Clinical Nursing Research最新文献

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.

Atherosclerotic cardiovascular disease (ASCVD) risk calculators estimate the 10-year incident risk of myocardial infarction (MI), coronary artery disease (CAD) death, or stroke; however, they lack comprehensiveness and accuracy. Carotid intima-media thickness (CIMT) is a surrogate marker that may improve risk estimation acumen. The objective of this study was to derive ASCVD risk scores from historical data and determine whether these risk scores are associated with the history of subclinical CAD and CIMT. This retrospective cross-sectional study used an existing dataset of individuals with prediabetes. Subclinical CAD history was defined as the history of CAD, coronary plaque, or coronary revascularization without a history of MI. The online ASCVD Risk Estimator Plus calculator was used to derive individual risk scores. Chi-square or Fisher's exact tests for categorical variables and ANOVA for continuous variables detected differences among ASCVD risk categories. Linear regression of CIMT measurements on ASCVD risk scores ascertained ASCVD risk scores' utility in predicting CIMT measurements. The sample included 86 participants, 28% with a history of CAD, 60% male, and 95% White. No differences in risk scores existed between participants with or without CAD. Individuals with higher ASCVD risk scores were older (p ≤ .001) and had higher systolic blood pressure (p ≤ .001), CIMT arterial age (p = .003), mean IMT common (p ≤ .001), mean IMT maximum (p ≤ .001), and plaque burden (p = .02) measurements. ASCVD risk scores were significantly associated and moderately correlated with CIMT measurements. ASCVD risk scores were not associated with CAD history but were associated with CIMT measurements. While risk calculators provide a starting point for ASCVD risk estimation, physical tools like CIMT can diagnose ASCVD, categorize plaque quality, and track intervention efficacy. CIMT may be used for more direct ASCVD risk estimation. Risk scores are easily imputed from existing records but are only intended for incident risk, and their accuracy relies on the variables' availability and validity and the boundaries of the calculators.

Parent caregivers of children requiring life-saving medical technology (e.g., mechanical ventilation) report higher levels of stress and poorer health than other caregivers, often neglecting health-promoting behaviors for themselves. This article describes an iterative implementation science strategy used to improve intervention delivery for a randomized controlled trial testing a telehealth, cognitive-behavioral resourcefulness intervention with this population during the COVID-19 pandemic. This process consisted of reflective team meetings and content analysis. Initial adjustments were made after content analysis of pilot study materials before intervention delivery including an intervention script, checklist, online daily log, Health Insurance Portability and Accountability Act (HIPAA)-compliant texting option, training material access, and fidelity checks. In vivo adjustments were implemented in four areas: recruitment/engagement, participation and use of resources, in-person delivery, and virtual delivery. Our efforts to streamline intervention delivery were enhanced by incorporating an iterative implementation science strategy including analysis and adjustment of intervention delivery procedures to decrease participant burden and promote intervention adherence. Reflective team meetings and a collaborative, problem-solving approach to resolve the various barriers and challenges with the randomized controlled trial were integral components of intervention delivery. This study informs future intervention research by providing details of barriers faced, pragmatic adjustments made to intervention implementation, and lessons learned (NCT0410524; www.clinicaltrials.gov).