Journal of Clinical Nursing最新文献

Aim: The aim of this study is to establish the correlation between the degree of psychological resilience and readiness for discharge in patients undergoing orthopaedic surgery.

Design: This study is of a descriptive correlational type.

Material and method: This study comprised a cohort of 190 patients who were admitted to the orthopaedics and traumatology department and had surgical procedures performed between November 2023 and April 2024. The study data were gathered via completion of the Introductory Information Form, the Psychological Resilience Scale and the Hospital Discharge Readiness Scale. IBM SPSS 25 package program was used to analyse the research data.

Results: In this study, 34.2% of the participants stated that they did not feel ready for discharge. Predictors of Readiness for Hospital Discharge were identified as being male (β = 0.118, p = 0.003), living alone (β = 0.222, p < 0.001), having undergone prosthesis, fracture or amputation surgery (β = 0.161, p < 0.001), not having received discharge training (β = 0.122, p = 0.001), not feeling ready for discharge (β = 0.442, p < 0.001) and resilience (β = 0.246, p < 0.001). These variables were found to explain 88.7% of Readiness for Hospital Discharge (adjusted R² = 0.773).

Conclusion: The findings of this study emphasise that including patients in their healthcare and creating comprehensive discharge plans tailored to their specific care requirements have a beneficial impact on their readiness for discharge. Additionally, the study demonstrates that enhancing psychological resilience plays a mediating role in facilitating discharge readiness.

Implications for the patient care: Patients who feel ready for discharge are less likely to be hospitalised and their recovery may be faster. Including the patient in the discharge plan, taking individual needs into consideration and disseminating programmes to increase resilience should be an integral part of holistic care.

Reporting method: The STROBE checklist was applied in the reporting of the finding.

Aim: To examine chain mediating roles of social support and self-efficacy between quality of frailty and depression in elderly people after percutaneous coronary intervention (PCI).

Background: Frailty is a cause of depression among elderly patients after PCI. Although previous studies have shown that frailty, social support, self-efficacy and depression are significantly related, the interaction mechanism remains unclear.

Methods: Employing a cross-sectional research design and convenience sampling methodology, data were collected at a tertiary hospital in China. Participants completed the FRAIL Scale, Social Support Rate Scale, General Self-Efficacy Scale and the Hospital Anxiety and Depression Scale. We utilised the PROCESS macro in SPSS to ascertain the mediating roles of social support and self-efficacy between frailty and depression.

Reporting method: The study used the STROBE checklist for reporting.

Result: A total of 241 elderly patients were included in the study, with an average age of 68.05 (6.04) years. Among them, 63.1% of the participants had experienced depression. Elderly patients after PCI's frailty score was negatively correlated with social support and self-efficacy, and positively correlated with depression. Social support was significantly positively correlated with self-efficacy, significantly negatively correlated with depression. Finally, self-efficacy was significantly negatively correlated with depression. Social support and self-efficacy mediated 11.61% and 29.46% of the total depressive role in elderly after frailty and PCI, respectively.

Conclusion: Frailty in elderly PCI patients is directly associated with depression and indirectly related through social support or self-efficacy.

Relevance to clinical practice: To enhance the quality of life for elderly patients following PCI, healthcare providers should address the impact of frailty on depression and develop intervention strategies based on the levels of social support and self-efficacy.

Patient or public contribution: Questionnaires filled out by patients were used to understand the relationship between frailty, social support, self-efficacy and depression.

Aim: To evaluate the relationship between social isolation, loneliness and psychological well-being in patients with inflammatory bowel disease (IBD). Additionally, we examined the mediating effect of disease activity on the relationships between social isolation, loneliness and psychological well-being.

Design: Cross-sectional descriptive study.

Methods: A total of 218 participants were recruited from outpatient clinic at a university hospital in Turkey and from the community membership of the patient support group. Participants provided their socio-demographic and disease-related information and completed (online and paper based) the Turkish Lubben Social Network Scale-6, the Turkish UCLA Loneliness Scale Short Form and the Turkish Psychological Well-being Scale. The data were analysed using univariate linear regression analysis. This study adhered to the STROBE checklist for reporting.

Results: The majority of the participants (72%) were socially isolated, and over half (54.1%) reported moderate to high levels of loneliness. Participants also had low psychological well-being. Linear regression analysis revealed that high loneliness level and social isolation were negative predictors of psychological well-being. The results revealed that the effect of social isolation and loneliness on psychological well-being was mediated by disease activity.

Conclusion: In line with the findings, it can be recommended to enhance social support and networks, along with regular psychological evaluation, should be integrated into the holistic care approach for IBD patients.

