Journal of Clinical Nursing最新文献

Background: Disease severity negatively affects health-related quality of life (HRQOL) among people with heart failure (HF). However, the underlying mechanisms remain underexplored. Illness perceptions and depression serve as potential mediators of this relationship, but the evidence supporting this is limited.

Objective: To investigate the relationships among disease severity, illness perceptions, depression and HRQOL in people with HF, as well as to explore the mediating roles of illness perceptions and depression in the relationship between disease severity and HRQOL.

Methods: People with HF were recruited from a tertiary hospital in China between January and May 2023. All the participants were assessed for disease severity, illness perceptions, depression, HRQOL and sociodemographic and clinical characteristics. The mediation analysis was performed using PROCESS macro in SPSS. The STROBE checklist was followed.

Results: This study recruited 164 subjects. Disease severity had a significant total effect on HRQOL (β = 0.716, 95% CI: 4.475, 12.068). The results showed that illness perceptions mediated the relationship between disease severity and HRQOL (β = 0.172, 95% CI: 0.042, 0.337), accounting for 24.02% of the total effect. However, a significant mediating role of depression in this relationship was not found. Furthermore, we found that illness perceptions and depression sequentially mediated the relationship between disease severity and HRQOL (β = 0.194, 95% CI: 0.005, 0.395), which accounted for 27.09% of the total effect.

Conclusions: The effect of disease severity on HRQOL is sequentially mediated by illness perceptions and depression. Illness perceptions are important predictors of HRQOL. Targeted interventions should be employed to improve illness perceptions, thereby enhancing HRQOL among people with HF.

Relevance to clinical practice: Medical staff can carefully assess patient's illness perceptions and implement appropriate strategies to enhance these illness perceptions, thereby improving their HRQOL.

Patient or public contribution: No patient or public contribution.

Background and objectives: Although a substantial amount of research has focused on negative aspects of caregiving, less research has been conducted investigating positive aspects of providing informal care. The aim of this study was to investigate the longitudinal association between caregiving satisfaction and psychological distress in informal carers of dependent older people, and whether this relationship is mediated by caregiver burden.

Research design and methods: Prospective longitudinal study with a probabilistic sample of 332 caregivers of older relatives, with data collected at baseline and at 1-year follow-up. We measured caregiving satisfaction, psychological distress, subjective caregiver burden and several covariates (caregivers' sex, age and objective caregiver burden). Data were analysed using generalised estimation equations with multiple imputation. The STROBE checklist was used to support the writing of this document.

Results: After controlling for covariates, caregiving satisfaction was significantly negatively associated with lower levels of subjective caregiver burden (B = -0.17, 95% CI: -0.23, -0.11) and emotional distress (B = -0.23, 95% CI: -0.36, -0.11). When subjective burden was included in the model, the relationship between caregiving satisfaction and psychological distress was no longer significant (B = -0.11, 95% CI: -0.23, 0.02), whereas the association between subjective burden and psychological distress remained (B = 0.75, 95% CI: 0.57, 0.92). The Sobel test confirmed these results (p < 0.001), indicating that subjective caregiver burden mediates the relationship between caregiving satisfaction and psychological distress (complete mediation) over time.

Discussion and implications: Caregiving satisfaction exerts a longitudinal protective effect on carers' psychological distress via subjective burden. Our findings indicate that interventions aimed at strengthening caregiving satisfaction may play a significant role in maintaining positive mental health outcomes for informal caregivers.

Aims: To classify the unmet integrated care needs of older adults with multimorbidity and to explore the factors associated with different categories of unmet integrated care needs among the target population.

Design: A cross-sectional survey using the statistical method of latent profile analysis.

Methods: From July 2022 to March 2023, 397 older adults with multimorbidity, aged 60 years or older, were recruited from one primary healthcare setting and from four secondary and tertiary hospitals to participate in face-to-face questionnaire surveys. The questionnaire used in this study to assess unmet integrated care needs among older adults with multimorbidity was self-designed through a series of steps, including a scoping review, expert consultation and cognitive interviews. Latent profile analysis was applied to uncover distinct profiles of unmet integrated care needs, and multinomial logistic regression was employed to explore whether the profiles were further distinguished by participants' sociodemographic and health-related covariates. The data were analysed using IBM SPSS v.29.0 and Mplus v.8.0.

Results: The optimal solution was a four-profile model, characterised by high unmet integration needs, high unmet system integration needs, low unmet system integration needs and low unmet integration needs, respectively. Multinomial logistic regression results indicated that profile differences were associated with place of residence, number of coresidents and the presence or absence of complex multimorbidity.

Conclusion: The integrated care needs of older adults with multimorbidity have not yet been fully met. Classifying and characterising unmet integrated care needs profiles is a crucial step in the rational allocation of integrated care resources.

Reporting method: This study was reported based on the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) for cross-sectional studies.

Patient or public contribution: All participants were older adults with multimorbidity, and they were informed that they could withdraw from the study at any time.

