Clinical Nursing Research最新文献

We explored the influence of social determinants of health (SDH) risk on stress and coping style in heart failure (HF) caregivers. In this cross-sectional study, data from 250 caregivers were analyzed. Multivariable linear regression analyses were performed to determine the extent to which SDH risk (measured using a modified PRAPARE tool (National Association of Community Health Centers), range 0-22) predicted stress (Perceived Stress Scale, 0-56) and coping style (active (0-45), avoidance (0-30), and minimization (0-30)) while accounting for caregiver burden (HF Caregiver Questionnaire (HF-CQ) 0-100). Multivariable regression analysis with backwards elimination variable selection approach was used to identify which SDH risk factors best predicted coping styles. SDH risk was significantly associated with avoidance and minimization coping styles. Each unit increase in SDH risk was associated with an increase of 0.6 ± 0.2 units (p = .0008) in avoidance and 0.7 ± 0.2 units (p < .0001) in minimization coping style. Race and "supporting others" significantly predicted avoidance coping style; scores were 3.3 ± 0.8 units greater for caregivers who were not White (p < .0001) and 1.4 ± 0.5 units greater (p < .01) for each additional person whom they supported. Race significantly predicted minimization coping style; scores were 4.4 ± 0.7 units greater for caregivers who were not White (p < .0001). Caregivers with higher SDH risk may avoid and minimize to cope with caregiving challenges.

Several individual social determinants of health have been identified as significant factors contributing to achieving glycemic targets (glycated hemoglobin < 7). However, it remains unclear how these social variables individually or collectively contribute to glycemic targets among adults with type 2 diabetes (T2D) in the United States (U.S.) The purpose of the current integrative review (IR) was to describe and synthesize findings from studies on social determinants of glycemic target achievement in adults with T2D in the U.S. and integrate them into the United States Department of Health and Human Services Conceptual Framework. The databases searched included PubMed, CINAHL Plus with Full Text, Medline with Full Text [EBSCO], Google Scholar, bibliography, and hand searching. A total of 948 records were identified. After excluding duplicates and irrelevant studies based on inclusion and exclusion criteria through title, abstract, and full-text screening, 13 studies were finally included in this IR. The results revealed that race/ethnicity, economic access and stability, educational access and quality, healthcare access and quality, neighborhood and built environment, and social and community context contribute to glycemic target achievement among adult patients with T2D in the U.S. Integrating findings from key studies on social determinants of glycemic health may contribute to developing interventions aimed at reducing and eventually eradicating health disparities for individuals with and at risk for T2D in the U.S.

The status syndrome proposed by Marmot is located at the closest level of influence within the Social Determinants of Health (SDH) framework, connecting the body's response to the mental states that arise from the subjective experience of social status. Marmot defines these psychological states through concepts of autonomy and social integration articulated in the Capability Approach (CA). These elements are further explored and expanded upon with the Self-Determination Theory (SDT), an empirically based framework with an extensive tradition of practical application. This lays the groundwork not only for understanding what makes a social environment conducive to well-being but also for shedding light on ways to promote it. The article goes beyond theoretical discussions by introducing a structured model based on the principles of the SDT for health promotion interventions. The model emphasizes the importance of providing a supportive atmosphere and is organized into four distinct phases aimed at aligning interventions with individual motivations, and cultural contexts. Ultimately, the goal is to engage individuals to actively participate in their own well-being while addressing the complexities associated with social inequalities in developed societies.

