Journal of Clinical Nursing最新文献

Aims: To explore the psychological process of parents caring for adolescents with depression and suicidal tendencies.

Design: Grounded theory.

Methods: The theoretical sample consisted of 19 parents of adolescents with depression and suicidal tendencies. Data were collected in 2023 at five psychiatric outpatient departments in Taiwan using semi-structured interviews. Constant comparative analysis was used to analyse the data.

Findings: Four interrelated phases emerged to describe the non-linear phases of the psychological process of parents caring for adolescents with depression and suicidal tendencies experienced: (a) Shock: Parents misjudged their child's emotions and behaviours due to the child's concealment; (b) Confronting reality: Parents realised that accepting their child's illness was crucial for providing compassionate care; (c) Challenges: Parents faced various challenges while gently supporting their child's healing and recovering from their illness; (d) Regulation: Parents regulated their mindsets and changed their own behavioural patterns and sought relevant support, ultimately discovering the most esteemed approach to interact with their child.

Conclusions: The main contribution was the use of Grounded Theory to generate an emergent theory recounting the four psychological phases of parents while caring for their children. The most critical aspect of this process was the parents' need to gently and compassionately face the challenges posed by their children's depression and suicidal tendencies.

Implications for the profession and/or patient care: In clinical practice, psychiatric professionals could use the findings as a map to provide care to parents caring for adolescents with depression and suicidal tendencies as they gently move through the non-linear phases of the psychological process. Future studies could explore appropriate care pathways that facilitate parents' timely transition from the shock phase to the regulation phase of healing.

Reporting method: This study adhered to the Consolidated Criteria for Reporting Qualitative Studies (COREQ) criteria.

Patient or public contribution: No patient or public contribution.

Aim: To evaluate the acceptability, mechanisms of impact, and contextual factors affecting a 9-month, nurse-led self-management intervention specifically designed for newly diagnosed patients with inflammatory arthritis, from both the patient and healthcare professional (HPs) perspectives.

Design: A qualitative longitudinal study.

Methods: Individual baseline and follow-up interviews were conducted with 12 patients (baseline n = 12; follow-up n = 10) and four focus group interviews were conducted with 4 HPs at key intervention stages. Interview guides were drafted with open-ended questions and iteratively refined across interviews to match the evolving stages of the intervention. Data analysis was conducted using template analysis. This study adhered to the Consolidated Criteria for Reporting Qualitative Studies (COREQ): 32-item checklist.

Results: Patients valued the tailored individual sessions, which provided emotional support and improved their understanding of IA. Group sessions received mixed feedback, with some patients suggesting a need for more organisation. The intervention fostered a sense of community, reducing isolation and empowering patients to navigate the healthcare system better. HPs praised the patient-centred approach and emphasised the importance of training and organisational support.

Conclusion: Both patients and HPs highly accepted our nurse-led self-management intervention, though group sessions received mixed feedback. Key impact mechanisms were the proactive management of symptoms and lifestyle, and the intervention's tailored support and emotional guidance. The HPs experienced professional growth but scheduling occasionally conflicted with regular work.

Impact: This study has provided valuable information in understanding intervention mechanisms. Findings from the evaluation will be used to refine the intervention.

Patient or public contribution: Two patients contributed to the development of the intervention, and a patient research partner was actively engaged in all phases of this study.

Aims: To evaluate the acceptability and feasibility among nurses of Decubitus Risk Prediction Alerts based on Artificial Intelligence (DRAAI), and to assess the feasibility of the implementation plan.

Design: A process evaluation of a pilot implementation study using mixed methods.

Methods: Acceptability and feasibility of DRAAI among nurses from three general wards in a university hospital was assessed via questionnaire. The tailored implementation plan included thirteen strategies distributed over six domains, such as facilitation, continuous evaluation, and educational sessions. Adaptations, acceptability, and feasibility were recorded in field notes.

Results: Fifty-five nurses completed the questionnaire and valued DRAAI's predictions, believing these could contribute to pressure ulcer (PU) prevention. Some initially faced challenges distinguishing between PU risk and PU detection. Most found it feasible to integrate DRAAI into their workflow. Adaptations included adding PU preventive measures to educational sessions and sharing frequently asked questions and answers. Overall, implementation efforts were feasible. DRAAI generated PU risk predictions for 428 unique admitted patients; 128 (30%) patients received at least one at-risk prediction. Regarding fidelity, nearly 80% (101/128) of at-risk predictions were followed by a nursing care plan.

Conclusion: Ongoing involvement and clear communication were crucial for successfully integrating AI into nursing workflows. Although some nurses were concerned that DRAAI might miss at-risk patients, they continued to independently identify at-risk patients.

