Applied Nursing Research最新文献

Psychological capital and organizational culture as mediators between workplace bullying type and its consequences for male nurses 心理资本和组织文化在男护士职场欺凌类型及其后果之间的中介作用

IF 2.2 4区医学 Q1 NURSING

Applied Nursing Research

Pub Date : 2026-01-10 DOI: 10.1016/j.apnr.2026.152048

Byung-Kul Lee , Young Sook Roh

Background

Workplace bullying among nurses has gained prominence as a crucial societal concern. Although previous studies have examined gender differences in workplace bullying and have often reported no significant differences by gender, research focusing specifically on the experiences of male nurses remains relatively limited.

Purpose

This study aimed to examine the impact of workplace bullying types on the consequences and to explore the mediating roles of psychological capital and nursing organizational culture among male nurses.

Methods

This study was a cross-sectional descriptive survey with a convenience sample of 175 male nurses. Participants completed a web-based self-administered questionnaire. A mediation analysis was conducted to examine the indirect effects of psychological capital and organizational culture on the relationships between workplace bullying types and their consequences.

Results

The type of workplace bullying had a significant direct effect on its consequences and a partial indirect effect via psychological capital. Nursing organizational culture did not significantly mediate this relationship. The model explained 49.7% of the variance in consequences.

Conclusions

These findings suggest that the type of workplace bullying directly affects the consequences, and psychological capital partially mediates this relationship. Enhancing psychological capital may help mitigate the negative outcomes of workplace bullying, whereas the nursing organizational culture showed no significant mediating effect.

护士的职场欺凌已经成为一个重要的社会问题。虽然以前的研究已经调查了职场欺凌中的性别差异，并且经常报告没有显著的性别差异，但专门针对男护士经历的研究仍然相对有限。目的探讨职场欺凌类型对男护士职场欺凌后果的影响，并探讨心理资本和护理组织文化的中介作用。方法采用横断面描述性调查方法，方便抽样175名男护士。参与者完成了一份基于网络的自我管理问卷。通过中介分析，考察了心理资本和组织文化对职场欺凌类型及其后果关系的间接影响。结果职场霸凌类型通过心理资本对霸凌后果有显著的直接影响，并有部分间接影响。护理组织文化对这一关系无显著调节作用。该模型解释了49.7%的结果差异。结论职场霸凌类型直接影响霸凌后果，心理资本在其中起部分中介作用。增强心理资本可能有助于缓解职场欺凌的负面后果，而护理组织文化没有显著的中介作用。

{"title":"Psychological capital and organizational culture as mediators between workplace bullying type and its consequences for male nurses","authors":"Byung-Kul Lee , Young Sook Roh","doi":"10.1016/j.apnr.2026.152048","DOIUrl":"10.1016/j.apnr.2026.152048","url":null,"abstract":"<div><h3>Background</h3><div>Workplace bullying among nurses has gained prominence as a crucial societal concern. Although previous studies have examined gender differences in workplace bullying and have often reported no significant differences by gender, research focusing specifically on the experiences of male nurses remains relatively limited.</div></div><div><h3>Purpose</h3><div>This study aimed to examine the impact of workplace bullying types on the consequences and to explore the mediating roles of psychological capital and nursing organizational culture among male nurses.</div></div><div><h3>Methods</h3><div>This study was a cross-sectional descriptive survey with a convenience sample of 175 male nurses. Participants completed a web-based self-administered questionnaire. A mediation analysis was conducted to examine the indirect effects of psychological capital and organizational culture on the relationships between workplace bullying types and their consequences.</div></div><div><h3>Results</h3><div>The type of workplace bullying had a significant direct effect on its consequences and a partial indirect effect via psychological capital. Nursing organizational culture did not significantly mediate this relationship. The model explained 49.7% of the variance in consequences.</div></div><div><h3>Conclusions</h3><div>These findings suggest that the type of workplace bullying directly affects the consequences, and psychological capital partially mediates this relationship. Enhancing psychological capital may help mitigate the negative outcomes of workplace bullying, whereas the nursing organizational culture showed no significant mediating effect.</div></div>","PeriodicalId":50740,"journal":{"name":"Applied Nursing Research","volume":"87 ","pages":"Article 152048"},"PeriodicalIF":2.2,"publicationDate":"2026-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145976749","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Effect of a nurse-led, triangle-based hierarchical management model on patients undergoing maintenance hemodialysis: A randomized controlled trial 护士主导的基于三角形的分层管理模式对维持性血液透析患者的影响：一项随机对照试验

IF 2.2 4区医学 Q1 NURSING

Applied Nursing Research

Pub Date : 2026-01-07 DOI: 10.1016/j.apnr.2025.152045

Fei Zha , Liqiong Tang , Wenwen Li , Jianming Shen , Yanyan Deng

Background

Maintenance hemodialysis (MHD) imposes a high disease burden, leading to diminished quality of life (QoL) and poor treatment adherence. Conventional nursing often lacks individualized, risk-stratified strategies. This study aimed to evaluate the effectiveness of a nurse-led, Triangle-Based Hierarchical Management model on patient outcomes.

Methods

In this prospective, single-center, cluster-randomized trial, 80 MHD patients were assigned to an observation group (n = 40) receiving the 24-week Triangle model intervention or a control group (n = 40) receiving routine care. The primary outcome was the change in Kidney Disease Quality of Life-Short Form (KDQOL-SF™) KDTA score. Secondary outcomes included self-management, adherence, knowledge, and hospitalization rates. Intention-to-treat analysis was performed using ANCOVA.

Results

Seventy-one patients completed the study. The observation group demonstrated significantly greater improvement in the primary KDTA score compared to controls (mean difference: 7.59; 95 % CI: 3.54 to 11.64; P < 0.001). Significant improvements were also observed in self-management (mean difference: 6.63; 95 % CI: 3.10 to 10.16; P < 0.001) and treatment adherence (mean difference: 10.09; 95 % CI: 5.61 to 14.57; P < 0.001). Furthermore, the hospitalization rate was significantly lower in the observation group (11.1 % vs. 28.6 %; P = 0.048).

Conclusion

The nurse-led Triangle Hierarchical Management model significantly improved quality of life, self-management, and adherence, while reducing hospitalizations in MHD patients. These findings support the adoption of risk-stratified nursing models in chronic disease management.

