Clinical Nursing Research最新文献

To respond to the local cardiovascular health literacy need through means of alternative forms of education utilizing serious games. A quality improvement project design utilizing pretest-posttest with in-depth literature review. A Cardiovascular (CV) BINGO game was developed, implemented, and analyzed for efficacy. Focus group participants (n = 10) were asked to recommend or advise against implementation of the serious game, then pilot study participants (n = 7) were asked to complete a five question Likert-scale survey along with one fill-in-the-blank action plan goal pre- and postgame implementation. Comparison between pretest and posttest surveys revealed an improved participant-perceived understanding and completion of personal action plans postimplementation. Overall, participants and instructors voiced satisfaction and lobbied for future use of this education tool. Literature supports the efficacy of serious games in knowledge and outcome improvement. The CV Bingo game applies alternative forms of education to establish deeper understanding of the material, spark health consumer interest, and open dialogue barriers. Application of serious games can be applied to any chronic disease process. The goal for the dissemination of this pilot study is to introduce new educational concepts and encourage fellow clinicians to utilize alternative forms of patient education.

Registered nurses (RNs) and nursing assistants (NAs) play critical roles during crises. Understanding how the perceived work environment affects psychological distress among these healthcare workers is essential for developing interventions that support mental health and organizational outcomes. This study examined the association between perceived workplace environment and psychological distress, including stress, depressive, anxiety, and somatic symptoms, among inpatient RNs and NAs during the COVID-19 pandemic. A cross-sectional survey was conducted with 84 RNs and NAs employed at a large academic medical center between April and September 2021. The Practice Environment Scale of the Nursing Work Index (PES-NWI) was used to measure the perceived workplace environment, while psychological distress symptoms were assessed using the Perceived Stress Scale, Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7, and PHQ-15. Descriptive statistics and independent t-tests analyzed cohort characteristics. A stepwise approach with univariate and adjusted linear regression models assessed the relationship between workplace environment scores and psychological distress, incorporating demographic variables. Approximately one-third of participants reported moderate to severe psychological distress. No significant differences in distress symptoms were found between RNs and NAs; however, NAs rated Collegial Nurse-Physician Relations significantly lower than RNs (t = -3.84, 95% confidence interval [CI] [-1.15, -0.33], p = .001). Across all unadjusted models, higher PES-NWI total scores were associated with lower psychological distress. In adjusted models, unit-level Nurse Manager Leadership and Support subscale was significantly related to lower depressive (estimate: -2.03, 95% CI [-4.01, -0.04], p = .045) and somatic symptoms (estimate: -2.11, 95% CI [-4.16, -0.06], p = .044). These findings underscore the critical role of nurse managers in fostering supportive workplace environments and highlight the unique challenges faced by NAs. Targeted interventions at the unit and hospital levels can enhance RN and NA well-being, improve organizational outcomes, and build a resilient nursing workforce equipped to navigate future crises.

Cancer is the second leading cause of death globally, following cardiovascular diseases. Radiotherapy (RT), a common cancer treatment modality, often induces both physical discomfort and psychological distress, including pain and anxiety. Although music interventions have shown promise in reducing such symptoms, most studies lack a theoretical foundation, limiting their generalizability and application in nursing practice. This study aimed to evaluate the effects of a music intervention on pain, anxiety, and vital signs in patients undergoing RT, using the Roy Adaptation Model (RAM) as the theoretical framework. A randomized controlled trial was conducted between May 2024 and April 2025 in the Radiation Oncology Department. A total of 120 patients were randomly assigned to either the intervention group (n = 60) or control group (n = 60). The intervention group listened to specially composed therapeutic music via speakers for 20 to 40 min during weekly RT sessions. Pain (Visual Analog Scale), anxiety (Facial Anxiety Scale), and vital signs (blood pressure, heart rate, and respiratory rate) were measured before and after RT sessions. Data were analyzed using paired-sample t-tests and Cohen's d for effect sizes. The music intervention significantly reduced pain and anxiety scores in the intervention group compared to the control group (p < .001). Additionally, positive changes in vital signs were observed, including decreased systolic blood pressure and heart rate. The findings support the regulatory and cognator adaptive responses described in RAM, indicating that music functions as an effective coping mechanism for physiological and psychological stressors during RT. Music intervention is a safe, non-pharmacological, and cost-effective strategy for enhancing patient adaptation during RT. This study contributes to the evidence base by integrating a theoretical model into clinical nursing practice and underscores the importance of model-based interventions in improving holistic patient care.