Relevance to clinical practice: The findings of this study hold significant implications for the management and support of patients with IBD, particularly within clinical settings in Turkey.

Patient or public contribution: Patients were invited to complete questionnaires. The investigators explained the study's content and purpose, and addressed any concerns during the data collection process.

Aims: To compare the individual and combined effects on 90-day mortality among four critically ill survivor groups: normal (without ICU-acquired delirium or ICU-acquired weakness), delirium-only (with ICU-acquired delirium only), weakness-only (with ICU-acquired weakness only) and delirium-weakness (combined ICU-acquired delirium and weakness).

Methods: A prospective cohort study consecutively recruited delirium-free critically ill patients admitted to six medical ICUs at a university hospital. Delirium was assessed once daily for 14 days (or until death or ICU discharge) using the Confusion Assessment Method for the ICU. Participants who were discharged from the ICUs were assessed for weakness using the Medical Research Council scale. A summed score below 48 defines ICU-acquired weakness. These survivors were evaluated again for 90-day mortality. The study is reported using the STROBE checklist.

Results: Delirium developed in 107 (43.2%) participants during their first 14 days of ICU stay; 55 (22.2%) met criteria for weakness by ICU discharge. Participants with delirium were at increased risk for also developing ICU-acquired weakness, and the 90-day mortality was 18.2%. Independent of age and Acute Physiology and Chronic Health Evaluation II score at ICU admission, delirium-only and weakness-only were not associated with higher 90-day mortality, while participants in the delirium-weakness group had a 3.69-fold higher risk of death, compared to those who were normal during the ICU stay. A non-significant interaction was found, suggesting the joint effect of delirium and weakness on mortality is not higher than the sum of both effects individually.

Conclusions: Mortality is substantially high among critically ill survivors who experience both delirium and weakness, although no additive effect on mortality was observed when these conditions occur together. Our findings highlight the urgent need to optimise ICU care by prioritising the prevention, early identification and management of these two common ICU-acquired conditions.

Patient contribution: Study participation and completion of all assessments.

Trial registration: ClinicalTrials.gov identifier: NCT04206306.

Aim: To examine the association between mutuality and quality of life in nurse-patient dyads.

Design: A cross-sectional multi-centre study was conducted.

Methods: The study was conducted in five tertiary hospitals in Italy. We enrol both inpatients and outpatients with chronic diseases and their nurses with a convenience sampling. One-hundred ninety-two dyads participated to the study. A self-assessment instrument including the Short-Form 12 Health Survey (SF-12), and the Nurse Patient Mutuality in Chronic Illness scale (NPM-CI scale), in the two versions-one for patients and one for nurses, was administered. The effects of nurse-patient mutuality on the physical and mental quality of life of nurses and patients were estimated with a series of actor-partner-interdependence models (APIM).

Results: Patients' and nurses' perceptions of their mutuality were positively correlated. For patient mental quality of life, there was a statistically significant actor effect both for patients, and for nurses. There was also a consistent statistically significant partner effect for patient mental quality of life. There were no statistically significant actor or partner effects for the nurses' and patients' physical quality of life. This construct may be influenced by additional components, further studies are needed.

Conclusions: Mutuality between nurses and patients in chronic diseases influence both patient and nurse quality of life.

Implications for the profession and/or patient care: Our results support the importance of taking a dyadic perspective when considering mutuality and quality of life in nurse-patient dyads.

Impact: Nurse-patient mutuality is an indicator of a high-quality relationship, which allows shared goals and shared decision-making. Quality of life is one of the most important outcomes for chronic conditions patients and is an indicator of well-being. Quality of life is also an important variable in healthcare professionals' lives. Little is known about the association between mutuality and quality of life in nurse-patient dyads. Mutuality has an actor effect on patient's and nurse's quality of life and has a negative partner effect on patient's quality of life. The understanding of mutuality and interdependence within the dyad, could increase mental quality of life in nurse-patient dyads.

Reporting method: STROBE checklist for cross-sectional studies was followed in this study.

Patient or public contribution: Patients were involved in the sample of the study.

Aim: To survey registered nurses' familiarity with delegation standards and confidence to delegate to unlicenced workers within their practice.

Design: Cross-sectional exploratory survey design.

Methods: The survey focused on Australian registered nurses (n = 420). Initial descriptive analysis was undertaken. Additionally, inferential analysis was undertaken between two independent variables focused on familiarity of delegation policy, and confidence to delegate, and several demographic and workplace variables. Stepwise linear regression was undertaken to determine predictors of the two delegation variables. The cross-sectional study was undertaken according to the STROBE reporting checklist.