背景：维持性血液透析（MHD）带来了很高的疾病负担，导致生活质量（QoL）下降和治疗依从性差。传统护理往往缺乏个性化、风险分层的策略。本研究旨在评估护士主导的基于三角的分层管理模式对患者预后的有效性。方法在这项前瞻性、单中心、集群随机试验中，80例MHD患者被分为观察组（n = 40）和对照组（n = 40），观察组接受24周三角模型干预，对照组接受常规护理。主要终点是肾病短生命质量（KDQOL-SF™）KDTA评分的变化。次要结局包括自我管理、依从性、知识和住院率。意向治疗分析采用ANCOVA进行。结果71例患者完成了研究。与对照组相比，观察组的KDTA评分有显著改善（平均差异：7.59;95% CI: 3.54 ~ 11.64; P < 0.001）。在自我管理（平均差异：6.63;95% CI: 3.10至10.16;P < 0.001）和治疗依从性（平均差异：10.09;95% CI: 5.61至14.57;P < 0.001）方面也观察到显著改善。观察组住院率明显低于对照组（11.1%比28.6%,P = 0.048）。结论护士主导的三角分层管理模式显著提高了MHD患者的生活质量、自我管理和依从性，同时减少了住院率。这些发现支持在慢性病管理中采用风险分层护理模式。

{"title":"Effect of a nurse-led, triangle-based hierarchical management model on patients undergoing maintenance hemodialysis: A randomized controlled trial","authors":"Fei Zha , Liqiong Tang , Wenwen Li , Jianming Shen , Yanyan Deng","doi":"10.1016/j.apnr.2025.152045","DOIUrl":"10.1016/j.apnr.2025.152045","url":null,"abstract":"<div><h3>Background</h3><div>Maintenance hemodialysis (MHD) imposes a high disease burden, leading to diminished quality of life (QoL) and poor treatment adherence. Conventional nursing often lacks individualized, risk-stratified strategies. This study aimed to evaluate the effectiveness of a nurse-led, Triangle-Based Hierarchical Management model on patient outcomes.</div></div><div><h3>Methods</h3><div>In this prospective, single-center, cluster-randomized trial, 80 MHD patients were assigned to an observation group (<em>n</em> = 40) receiving the 24-week Triangle model intervention or a control group (n = 40) receiving routine care. The primary outcome was the change in Kidney Disease Quality of Life-Short Form (KDQOL-SF™) KDTA score. Secondary outcomes included self-management, adherence, knowledge, and hospitalization rates. Intention-to-treat analysis was performed using ANCOVA.</div></div><div><h3>Results</h3><div>Seventy-one patients completed the study. The observation group demonstrated significantly greater improvement in the primary KDTA score compared to controls (mean difference: 7.59; 95 % CI: 3.54 to 11.64; <em>P</em> < 0.001). Significant improvements were also observed in self-management (mean difference: 6.63; 95 % CI: 3.10 to 10.16; <em>P</em> < 0.001) and treatment adherence (mean difference: 10.09; 95 % CI: 5.61 to 14.57; P < 0.001). Furthermore, the hospitalization rate was significantly lower in the observation group (11.1 % vs. 28.6 %; <em>P</em> = 0.048).</div></div><div><h3>Conclusion</h3><div>The nurse-led Triangle Hierarchical Management model significantly improved quality of life, self-management, and adherence, while reducing hospitalizations in MHD patients. These findings support the adoption of risk-stratified nursing models in chronic disease management.</div></div>","PeriodicalId":50740,"journal":{"name":"Applied Nursing Research","volume":"87 ","pages":"Article 152045"},"PeriodicalIF":2.2,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145976751","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Evaluating a nurse-managed alcohol withdrawal syndrome pathway: A symptom-triggered protocol study 评估护士管理的酒精戒断综合征途径：一项症状触发的方案研究

IF 2.2 4区医学 Q1 NURSING

Applied Nursing Research

Pub Date : 2026-01-04 DOI: 10.1016/j.apnr.2025.152047

Megan Burnette , Amy Cooley , Mary Mills , Meredith Lucas , Olawunmi Obisesan

Aim

This retrospective, single-center nursing research study evaluates the effectiveness of a standardized, stepwise, nurse-managed protocol for Alcohol Withdrawal Syndrome (AWS). The primary objective was to determine how nursing process measures—specifically Time to First AWS Assessment—associate with inpatient Length of Stay (LOS).

Background

AWS significantly affects resource utilization. While symptom-triggered protocols are standard, empirical evidence is needed regarding nurse-managed models that grant autonomy in medication titration.

Methods

We analyzed 419 patients managed under a nurse-managed Lorazepam protocol. Predictors of LOS were evaluated via hierarchical multiple regression, controlling for demographics and baseline severity.

Results

Participants had an average age of 54.03 years (±14.98), with 72.3 % identifying as male and 83.8 % as White. The median time from admission to the first AWS assessment was 7 hours. The percentage of patients with moderate to severe withdrawal symptoms decreased from 48.3 % at the first AWS assessment to 21.7 % at the last evaluation. Hierarchical regression confirmed that Time to First AWS Assessment was a significant independent predictor of LOS (p < 0.05, 95 % CI [0.025, 0.125]), with every minute of delay associated with a proportional increase in stay duration.

Conclusions

Formalizing nurse autonomy through structured protocols improves clinical efficiency. While limited by its single-center design, the study suggests that early nursing intervention is a critical driver of reduced LOS.

目的：本回顾性单中心护理研究评估了一种标准化的、逐步的、护士管理的酒精戒断综合征（AWS）治疗方案的有效性。主要目的是确定护理过程测量-特别是第一次AWS评估时间-与住院时间（LOS）的关系。daws对资源的利用影响很大。虽然症状触发的方案是标准的，但关于护士管理的模式，在药物滴定中赋予自主权，还需要经验证据。方法对419例采用护士管理的劳拉西泮治疗方案的患者进行分析。通过分层多元回归评估LOS的预测因子，控制人口统计学和基线严重程度。结果参与者平均年龄为54.03岁（±14.98岁），男性占72.3%，白人占83.8%。从入院到第一次AWS评估的中位时间为7小时。出现中度至重度戒断症状的患者比例从第一次AWS评估时的48.3%下降到最后一次评估时的21.7%。分层回归证实，首次AWS评估时间是LOS的重要独立预测因子（p < 0.05, 95% CI[0.025, 0.125]），每延迟一分钟与住院时间成比例增加相关。结论通过结构化协议使护士自主权正规化，可提高临床效率。尽管受到单中心设计的限制，该研究表明早期护理干预是降低LOS的关键驱动因素。

