Clinical Nursing Research最新文献

Music is one nonpharmacological intervention to reduce anxiety and stress for mechanically ventilated patients. Efficient delivery of a music listening intervention can be enhanced through digital tools such as a mobile application (app) loaded onto an electronic tablet device. The objective of this study is to describe the iterative development and deployment of a novel app (Soundese) to deliver, record, and retrieve data associated with a two-arm randomized, blinded clinical trial testing music listening intervention compared to control silence condition on delirium severity among critically ill intensive care unit (ICU) older adult patients receiving mechanical ventilatory support. The Soundese mobile app was developed to deliver either experimental music listening intervention or a silence control listening condition to a sample of older adults receiving mechanical ventilatory support in the ICU and retrieve all protocol data. The Soundese app was developed using the Swift software language and is compatible with all iOS devices. The Soundese app consists of two components: (1) a mobile app that delivers the assigned, blinded listening intervention from an iPad through headphones to each subject and automatically logs each listening session, its duration, the randomization arm, and uploads these data to a server, and (2) an analysis app that generates a spreadsheet with summarized data of the respective listening session, music details, and reports for further analyses. A Dropbox application programmer interface enabled the secure storage of files on a designated Dropbox account. After initial field testing and iterative development changes based on research staff feedback, the Soundese app delivers the assigned experimental listening condition or silence control condition when deployed remotely in the field. The app's mobile nature allows for immediate and automatic data capture, which is summarized for statistical analysis. There is no need for any manual recording of any intervention data by busy ICU staff, including listening time or music selections. The Soundese mobile app efficiently delivers the research protocol with fidelity and collects the necessary data for an ICU-based clinical trial. The app may be useful in other clinical trials testing music listening interventions in various settings or for deploying other audio-based interventions.

A growing body of literature highlights the involvement of nurses in the application of involuntary commitment and treatments in psychiatry. The violence underlying these coercive practices is often discussed, as they infringe on human rights and have negative effects on both patients and healthcare staff. The current state of knowledge on this subject, however, fails to inform us of what characterizes and influences these practices in psychiatric nursing. A situational analysis was conducted to gain a better understanding of this issue. This qualitative research aims to explore the characteristics of nursing care during involuntary commitment and treatments. In all, 10 nurses (n = 10) and 11 patients (n = 11) participated in semi-structured interviews and completed a sociodemographic questionnaire. Data analysis followed a grounded theory approach, involving a process of coding, conceptualizing, categorizing, constant comparison, and relational mapping, accompanied by analytical memos. Four conceptual categories emerged from data analysis: (1) Psychiatry as a waiting room, (2) nurses as subordinates, (3) nothing else but medication, and (4) resisting undignifying care. The results suggest that clinical issues surrounding involuntary commitment and treatments can be explained by how care is conceived. The psychiatric nursing practice seems to be limited to the application of coercive power, such as forced administration of medication. The distress potentially induced by involuntary commitment and treatments in patients comes to be ignored in favor of compliance with the legal procedures. The results describe a situation where patients felt abandoned to those procedures as if refusing to be hospitalized or treated were incompatible with any other form of care. Several participants also report having suffered negative consequences following one or more coerced psychiatric episodes. For them, refusal of care therefore seems to be associated with a resistance against the current violence of biomedical psychiatry, rather than a refusal to obtain help and support.

This study aimed to explore contextual elements of the cancer experience that are consistently distressing and/or psychologically traumatic, as well as explore perceptions of Accelerated Resolution Therapy® (ART®) and its influence on the cancer experience. Using a qualitative descriptive design, semi-structured interviews were completed by 12 participants following the completion of ART. Interview data were analyzed using content analysis to identify major themes and patterns. Four themes included: (a) Cancer as the straw that broke the camel's back, (b) ART® is different from previous therapy, (c) Don't need to always be looking in the rearview mirror, and (d) Importance of early psychological intervention. Participants perceived that ART® was different and potentially more effective than other types of therapy they had previously received. Results support the diagnosis of cancer and the cumulative effects of previous life events and cancer-related stressors as traumatic events.

