisting of 16 questions about nurses' specialised training in caring for tracheostomy patients. The study adhered to the STROBE checklist. Statistical analyses were performed using SPSS (24.0) from IBM.

Results: Nurses in hospitals with a dedicated tracheostomy service obtained a higher mean score (7.1/10) and demonstrated greater anxiety when managing patients with stomas (p < 0.001), as well as an increased willingness to undergo specific training (p = 0.017) to reduce their lack of self-confidence.

Conclusions: A higher level of anxiety in the management of tracheostomised patients and a greater interest in receiving specific training have been observed among nurses in hospitals with advanced practice services (APTS), despite having greater training. Therefore, institutions should commit to incorporating advanced practice nurses and continuing education in the approach to ostomies among their professionals.

Implications for the profession and/or patient care: Implementing ongoing training programmes and specific tracheostomy services or units in hospitals would enable nurses to provide high-quality care for patients with respiratory stomas.

Reporting method: The study adhered to the STROBE checklist.

Patient or public contribution: Neither patients nor the public were involved in the design or conduct of this research. Nurses participated exclusively in data collection.

Aim: The objectives of this study were to determine the prevalence of burnout risk and intention-to-leave among intensive care unit (ICU) nurses and analyse the association of these with workload and work environment.

Design: A cross-sectional survey of nurses working in ICUs was conducted in France between 15 January 2024 and 15 April 2024 alongside a longitudinal assessment of workload during the same period.

Methods: ICU nurse workload was assessed using the Nursing Activities Score (NAS). The risk of burnout was assessed using the Maslach Burnout Inventory scale and intention-to-leave the hospital was assessed with a binary question. A total of 1271 nurses working in 61 intensive care units completed the questionnaire and 14,134 NAS per patient and 1885 NAS per nurse were included in the study.

Results: The median overall of burnout by hospital site was 64.7% [P25: 53.3-P75: 72.7] for the broad definition and a median of 20.7% [13.3-27.3] of ICU nurses reported an intent-to-leave their job. The median overall NAS score per nurse was 135.9% [121.4-156.9] and the prevalence of NAS scores exceeding 100% per nurse was 73.9% [62.8-80.3]. A significant association was found between nurses working in an ICU with a better work environment and all dimensions of burnout as well as the intention-to-leave the job. A prevalence in the hospital site of NAS scores exceeding 100% per nurse below the median was associated with a lower burnout (OR = 0.69, 95% CI: 0.50-0.88 for broad definition) and intention-to-leave the job (OR = 0.68, 95% CI: 0.50-0.92).

Conclusion: This study found significant associations between burnout and the intention to leave the job for nurses in ICUs, mainly due to a better work environment and, to a lesser extent, a lower workload for nurses.

Implications for the profession and/or patient care: In an era of nurse shortages and absenteeism, it is crucial for institutions to retain their nursing staff. Our results should encourage hospital managers to take action to improve the ICU work environment and keep ICU workloads manageable to decrease burnout and the intention-to-leave the job among ICU nurses.

Reporting method: This article follows the STROBE guidelines for the reporting of cross-sectional studies.

Patient or public contribution: No patient or public contribution.

Aim: To develop a deep learning-based smart assessment model for pressure injury surface.

Design: Exploratory analysis study.

Methods: Pressure injury images from four Guangzhou hospitals were labelled and used to train a neural network model. Evaluation metrics included mean intersection over union (MIoU), pixel accuracy (PA), and accuracy. Model performance was tested by comparing wound number, maximum dimensions and area extent.

Results: From 1063 images, the model achieved 74% IoU, 88% PA and 83% accuracy for wound bed segmentation. Cohen's kappa coefficient for wound number was 0.810. Correlation coefficients were 0.900 for maximum length (mean difference 0.068 cm), 0.814 for maximum width (mean difference 0.108 cm) and 0.930 for regional extent (mean difference 0.527 cm²).

Conclusion: The model demonstrated exceptional automated estimation capabilities, potentially serving as a crucial tool for informed decision-making in wound assessment.

Implications and impact: This study promotes precision nursing and equitable resource use. The AI-based assessment model serves clinical work by assisting healthcare professionals in decision-making and facilitating wound assessment resource sharing.

Reporting method: The STROBE checklist guided study reporting.

Patient or public contribution: Patients provided image resources for model training.

Background: Although several models have been developed to predict postoperative pneumonia in elderly hip fracture patients, no systematic review of the model quality and clinical applicability has been reported.

Objective: To systematically review and critically appraise existing models for postoperative pneumonia in elderly hip fracture patients.

Design: Systematic review and meta-analysis.