Aim: To explore the role of nurse practitioners (NPs) in delivering models of acute and urgent care in local communities informing the development of NPs as a solution to providing sustainable and effective healthcare in these settings.

Design: Descriptive qualitative multicase study.

Methods: The study population comprised NPs, clinic managers and general practitioners from NP-led acute and urgent care clinics across urban and rural Aotearoa New Zealand. Data were gathered from 20 semistructured interviews across seven sites. Data were thematically analysed to identify themes. Clinic-level operational data relating to the governance, team structures, and service delivery models were also collated and content from these data was integrated into the analysis and findings.

Results: Five key themes were identified: meeting the needs of the community; development of NP-led acute care services; NPs as part of the healthcare team; training and support systems and supporting junior NPs and NP candidates.

Conclusion: Nurse practitioners have a valuable role to play in delivering acute and urgent care services to local communities. Increasing awareness of the NP role, the prioritisation of community needs and strengthening training and support structures at both a workforce and clinic level were key findings from this research.

Implications for the profession and/or patient care: Findings from this research guided the development of a set of recommendations which consider community, clinic and wider national perspectives and aim to support the future growth of NP-led community acute/urgent care.

Reporting method: This research has adhered to the Standards for Reporting Qualitative Research (SRQR) guidelines.

Patient or public contribution: The authors have nothing to report.

Aims: To analyse the level of patient satisfaction regarding the care received in triage and its relationship with the competency level of clinical nurses in a hospital setting.

Design: A cross-sectional, prospective and multicentre study of nurses in hospital emergency triage and the patients they attended.

Method: Data were collected between October and November 2019 using two questionnaires; one collected sociodemographic factors, professional experience of the nurse and the competency assessment questionnaire for clinical nurses in the hospital setting (COM_VA). The other questionnaire recorded the age of patients, reason for consultation, pain and the Patient Satisfaction with Emergency Nursing Care Scale (CECSS). The abstract includes an indication of the chosen checklist, specifically the STROBE checklist for descriptive observational studies.

Results: The study included a sample of 624 patients and 77 nurses. The findings indicated that the nurses' level of competence, with an average score of 8.61, is significantly correlated with patient satisfaction. A total of 90.2% of patients reported being satisfied with the care they received during triage, highlighting the technical competence and empathy of the nurses as highly valued attributes. However, areas for improvement were identified, particularly in pain management and addressing the emotional needs of patients. Other factors related to nursing competence that influenced patient satisfaction included perceived safety in clinical practice and the sense of respect from the multidisciplinary team. Additionally, the intensity of pain experienced by patients during triage was a significant determinant of their overall satisfaction.

Conclusions: The results of this study indicate that the higher the level of nursing competence, the more satisfied the patients. In addition to knowledge and skills in triage, aspects such as empathy, concern and assertive listening influence patient satisfaction, and, therefore, perceived quality of care.

Reporting method: In preparing the manuscript, the authors adhered to the relevant EQUATOR guidelines and the STROBE checklist for descriptive observational studies.

Public or patient contribution: No public or patient or professional contribution outside of participation for data collection purposes.

Trial registration: N/A. This was not a clinical trial.

Aims: To determine patient and nursing factors associated with peripheral intravenous access success among hospitalised adults on medical-surgical units.

Design: A prospective, cross-sectional, correlational design was guided by STROBE.

Methods: Within a quaternary care hospital with multiple medical-surgical units, nurses who attempted intravenous access completed case report forms and medical records were reviewed to record 38 factors associated with intravenous access success. After identifying factors associated with first attempt and overall intravenous access success in univariate analyses, prediction models were fit and calibration (based on plots) and discrimination (using the C-statistic) were evaluated using bootstrap sampling.

Results: Of 394 adults, 244 (61.9%) had first attempt and 323 (82.0%) had overall intravenous access success. Ultrasound was used in 227 (57.6%) intravenous access attempts and use was associated with less vein visibility and palpability and higher nurse perception of difficult intravenous access. In multivariable modelling, four factors were associated with first attempt intravenous access success: using a wrist vein, higher nurse expertise in intravenous access, nurse use of an ultrasound in patients with high-risk vein characteristics, and higher nurse confidence in first attempt success; model goodness of fit was good. Seven factors were associated with overall intravenous access success: shorter patient hospital length of stay, no history of diabetes, higher patient anxiety level, nurse use of an ultrasound in patients with high-risk vein characteristics, higher nurse expertise in intravenous access, higher nurse confidence in first attempt success, and nurse prediction of difficult intravenous access was low; model goodness of fit was strong.

Conclusion: Patients' vein characteristics and nurses' confidence in first attempt intravenous access success were predominant characteristics of intravenous access success.

Implications: Factors of importance in achieving intravenous access can be easily assessed prior to first attempt and may enhance first attempt and overall success.

Reporting method: Authors adhered to relevant EQUATOR guidelines and used the following reporting method: STROBE (The Strengthening the Reporting of Observational Studies).

Aim: To investigate predictors of nurses' reporting behaviours and their reasons for not formally reporting.

