Journal of Clinical Nursing最新文献

Aims: To compare contextual factors influencing discharge practices in three intensive care units (ICUs).

Design: A prospective observational study.

Methods: Data were collected using a discharge process report form (DPRF) between May and September 2023. Descriptive statistics were performed to analyse demographic and clinical data. One-way analysis of variance (ANOVA) was used to test the time interval differences among the three sites.

Results: Overall, 69 patients' discharge processes were observed. Among them, 41 (59%) experienced discharge delay, and 1 in 5 patients experienced after-hours discharge. There were statistically significant differences in mean hours in various time intervals during the discharge processes among the three sites. Patients in Hospital C waited the longest time (mean = 31.9 h) for the ward bed to be ready after the bed was requested and for being eventually discharged after ICU nurses to get them ready for discharge (mean = 26.7 h) compared to Hospital A and Hospital B.

Conclusions: We found that discharge delay and after-hours discharge were common and there were significant differences in mean hours of various time intervals during the discharge processes occurred among the three sites. The influence of contextual factors in different hospitals/ICU needs to be considered to improve the ICU discharge process.

Implications for the profession and/or patient care: Researchers and clinicians should consider targeted context-specific interventions and strategies to optimise patient discharge process from ICUs.

Impact: The study findings will inform the development of tailored interventions to reduce the discharge delay and after-hours discharge and, in turn, improve the quality and safety of patient care and health service efficiency.

Reporting method: The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines.

Patient or public contribution: Patients' discharge processes were observed, and consumer representatives were involved in the study design.

Aims and objectives: The purpose of this study was to explore the relationship between symptom clusters and self-management among maintenance haemodialysis (MHD) patients.

Background: MHD patients experience disease progression and multiple symptom burdens that severely impact quality of life, and self-management of symptoms may significantly improve patient-reported outcomes.

Design: A cross-sectional study.

Methods: This cross-sectional descriptive study included 194 patients undergoing MHD. The patients were assessed using the Dialysis Symptom Index (DSI) and the Haemodialysis Self-Management Instrument (HD-SMI). We used descriptive analysis, exploratory factor analysis, Pearson's correlation analysis and linear regression analysis to examine (1) the level of individual self-management, (2) the presence of symptom clusters by symptom severity and (3) the correlation between symptom clusters and self-management behaviours. This study was conducted in accordance with the STROBE checklist.

Results: The top five most severe symptoms among the patients were itching, feeling tired or lack of energy, difficulty sleeping, dry mouth and dry skin. We identified five groups of symptoms: (1) poor sleep, (2) neuromuscular, (3) gastrointestinal, (4) skin irritation and (5) psychological. In the present study, MHD patients reported low to moderate levels of self-management behaviours (50.84 ± 10.56), and low self-management ability was correlated with greater severity of the five symptom clusters (p < 0.01). Linear regression analysis revealed that all five symptom clusters were included in the regression equation, explaining 30% of the total variance in self-management skills among MHD patients.

Conclusion: Enhanced awareness of symptom clusters and comprehensive symptom management are necessary to improve patients' quality of life.

Clinical relevance: Nursing practices should incorporate comprehensive symptom assessments to help patients develop effective self-management strategies to improve quality of life.

Aims: To develop and preliminarily validate a measure of beliefs about compassion in health care and assess whether and which beliefs may predict compassion.

Design: Pre-registered cross-sectional online survey study with a repeated-measures vignette component.

Method: Exploratory and Confirmatory Factor analyses were performed on a split sample of 890 healthcare professionals in Aotearoa New Zealand (NZ). Links with fears of compassion for others, burnout, trait compassion, compassion competency and ability and self-efficacy were used to assess convergent and divergent validity. Linear mixed model regression analyses were used to assess relationships between beliefs and compassion. In writing this report, we adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines.

