Clinical Nursing Research最新文献

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.

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.

Patient experience is increasingly recognized as a key performance indicator in healthcare. A tertiary hospital in Singapore introduced bedside tablets to enhance patient engagement and informed care. The tablets provide patients with access to health information and communication with healthcare teams. The study team hypothesized that patient experience would improve over time from pre-implementation of the initiative to post-implementation and with each addition of functionality. This prospective observational study, conducted at Singapore General Hospital, used sequential cross-sectional samples collected across different phases of bedside tablet implementation. Patient experience was evaluated using four specific domains of the validated Picker Patient Experience Questionnaire related to nurse communication, patient involvement, addressing patient concerns, and family information provision. Positive scores were calculated following the questionnaire guidelines, based on the proportion of patients reporting the most favourable responses. Data were collected from June 2019 to July 2024 and analyzed using descriptive statistics and Kruskal-Wallis tests. Nurse communication clarity and patient involvement positive scores increased overall, consistently receiving high positive scores across all stages. Patient involvement scores peaked in stage 3, coinciding with added functionalities like self-charting and electronic medical records synchronization. In contrast, addressing patients' concerns received the lowest positive scores, and family information provision demonstrated a steady decline across all stages. Kruskal-Wallis tests indicated significant differences for patient involvement and family information provision. However, post-hoc tests revealed no significant pairwise differences. The implementation of bedside tablets improved nurse communication clarity and patient involvement in care decisions, although areas for improvement remain, particularly in addressing patient concerns and family information provision. However, the calculation of positive scores, which only account for the most favourable responses, may obscure nuanced patient experiences. Future research would benefit from combining quantitative data with qualitative insights to gain a more comprehensive understanding of patient and family needs.

Maintenance hemodialysis is a common alternative therapy for patients with end-stage renal disease (ESRD). We designed a prediction model of hypoproteinemia among the patients based on machine learning algorithms. The "hypoproteinemia risk factor data" were obtained, and univariate analysis was used to screen independent risk factors as prediction variables. A total of 468 patients were recruited. The incidence of hypoproteinemia in total was 30.8%. A difference between the hypoproteinemia and non-hypoproteinemia groups was significant in 18 aspects, including age, weight, dialysis duration, and dialysis frequency. In the training set, after hyper-parameter adjustment by k-fold (k = 5) cross-validation and grid search, random forest (RF), support vector machine, and logistic regression (LR) prediction models were greater than 0.8. The RF model had the highest value (0.924). The specificities of the LR and RF models were similar (0.846 and 0.839), whereas the RF model had the best accuracy (0.924). The prediction model provided by the results of this study is likely to recognize the characteristics related to hypoproteinemia. The clinical significance of the findings is a prediction of the risk of hypoproteinemia in ESRD, thus helping risk observation to nurses and improving accurate screening, primary prevention, and early intervention.

This study aimed to explore the effects of the incomplete prone position in non-mechanically ventilated adults with a tracheostomy, providing evidence for its clinical management. Non-mechanically ventilated adults (n = 64) with a tracheostomy who met the inclusion and exclusion criteria were included in this randomized controlled trial. They were randomly assigned to either a control group (n = 32) and or an experimental group (n = 32). Both groups received standard tracheostomy care. The experimental group was positioned in the incomplete prone position, while the control group was maintained in the lateral position. Continuous intervention lasted for 7 days. We compared the differences in respiratory oxygenation indicators, pulmonary infection rates, sputum volume, hemodynamics, and the complications between the two groups. After 7 days of intervention, the experimental group demonstrated significantly higher arterial partial pressure of oxygen and oxygenation index than the control group (p < .05). From day 2 onward, pulse oxygen saturation was consistently higher in the experimental group compared to the control group (p < .001). Furthermore, a significantly lower respiratory rate was observed in the experimental group from day 4 onward (p < .001). No statistically significant difference was found in the incidence of pulmonary infection between the two groups (p > .05). However, a significant intergroup difference was observed in the Clinical Pulmonary Infection Score (p < .05). From day 1 to 7, the experimental group exhibited significantly higher daily sputum volume than the control group (p < .001). The analysis of sputum volume revealed significant effects for both time and group (p < .001), but the group-by-time interaction effect was not statistically significant (p = .064). No significant effects for time or group were found on hemodynamic parameters, including heart rate, systolic blood pressure, diastolic blood pressure, and mean arterial pressure (p > .05). Additionally, the group-by-time interaction effect was not statistically significant (p > .05). Importantly, no severe complications occurred in either group. The incomplete prone position significantly improved oxygenation, promoted airway secretion clearance, and reduced pulmonary infection severity in non-mechanically ventilated adults with a tracheostomy.

Many patients, especially those with long-term conditions, face significant challenges in managing their health. Burden of treatment is the effort required for self-managing health. This burden is often intensified by social determinants of health, such as limited access to care and financial instability. Burden of treatment is understudied in socially and medically complex patients, particularly in the critical period of transitioning home after hospital discharge. To address this gap, this study analyzed data from telephone interviews with urban primary care patients who had been recently hospitalized and were identified by an algorithm as having complex medical and social needs, and received a nurse-led outreach call intervention to examine the following areas: (a) how patients with complex health and social needs experience burden of treatment following hospitalization; (b) the individual, interpersonal, and healthcare system factors that patients perceive as impacting burden of treatment; and (c) the impact of an outreach phone call on burden of treatment. The study team completed telephone interviews with 22 patients who received the outreach call intervention, using a semi-structured interview guide based on established treatment burden measurement tools. Interview data were analyzed using rapid qualitative data analysis techniques to identify key themes to answer the research questions. Findings indicated that most participants reported minimal treatment burden across key domains, such as understanding diagnoses, scheduling appointments, managing medications, and engaging in self-care. A minority experienced substantial difficulties, such as frustration with appointment scheduling and challenges with activities of daily living due to their conditions. Several factors were identified as influencing treatment burden, including health condition complexity, family support, and provider communication. Patients generally responded positively to the outreach calls, finding them reassuring and informative. Treatment burden is variable among medically and socially complex patients following hospitalization and is shaped by a number of individual, interpersonal, and healthcare system factors. Further research is needed to develop and evaluate interventions to build healthcare system capacity to serve this population, to minimize treatment burden.