Depression is recognized as a significant public health issue in the United States. The National Survey on Drug Use and Health reports that 21.0 million adults aged 18 or older had major depressive disorder in 2020, including 14.8 million experiencing a major depressive episode with severe impairment. The aim is to predict the positivity of Patient Health Questionnaire-2 (PHQ-2) outcomes among patients in primary care settings by analyzing a range of variables, including socioeconomic status, demographic characteristics, and health behaviors, thereby identifying those at increased risk for depression. Employing a machine learning approach, the study utilizes retrospective data from electronic health records across 15 primary care clinics in South Florida to explore the relationship between social determinants of health (SDoH), including area of deprivation index (ADI) and PHQ-2 positivity. The study encompasses 15 primary care clinics located in South Florida, where a diverse patient population receives care. Analysis included 94,572 patient visits; 74,636 records were included in the study. If a zip+4 was not available or an ADI score did not exist, the visit was not included in the final analysis. Screening involved the PHQ-2, assessing depressed mood and anhedonia, with a cutoff >2 indicating positive screening. ADI was used to assess SDoH by matching patients' residential postal codes to ADI national percentiles. Demographics, sexual history, tobacco use, caffeine intake, and community involvement were also evaluated in the study. Over 40 machine learning algorithms were explored for their accuracy in predicting PHQ-2 outcomes, using software tools including Scikit-learn and stats models in Python. Variables were normalized, scored, and then subjected to predictive regression models, with Random Forest showing outstanding performance. Feature engineering and correlation analysis identified ADI, age, education, visit type, coffee intake, and marital status as significant predictors of PHQ-2 positivity. The area under the curve and model accuracies varied across clinics, with specific clinics showing higher predictive accuracy and others (p > .05). The study concludes that the ADI, as a proxy for SDoH, alongside other individual factors, can predict PHQ-2 positivity. Health organizations can use this information to anticipate health needs and resource allocation.

Lack of access to primary care contributes to health inequities. Treatment settings that utilize the full experience and training of nurses, both registered nurses (RNs) and advanced practice registered nurses (APRNs), can expand in primary care and successfully address health inequities. This small study describes the implementation of a model of primary care called intensive primary care (IPC), which has eight elements that support the full utilization of a nurse's experience and training. This is a mixed method qualitative study, which reports the observations of the implementation and pre- and post-intervention measures. The IPC model was implemented at a free clinic, which targeted underserved population between 2020 and 2023. Participants were selected as a convenience sample. Participants were to have two or more chronic health problems The participants received primary care using the IPC model, which included setting self-management goals, and meeting with RN or APRN on a monthly basis (face to face, via phone or zoom) to monitor progress toward goals. Twenty-two people were approached, and 19 completed the intervention. Pre- and Post-intervention measures (Patient Assessment of Chronic Illness Care [PACIC]-20); Functional, Communicative, Critical Thinking Health Literacy; Perceived Stress; Patient Activation; Perceived Self Efficacy for Chronic Disease; EuroQo- 5 Dimension (EQ-5D); Trust in Provider; Emotional Support-Patient Reported Outcome Measure Information System (PROMIS); and Patient Health Questionnaire-9) were obtained and analyzed with paired T test (α < .05). Nurses involved meet weekly to share observations recorded in free form notes. These observations were summarized by two of the authors (MD and KF) at the end of the study. All patients had improved physical health outcomes, but more importantly, there were significant improvements in measures known to impact health and health outcomes, specifically, patient activation, self-efficacy for chronic illness, PACIC, and trust in provider. Time spent with patients, both duration and frequency of contact, was observed to have significant impacts.

Around 5% to 10% of hospitalized patients develop a hospital-acquired infection (HAI). Scrubs are a potential vector of HAIs. To compare the antimicrobial characteristics of scrubs with and without an antimicrobial fabric coating, as tested in the laboratory (in vitro) and hospital (in vivo) environments. Two protocols were conducted to address the purpose. The in vitro protocol was a laboratory study that involved observing the microbe growth after inoculating coated and uncoated scrub fabric swatches with S. aureus and then processing them in moist and dry environments. The in vivo protocol was a clinical trial that measured microbe growth on coated and uncoated scrubs prior to and following nursing staff completing a 12-hr shift on an acute care unit, as measured by colony forming units (CFUs). For high-humidity environments, the in vitro study indicated that swatches treated with an antimicrobial coating exhibited minimal microbe growth, while untreated swatches exhibited significant microbe growth. For low-humidity environments, coated and uncoated swatches were all found to exhibit minimal microbe growth. In the in vivo study, the CFUs increased on scrubs worn by nurses over a 12-hr shift with no significant difference in CFUs for coated and uncoated scrubs. For bacteria in a warm and moist environment, the antimicrobial coating was found to be important for inhibiting growth. For bacteria in a warm and dry environment, both coated and uncoated fabrics performed similarly as measured at 24 hr, with minimal bacterial growth observed. In a hospital environment, microbe growth was observed, but no significant difference was detected when comparing coated and uncoated scrubs. This may have been due to the short time between exposure and culturing the scrubs for analysis immediately at the end of the shift not allowing for enough time to kill or inhibit growth. Contact time between the bacteria and scrub fabric (coated or uncoated) in the in vivo study more directly correlated with the 0-hr observations for the in vitro study, suggesting that the ineffectiveness of the treated scrubs in the clinical results may be due in part to short residence times before collection.