Results: Four-factor structure featuring three negative (compassion as harmful, not useful, draining) and one positive (compassion is important) type of beliefs was established. Confirmatory factor analysis indicated a good fit and subscales indicated good measures of validity. Internal consistency was achieved for the subset of beliefs (harmful, not useful). Regression analyses indicated negative effects of the belief that compassion is draining on caring, motivation to help and compassion overall; negative effects of the belief that compassion is not useful on the motivation to help and a positive effect of the belief that compassion is important on caring and compassion overall. There was no effect of beliefs that compassion is harmful on compassion measures.

Conclusion: This report extends prior qualitative studies of beliefs about compassion in a large healthcare sample, offering a way to measure these potentially malleable factors that might be targeted in education, interventions and future research.

Patient or public contribution: The study was designed in consultation with healthcare and compassion research professionals, including substantial input from Indigenous Māori healthcare professionals.

Aims and objectives: To translate and validate the Nonverbal Pain Assessment Tool.

Background: Timely assessment of the pain degree of nonverbal intensive care unit (ICU) patients can provide humanistic care. However, there is a lack of pain assessment tools that can meet the needs of patients who cannot use language in ICUs in China.

Design: A cross-sectional survey.

Methods: We conducted forward-backward translation of the Nonverbal Pain Assessment Tool. A total of 300 critically ill patients in the intensive care unit who could not communicate verbally completed the Chinese version of the Nonverbal Pain Assessment Tool and the Critical Care Pain Observation Tool. Exploratory and confirmatory factor analyses were performed to verify structural validity, and content validity and reliability analyses were also conducted.

Results: The Nonverbal Pain Assessment Tool demonstrated high internal consistency (α = 0.901) and interrater reliability (intraclass correlation coefficient = 0.981), with good split-half reliability. Content validity was established through acceptable item-level content validity index and scale-level content validity index scores. Exploratory factor analysis showed a single factor explaining 71.79% of total variance, and confirmatory factor analysis confirmed good model fit. The Spearman rank correlation coefficient was 0.917 between the Nonverbal Pain Assessment Tool and the Critical Care Pain Observation Tool. The Chinese Nonverbal Pain Assessment Tool demonstrated significant differences in scores between different states of consciousness and illness severity, supporting its known-groups validity.

Conclusion: The Chinese version of the Nonverbal Pain Assessment Tool is a reliable and valid tool for nonverbal pain assessment in ICU patients in China.

Relevance to clinical practice: The Chinese version of the Nonverbal Pain Assessment Tool can assess the pain of patients who cannot use language in ICU, which provides a new valuable assessment tool for Chinese clinicians and nurses in pain assessment and management.

Reporting method: Our study followed the STROBE Checklists.

Patient or public contribution: Patients actively cooperated and participated in data collection during the implementation of the study.

Aim: To analyse the effectiveness of an active ageing intervention modality through peer mentoring.

Design: A quasi-experimental research study is carried out through three groups, one control (educational workshops on active ageing given by professionals) and two experimental (workshops given by peers with digital or face-to-face exposure).

Methods: All groups share duration (7 weeks) and content, modifying the route of exposure. The effectiveness of the model is measured through the variables of physical health, mental health and social support. Loneliness and the need for care are also controlled for.

Results: The total sample consists of n = 209 people aged over 60 living in a rural context, of which n = 12 form the volunteer/mentor group. Active ageing interventions show an improvement in the perception of physical and mental health among people in need of some form of care, with all three modalities being equally effective. The impact on social support is analysed by controlling for the loneliness and social participation variable; in these cases, the face-to-face experimental group of peers is more effective than the others.

Conclusions: The peer-to-peer methodology is as effective as the traditional methodology with a practitioner in maintaining and improving health perception, and the face-to-face methodology with peers is more useful in fostering social support among people experiencing loneliness.

Implications for the profession and/or patient care: Peer mentoring is presented as a good strategy to improve social support for older people and to combat loneliness.

Impact: To address the prevention of dependency through the promotion of active ageing. Peer mentoring is confirmed to have a significant impact on social support and could be a socio-educational tool applicable to older people experiencing loneliness.