Continuous care provided by the same midwife throughout the maternity journey may have significant benefits for labor outcomes and women's childbirth experiences. This single-blind randomized controlled trial, conducted in a public hospital in Türkiye between October 2024 and February 2025, investigated the effects of continuous midwifery care on labor pain, duration, comfort, and the perception of respectful maternity care. A total of 85 women were randomly assigned to either an intervention group (n = 43), receiving care from the same midwife during the prenatal, intrapartum, and postnatal periods, or a control group (n = 42), where care was provided by different midwives. Findings revealed that women in the intervention group experienced significantly lower pain during labor, shorter labor durations, and greater comfort. Additionally, their perceptions of respectful maternity care were markedly more positive than those in the control group (p < .001). These results suggest that continuity of midwifery care enhances both clinical and experiential outcomes for women. Implementing midwife-led continuity of care models in Türkiye could contribute to more personalized, comfortable, and respectful childbirth experiences, ultimately improving maternal satisfaction and well-being.

Mixed methods research (MMR) offers rich opportunities for doctoral inquiry, but its complexity demands careful navigation of design, data integration, and dissemination. For doctoral candidates, one under-recognised risk is the ethical and methodological challenge of fragmentation and salami-slicing practices that undermine the coherence and transparency central to MMR. Fragmentation involves separating components of a study across publications, while salami slicing divides a dataset into minimally contributive outputs, often misaligning with the original study design. This discussion paper addresses the implications of these practices in the context of doctoral research and supervision. It highlights the need for supervisory guidance in ethically planning publications, particularly in aligning dissemination with MMR design logic. Drawing on doctoral inquiry and supervisory discourse, the paper proposes design-informed strategies to help candidates and supervisors protect the integrity of MMR. In doing so, it contributes to the methodological literature by offering actionable guidance for ethically navigating dissemination within the context of complex, mixed methods doctoral projects.

To explore the effect of maternal self-efficacy and social support in the development of postpartum depression (PPD) among Jordanian primiparous mothers. In a cross-sectional study using convenience sampling, 250 mothers aged 18 years or above, 6 to 8 weeks postpartum, and who could speak and read Arabic were interviewed in a participating health clinic. The interview occurred before or after a woman's scheduled clinic appointment. It included sociodemographic data, Edinburgh Postnatal Depression Scale (EPDS), the Perceived Maternal Parental Self-Efficacy Scale, and the Perinatal Infant Care Social Support Scale. Data were analyzed using IBM SPSS Statistics (version 24; IBM Corp., Armonk, NY, USA). Reporting followed the Strengthening the Reporting of Observational Studies in Epidemiology guidelines. Results revealed that 47.2% of participants had probable PPD (EPDS ≥ 13); 35.2% had low maternal self-efficacy, and 36.8% had low functional social support. Older and employed mothers were at increased risk of PPD symptoms. In contrast, higher monthly income, greater maternal self-efficacy, and higher functional social support were significantly associated with decreased risk of PPD symptoms. The prevalence of PPD reported in the current study warrants immediate action on early assessment, detection, and intervention. The findings also call for culturally tailored interventions and greater involvement of healthcare professionals and families to support maternal mental health. The study highlights the need for early screening and culturally tailored interventions to strengthen maternal self-efficacy and social support in preventing PPD. Nurses and midwives should collaborate with families to provide holistic, patient-centered care that addresses both emotional and practical needs of primiparous mothers.

Individuals with inflammatory bowel disease (IBD) experience overlooked deficits in objectively measured cognitive functioning; however, there is limited knowledge about self-reported cognitive symptoms in this group. Sleep characteristics, such as insomnia, poor sleep quality, or fragmented sleep, may be key modifiable factors that are associated with cognitive symptoms among individuals with IBD. This study aimed to describe cognitive symptoms and examine the relationship between these symptoms and sleep characteristics among adults with IBD. We conducted a descriptive, cross-sectional study using the Pittsburgh Sleep Quality Index, wrist actigraphy, the Insomnia Severity Index, and the FACT-Cog Perceived Cognitive Impairments subscale. Bivariate statistics were used to evaluate relationships between variables. The sample included 83 participants (mean age 40.44 years [standard deviation 10.7], 71% female). Over 77% (n = 60) had poor self-reported sleep quality, and 69.5% (n = 57) had clinically meaningful insomnia. The most frequently reported cognitive symptoms (experienced two or more times a week) were trouble concentrating (51.3%), forgetting names (43.8%), forgetting intended tasks (38.9%), and slow thinking (37.6%). Insomnia severity was moderately correlated with three out of the four most common cognitive symptoms (trouble concentrating: r_s = .51, p < .01; forgetting intended tasks: r_s = .38, p < .01; slow thinking: r_s = .46, p < .01). Future research is needed to examine relationships between objective cognitive measures and sleep characteristics and to test the effects of insomnia treatment on daytime cognitive symptoms in this complex patient population.

