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.

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).

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.

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.

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.