Background: Underreporting of workplace violence (WPV) among nurses contributes to gaps in WPV prevention measures, as it cannot be fully understood. WPV is classified according to its source (Type II: patients and visitors, Type III: coworkers) and forms (physical assault, threat of assault, emotional abuse, verbal sexual harassment and sexual assault).

Design: This is a secondary analysis of cross-sectional survey data collected in 2019 from British Columbia (BC), Canada.

Methods: This study had a sample of 4109 BC nurses. Multinomial logistic regression was used to analyse predictors of reporting behaviours. Reasons for not reporting were analysed descriptively.

Results: Informal reporting to management or through a patient safety incident report was less likely when nurses experienced threat of assault, emotional abuse and verbal sexual harassment from both Type II and III sources and physical assault from Type III sources. Higher perceptions of WPV prevention efforts increased odds of informal and formal reporting through employee incident procedures. Believing that nothing would change after reporting remained among the top three reasons for not formally reporting across all WPV sources and forms. Nurses also commonly selected not knowing the formal process, lack of leadership support and other reasons stated in an open-text response.

Conclusion: Findings indicate that nurses in BC, Canada, perceive many barriers to formal WPV reporting. Formal reporting systems should address these barriers so that healthcare organisations can effectively track WPV and have data to inform WPV prevention measures.

Implications: To promote WPV reporting, healthcare organisations need multifaceted interventions including confidential and simplified reporting systems, leadership support to follow-up with nurses and education and training on reporting systems.

Reporting method: The authors of this manuscript have adhered to the relevant EQUATOR guidelines based on the STROBE cross-sectional reporting method.

Patient or public contribution: No patient or public contribution.

Aim: To investigate the correlation between intensive care unit (ICU) nurses' demographic characteristics, teamwork, moral sensitivity and missed nursing care.

Background: Teamwork, moral sensitivity and missed nursing care are important health challenges among ICU nurses. Clarifying the relationship between variables is benefit to improve the quality of patients care. Nevertheless, a comprehensive conceptualisation of the relationship between teamwork, moral sensitivity and missed nursing care remains lacking.

Design: A cross-sectional design.

Methods: This study follows the STROBE checklist. ICU nurses were recruited by two hospitals between November 2023 and January 2024, in Shandong Province, China. The demographic characteristic questionnaire, teamwork perceptions questionnaire, moral sensitivity questionnaire-revised version into Chinese and the Chinese version of the missed nursing care questionnaire were used for investigation. Multiple linear regression was used to clarify the factors affecting missed nursing care. Pearson correlation was used to test the correlation between teamwork, moral sensitivity and missed nursing care.

Results: The level of missed nursing care for ICU nurses was low, with overall mean score of 37.49. Missed nursing care for ICU nurses in the labour dispatch were much higher than nurses with the contract system and personnel agency (p < 0.05). The 12-h shifts of ICU nurses also influenced missed nursing care. Furthermore, teamwork has a positive relationship with moral sensitivity (r = 0.653, p < 0.001).

Conclusion: Hospital and nursing managers should pay attention to the clinical sense of belonging of ICU nurses, reasonably set the working shifts, which will help to reduce the occurrence of missed nursing care.

Relevance to clinical practice: It is recommended that nursing managers should invest in strategies to enhance nurse teamwork and implement a 12-h shift pattern, which can alleviate moral distress and improve quality of care.

Patient or public contribution: No patient or public contribution. (The data of this were collected from nurses and not related to patients. They were informed of the research process and precautions, signed informed consent.).

Aims and objectives: To summarise the currently developed risk prediction models for medication adherence in patients with chronic diseases and evaluate their performance and applicability.

Background: Ensuring medication adherence is crucial in effectively managing chronic diseases. Although numerous studies have endeavoured to construct risk prediction models for predicting medication adherence in patients with chronic illnesses, the reliability and practicality of these models remain uncertain.

Design: Systematic review.

Methods: We conducted searches on PubMed, Web of Science, Cochrane, CINAHL, Embase and Medline from inception until 16 July 2023. Two authors independently screened risk prediction models for medication adherence that met the predefined inclusion criteria. The Prediction Model Risk of Bias Assessment Tool (PROBAST) was employed to evaluate both the risk of bias and clinical applicability of the included studies. This systematic review adhered to the 2020 PRISMA checklist.

Results: The study included a total of 11 risk prediction models from 11 studies. Medication regimen and age were the most common predictors. The use of PROBAST revealed that some essential methodological details were not thoroughly reported in these models. Due to limitations in methodology, all models were rated as having a high-risk for bias.

Conclusions: According to PROBAST, the current models for predicting medication adherence in patients with chronic diseases exhibit a high risk of bias. Future research should prioritise enhancing the methodological quality of model development and conducting external validations on existing models.

Relevance to clinical practice: Based on the review findings, recommendations have been provided to refine the construction methodology of prediction models with an aim of identifying high-risk individuals and key factors associated with low medication adherence in chronic diseases.

Patient or public contribution: This systematic review was conducted without patient or public participation.