Results: The majority of respondents were somewhat familiar, or not familiar at all with delegation standards. This pattern was followed for results relevant to confidence delegating to unlicenced workers. Nurses working in adult acute, intensive care and emergency department reported the lowest levels of familiarity with delegation. Additionally, intensive care nurses were significantly less likely to feel very confident delegating to unlicenced support workers. Stepwise regression revealed identifying as male, and working in the public sector were less likely to be confident delegating. Nurses working in the acute setting and public sector were less familiar with delegation standards.

Conclusion: The findings of this study highlight the nuanced nature of delegation to unlicenced workers in Australian nursing settings, with nurses from certain contexts being far less likely to be familiar with or confident undertaking the practice.

Implications for clinical practice: The findings of this study have significant implications to increase understanding of nurses diverse contexts of practice and how delegation standards might not be implemented in practice in a confident manner.

Background: Leukaemia children often encounter various social adaptation issues stemming from changes in their living environment. Identifying and optimising the factors associated with social adaptation is crucial in improving social adaptation in children with leukaemia.

Objectives: To investigate social adaptation in children with leukaemia and to clarify the impact pathway of cognitive flexibility, problem behaviour, prosocial behaviour, parenting style and social support on social adaptation.

Methods: Using a convenience sampling method, 264 leukaemia children completed a cross-sectional survey. Data were collected using the Social Adaptation Assessment Scale for Children with Leukaemia, Strengths and Difficulties Questionnaire, Cognitive Flexibility Scale, Short-Egna Minnenav Barndoms Uppfostran and Multi-Dimensional Scale of Perceived Social Support. Structural equation modelling was used to test the influencing factors of social adaptation.

Results: Social support directly influenced social adaptation (β = 0.19, p < 0.01) and indirectly influenced social adaptation through prosocial behaviour (β = 0.06, p < 0.01) and problem behaviour (β = 0.18, p < 0.01). Prosocial behaviour (β = 0.17, p < 0.01) and problem behaviour (β = -0.61, p < 0.01) directly influenced social adaptation. Negative parenting directly influenced social adaptation (β = 0.12, p < 0.01) and indirectly influenced social adaptation (β = -0.23, p < 0.01) through problem behaviour.

Conclusion: Our finding indicated that there are prominent social adjustment problems in the recovery process of children with leukaemia. These findings suggest that targeted education is needed to enhance social adaptation among children with leukaemia.

Relevance to clinical practice: The final model should serve as a framework to guide intervention research targeting social support and negative parenting to improve the social adaptation of children with leukaemia. During the recovery process, nurses need to regularly follow up on the children's social adaptation and encourage them to participate in social activities to increase social support while providing family guidance based on improving parenting styles.

Patient or public contribution: The subjects of this study were children with leukaemia aged 8-18 years. All authors read and approved the final manuscript.

Aims and objectives: To develop and validate a prediction model for high-flow nasal cannula (HFNC) failure in patients with acute hypoxaemic respiratory failure (AHRF).

Background: AHRF accounts for a major proportion of intensive care unit (ICU) admissions and is associated with high mortality. HFNC is a non-invasive respiratory support technique that can improve patient oxygenation. However, HFNC failure, defined as the need for escalation to invasive mechanical ventilation, can lead to delayed intubation, prolonged mechanical ventilation and increased risk of mortality. Timely and accurate prediction of HFNC failure has important clinical implications. Machine learning (ML) can improve clinical prediction.

Design: Multicentre observational study.

Methods: This study analysed 581 patients from an academic medical centre in Boston and 180 patients from Guangzhou, China treated with HFNC for AHRF. The Boston dataset was randomly divided into a training set (90%, n = 522) and an internal validation set (10%, n = 59), and the model was externally validated using the Guangzhou dataset (n = 180). A random forest (RF)-based feature selection method was used to identify predictive factors. Nine machine learning algorithms were selected to build the predictive model. The area under the receiver operating characteristic curve (AUC) and performance evaluation parameters were used to evaluate the models.

Results: The final model included 38 features selected using the RF method, with additional input from clinical specialists. Models based on ensemble learning outperformed other models (internal validation AUC: 0.83; external validation AUC: 0.75). Important predictors of HFNC failure include Glasgow Coma Scale scores and Sequential Organ Failure Assessment scores, albumin levels measured during HFNC treatment, ROX index at ICU admission and sepsis.

Conclusions: This study developed an interpretable ML model that accurately predicts the risk of HFNC failure in patients with AHRF.

Relevance to clinical practice: Clinicians and nurses can use ML models for early risk assessment and decision support in AHRF patients receiving HFNC.

Reporting method: TRIPOD checklist for prediction model studies was followed in this study.

Patient or public contribution: Patients were involved in the sample of the study.