Previous studies have shown that single symptoms are associated with self-management, and symptom clusters are still a sparsely investigated field. This study aimed to explore the possible symptom clusters after renal transplantation and investigate the correlation between symptom clusters and self-management. A cross-sectional survey was conducted on 381 renal transplant recipients (RTRs) from 2 tertiary hospitals in different regions. Sociodemographic and clinical characteristics, Symptom Experience Scale, and RTRs Self-Management Scale were used. Symptom clusters were created with exploratory factor analysis. Multiple regression analysis was used to explore the relationship between self-management and symptom clusters. Four symptom clusters were extracted, which were related to activity endurance, emotion, neuro-gastrointestinal, and hormone. Symptom clusters were negatively correlated with self-management (p < .001), and the activity endurance symptom cluster was the influencing factor of self-management (β = -.209, p < .001). The impact of symptom clusters on self-management among RTRs exhibits heterogeneity. Clinical therapies should prioritize the activity endurance symptom cluster since it is a substantial risk factor for impaired self-management ability.

The identification of frail older adults is a critical public health challenge and a growing priority in geriatric research. Nevertheless, the identification of sex-specific predictors of frailty remains an unsolved challenge. The objective of this study is to examine sex differences in the predictors of physical frailty among community-dwelling older adults in Chile. A nationally representative sample of 9,123 individuals aged 60 and older (n = 5,363 women; n = 3,760 men) from the National Disability and Dependency Survey was analyzed. Supervised machine learning regression models were applied to identify the most relevant predictors of physical frailty. In both male and female subjects, the predominant predictor was the number of health conditions present. For men, physical activity emerged as the second most salient factor, while for women, engagement in leisure and recreational activities demonstrated a more pronounced correlation with frailty. The findings of the study demonstrated that age was a significant predictor in both male and female subjects. These findings offer valuable insights for developing gender-responsive strategies to prevent or delay the progression of physical frailty among older adults in Chile.

ICU survivors are at increased risk for persistent physical, cognitive, and psychological impairments, collectively known as Post-Intensive Care Syndrome (PICS). Critically ill patients, especially those on mechanical ventilation, experience increased oxidative stress burden, potentially contributing to telomere shortening. However, the relationship between oxidative stress, telomere attrition, and PICS-related outcomes remains unclear. Our objective was to examine associations among oxidative stress markers, telomere length, clinical characteristics, and PICS-related outcomes in mechanically ventilated ICU survivors. A cross-sectional study design was used. Blood samples were collected at two timepoints: study enrollment and within 48 hr of ICU discharge. PICS-related outcome measures were assessed within 48 hr of ICU discharge. Oxidative stress markers-including plasma protein carbonyls, vitamin C, reduced-to-oxidized glutathione ratio (GSH:GSSG), and total antioxidant capacity (TAC)-were quantified via ELISA. Three oxidative stress indices were calculated: vitamin C/GSH:GSSG, TAC/GSH:GSSG, and protein carbonyls/GSH:GSSG. Telomere length was determined using RT-qPCR. Clinical data included APACHE III and SOFA scores, ICU and hospital length of stay (LOS), and duration of mechanical ventilation. PICS-related outcomes included grip and foot strength, National Institutes of Health (NIH) Toolbox Cognition and Emotion assessments, and the Connor-Davidson Resilience Scale. Pearson's correlations were performed. Twenty-one participants were included in the final analysis. Plasma antioxidant status positively correlated with muscle strength and psychological resilience. Elevated plasma oxidant levels were associated with poorer cognitive outcomes. ICU LOS and duration of mechanical ventilation negatively correlated with muscle strength and cognitive performance. No significant correlations were observed between telomere length changes and PICS-related outcomes. Oxidative stress during acute critical illness may impede recovery and contribute to PICS. The lack of short-term associations with telomere length suggests that telomere-related effects on PICS may, possibly, become apparent over a longer post-ICU period.