Quality of life (QOL) at the end of life often declines in relation to various determinants, yet the role of social determinants, including social capital, in end-of-life care is frequently overlooked. This study aims to examine the association between social determinants and QOL in the last year of life and to test the mediating role of social capital in the relationship between social determinants and QOL among older adults with multimorbidity (MM). We used secondary data from the National Health and Aging Trends Study (NHATS) in Rounds 10 and 11, involving 3,085 adults aged 65 and older. The final analysis comprised 230 participants. Multiple linear regression was conducted to assess the associations between social determinants and QOL, and path analysis was used to evaluate the mediating effect of social capital. The regression model showed that social capital was positively and significantly associated with QOL (β = 0.378, 95% CI [0.099, 0.657], SE = 0.139), as were mental conditions (β = 0.614, 95% CI [0.167, 1.062], SE = 0.194). The mediation analysis demonstrated that social capital functioned as a complementary mediator, partially mediating the relationship between mental conditions and QOL in the last year of life. These findings underscore the potential role of social capital in enhancing QOL at the end of life, particularly through its influence on mental health. The study highlights the need for healthcare practices and policies that promote social support systems and community-based care for older adults with MM. By addressing social capital, end-of-life care could be improved, resulting in better overall well-being for individuals facing the last stages of life.

Adolescents and emerging adults are at highest risk for sexual violence. While technology-based interventions are emerging in the literature, little is known regarding mobile applications specifically for use with young people. The objective was to identify and map available mobile-based applications designed to reach adolescent or emerging adult users at risk of sexual or dating violence. The Joanna Briggs Institute methodology for scoping reviews and Preferred Reporting Items for Systematic Review and Meta-Analysis extension for scoping reviews were employed. All available English language studies and methodological papers describing mobile-based applications designed to prevent and/or mitigate sexual violence targeting young persons were included with no time limits. Abstracts and full-text readings were carried out by three independent reviewers, followed by data charting and thematic analysis, presented in narrative. Mobile applications targeting young people show promise (N = 15). Most applications target emerging adults over the age of 18 years, with a scarcity of mobile applications designed for adolescents. The myPlan Safety Planning app is the most reported in the literature, adapted to three countries, demonstrating promise across three available randomized controlled trials. Mobile applications can aid in reaching young people at the highest risk for sexual violence. Findings may inform further mobile application development and intervention research. This scoping review was registered prospectively on the Open Science Framework (https://doi.org/10.17605/OSF.IO/QWZBE).

Studies addressing patients' experiences of person-centered care (PCC) in the context of allogeneic hematopoietic stem cell transplantation (allo-HSCT) are scarce; hence, this study aimed to explore patients' experiences of PCC, and its associations with individual characteristics and health-related quality of life, in the context of allogeneic stem cell transplantation. It is a cross-sectional survey study, in patients who had undergone an allo-HSCT at one center in Sweden. The PCC instrument for outpatient care in rheumatology (PCCoc/rheum) was used. Descriptive and analytical statistics were employed. The study had 126 participants, evenly distributed males and females, 18-79 years old (>60% were 50-69 years old), and most were (>70%) married or cohabiting. The sum score for all items on PCCoc/rheum ranged from 20 to 72 (higher score = higher degree of PCC), with a mean value of 62.67 (SD: 9.863). Most participants (87-99%) agreed with the level of person-centeredness for 22 of the 24 items. Of the participants, 83.3% agreed that they had undisturbed conversations, that their problems had been taken seriously (79.0%), that they had an opportunity to tell their story (77.8%), and collaboration with the nurse was good (77.6%). A sizeable proportion disagreed that the care environment was welcoming (11.9%), family members' involvement (13.7%), and the possibility to influence the care (15.5%). The fulfillment of PCC was rated as high, but the results indicate that there is room for improvement regarding the possibility of influencing the care and family members' involvement.

Solid organ transplant (SOT) recipients now have widespread access to telehealth, but the factors influencing their satisfaction still need to be understood. This cross-sectional study explored potential contributors to telehealth satisfaction among SOT recipients, including liver, kidney, and simultaneous liver-kidney recipients. A total of 136 adult SOT recipients completed an online survey. The survey assessed telehealth satisfaction, previous telehealth experiences, including confidence levels and the need for assistance from others, electronic health literacy (eHealth literacy), perceived physical and mental health status, and cognitive function, along with demographic and clinical characteristics. The multivariate regression backward selection method was used to identify potential factors contributing to telehealth satisfaction. Participants had a mean age of 60.1 years (standard deviation [SD] = 10.5) and were, on average, 92 months post-transplant (SD = 99.9). The mean telehealth satisfaction score was 5.3 out of 7 (SD = 1.2), indicating positive satisfaction with telehealth. However, lower telehealth satisfaction was associated with poor confidence in communicating with providers via telehealth, lower eHealth literacy, better perceived cognitive function, and a prolonged time since SOT (adjusted R² = 0.49). SOT recipients who perceive vulnerability in online technology, report better perceived cognitive function, and are farther out from their SOT may exhibit lower satisfaction with telehealth. When considering telehealth for transplant care, clinicians should prioritize addressing the specific concerns and challenges of SOT recipients who may perceive telehealth unfavorably.