Saliva measurements serve as a noninvasive tool for clinically monitoring newborns (NB) and children, a vulnerable population with promising potential for both research and clinical practice. Saliva acts as a repository for various inflammatory biomarkers involved in diverse biological functions. Particularly for children, it offers numerous advantages when compared to plasma and urine sampling. Nevertheless, there is a significant knowledge gap regarding detectable levels of cytokines in the saliva of newborns and children, as well as studies aiming to assess the relationship of this content with physiological and pathological processes.

Objectives: To characterize the levels of 11 inflammatory mediators (IFNg, IL1b, IL2, IL4, IL6, IL8, IL10, IL12, IL17, TNF, and VEGF) in saliva samples from NB on the first and second day of hospitalization in the Neonatal Intensive Care Unit (NICU).

Method: Exploratory study, descriptive, nested within a primary clinical, observational, and prospective study, conducted in the NICU of a public hospital in São Paulo, Brazil. Demographic data and vital signs were recorded in the clinical records of 90 NB, and five saliva samples from 5 NB were collected between the first and second day of life (D1-D2) at approximately 8-hr intervals (8-9 am, 4-5 pm, and 11-12 pm). Saliva samples were used for the measurement of 11 cytokines (IFNg, IL1b, IL2, IL4, IL6, IL8, IL10, IL12, IL17, TNF, and VEGF).

Results: Five NBs participated in this exploratory study, and the vital signs showed variability from the first (D1) to the second day (D2) of hospitalization, variability similar to that of the total population of the primary study. The presence and levels of the 11 cytokines were detected in the saliva samples, as well as a statistical correlation between 10 cytokines (IFNg, IL1b, IL2, IL4, IL6, IL10, IL12, IL17, TNF, and VEGF) and vital signs.

Conclusions: The novelty of measuring inflammatory mediators in saliva samples from hospitalized NBs in the NICU is highlighted, providing support and new perspectives for the development of clinical and experimental research and an opportunity for developing and implementing new salivary biomarkers in different population segments.

This retrospective study investigated the long-term incidence and risk of postoperative complications following spinal fusion. This study included 640,366 participants from a National Health Examination cohort in the Republic of Korea. Among them, 11,699 individuals underwent spinal fusion, and 56,667 individuals who underwent non-fusion spinal procedures served as controls. Propensity score matching was used to account for patient characteristics including demographic factors, comorbidities, and other relevant variables. The participants were followed for 8 years to assess the occurrence of cerebrovascular disease (CVD), hemorrhagic infarction (HA), ischemic infarction (II), occlusion and stenosis, and ischemic heart disease (IHD). The incidence rates of CVD and IHD were found to be 27.58 and 31.45 per 1,000 person-years in the spinal fusion group compared to 18.68 and 25.73 per 1,000 person-years in the control group (p < .001), respectively. Patients who underwent spinal fusion had a higher risk of CVD, HA, and IHD than those in the control group (all p < .001). In the subgroup analysis, thoracolumbar and noncervical spinal fusion were associated with a higher risk of CVD, II, and IHD (all p < .005). Patients undergoing thoracolumbar fusion may have an increased association with CVD, II in cerebral arteries, and IHD. This suggests a need for careful consideration of vascular risks in such patient populations.

Patient-reported outcome measures (PROMs) play a central role in clinical research and patient care resulting in a plethora of standardized PROMs to measure a range of constructs, including disease symptoms, health-related quality of life, and health status (Meadows/Reaney) used in a range of settings, including the nursing environment. However, the use of PROMs in drug development and their use in healthcare evaluation do not easily marry together. In drug development, standardization of measurement is key to the interpretation of the formation at a population level with minimal biases. However, in health care, the individual patient perspective, priority, and needs should be taken into account whereas, in the clinical encounter, one has to also deal with what is particular and unique. The purpose of this paper is to describe the characteristics of the phenomenological method as a means within a mixed-method framework, to supplement participants' patient-reported outcome numeric scores with a more in-depth commentary on the essence of the lived health experiences.