{"title":"Evaluating a nurse-managed alcohol withdrawal syndrome pathway: A symptom-triggered protocol study","authors":"Megan Burnette , Amy Cooley , Mary Mills , Meredith Lucas , Olawunmi Obisesan","doi":"10.1016/j.apnr.2025.152047","DOIUrl":"10.1016/j.apnr.2025.152047","url":null,"abstract":"<div><h3>Aim</h3><div>This retrospective, single-center nursing research study evaluates the effectiveness of a standardized, stepwise, nurse-managed protocol for Alcohol Withdrawal Syndrome (AWS). The primary objective was to determine how nursing process measures—specifically Time to First AWS Assessment—associate with inpatient Length of Stay (LOS).</div></div><div><h3>Background</h3><div>AWS significantly affects resource utilization. While symptom-triggered protocols are standard, empirical evidence is needed regarding nurse-managed models that grant autonomy in medication titration.</div></div><div><h3>Methods</h3><div>We analyzed 419 patients managed under a nurse-managed Lorazepam protocol. Predictors of LOS were evaluated via hierarchical multiple regression, controlling for demographics and baseline severity.</div></div><div><h3>Results</h3><div>Participants had an average age of 54.03 years (±14.98), with 72.3 % identifying as male and 83.8 % as White. The median time from admission to the first AWS assessment was 7 hours. The percentage of patients with moderate to severe withdrawal symptoms decreased from 48.3 % at the first AWS assessment to 21.7 % at the last evaluation. Hierarchical regression confirmed that Time to First AWS Assessment was a significant independent predictor of LOS (<em>p</em> < 0.05, 95 % CI [0.025, 0.125]), with every minute of delay associated with a proportional increase in stay duration.</div></div><div><h3>Conclusions</h3><div>Formalizing nurse autonomy through structured protocols improves clinical efficiency. While limited by its single-center design, the study suggests that early nursing intervention is a critical driver of reduced LOS.</div></div>","PeriodicalId":50740,"journal":{"name":"Applied Nursing Research","volume":"87 ","pages":"Article 152047"},"PeriodicalIF":2.2,"publicationDate":"2026-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145924783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Factors influencing nurses' safety voices about patient safety concerns: A cross-sectional study 影响护士对患者安全问题安全发声的因素：一项横断面研究

IF 2.2 4区医学 Q1 NURSING

Applied Nursing Research

Pub Date : 2026-01-04 DOI: 10.1016/j.apnr.2025.152046

Shinae Ahn

Aim

This study aimed to examine the relationships among perceived concerns about patient safety, patient safety culture, systems thinking, and nurses' safety voices.

Background

Nurses' speaking up behavior is a crucial strategy for enhancing patient safety and preventing incidents in hospital settings. As patient advocates, nurses should be encouraged to speak up appropriately when they encounter situations that threaten patient safety.

Methods

A descriptive cross-sectional design was used. Questionnaires were used to collect data on socio-demographic information, perceived concerns about patient safety, patient safety culture, systems thinking, and safety voices. An online survey tool was used from May 25 to June 30, 2023. This study was conducted in South Korea, and 235 clinical nurses participated. Data were analyzed using multiple linear regression analysis and Hayes' PROCESS macro with the bootstrap method.

Results

Perceived concerns about patient safety, patient safety culture (‘communication openness’ and ‘handoffs and information exchange’) and job tenure were significant predictors of both types of safety voices. Patient safety culture partially mediated the relationship between perceived concerns about patient safety and speaking up (β = −0.087, 95 % confidence interval: −0.160 to −0.032), and also between perceived concerns about patient safety and withholding voice (β = 0.140, 95 % confidence interval: 0.069 to 0.222).

Conclusions

Creating a supportive and open communication environment that fosters information sharing is essential for encouraging nurses to voice their opinions regarding patient safety. Further research is needed to develop and implement assertive communication programs for clinical nurses.

目的本研究旨在探讨患者安全关注感知、患者安全文化、系统思维和护士安全声音之间的关系。护士直言不讳的行为是提高患者安全和预防医院事故的关键策略。作为病人的倡导者，当护士遇到威胁病人安全的情况时，应该鼓励他们适当地说出来。方法采用描述性横断面设计。使用问卷收集有关社会人口统计信息、对患者安全的感知关注点、患者安全文化、系统思维和安全声音的数据。从2023年5月25日到6月30日使用了在线调查工具。本研究在韩国进行，共有235名临床护士参与。数据分析采用多元线性回归分析，Hayes’PROCESS宏采用自举法。结果对患者安全、患者安全文化（“沟通开放”和“交接和信息交流”）和工作任期的感知担忧是两种安全声音的显著预测因子。患者安全文化部分介导了患者安全感知担忧与直言之间的关系（β = - 0.087, 95%置信区间：- 0.160至- 0.032），以及患者安全感知担忧与沉默之间的关系（β = 0.140, 95%置信区间：0.069至0.222）。结论营造一个支持性和开放性的沟通环境，促进信息共享，是鼓励护士就患者安全发表意见的必要条件。需要进一步的研究，以制定和实施自信的沟通方案，临床护士。

{"title":"Factors influencing nurses' safety voices about patient safety concerns: A cross-sectional study","authors":"Shinae Ahn","doi":"10.1016/j.apnr.2025.152046","DOIUrl":"10.1016/j.apnr.2025.152046","url":null,"abstract":"<div><h3>Aim</h3><div>This study aimed to examine the relationships among perceived concerns about patient safety, patient safety culture, systems thinking, and nurses' safety voices.</div></div><div><h3>Background</h3><div>Nurses' speaking up behavior is a crucial strategy for enhancing patient safety and preventing incidents in hospital settings. As patient advocates, nurses should be encouraged to speak up appropriately when they encounter situations that threaten patient safety.</div></div><div><h3>Methods</h3><div>A descriptive cross-sectional design was used. Questionnaires were used to collect data on socio-demographic information, perceived concerns about patient safety, patient safety culture, systems thinking, and safety voices. An online survey tool was used from May 25 to June 30, 2023. This study was conducted in South Korea, and 235 clinical nurses participated. Data were analyzed using multiple linear regression analysis and Hayes' PROCESS macro with the bootstrap method.</div></div><div><h3>Results</h3><div>Perceived concerns about patient safety, patient safety culture (‘communication openness’ and ‘handoffs and information exchange’) and job tenure were significant predictors of both types of safety voices. Patient safety culture partially mediated the relationship between perceived concerns about patient safety and speaking up (β = −0.087, 95 % confidence interval: −0.160 to −0.032), and also between perceived concerns about patient safety and withholding voice (β = 0.140, 95 % confidence interval: 0.069 to 0.222).</div></div><div><h3>Conclusions</h3><div>Creating a supportive and open communication environment that fosters information sharing is essential for encouraging nurses to voice their opinions regarding patient safety. Further research is needed to develop and implement assertive communication programs for clinical nurses.</div></div>","PeriodicalId":50740,"journal":{"name":"Applied Nursing Research","volume":"87 ","pages":"Article 152046"},"PeriodicalIF":2.2,"publicationDate":"2026-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145924785","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Nurses' psychological impact of caring for patients with LVADs: Patients, providers, & caregivers “triangle of relationships” 护士对lvad患者护理的心理影响：患者、提供者和护理者的“三角关系”

IF 2.2 4区医学 Q1 NURSING

Applied Nursing Research

Pub Date : 2025-12-31 DOI: 10.1016/j.apnr.2025.152044

John C. Mikovits , Kayla Biege

Nurses risk developing psychological distress due to the nature of their work environments and patient populations. Nurses caring for Left Ventricular Assist Device (LVAD) patients are at risk of distress related to stressful care requirements, patient relationships, and ethical dilemmas.