Implications for the profession and/or patient care: Implementation of DRAAI served as a prompt for nurses to focus more on PU prevention. While DRAAI shows promise in improving PU prevention, future research is needed to evaluate its clinical impact.

Impact: Addressed the challenge of identifying patients at risk for developing pressure ulcers. Demonstrated feasibility and acceptability of implementing AI in clinical practice. Highlighted the need for ongoing support and communication for successful implementation.

Patient contribution: None.

Reporting method: Standard for Reporting Implementation Studies (StaRI).

Objective: This study aimed to identify potential latent profiles of frailty among patients undergoing cardiac surgery, reveal the risk factors associated with these subgroups and understand the nursing needs of patients in different subgroups.

Methods: Patients scheduled for cardiac surgery at a tertiary general hospital in Southwest China between August 2022 and June 2023 were recruited using convenience sampling. The instruments included the General Information Questionnaire, the Chinese version of the Tilburg Frailty Indicator, the Hospital Anxiety and Depression Scale, the Mini-Mental State Examination and the Fatigue Severity Scale. Latent profile analysis was performed to identify potential classifications of preoperative frailty. Univariable and multinomial logistic regression analyses were used to determine associated influencing factors.

Results: A total of 261 patients were included, with a preoperative frailty prevalence of 69.7% and a median TFI score of 6 (IQR: 4-8). Latent profile analysis identified three distinct frailty phenotypes: 'multidimensional low-load frailty' (29.5%), 'social high-load frailty' (8.8%) and 'physiopsychological complex frailty' (61.7%). Multinomial logistic regression revealed significant predictors for these profiles: absence of a spouse, younger age and longer disease duration were independently associated with social high-load frailty. Higher fatigue scores increased the likelihood of physiopsychological complex frailty. Conversely, higher cognitive scores were significantly associated with the multidimensional low-load frailty profile.

Conclusion: Preoperative frailty in cardiac surgery patients presents significant heterogeneity. Clinicians should pay particular attention to patients with social high-load frailty and physiopsychological complex frailty. Tailored nursing interventions based on these specific profiles and their associated risk factors are essential to alleviate frailty and improve patient outcomes.

Reporting method: This study adhered to the STROBE guidelines for cross-sectional studies.

Relevance to clinical practice: Distinct frailty profiles among preoperative cardiac surgery patients were identified. Understanding these profiles enables tailored nursing interventions and potentially optimises postoperative outcomes. Implementing profile-specific care pathways can enhance perioperative patient management.

Patient or public contribution: Patients recovering from cardiac surgery participated in reviewing the comprehensibility of survey questions for latent profiles. Members of a cardiac patient support group provided feedback on the interpretability of the findings.

Aim: To analyse predictors of burnout in nursing professionals during and after the COVID-19 pandemic.

Design: Cohort study.

Method: A two-phase study conducted during the COVID-19 pandemic's peak (2020) and post-vaccination period (2022). Data from nursing professionals of four hospitals in southern Brazil included sociodemographic, occupational, lifestyle, and health variables, and Maslach Burnout Inventory responses. Multivariate logistic and linear regression analyses were used to identify independent predictors of burnout syndrome. The study was approved by the Research Ethics Committee (approval no. 4.152.027).

Results: A sample of 163 participants were assessed at two distinct time points. In 2020, 9.2% of nursing professionals experienced burnout syndrome, decreasing slightly to 7.4% in 2022. As for the burnout dimensions, emotional exhaustion was reported by 27% of professionals in 2020 and 26.4% in 2022. Depersonalisation affected 28.2% during the pandemic and 25.2% afterward. Low professional accomplishment was identified in 29.4% of professionals in 2020, increasing to 30.1% in 2022. Distinct predictors were identified for overall burnout and its specific dimensions. The main predictors included: perceiving a mental health impact from the pandemic, previous mental health issues, recent medical leave, and working directly with COVID-19 patients.

Conclusions: Burnout syndrome remained stable post-pandemic. Key predictors were identified, highlighting the need for preventive mental health interventions.

Relevance for clinical practice: Identifying predictors of burnout in nursing professionals supports the development of targeted interventions to protect mental health, improve job satisfaction, and enhance the quality of patient care during and after health crises.

Impacts: This study fills a gap in post-pandemic research by identifying predictors of burnout in nursing professionals. It supports the development of policies and interventions to protect mental health and improve working conditions in Brazilian hospitals.

Reporting method: STROBE guidelines for cohort studies.

Patient or public contribution: Participants contributed only through data collection.