Reporting method: This study has adhered to JBI guidelines. JBI critical appraisal checklist for quasi-experimental studies has been used.

Patient or public contribution: Volunteer mentors contributed to the design and delivery of the workshops.

Background: Pre-hospital emergency nurses, frequently exposed to high-stress situations, are at risk for burnout and stress-related issues, affecting their overall well-being. The Professional Quality of Life (ProQoL) scale, widely used among hospital nurses, remains untested in pre-hospital emergency settings.

Aim: To adapt and validate the ProQoL scale for pre-hospital emergency contexts and explore the protective role of emotional intelligence in professional well-being.

Methods: A mixed-method study was conducted. The qualitative approach involved semi-structured interviews to inform the modification of items for adapting the ProQoL to the pre-hospital emergency setting. A quantitative method was applied to assess the relationship between emotional intelligence and professional well-being through content and face validity measures.

Results: Qualitative interviews suggested refining the ProQoL for pre-hospital emergency settings, emphasising factors such as job satisfaction and professional conduct. The revised 21-item Pre-Hospital Emergency-Professional Quality of Life (PHE-ProQoL) scale demonstrated strong content validity (I-CVI: 0.86-1, S-CVI: 0.9) and face validity. Significant correlations were observed between emotional intelligence and professional well-being, with negative correlations between emotional intelligence and both burnout (Pearson's r = -0.859) and post-traumatic stress (Pearson's r = -0.792), and a positive correlation with compassion satisfaction (Pearson's r = +0.917). Pre-hospital nurses displayed moderate levels of compassion satisfaction (27.3 ± 9.81), high emotional intelligence (28.0 ± 9.58), especially in empathy, and substantial levels of burnout (22.5 ± 6.09) and stress (21.2 ± 4.3).

Discussion: The study found that pre-hospital emergency nurses exhibit moderate compassion satisfaction and above-average emotional intelligence, particularly in perceiving and managing others' emotions. However, they also experience significant levels of burnout and post-traumatic stress.

Conclusions: Burnout and post-traumatic stress significantly affect pre-hospital emergency nurses. Enhancing emotional intelligence is crucial for their well-being. Nursing managers now have access to a validated and reliable tool to assess this.

Aim: This study aimed to establish a comprehensive set of nursing-sensitive quality indicators (NSQIs) for patients with dysphagia following tracheotomy due to acquired brain injury (ABI), based on the 'structure-process-outcome' model.

Design: A Delphi survey.

Methods: The research utilised a mixed-methods approach, including systematic literature reviews, qualitative interviews and two rounds of Delphi expert consultations. A diverse team comprising specialists in dysphagia rehabilitation and nursing management conducted the research, which involved defining and refining NSQIs through extensive evaluations and consensus among recruited experts.

Results: The finalised NSQI includes 4 structural indicators, 13 process indicators and 4 outcome indicators, covering key aspects such as resource allocation, patient assessment and clinical outcomes. The expert consensus provides verification. Kendall's harmony coefficients are 0.304 and 0.138 (p < 0.001), respectively, and the mean importance assignments of indicators at all levels are 3.90-5.00. The final care of patients with tracheotomy and dysphagia after brain injury was constructed. The evaluation indicators include a total of 4 first-level indicators, 23 second-level indicators and 52 third-level indicators.

Conclusion: The established NSQIs offer a systematic framework to enhance the quality of nursing care for ABI patients with posttracheotomy dysphagia. This model facilitates precise monitoring and proactive management of nursing practices, promising better patient outcomes and streamlined care processes.

Implication for the profession and patient care: This study develops targeted NSQIs to improve dysphagia management in ABI patients' posttracheotomy, fostering better patient outcomes and advancing nursing education through essential specialised training.

Patient or public contribution: Expert-driven insights from experienced clinicians informed the NSQIs, ensuring their relevance and effectiveness in enhancing patient-centred care.