Objectives

To explore the impact of caring for patients with LVADs on nurses' psychological health and examine strategies for stress management.

Methods

A descriptive, qualitative study was completed using a semi-structured interview process. Interviews with registered nurses working in various roles and settings included predetermined questions to provide structure while allowing for open-ended elaboration of the topic from the participant's perspective through natural conversation.

Findings

Five themes were developed from interviews with nurses and include Caring for the LVAD Instead of the Patient; Right Implant, Wrong Patient; Complex and Connected Care; Mental Exhaustion and Life Balance; Effective Coping and Semi-effective Resources.

Conclusions

The results of the study provide implications for nursing practice and education surrounding the use of LVADs while highlighting the importance of emotional and mental health support in the workplace to decrease the burden experienced by nurses caring for these patients.

Implications for clinical practice

The complexity of relationships with patients with LVADs and their multidisciplinary teams creates a workplace culture that fails to prioritize mental health support for nurses caring for these patients. Current support for nurses caring for patients with LVADs is not effective. Clinical practice settings would benefit in supporting nurses' mental health to allow them to remain mentally present, resilient, and effective clinically.

由于护士的工作环境和患者群体的性质，护士有发展心理困扰的风险。护理左心室辅助装置（LVAD）患者的护士面临着与压力护理要求、患者关系和道德困境相关的痛苦风险。目的探讨左心室辅助器患者护理对护士心理健康的影响，探讨压力管理策略。方法采用半结构化访谈法进行描述性定性研究。对在不同角色和环境中工作的注册护士的采访包括预先确定的问题，以提供结构，同时允许通过自然对话从参与者的角度对主题进行开放式阐述。从对护士的采访中得出了五个主题，包括照顾LVAD而不是病人；正确的种植体，错误的患者；复杂和互联护理；精神疲劳与生活平衡；有效的应对和半有效的资源。结论本研究的结果为lvad的护理实践和教育提供了启示，同时强调了工作场所情感和心理健康支持的重要性，以减轻护理这些患者的护士所经历的负担。与lvad患者及其多学科团队关系的复杂性造成了一种工作场所文化，无法优先考虑照顾这些患者的护士的心理健康支持。目前对护理lvad患者的护士的支持并不有效。临床实践环境将有利于支持护士的心理健康，使他们保持精神上的存在，弹性和有效的临床。

{"title":"Nurses' psychological impact of caring for patients with LVADs: Patients, providers, & caregivers “triangle of relationships”","authors":"John C. Mikovits , Kayla Biege","doi":"10.1016/j.apnr.2025.152044","DOIUrl":"10.1016/j.apnr.2025.152044","url":null,"abstract":"<div><div>Nurses risk developing psychological distress due to the nature of their work environments and patient populations. Nurses caring for Left Ventricular Assist Device (LVAD) patients are at risk of distress related to stressful care requirements, patient relationships, and ethical dilemmas.</div></div><div><h3>Objectives</h3><div>To explore the impact of caring for patients with LVADs on nurses' psychological health and examine strategies for stress management.</div></div><div><h3>Methods</h3><div>A descriptive, qualitative study was completed using a semi-structured interview process. Interviews with registered nurses working in various roles and settings included predetermined questions to provide structure while allowing for open-ended elaboration of the topic from the participant's perspective through natural conversation.</div></div><div><h3>Findings</h3><div>Five themes were developed from interviews with nurses and include <em>Caring for the LVAD Instead of the Patient; Right Implant, Wrong Patient; Complex and Connected Care; Mental Exhaustion and Life Balance; Effective Coping and Semi-effective Resources.</em></div></div><div><h3>Conclusions</h3><div>The results of the study provide implications for nursing practice and education surrounding the use of LVADs while highlighting the importance of emotional and mental health support in the workplace to decrease the burden experienced by nurses caring for these patients.</div></div><div><h3>Implications for clinical practice</h3><div>The complexity of relationships with patients with LVADs and their multidisciplinary teams creates a workplace culture that fails to prioritize mental health support for nurses caring for these patients. Current support for nurses caring for patients with LVADs is not effective. Clinical practice settings would benefit in supporting nurses' mental health to allow them to remain mentally present, resilient, and effective clinically.</div></div>","PeriodicalId":50740,"journal":{"name":"Applied Nursing Research","volume":"87 ","pages":"Article 152044"},"PeriodicalIF":2.2,"publicationDate":"2025-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145924784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Risk factors for adverse clinical outcomes in elderly patients with heart failure and cognitive frailty 老年心力衰竭和认知衰弱患者不良临床结局的危险因素

IF 2.2 4区医学 Q1 NURSING

Applied Nursing Research

Pub Date : 2025-12-22 DOI: 10.1016/j.apnr.2025.152043

Marta Wleklik , Dorota Diakowska , Christopher S. Lee , Ercole Vellone , Magdalena Lisiak , Remigiusz Szczepanowski , Heba M. Aldossary , Maria Jędrzejczyk , Izabella Uchmanowicz

Aims

Cognitive frailty, defined as the coexistence of frailty and cognitive impairment, poses

a dual burden in elderly heart failure (HF) patients. Its impact on clinical outcomes, particularly hospitalization duration, rehospitalization, and survival, remains unclear. This study examines the relationship between frailty, cognitive impairment, and cognitive frailty with adverse clinical outcomes over 12 months.