Methods: 10 databases were systematically searched from inception to April 15, 2024, updated on August 26. Two reviewers independently performed literature selection, information extraction and quality assessment. A narrative synthesis was employed to summarise the characteristics of the models. Meta-analysis was performed using Stata 17.0.

Results: 13 studies containing 25 models were included. The prevalence of pneumonia was 9.62% (95% CI: 7.62%-11.62%). Age (53.8%), hypoproteinemia (46.2%), chronic obstructive pulmonary disease (COPD, 30.8%), gender (30.8%), activity of daily living score (ADL, 30.8%) and American Society of Anesthesiologists (ASA, 30.8%) score were the top six predictors. All models reported area under curve (AUC: 0.617-0.996). 9 studies (69.2%) used the Hosmer-Lemeshow (H-L) test, calibration curves, or Brier scores to evaluate the calibration. 5 studies (38.5%) performed internal validation, 4 studies (30.8%) performed external validation. All studies had a high risk of bias due to single sample source, inappropriate data processing, inadequate model evaluation, and negligence of calibration and validation. 10 studies (76.9%) had good applicability.

Conclusions: Prediction models for postoperative pneumonia in elderly hip fracture patients are still in the developing stage. The validation and evaluation of existing models are poor. Future studies should focus on robust external validation and updating. Additionally, the Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis + artificial intelligence (TRIPOD+AI) statement should be followed.

Relevance to clinical practice: Prediction models are effective in discriminating postoperative pneumonia in elderly hip fracture patients, but further external validation and adjustment are still warranted.

Aim: To explore the impact of simulation-based training on communication and empathy skills among nurses working with elderly patients in the Abha region of Saudi Arabia. The study also aimed to identify the barriers and facilitators to applying these skills in real-world clinical practice.

Design: A qualitative study.

Method: Semi-structured interviews were conducted between June and July 2024 with 17 nurses from urban and rural healthcare settings in the Abha region. Data were analysed using both deductive framework analysis, guided by social support theory, and inductive thematic analysis to identify key themes related to communication, empathy, and the application of simulation-based skills in practice. We adhered to the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist.

Results: The study involved 17 participants aged 22-50 years, with diverse educational backgrounds and work experience. The findings indicated that simulation-based training significantly improved nurses' confidence in delivering difficult news and their ability to empathise with elderly patients. Nurses working in urban settings with regular access to simulation training reported better outcomes compared to those in rural settings with less frequent training opportunities.

Conclusion: Simulation-based training has a positive impact on enhancing communication and empathy skills among nurses, but challenges in real-world application remain. Efforts should be made to improve the accessibility of simulation training and address the barriers preventing its effective implementation in clinical practice.

Implication for the profession and/or patient care: Healthcare practitioners and policymakers should prioritise simulation-based training in nursing education and professional development to improve the quality of care for elderly patients.

Reporting method: The Consolidated Criteria for Reporting Qualitative Research (COREQ).

Patient or public contribution: The engagement and interview data from nursing participants provided valuable insights into the impact of simulation-based training on communication and empathy in elderly care.

Aim: This study aimed to identify the heterogeneous trajectories of frailty and determine the predictors of distinct trajectories in patients with heart failure.

Design: A longitudinal study.

Methods: A total of 253 patients with heart failure were recruited at the cardiology department of a tertiary hospital between February and December 2023. Frailty was assessed at baseline, 1 and 4 months after discharge. Patients' sociodemographic characteristics, physical symptoms, nutritional status, psychological distress, illness perception and social networks were obtained at baseline using a structured questionnaire. Group-based trajectory modelling was performed to identify the heterogeneity of the trajectories of frailty. Multiple logistic regression and decision tree models were used to explore the predictors of heterogeneous trajectories of frailty.

Results: Three distinct trajectories of frailty were identified in patients with heart failure: low frailty with high-degree improvement group (46.2%), moderate frailty with high-degree improvement group (41.1%) and high frailty with low-degree improvement group (12.6%). Multiple logistic regression analysis showed that physical symptoms, nutritional status, illness perception and employment status were entered as independent predictors of heterogeneous trajectories of frailty. The decision tree model demonstrated that physical symptoms were the primary predictors, followed by nutritional status, illness perception and psychological distress.

Conclusions: Three distinct categories of frailty trajectories were identified in patients with heart failure. Physical symptoms, nutritional status, psychological distress, illness perception and employment status were independent predictors of heterogeneous trajectories of frailty, with physical symptoms being the most important predictor.

Implication to clinical practice: Dynamic frailty assessment is recommended. Interventions aimed at alleviating physical symptoms, psychological distress and negative illness perception, and improving nutritional status may be conducive to delaying or reversing frailty in patients with heart failure, particularly in unemployed individuals.

Reporting method: The reporting followed the STROBE guideline.

Patient or public contributions: No patient or public contribution.