Clinical Nursing Research最新文献

Assessing and monitoring respiratory parameters, such as respiratory rate, oxygen saturation, and lung sounds, is crucial for the management and prognosis of pneumonia patients. Prone positioning has been shown to improve oxygenation in patients with respiratory disorders, including pneumonia, by reducing ventilation/perfusion mismatch. However, there is a lack of evidence supporting the benefits of self-proning in spontaneously breathing pneumonia patients. This study aims to evaluate the effect of self-proning on respiratory functions, pneumonia, and mortality risk among patients diagnosed with community-acquired pneumonia. The study used a pre- and post-test quasi-experimental design with a control group, adhering to the Transparent Reporting of Evaluations with Nonrandomized Designs guidelines. It was conducted in the Medical Respiratory Department inpatient wards at the Respiratory Diseases Hospital in Alexandria, Egypt. The study recruited 128 patients with community-acquired pneumonia, conveniently assigned to an intervention group (n = 64) and a control group (n = 64). Data were collected using socio-demographic and historical data sheets, respiratory parameters assessment sheets, the confusion uremia respiratory rate and blood pressure (CURB-65) severity of pneumonia score, and the Pneumonia Severity Index. Prone positioning significantly positively impacted respiratory parameters in the intervention group compared to the control group. Specifically, the intervention group exhibited improvements in respiratory rate, oxygen saturation, reduced need for supplemental oxygen, and cough (p < .05). Furthermore, the intervention group exhibited fewer changes in findings from chest inspection, palpation, and auscultation. In addition, the severity of pneumonia was reduced in the intervention group compared to the control group, as indicated by lower CURB-65 (p = .014) and pneumonia severity index scores (p = .005). The study demonstrated that self-proning interventions significantly improved respiratory functions and reduced the risk of death among participants with community-acquired pneumonia. These findings suggest that self-proning is a beneficial technique for managing respiratory distress, particularly in non-intubated patients, and can be an effective strategy to improve patient outcomes in clinical settings.

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).

This study aimed to investigate the prevalence of frailty and its predictors among Taiwanese patients with atrial fibrillation (AF). A cross-sectional study was conducted, enrolling 188 AF patients aged over 20 years from a medical center in northern Taiwan. Participants were recruited from September 1 to December 30, 2022. Structured questionnaires were used to gather data on demographics, disease characteristics, Study of Osteoporotic Fractures Index, Short Portable Mental Status Questionnaire, Mini Nutritional Assessment Short-Form, Chinese Version Pittsburgh Sleep Quality Index, and Hospital Anxiety and Depression Scale. Among Taiwanese AF patients, over two-thirds were at risk of frailty, with susceptibility increasing with age. Key potential predictors included sex, cognitive function, nutritional status, sleep quality, and depression, jointly explaining 47.6% of the variation, with nutritional status being the most significant. These findings underscore the importance of comprehensive assessment and management strategies to address frailty in AF patients and improve overall health outcomes.

African American patient populations are disproportionately diagnosed with severe obstructive sleep apnea (OSA) compared to non-Hispanic white adults. Research suggests a link between OSA and anxiety. However, OSA and anxiety symptoms may present differently across minority groups. Research examining the reliability and validity of measures used to assess anxiety symptom severity in African American patient populations living with OSA is needed. This pilot study evaluated the reliability and validity of the Patient Reported Outcomes Measurement Information System (PROMIS) Anxiety short form and the longer State-Trait Anxiety Inventory-State (STAI-S) in a sample of African American adults recently diagnosed with OSA. In this cross-sectional pilot study, 32 African American patients newly diagnosed with OSA were recruited from an academic sleep medicine clinic in the Southeastern United States to complete survey measures. Participants completed the 6-item PROMIS Anxiety short form and 20-item STAI-S. Cronbach's alphas assessed the internal reliability of measures, and concurrent validity between measures was assessed using correlation coefficients (r_s). Both PROMIS Anxiety and STAI-S showed excellent internal consistency with Cronbach's α ≥.90. The PROMIS Anxiety T-scores and STAI-S scores were positively moderately correlated with each other (r_s = .68; p < .0001), indicating concurrent validity. These results illustrate that both the PROMIS Anxiety and STAI-S scales have strong internal reliability in this sample of African American adults with co-occurring OSA and prediabetes. The brief PROMIS Anxiety short-form measure is validated to the longer STAI measure in this sample. An advantage of the PROMIS Anxiety scale is that it has a lower participant burden when completing questionnaires, contributing to a more refined approach to diagnosis and management when both OSA and anxiety coexist. These findings also underscore the importance of validating psychometric measures in marginalized populations, such as African Americans, who have historically been underrepresented in psychometric research.

