Clinical Nursing Research最新文献

Advance care planning, involving goals-of-care and surrogate-designation conversations, is crucial for patient-centered care. However, determining the optimal timing and participants for these conversations remains challenging. This study explored the frequency, timing, and predictors of documenting two advance care planning elements, goals-of-care and surrogate-designation conversations, in clinical notes for patients with advanced illness. In this retrospective observational study, we leveraged high-dimensional data and natural language processing (NLP) to analyze clinical notes and predict the presence or absence of advance care planning conversations. We included notes for patients treated at a Midwestern United States hospital who had advanced chronic conditions and eventually passed away. We manually labeled a gold-standard dataset (n = 913 notes) for the presence or absence of advance care planning conversations at the note level, achieving excellent inter-annotator agreement (90.5%). Training and testing four NLP models to detect goals-of-care and surrogate-designation conversations revealed that a transformer-based model (Bidirectional Encoder Representations from Transformers [BERT]) achieved the highest accuracy, with an F1 score of 93.6. We then deployed the BERT model to a high-dimensional corpus of 247,241 notes for 4,341 patients and detected goals-of-care and surrogate-designation conversations in the records of 85% and 60% of patients, respectively. Temporal analysis revealed that goals-of-care and surrogate-designation conversations were first documented at medians 28 and 8 days before death, respectively. Patient characteristics and referral to specialty palliative care emerged as significant factors associated with documenting these conversations. Our findings demonstrate the potential of NLP, particularly Transformer-based models like BERT, to accurately detect goals-of-care and surrogate-designation conversations in clinical narratives. This study identified significant temporal patterns, including late documentation, and patient characteristics associated with these conversations. It highlights the value of high-dimensional data in enhancing our understanding of advance care planning and offers insights for improving patient-centered care in clinical settings. Future research should explore the integration of these models into clinical workflows to facilitate timely and effective advance care planning discussions.

Glucocorticoids are commonly used in the management of patients with hematological and solid malignancies. However, their use may be associated with impaired glycemic metabolism and increased treatment-related morbidity and mortality. This study aimed to examine the feasibility and acceptability of a nurse-led model of care (MOC) for screening and managing glucocorticoid-induced hyperglycemia (GIH) in non-diabetic patients requiring high-dose glucocorticoid (HDG) therapies, as well as patients' and health professionals' experiences with the MOC. This study was a single-site feasibility study. Patients with hematological or oncological malignancies who were >18 years of age, receiving a chemotherapy regimen including HDGs, had no prior diagnosis of diabetes or prediabetes, and were not at the end of life were considered eligible for this study. Participants were recruited from a district hospital's Cancer Centre in Australia. All consenting participants were screened for diabetes and were provided with a blood glucose meter to monitor their blood glucose levels (BGLs) four times a day on the days of glucocorticoid therapy (GT) plus one extra day following GT, for the first four cycles of their treatment, to screen for the presence of GIH. Feasibility and acceptability were assessed using rates of consent, study completion, and staff and patient surveys. Forty-eight percent (35/74) of patients approached consented to participate in the study and had screening tests for preexisting diabetes. None were diagnosed with diabetes. Six out of 35 patients withdrew, and 10/29 patients did not complete the recommended BGL monitoring. Thirteen percent (4/29) of patients developed GIH. The most common reasons for non-participation and study withdrawal were related to the self-monitoring of BGLs. While clinical stakeholders found the MOC feasible and acceptable, the results of this study suggest that alternative methods for encouraging self-monitoring of BGL and monitoring the presence of GIH during high-dose chemotherapy need to be explored to address issues associated with adherence and sustainability.