Methods and results

A prospective cohort study included 250 elderly HF patients (mean age 72.32 ± 6.73 years), categorized into four groups: non-frailty/non-cognitive impairment (non-CI), frailty/non-CI, non-frailty/CI, and cognitive frailty. Baseline assessments included clinical, laboratory, and psychological evaluations. Outcomes measured were hospitalization length (>6 days), rehospitalization, and survival. Patients with cognitive frailty had significantly longer hospital stays (p < 0.0001). Elevated NT-proBNP levels were the sole predictor of prolonged hospitalization in this group (HR: 0.99, p = 0.048). In frail patients without CI, NT-proBNP was also a predictor (HR: 0.99, p = 0.004), along with lower BMI (HR: 0.88, p < 0.001), higher creatinine (HR: 3.42, p = 0.042), lower haemoglobin (HR: 1.41, p = 0.008), and anxiety levels (HR: 0.031, p = 0.005). No significant differences in rehospitalization or survival rates were observed among groups.

Conclusion

Cognitive frailty was associated with prolonged hospitalization among older patients with heart failure. Early identification and comprehensive care planning may help guide management and support this high-risk group.

目的认知衰弱是老年心力衰竭（HF）患者的双重负担，其定义是虚弱和认知功能障碍并存。其对临床结果的影响，特别是住院时间、再住院和生存率的影响尚不清楚。本研究探讨了衰弱、认知障碍和认知衰弱与12个月内不良临床结果之间的关系。方法和结果一项前瞻性队列研究纳入250例老年HF患者（平均年龄72.32±6.73岁），分为四组：非衰弱/非认知障碍（non-CI）、衰弱/非CI、非衰弱/CI和认知衰弱。基线评估包括临床、实验室和心理评估。测量的结果是住院时间（6天）、再住院和生存。认知衰弱患者的住院时间明显更长（p < 0.0001）。NT-proBNP水平升高是该组住院时间延长的唯一预测因子（HR: 0.99, p = 0.048）。在没有CI的体弱患者中，NT-proBNP也是一个预测因子（HR: 0.99, p = 0.004），以及较低的BMI （HR: 0.88, p < 0.001）、较高的肌酐（HR: 3.42, p = 0.042）、较低的血红蛋白（HR: 1.41, p = 0.008）和焦虑水平（HR: 0.031, p = 0.005）。两组再住院率和生存率无显著差异。结论老年心力衰竭患者认知衰弱与住院时间延长有关。早期识别和全面的护理计划可能有助于指导管理和支持这一高危群体。

{"title":"Risk factors for adverse clinical outcomes in elderly patients with heart failure and cognitive frailty","authors":"Marta Wleklik , Dorota Diakowska , Christopher S. Lee , Ercole Vellone , Magdalena Lisiak , Remigiusz Szczepanowski , Heba M. Aldossary , Maria Jędrzejczyk , Izabella Uchmanowicz","doi":"10.1016/j.apnr.2025.152043","DOIUrl":"10.1016/j.apnr.2025.152043","url":null,"abstract":"<div><h3>Aims</h3><div>Cognitive frailty, defined as the coexistence of frailty and cognitive impairment, poses</div><div>a dual burden in elderly heart failure (HF) patients. Its impact on clinical outcomes, particularly hospitalization duration, rehospitalization, and survival, remains unclear. This study examines the relationship between frailty, cognitive impairment, and cognitive frailty with adverse clinical outcomes over 12 months.</div></div><div><h3>Methods and results</h3><div>A prospective cohort study included 250 elderly HF patients (mean age 72.32 ± 6.73 years), categorized into four groups: non-frailty/non-cognitive impairment (non-CI), frailty/non-CI, non-frailty/CI, and cognitive frailty. Baseline assessments included clinical, laboratory, and psychological evaluations. Outcomes measured were hospitalization length (>6 days), rehospitalization, and survival. Patients with cognitive frailty had significantly longer hospital stays (<em>p</em> < 0.0001). Elevated NT-proBNP levels were the sole predictor of prolonged hospitalization in this group (HR: 0.99, <em>p</em> = 0.048). In frail patients without CI, NT-proBNP was also a predictor (HR: 0.99, <em>p</em> = 0.004), along with lower BMI (HR: 0.88, <em>p</em> < 0.001), higher creatinine (HR: 3.42, <em>p</em> = 0.042), lower haemoglobin (HR: 1.41, <em>p</em> = 0.008), and anxiety levels (HR: 0.031, <em>p</em> = 0.005). No significant differences in rehospitalization or survival rates were observed among groups.</div></div><div><h3>Conclusion</h3><div>Cognitive frailty was associated with prolonged hospitalization among older patients with heart failure. Early identification and comprehensive care planning may help guide management and support this high-risk group.</div></div>","PeriodicalId":50740,"journal":{"name":"Applied Nursing Research","volume":"87 ","pages":"Article 152043"},"PeriodicalIF":2.2,"publicationDate":"2025-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145883887","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Missed nursing care in surgical units: A cross-sectional study on prevalence, causes, and influencing factors 外科科室护理缺失：发生率、原因及影响因素的横断面研究

IF 2.2 4区医学 Q1 NURSING

Applied Nursing Research

Pub Date : 2025-12-20 DOI: 10.1016/j.apnr.2025.152041

Susanne Ahlstedt Karlsson , Elin Svenningsson , Hanna Järbrink , Ingela Thylén , My Engström

Background

Missed nursing care (MNC) is defined as any aspect of patient care that is either omitted (in part or in whole) or delayed. Consequently, the potential risks associated with MNC represent a significant threat to patient safety. Identifying MNC is essential for enhancing patient safety, the quality of care, and the overall efficiency of the healthcare system.

Aim(s)

To investigate the type, prevalence, and reasons for MNC within a surgical context, and to investigate associations between MNC, work-related factors, and individual characteristics of the nursing staff.

Methods

A cross-sectional design was employed. Data were collected online from November to December 2024 using the MISSCARE survey – Swedish Version 2.0. Registered nurses (RNs) and nurse assistants (NAs) from three surgical units at one Swedish university hospital participated (n = 84).

Results

Most MNC involved basic care and individual needs, with the most frequently missed items being ambulation (78.0 %), mouth care (77.1 %), and turning (73.5 %). The main reason for MNC was lack of labor resources (59.7 %). Over three-quarters of the respondents reported inadequate staffing, interruptions/multitasking, and unexpected increases in patient volume or acuity as significant reasons. Analysis of associated factors indicated that reported MNC and contributing factors may vary according to professional role, work experience, and unit type as less experienced nurses reported higher MNC rates in an acute setting.

Conclusion

MNC frequently occurs in surgical units, and is particularly reported in acute care. The discrepancy between nursing staff levels and patient acuity forces the prioritization of essential nursing tasks.