Although there are many sleep-related complaints in chronic obstructive pulmonary disease (COPD) patients, nocturnal leg cramps have not been adequately and extensively studied. This study fills a significant gap in the literature by determining the prevalence and influencing factors of nocturnal leg cramps in COPD patients. However, our findings also underscore the need for further research, inspiring future studies and interventions in this area. This study was conducted with a rigorous methodology, employing a comprehensive approach to evaluate the probability of experiencing nocturnal leg cramps in 215 COPD and 215 control group patients matched for age and gender. Logistic regression analysis was used, supplemented by artificial neural networks, to identify the influencing factors. This robust methodology ensures the reliability and validity of our findings. The findings of this study are not only significant but also enlightening, shedding light on the prevalence and influencing factors of nocturnal leg cramps in COPD patients. The frequency of experiencing these cramps was found to be 40.9% in chronic obstructive pulmonary patients and 21.9% in the control group (p < .05). In COPD patients, factors such as milk group food consumption, blood erythrocyte level, the cover used while sleeping, blood creatinine level, the presence of coronary artery disease, the diagnosis of diabetes mellitus, the upper mid-arm muscle area, and use of drugs with methylxanthine active ingredient methylxanthine were found to affect the occurrence of these cramps. Our findings not only call for further research but also have immediate practical implications. They highlight the crucial role of nurses in managing nocturnal leg cramps in COPD patients. By controlling patients' cold stress, the bed covers they use, and their dairy product consumption, nurses can significantly contribute to managing these cramps, thereby improving the quality of life for these patients. This underscores the importance of their role in patient care and management.

Stroke is a leading cause of death and disability worldwide. Early and comprehensive risk identification is essential for identifying individuals at high risk for stroke. This study aimed to evaluate each question in the new Stroke Risk Screening Scales (SRSS) and assess the domains for content relevance and representativeness. Initially, six stroke experts were invited to evaluate the SRSS questions. The content validity index (CVI), including the item-CVI (I-CVI) and the average-CVI (Ave-CVI), was then calculated. In our study, the acceptable standards for I-CVI and Ave-CVI were ≥0.78 and ≥0.9, respectively. The results showed that all invited experts accepted the invitation and evaluated the SRSS questions. The previous version of the SRSS consisted of 33 questions. Of these, 30 questions reached an I-CVI of ≥0.78, indicating good content validity. Three questions had an I-CVI of 0.67 and were considered invalid; thus, they were deleted. The overall instrument achieved an Ave-CVI of 0.95. Comprehensive SRSS are essential for effective stroke prevention planning. By facilitating the early identification of individuals at high risk for stroke, these scales help reduce the incidence and impact of stroke. The high content validity found in this study supports the reliability of the SRSS as a screening tool. In the future, implementing such validated scales in clinical practice can improve early intervention strategies, ultimately enhancing health outcomes and optimizing the use of healthcare resources.

Neutropenic sepsis (NS) is one of the leading causes of death among patients with hematologic malignancies. Identifying its predictive factors is fundamental for early detection. Few studies have evaluated the predictive factors in relation to microbial infection confirmation, which is clinically important for initiating sepsis treatment. This study aimed to determine whether selected biomarkers (i.e., body temperature, C-reactive protein, albumin, procalcitonin), treatment-related characteristics (i.e., diagnosis, duration of neutropenia, treatment modality), and infection-related characteristics (i.e., infection source, causative organisms) can predict NS in patients with hematologic malignancies. We also aimed to identify the optimal predictive cutoff points for these parameters. This retrospective case-control study used the data from a total of 163 patients (58 in the sepsis group and 105 in the non-sepsis group). We collected data with reference to the day of specimen collection, with which microbial infection was confirmed. Multiple logistic regression was used to determine predictive risk factors and the area under the curve (AUC) of the receiver operating characteristic for the optimal predictive cutoff points. The independent predictors of NS were average body temperature during a fever episode and procalcitonin level. The odds for NS rose by 9.97 times with every 1°C rise in average body temperature (95% confidence interval, CI [1.33, 75.05]) and by 2.09 times with every 1 ng/mL rise in the procalcitonin level (95% CI [1.08, 4.04]). Average body temperature (AUC = 0.77, 95% CI [0.68, 0.87]) and procalcitonin levels (AUC = 0.71, 95% CI [0.59, 0.84]) have fair accuracy for predicting NS, with the optimal cutoff points of 37.9°C and 0.55 ng/mL, respectively. This study found that average body temperature during a fever episode and procalcitonin are useful in predicting NS. Thus, nurses should carefully monitor body temperature and procalcitonin levels in patients with hematologic malignancies to detect the onset of NS.