In Brazil, research indicates that primary family members are the main source of support for individuals with chronic conditions such as hypertension (HTN). The burden of caregiving not only hinders effective HTN management but can also cause stress and anxiety, potentially leading to HTN in caregivers. Despite this, few studies have explored the impact of caregiving on these family members. Aims of the study were to: (1) Describe the prevalence of blood pressure (BP) control in family members of individuals with HTN; (2) identify family member perspectives on facilitators and barriers to HTN management; and (3) identify influences that help or interfere with family member functioning (levels of stress, quality of life [QOL], and caregiver burden). This descriptive, cross-sectional study included 213 family members randomly selected from 3 Family Health Strategy units. Family members were largely female (n = 143; 67.1%); the mean age was 60.1 years (SD ± 17.02) and 42.6% (n = 96) had less than a high school education. The three most important facilitators and barriers were related to medication, medical visits, healthy eating, physical activity, and stress. The mean systolic BP was 132.7 (SD ± 21.9) mmHg and a diastolic BP of 85.9 (SD ± 18.1) mmHg with 120 (56.3%) of family members classified as having normal BP. In regard to family member contributions to the self-care of the individual with HTN, family members displayed low levels of self-care maintenance (n = 148; 69.4%) and management (n = 47; 71.2%) support, while a slight majority (n = 114; 53.5%) had adequate levels of self-care confidence in supporting the individual with HTN. Family members (n = 189; 88.8%) showed moderate-to-high levels of perceived stress, but good physical (n = 189; 88.7%) and mental QOL (n = 196; 92%) and low levels of caregiver burden (n = 113; 53.1%). A variety of contextual sociocultural influences were associated with the outcomes under study. Family-based interventions are urgently needed to address the inadequate management of HTN.

In the midst of a pandemic like COVID-19, migrant workers are highly vulnerable to the risk of mental health challenges and disorders. This study aimed to examine the variations in mental health and associated factors among migrant workers in Korea during and after the COVID-19 pandemic. A total of 830 migrant workers were included in this quantitative population-based study across two distinct COVID-19 periods: 415 from August 15, 2020 to January 20, 2021 (termed "during COVID-19" post-WHO pandemic declaration) and 415 from June 10 to September 18, 2023 (termed "after COVID-19" post-WHO and Korean Government announcement of the end COVID-19 as a global health emergency). The mental health of migrants was assessed using Patient Health Questionnaire-9 for depression and Generalized Anxiety Disorder-7 for anxiety, and compared between the two defined COVID-19 periods. Migrant workers exhibited higher means of depression (15.99 ± 5.16 vs. 8.78 ± 5.77) and anxiety (11.02 ± 4.45 vs. 6.97 ± 4.42) during the COVID-19 compared to after the COVID-19. The prevalence of severe depression (30.4% vs. 8.2%, p = .038) and severe anxiety (24.1% vs. 5.3%, p = .047) was significantly higher during the COVID-19 than after the pandemic. Changes in the mean depression scores among migrants were significantly influenced by living status (0.12 ± 11.10, p = .030) and employment status (0.44 ± 10.33, p = .043), while changes in mean anxiety scores were influenced by social relief funds (2.88 ± 8.61, p = .046) and employment status (1.13 ± 8.39, p = .012). This study highlights the increased susceptibility of migrant workers to depression and anxiety during COVID-19 compared to after the pandemic. Thus, it is imperative to prioritize the expansion of social support funds, ensure employment stability, and implement regular health check-up services to reduce mental health disorders among migrants.

One and a half million cardiac surgeries are completed worldwide each year where undertreated postoperative pain increases the risk of patient morbidity and mortality. Patient-centered pain management is recommended to improve patient outcomes but there is insufficient information regarding how the patient views their role. The objective of this study is to explore cardiac surgery patients' perspectives on their role in postoperative pain management. This study used an interpretive phenomenological design and convenience sampling. Six participants who had undergone cardiac surgery were recruited from a cardiac rehabilitation program in Western Canada. The first author conducted semi-structured digitally recorded interviews. Sociodemographic characteristics and measures of anxiety and depression were also collected. Emergent thematic analysis of the qualitative data generated three themes: attitude, coping and care, and communication. The findings of this study address a gap in the literature with regard to patients' perceived roles in pain management. There is a complex relationship between patient attitude, coping and care, and communication which, in turn, influences how patients view their role within the pain management continuum. These themes contribute to the development of the patient role within the pain management continuum and form an integrated feedback loop. The patient's attitude contributes to their ability to cope with pain and participate in pain assessment and management. Furthermore, their ability to cope and desire to participate influences the development of their attitude. These findings may enhance providers' understanding of the patient's perspective and improve pain management outcomes.