背景：遗漏护理（MNC）被定义为患者护理的任何方面被忽略（部分或全部）或延迟。因此，与跨国公司相关的潜在风险对患者安全构成重大威胁。识别跨国公司对于提高患者安全、护理质量和医疗保健系统的整体效率至关重要。目的：调查手术背景下MNC的类型、患病率和原因，并调查MNC、工作相关因素和护理人员个人特征之间的关系。方法采用横断面设计。数据从2024年11月到12月在线收集，使用MISSCARE调查-瑞典版2.0。来自一家瑞典大学医院三个外科单位的注册护士（RNs）和护士助理（NAs）参与了研究（n = 84）。结果MNC多涉及基本护理和个体需求，最常遗漏的项目为下床（78.0%）、口腔护理（77.1%）和翻身（73.5%）。跨国公司的主要原因是劳动力资源不足（59.7%）。超过四分之三的受访者表示，人员配备不足、中断/多任务处理以及患者数量或敏锐度的意外增加是重要原因。相关因素分析表明，报告的跨国行为和促成因素可能因专业角色、工作经验和单位类型而异，因为经验不足的护士在急性环境中报告的跨国行为率较高。结论mnc多发生于外科，尤其在急症护理中报道较多。护理人员水平和患者敏锐度之间的差异迫使基本护理任务的优先级。

{"title":"Missed nursing care in surgical units: A cross-sectional study on prevalence, causes, and influencing factors","authors":"Susanne Ahlstedt Karlsson , Elin Svenningsson , Hanna Järbrink , Ingela Thylén , My Engström","doi":"10.1016/j.apnr.2025.152041","DOIUrl":"10.1016/j.apnr.2025.152041","url":null,"abstract":"<div><h3>Background</h3><div>Missed nursing care (MNC) is defined as any aspect of patient care that is either omitted (in part or in whole) or delayed. Consequently, the potential risks associated with MNC represent a significant threat to patient safety. Identifying MNC is essential for enhancing patient safety, the quality of care, and the overall efficiency of the healthcare system.</div></div><div><h3>Aim(s)</h3><div>To investigate the type, prevalence, and reasons for MNC within a surgical context, and to investigate associations between MNC, work-related factors, and individual characteristics of the nursing staff.</div></div><div><h3>Methods</h3><div>A cross-sectional design was employed. Data were collected online from November to December 2024 using the MISSCARE survey – Swedish Version 2.0. Registered nurses (RNs) and nurse assistants (NAs) from three surgical units at one Swedish university hospital participated (<em>n</em> = 84).</div></div><div><h3>Results</h3><div>Most MNC involved basic care and individual needs, with the most frequently missed items being ambulation (78.0 %), mouth care (77.1 %), and turning (73.5 %). The main reason for MNC was lack of labor resources (59.7 %). Over three-quarters of the respondents reported inadequate staffing, interruptions/multitasking, and unexpected increases in patient volume or acuity as significant reasons. Analysis of associated factors indicated that reported MNC and contributing factors may vary according to professional role, work experience, and unit type as less experienced nurses reported higher MNC rates in an acute setting.</div></div><div><h3>Conclusion</h3><div>MNC frequently occurs in surgical units, and is particularly reported in acute care. The discrepancy between nursing staff levels and patient acuity forces the prioritization of essential nursing tasks.</div></div>","PeriodicalId":50740,"journal":{"name":"Applied Nursing Research","volume":"87 ","pages":"Article 152041"},"PeriodicalIF":2.2,"publicationDate":"2025-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145840202","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Influence of organizational culture on nursing perception of quality of healthcare services and intent to stay among nurses employed in public hospitals: A cross-sectional study 组织文化对公立医院护士医疗服务质量感知及留任意愿的影响：一项横断面研究

IF 2.2 4区医学 Q1 NURSING

Applied Nursing Research

Pub Date : 2025-12-19 DOI: 10.1016/j.apnr.2025.152042

Ahmad Rayan RN, PhD (Associate Professor, Dean) , Ibtihal Al-Jaafreh MSN , Manal Hassan Baqeas RN, PhD , Fadwa Alhalaiqa , Suhair Al-Ghabeesh RN, MsN, PhD (Prof) , Hanan Alyami RN, MSN, PhD (Assistant Professor)

Background

Organizational culture significantly shapes nurses' perceptions of healthcare quality and their intention to stay, yet its specific impact on these outcomes remains underexplored in Jordanian public hospitals, where retention and healthcare quality challenges persist.

Aim

This study aims to investigate the influence of organizational culture on nurses' perceptions of healthcare service quality and their intention to stay in Jordanian public hospitals.

Methods

A descriptive correlational design was applied. Validated scales of organization culture, quality of healthcare, and intention to stay were used to gather data on 131 nurses in a large governmental hospital in Jordan. It was analyzed by the use of descriptive statistics, t-tests, ANOVA, Pearson correlation, and multiple linear regression.

Results

The sample was predominantly female (64.9 %), married (63.4 %), aged 21–30 years (47.3 %), and held bachelor's degrees (78.7 %). Organizational culture subscale scores ranged moderately high, reflecting a positive culture perception. Nurses generally perceived healthcare service quality favorably. Male gender was significantly associated with higher intention to stay, and greater nursing experience correlated with better perceived care quality. All four organizational culture types (Clan, Hierarchy, Adhocracy, Market) showed strong positive correlations with perception of healthcare quality but no significant correlations with intention to stay.

Conclusions

The findings underscore the crucial role of organizational culture in shaping perceptions of care quality but suggest that nurses' retention decisions may depend on other factors. Hospital administration should strengthen organizational culture to enhance care quality while addressing broader workforce needs to improve retention.

组织文化显著影响护士对医疗保健质量的看法及其留下来的意图，但其对这些结果的具体影响在约旦公立医院仍未得到充分探讨，在那里保留和医疗保健质量挑战持续存在。目的本研究旨在探讨组织文化对约旦公立医院护士对医疗保健服务质量的认知及留在医院意愿的影响。方法采用描述性相关设计。本研究采用组织文化、医疗保健质量和留用意向的有效量表收集了约旦一家大型政府医院131名护士的数据。采用描述性统计、t检验、方差分析、Pearson相关和多元线性回归进行分析。结果调查对象以女性（64.9%）为主，已婚（63.4%），年龄21-30岁（47.3%），本科学历（78.7%）。组织文化分量表得分适中，反映了积极的文化感知。护士普遍认为医疗服务质量较好。男性与更高的护理意愿显著相关，更多的护理经验与更好的护理质量感知相关。所有四种组织文化类型（氏族、等级、民主、市场）与医疗保健质量感知呈显著正相关，但与留下来意愿无显著相关。结论：研究结果强调了组织文化在塑造护理质量观念方面的关键作用，但表明护士的保留决定可能取决于其他因素。医院管理部门应加强组织文化，以提高护理质量，同时解决更广泛的劳动力需求，以提高留用率。