Alzheimer's disease (AD) patients admitted to intensive care units (ICUs) exhibit varying survival outcomes due to the unique challenges in managing AD patients. Stratifying patient mortality risk and understanding the criticality of nursing care are important to improve the clinical outcomes of AD patients. This study aimed to leverage machine learning (ML) and electronic health records (EHRs) only consisting of demographics, disease history, and routine lab tests, with a focus on nursing care, to facilitate the optimization of nursing practices for AD patients. We utilized Medical Information Mart for Intensive Care III, an open-source EHR dataset, and AD patients were identified based on the International Classification of Diseases, Ninth Revision codes. From a cohort of 453 patients, a total of 60 features, encompassing demographics, laboratory tests, disease history, and number of nursing events, were extracted. ML models, including XGBoost, random forest, logistic regression, and multi-layer perceptron, were trained to predict the 30-day mortality risk. In addition, the influence of nursing care was analyzed in terms of feature importance using values calculated from both the inherent XGBoost module and the SHapley Additive exPlanations (SHAP) library. XGBoost emerged as the lead model with a high accuracy of 0.730, area under the curve (AUC) of 0.750, sensitivity of 0.688, and specificity of 0.740. Feature importance analyses using inherent XGBoost module or SHAP both indicated the number of nursing care within 14 days post-admission as an important denominator for 30-day mortality risk. When nursing care events were excluded as a feature, stratifying patient mortality risk was also possible but the model's AUC of receiver operating characteristic curve was reduced to 0.68. Nursing care plays a pivotal role in the survival outcomes of AD patients in ICUs. ML models can be effectively employed to predict mortality risks and underscore the importance of specific features, including nursing care, in patient outcomes. Early identification of high-risk AD patients can aid in prioritizing intensive nursing care, potentially improving survival rates.

Gynecological cancers constitute an important global health problem with increasing incidence and prevalence. The aim of this study was to explain gynecologic cancer knowledge, attitudes, and cultural beliefs of Afghan refugee women living in Türkiye. This research was carried out as a descriptive phenomenological design for qualitative research. The study was conducted at the Refugee Support Center Association in Eskişehir, Türkiye, and data were collected between January and April 2023, guided by a semi-structured interview guide. Nineteen Afghan refugee women were interviewed. A purposive sampling method was used to recruit participants. Content analysis method was used for data analysis. Four overarching themes that described Afghan women's gynecologic cancer knowledge, attitudes, and cultural beliefs were identified: (a) limited awareness and knowledge of gynecological cancer among women, (b) women's attitudes toward gynecological cancers, (c) women's cultural beliefs regarding gynecological cancer, and (d) healthcare system factors. In line with the main themes, subthemes were created for each main theme. Afghan refugee women, who were in the double risk group as both women and refugees, had insufficient knowledge of gynecological cancers, and their cultural beliefs and attitudes played an essential role in their access to gynecological cancer-related preventive healthcare services. It is recommended that training be planned to increase the awareness and knowledge of Afghan women on gynecological cancers, considering their cultural characteristics.

This study aimed to explore the effects of meaning-in-life intervention on meaning in life, quality of life, spiritual well-being, anxiety, and depression in advanced cancer patients. Databases, including Ovid Medline, Cochrane, PsycINFO, CINAHL, and Embase, were searched to identify relevant randomized controlled trials based on predefined criteria. Seven studies were included. Meta-analysis was performed for five studies, involving 718 patients with advanced cancer. The meta-analysis revealed no significant effects of the meaning-in-life intervention on spiritual well-being, depression, and anxiety of advanced cancer patients. The insufficient number of studies and risk of bias limit the strength of the conclusions. Therefore, further studies with larger sample sizes and methodologically rigorous designs are required to evaluate the effects of meaning-in-life interventions for advanced cancer patients. Our findings can support a better understanding of the need to study meaning-in-life interventions in advanced cancer patients and foster sustained attention to recognize meaning-in-life interventions as an effective method in healthcare.