Older adults living with dementia engage in little physical activity when hospitalized. This has negative implications including functional decline, infections, and longer lengths of stay, and reflects a lower quality of care. One of the approaches used to help overcome challenges to engaging patients in physical activity and optimizing the quality of care provided is referred to as function-focused care. Function-focused care is a philosophy of care in which patients are helped to engage in physical activity, including mobility and self-care, at their highest level during all care interactions. The focus of this study was to describe the function-focused care provided by nurses at 2 and 6 months after exposure to the implementation of Function-Focused Care for Acute Care Using the Evidence Integration Triangle (FFC-AC-EIT). It was hypothesized that in treatment sites there would be an increase in the percentage of routine activities in which nurses provided function-focused care to patients between 2 and 6 months. This was a descriptive study of nurse-patient interactions. At 2 months, 54 nurse-patient observations were done, and at 6 months, 69 nurse-patient observations were done. Out of 19 possible activities in which the nurse could provide function-focused care, the mean number of function-focused care activities performed by nurses at 2 months was 3.2 (SD = 2.0), or 83% of the observed activities. At 6 months, 2.6 (SD = 2.6) function-focused care activities were performed and this increased to 86% of the activities observed. There was a mean of 0.5 (SD = 1.1) or 16% of the observed function-focused care activities not performed at 2 months and .3 (SD = 0.8) or 11% of observed activities not performed at 6 months. Although there was a limited engagement of patients in physical activity during routine care overall, more function-focused care was provided to patients following the implementation of FFC-AC-EIT, the longer the staff were exposed to the intervention.

The most frequently reported post-coronavirus disease of 2019 (COVID-19) symptoms include shortness of breath, fatigue, and cognitive disturbances, with reports of persistent dyspnea ranging between 26% and 41%. There is an urgent need to understand the risk factors and predictors for persistent COVID-19 dyspnea in individuals at all levels of COVID-19 illness severity, to enable the implementation of targeted interventions for those likely to be most affected with persistent dyspnea. Thus, the purpose of this systematic review is to explore the risk factors and predictors that are associated with persistent dyspnea in the post-COVID-19 population. This review was performed according to the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines and registered prospectively in PROSPERO as CRD42023466713. A search strategy was conducted across PubMed, CINAHL, Web of Science, and EMBASE databases, that included studies conducted from 2020 to March 2024. The Covidence platform was used for screening studies, scoring methodologic quality, and performing data extraction using a two-step independent review process. This review included 33 studies, addressing 83,920 participants across 20 countries. The strongest predictive risk factors for persistent dyspnea included the following: female sex, elevated body mass index, pulmonary comorbidities, pre-existing anxiety and depression, pre-COVID-19 physical limitations, the severity of the COVID-19 illness, and socioeconomic differences. Potential risk factors included increased age, smoking history, and COVID-19 variant type. The presence of biomarkers for persistent dyspnea in the post-COVID-19 population can be used by clinicians to prospectively identify those individuals who should be flagged. Early identification may then be leveraged for timely referral for prophylactic and rehabilitative interventions for dyspnea. A personalized plan to target those risk factors that are modifiable should follow.

The hypoxia-inducible factor-1 alpha (HIF-1 alpha) is a major regulator of adaptive response to hypoxia, common in patients with severe coronavirus disease 2019 (COVID-19). In addition, HIF-1 alpha regulates the expression of the most important proteins necessary for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection of cells. The study included 129 hospitalized COVID-19 patients. Genotypes of HIF-1A gene polymorphisms rs11549465 and rs2057482 were determined by the RT-PCR method. We have observed lower mean platelet counts in carriers of HIF-1A rs11549465CC genotype (p = .050) and a significant association of thrombocytopenia with rs11549465CC/rs2057482CT HIF-1A genotypes combination (p = .037) in the group of patients under the age of 40. HIF-1A rs11549465CC genotype and rs11549465CC/rs2057482CT genotype combination could be predictive markers for thrombocytopenia in COVID-19 patients. Identification of such predictive markers for severe disease may contribute to a more efficient response of health systems to the SARS-CoV-2 pandemic.