Workplace bullying among nurses significantly impacts patient safety and nurse retention. The psychological predictors of bullying experiences may vary according to nurses' career development stages, necessitating career-specific understanding of underlying factors such as pathological narcissism and interpersonal cognitive distortions. This study aimed to investigate factors affecting workplace bullying (victim aspects) among nurses according to career stage, with a focus on pathologic narcissistic personality, interpersonal cognitive distortion, and organizational culture. This secondary analysis used data originally collected from 236 Korean nurses between January and February 2022. The participants were grouped into early- and mid-career nurses. Pathological narcissistic personality and interpersonal cognitive distortions were measured using the Pathological Narcissism Inventory and Interpersonal Cognitive Distortions Scale, respectively. Workplace bullying was measured using the Negative Acts Questionnaire-Revised. The multiple regression model for early- and mid-career nurses' workplace bullying had an explanatory power of 41.3% and 37.5%, respectively. Organizational culture (β = -.35, p ≤ .001) and narcissistic vulnerability (β = .53, p < .001) were the most significant factors affecting workplace bullying among early- and mid-career nurses, respectively. These findings suggest that interventions to prevent workplace bullying among nurses should be tailored according to career stage. For early-career nurses, efforts to foster a positive and supportive organizational culture are essential; whereas, for mid-career nurses, psychological support addressing narcissistic vulnerability may be more effective.

Identifying the symptoms that most significantly deteriorate patient outcomes (i.e., quality of life [QoL] and daily activities) at specific treatment stages is important in caring for patients with hematologic cancer. Yet, few studies have examined symptom experiences and patient outcomes during the early phases of chemotherapy immediately after diagnosis. Hence, this study aimed to (a) evaluate symptom experience (prevalence, severity), QoL, and interference with daily activities before and 1 week after completing induction chemotherapy and (b) identify key symptoms affecting QoL and daily activities at each time point. The sample included 124 patients undergoing their first chemotherapy for hematologic cancer. We administered the Memorial Symptoms Assessment Scale, a single-item QoL scale, and the symptom-interference subscale of the Brief Pain Inventory. Statistical analyses included Wilcoxon rank-sum tests, Spearman's rho, and multiple-regression analysis. No significant changes emerged in QoL or interference with daily activity scores from pre- to postchemotherapy, suggesting that the impact of chemotherapy on patient outcomes was not instant. However, two items in interference with daily activities worsened following treatment, possibly due to hospitalization: "relationships with others" (p = .03), and "sleep" (p = .001). At both time points, interference with daily activities was highest for "enjoyment of life." Across time points, "lack of energy" most frequently and severely occurred. Symptom experience was strongly associated with interference in daily activities but not with QoL. Significant independent predictors of interference with daily activities were "being irritable" (β = .31, p < .001), "insomnia" (β = .18, p = .04), and "difficulty in concenting" (β = .18, p = .02) before chemotherapy; "difficulty in concentrating" (β = .30, p < .001), "worrying" (β = .30, p = .003), and "lack of energy" (β = .20, p = .02) 1 week after induction chemotherapy. In conclusion, psychological symptoms (e.g., lack of energy, difficulty in concentrating, being irritable, and worrying) were not only prevalent but also greatly influenced daily activities before and after treatment. Nurses should assess and manage these symptoms and be aware of pharmacological/nonpharmacological interventions to alleviate them. Interference in "enjoyment of life" is a notable patient outcome throughout treatment.

This research was conducted to determine the effects of preoperative fasting durations on blood glucose levels, dehydration, and anxiety in patients. This cross-sectional study was conducted in the General Surgery Clinic of a university hospital. The study included 92 patients undergoing elective laparoscopic cholecystectomy. Data collection forms such as the Sociodemographic Characteristics Questionnaire and the State Anxiety Inventory were administered in the preoperative period, while the Dehydration and Blood Glucose Monitoring Form and Visual Analog Scale were applied a total of three times: in the preoperative period, at the second hour postoperatively, and at the 8th hour postoperatively. Necessary permissions were obtained for the study. The patients' mean solid and liquid fasting time was 16.65 (2.80) and 15.85 (2.95) hr. The prolongation of the preoperative mean solid fasting time showed a negative correlation with blood glucose levels and a positive correlation with some dehydration symptoms, skin turgor return time, and the nausea score. The prolongation of the preoperative mean liquid fasting time showed a positive correlation with prominence of lingual fissures, nausea scores, thirst scores, heart rate, skin turgor return time and heart rate. In addition, prolonged solid fasting time was associated with higher anxiety levels. Prolonged fasting before surgery negatively affected patients' anxiety and blood glucose levels and led to dehydration symptoms. Prolonged fasting and fluid restriction before surgery had negative effects on patients' anxiety and blood glucose levels, while also leading to the emergence of some dehydration symptoms.