{"title":"Influence of organizational culture on nursing perception of quality of healthcare services and intent to stay among nurses employed in public hospitals: A cross-sectional study","authors":"Ahmad Rayan RN, PhD (Associate Professor, Dean) , Ibtihal Al-Jaafreh MSN , Manal Hassan Baqeas RN, PhD , Fadwa Alhalaiqa , Suhair Al-Ghabeesh RN, MsN, PhD (Prof) , Hanan Alyami RN, MSN, PhD (Assistant Professor)","doi":"10.1016/j.apnr.2025.152042","DOIUrl":"10.1016/j.apnr.2025.152042","url":null,"abstract":"<div><h3>Background</h3><div>Organizational culture significantly shapes nurses' perceptions of healthcare quality and their intention to stay, yet its specific impact on these outcomes remains underexplored in Jordanian public hospitals, where retention and healthcare quality challenges persist.</div></div><div><h3>Aim</h3><div>This study aims to investigate the influence of organizational culture on nurses' perceptions of healthcare service quality and their intention to stay in Jordanian public hospitals.</div></div><div><h3>Methods</h3><div>A descriptive correlational design was applied. Validated scales of organization culture, quality of healthcare, and intention to stay were used to gather data on 131 nurses in a large governmental hospital in Jordan. It was analyzed by the use of descriptive statistics, <em>t-</em>tests, ANOVA, Pearson correlation, and multiple linear regression.</div></div><div><h3>Results</h3><div>The sample was predominantly female (64.9 %), married (63.4 %), aged 21–30 years (47.3 %), and held bachelor's degrees (78.7 %). Organizational culture subscale scores ranged moderately high, reflecting a positive culture perception. Nurses generally perceived healthcare service quality favorably. Male gender was significantly associated with higher intention to stay, and greater nursing experience correlated with better perceived care quality. All four organizational culture types (Clan, Hierarchy, Adhocracy, Market) showed strong positive correlations with perception of healthcare quality but no significant correlations with intention to stay.</div></div><div><h3>Conclusions</h3><div>The findings underscore the crucial role of organizational culture in shaping perceptions of care quality but suggest that nurses' retention decisions may depend on other factors. Hospital administration should strengthen organizational culture to enhance care quality while addressing broader workforce needs to improve retention.</div></div>","PeriodicalId":50740,"journal":{"name":"Applied Nursing Research","volume":"87 ","pages":"Article 152042"},"PeriodicalIF":2.2,"publicationDate":"2025-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145840201","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Nurses' decisions to recognize and respond to deterioration not meeting rapid response system activation criteria: A qualitative descriptive study 护士识别和应对不符合快速反应系统激活标准的恶化的决定：一项定性描述性研究

IF 2.2 4区医学 Q1 NURSING

Applied Nursing Research

Pub Date : 2025-12-17 DOI: 10.1016/j.apnr.2025.152040

Gabrielle Burdeu , Bodil Rasmussen , Grainne Lowe , Julie Considine

To explore and describe nurses’ assessment and management decisions to recognize and respond to patient deterioration not meeting rapid response system (RRS) activation criteria.

Nurses’ decision-making in response to deterioration that meets RRS activation criteria is well documented. RRSs are activated when deterioration meets pre-defined criteria or from clinicians’ concern, escalating care to teams of suitably qualified clinicians. Most deterioration is expected from illness and treatment and is managed within nurses’ clinical role. Safe healthcare relies on nurses’ surveillance for patient changes to prevent deterioration progressing towards RRS activation criteria. Evidence does not examine nurses’ safety role in response to expected deterioration occurring from acute illness and treatment. Studies examining nurses’ decision making in response to patient changes have limitations in designs that rely on self-report and retrospective audits.

Informed by Tanner’s Clinical Judgment Model, a qualitative descriptive study was conducted using non-participant observations of nurse-patient interactions followed by semistructured interviews between January and May 2021. Twenty nurses participated. Verbatim transcripts were analyzed using reflexive thematic analysis. First, nurses make targeted assessment decisions based on their prediction of patients’ risk of deterioration. Second, subjective assessment was perceived by nurses as highly sensitive in identifying early signs of deterioration. Third, nurses’ concern for patients prompted further assessment to inform safety-related judgments.

This study reaffirms nurses’ essential safety role for patients who experience deterioration during their hospitalization. Further research should evaluate nurses’ concern and subjective assessment to recognize deterioration to contribute to the evidence-based approach to patient assessment.

探讨和描述护士在识别和应对不符合快速反应系统（RRS）激活标准的患者恶化时的评估和管理决策。护士应对病情恶化的决策符合RRS激活标准，这是有充分记录的。当病情恶化符合预先定义的标准或临床医生的担忧时，就会启动rrs，将护理升级到由合格的临床医生组成的团队。大多数恶化是预期的疾病和治疗，并在护士的临床角色管理。安全的医疗保健依赖于护士对患者变化的监测，以防止病情向RRS激活标准发展。没有证据检验护士在应对急性疾病和治疗导致的预期恶化时的安全作用。研究检查护士的决策，以应对病人的变化有局限性的设计，依赖于自我报告和回顾性审计。根据坦纳的临床判断模型，在2021年1月至5月期间进行了一项定性描述性研究，使用非参与性观察护士-患者互动，然后进行半结构化访谈。20名护士参与了研究。使用反身性主题分析对逐字文本进行分析。首先，护士根据对患者病情恶化风险的预测，做出有针对性的评估决策。其次，护士认为主观评估在识别早期恶化迹象方面非常敏感。第三，护士对患者的关心促使进一步评估，为安全相关判断提供信息。本研究重申了护士在住院期间经历病情恶化的患者中扮演的重要安全角色。进一步的研究应评估护士的关注和主观评价，以识别恶化，有助于循证方法的患者评估。