The objective of this article is to illustrate the importance of the role philosophy and its tools play in the designing and undertaking of nursing research and its importance to be understood by the practicing researcher to ensure the selected methodology and the tools used provide the framework for obtaining reliable and valid answers to their research questions. The article discusses the three major paradigms (Positivism, Interpretivism, and Pragmatism) which have characterized much of health-related research together with a set of essential and practical tools with no metaphysical assumptions that will hopefully provide an explicit framework and a nomenclature which can be applied as we proceed through the research process.

Psychiatric nurses who work with people who are involved with the justice system experience ethical and moral tension arising from their dual role (care and control). This is known to significantly affect the development of a therapeutic relationship between nurses and patients. (a) better understand how justice system involvement affects people living with mental disorders and the nurses who work with them; (b) explore the influence of judiciarization on social interactions between these actors. Grounded theory (GT) was used as the qualitative methodology for this research. Semi-structured interviews were conducted with participants. The study was carried out in three different units of a psychiatric institution: Psychiatric Intensive Care Unit, Emergency Department, and Brief Intervention Unit. A sample of 10 patients and 9 psychiatric nurses was recruited (n = 19). Theoretical sampling was used to recruit participants. We followed the iterative steps of qualitative GT analysis (open coding, axial coding, constant comparison, and modelization). Three main themes emerged from the qualitative analysis: (a) Experience of Justice System Involvement, (b) Crisis, (c) Relational Aspects and Importance of the Approach. These results will inform nurses and healthcare providers about the impacts of justice system involvement on people living with mental illness and how clinical practices can be better adapted to this population with complex health needs.

Chronic kidney disease (CKD) has considerable effects on the quality of life of female patients. Receiving the diagnosis and beginning renal replacement therapy (RRT) has a great personal impact on patients. The purpose of this study was to describe the experience of female patients with CKD at an ambulatory dialysis unit regarding diagnosis, life changes, and initiation of RRT. A qualitative exploratory study was conducted based on a social contructivism framework. Participants were recruited using purposeful sampling. In total, 18 women who received treatment for CKD with RRT were included. The women were attending the Ambulatory Dialysis Unit at a hospital belonging to the public health system of Madrid (Spain). Unstructured and semi-structured in-depth interviews, researchers' field notes, and women's personal letters were used. A systematic text condensation analysis was performed. The criteria used to control trustworthiness were credibility, transferability, dependability, and confirmability. Two themes emerged from the data: (a) A turning point in their lives, and (b) The emotional journey of beginning RRT. The diagnosis of CKD and the beginning of treatment implies changing routines and adapting to a new life with CKD. The first dialysis and puncture of the arteriovenous fistula is a major experience. Support from other CKD patients with more experience is perceived as a necessity and a tool to share their experiences and resolve doubts among peers. The diagnosis and initiation of RRT leads to numerous changes in the lives of women with CKD, which may influence the acceptance of treatment.

Race/ethnicity and individual-level socioeconomic status (SES) may contribute to health disparities in liver transplant (LT) outcomes. The socioeconomic conditions of a neighborhood may either mitigate or exacerbate these health disparities. This retrospective study investigated the relationship between race/ethnicity, individual- and neighborhood-level SES, and LT outcomes, and whether neighborhood-level SES modified the relationship between individual factors and LT outcomes. Adult individuals who underwent LT between 2010 and 2019 (n = 55,688) were identified from the United Network for Organ Sharing database. Primary exposures were race/ethnicity, education, primary insurance type, and the Social Deprivation Index (SDI) scores. Education and primary insurance type were used as proxies for individual-level SES, while SDI scores were used as a proxy for neighborhood-level SES. The primary outcome was time to occurrence of graft failure or mortality. Cox proportional hazard models were used to examine the associations between the exposures and outcomes. LT recipients who were Black (hazard ratio [HR]: 1.27, p < .0001), completed high school or less (HR: 1.06, p = .002), and had public insurance (HR: 1.14, p < .0001) had a higher rate of graft failure or mortality than those who were White, completed more than high school, and had private insurance, respectively. The SDI scores were not significantly associated with LT outcomes when adjusting for individual factors (HR: 1.02, p = .45) and did not modify the associations between individual factors and LT outcomes. Findings of this study suggest that disparities based on individual factors were not modified by neighborhood-level SES. Tailored interventions targeting the unique needs associated with race/ethnicity and individual-level SES are needed to optimize LT outcomes.