{"title":"Nurses' decisions to recognize and respond to deterioration not meeting rapid response system activation criteria: A qualitative descriptive study","authors":"Gabrielle Burdeu , Bodil Rasmussen , Grainne Lowe , Julie Considine","doi":"10.1016/j.apnr.2025.152040","DOIUrl":"10.1016/j.apnr.2025.152040","url":null,"abstract":"<div><div>To explore and describe nurses’ assessment and management decisions to recognize and respond to patient deterioration not meeting rapid response system (RRS) activation criteria.</div><div>Nurses’ decision-making in response to deterioration that meets RRS activation criteria is well documented. RRSs are activated when deterioration meets pre-defined criteria or from clinicians’ concern, escalating care to teams of suitably qualified clinicians. Most deterioration is expected from illness and treatment and is managed within nurses’ clinical role. Safe healthcare relies on nurses’ surveillance for patient changes to prevent deterioration progressing towards RRS activation criteria. Evidence does not examine nurses’ safety role in response to expected deterioration occurring from acute illness and treatment. Studies examining nurses’ decision making in response to patient changes have limitations in designs that rely on self-report and retrospective audits.</div><div>Informed by Tanner’s Clinical Judgment Model, a qualitative descriptive study was conducted using non-participant observations of nurse-patient interactions followed by semistructured interviews between January and May 2021. Twenty nurses participated. Verbatim transcripts were analyzed using reflexive thematic analysis. First, nurses make targeted assessment decisions based on their prediction of patients’ risk of deterioration. Second, subjective assessment was perceived by nurses as highly sensitive in identifying early signs of deterioration. Third, nurses’ concern for patients prompted further assessment to inform safety-related judgments.</div><div>This study reaffirms nurses’ essential safety role for patients who experience deterioration during their hospitalization. Further research should evaluate nurses’ concern and subjective assessment to recognize deterioration to contribute to the evidence-based approach to patient assessment.</div></div>","PeriodicalId":50740,"journal":{"name":"Applied Nursing Research","volume":"87 ","pages":"Article 152040"},"PeriodicalIF":2.2,"publicationDate":"2025-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145883886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Mediating effects of depressive and heart failure symptoms in their associations with quality of life in patients with heart failure 抑郁和心衰症状在心衰患者生活质量相关性中的中介作用

IF 2.2 4区医学 Q1 NURSING

Applied Nursing Research

Pub Date : 2025-11-30 DOI: 10.1016/j.apnr.2025.152039

Seongkum Heo , Jisun Yang , KyungAh Cho , JinShil Kim

Aim

To test the bidirectional mediating relationships among heart failure (HF) symptoms, depressive symptoms, and health-related quality of life (HRQoL) in patients with HF, controlling for age, functional status, comorbidity, self-care, and self-care self-efficacy.

Background

Patients with HF often have poor HRQoL. HF and depressive symptoms affect HRQoL, suggesting their potential mediating roles. However, these associations have not been investigated in patients with HF.

Methods

In this cross-sectional, correlational study, data on all study variables and sociodemographic and clinical characteristics were collected from 54 patients with HF (mean age = 67.5). The PROCESS macro for SPSS was used to address the purpose.

Results

More severe HF symptoms (p < 0.001) were significantly associated with more severe depressive symptoms, and both symptoms (p = 0.007 and p = 0.005, respectively) were significantly associated with poorer HRQoL (F = 7.947, R² = 0.619, p < 0.001), after controlling for covariates (indirect effect: effect = 0.309, bootstrap 95 % CI = 0.045–0.648). By contrast, HF symptoms did not mediate the relationship between depressive symptoms and HRQoL.

Conclusions

Both depressive and HF symptoms play critical roles in the HRQoL; however, their mechanisms differ. Depressive symptoms were only directly associated, whereas HF symptoms were directly and indirectly associated with HRQoL. Healthcare providers and researchers should prioritize improving HF symptoms and addressing depressive symptoms to improve HRQoL in patients with HF.

目的在控制年龄、功能状态、合并症、自我保健和自我保健效能的情况下，检验心力衰竭（HF）症状、抑郁症状和健康相关生活质量（HRQoL）之间的双向中介关系。心衰患者的HRQoL通常较差。心衰和抑郁症状影响HRQoL，提示其潜在的中介作用。然而，这些关联尚未在心衰患者中进行研究。方法在这项横断面相关研究中，收集了54例HF患者（平均年龄67.5岁）的所有研究变量以及社会人口学和临床特征的数据。SPSS的PROCESS宏被用来解决这个问题。结果经协变量控制（间接效应：效应= 0.309,bootstrap 95% CI = 0.045-0.648）后，HF症状越严重与抑郁症状越严重相关（p < 0.001），两种症状（p = 0.007和p = 0.005）与HRQoL越差相关（F = 7.947, R2 = 0.619, p < 0.001）。相比之下，心衰症状不介导抑郁症状与HRQoL之间的关系。结论抑郁和心衰症状对患者HRQoL均有重要影响；然而，它们的机制不同。抑郁症状仅与HRQoL直接相关，而心衰症状与HRQoL直接或间接相关。医疗保健提供者和研究人员应优先改善心衰症状和解决抑郁症状，以改善心衰患者的HRQoL。

{"title":"Mediating effects of depressive and heart failure symptoms in their associations with quality of life in patients with heart failure","authors":"Seongkum Heo , Jisun Yang , KyungAh Cho , JinShil Kim","doi":"10.1016/j.apnr.2025.152039","DOIUrl":"10.1016/j.apnr.2025.152039","url":null,"abstract":"<div><h3>Aim</h3><div>To test the bidirectional mediating relationships among heart failure (HF) symptoms, depressive symptoms, and health-related quality of life (HRQoL) in patients with HF, controlling for age, functional status, comorbidity, self-care, and self-care self-efficacy.</div></div><div><h3>Background</h3><div>Patients with HF often have poor HRQoL. HF and depressive symptoms affect HRQoL, suggesting their potential mediating roles. However, these associations have not been investigated in patients with HF.</div></div><div><h3>Methods</h3><div>In this cross-sectional, correlational study, data on all study variables and sociodemographic and clinical characteristics were collected from 54 patients with HF (mean age = 67.5). The PROCESS macro for SPSS was used to address the purpose.</div></div><div><h3>Results</h3><div>More severe HF symptoms (<em>p</em> < 0.001) were significantly associated with more severe depressive symptoms, and both symptoms (<em>p</em> = 0.007 and <em>p</em> = 0.005, respectively) were significantly associated with poorer HRQoL (F = 7.947, R<sup>2</sup> = 0.619, p < 0.001), after controlling for covariates (indirect effect: effect = 0.309, bootstrap 95 % CI = 0.045–0.648). By contrast, HF symptoms did not mediate the relationship between depressive symptoms and HRQoL.</div></div><div><h3>Conclusions</h3><div>Both depressive and HF symptoms play critical roles in the HRQoL; however, their mechanisms differ. Depressive symptoms were only directly associated, whereas HF symptoms were directly and indirectly associated with HRQoL. Healthcare providers and researchers should prioritize improving HF symptoms and addressing depressive symptoms to improve HRQoL in patients with HF.</div></div>","PeriodicalId":50740,"journal":{"name":"Applied Nursing Research","volume":"87 ","pages":"Article 152039"},"PeriodicalIF":2.2,"publicationDate":"2025-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145693553","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0