Research in Nursing & Health最新文献

Despite advancements in diabetes management technology, many patients with type 2 diabetes (T2D) struggle to achieve optimal glycemic control. Sleep disorders such as obstructive sleep apnea (OSA) and insomnia are common in T2D and linked to poor glycemic control. Insomnia, particularly with short sleep duration, may worsen glycemic control by increasing diabetes-related distress. To improve glucose management, the association among sleep duration, insomnia severity, diabetes-related distress, and glycemic control needs to be further evaluated. A path analysis was conducted using data from 237 adults with T2D and OSA from the total of 406 participants who completed the baseline assessment in the Diabetes Sleep Treatment Trial (DSTT; N = 351) and the Diabetes Sleep Treatment Trial for Insomnia (DSTT-I; N = 55). Parent studies were conducted from July 2013 to June 2018 (DSTT) and from April 2017 to March 2020 (DSTT-I). Sleep duration was assessed using the Pittsburgh Sleep Quality Index, insomnia severity using the Insomnia Severity Index, and diabetes-related distress using the Problem Areas in Diabetes. Glycemic control was measured by hemoglobin A1c. The results showed that shorter sleep duration indirectly worsened glycemic control by increasing insomnia severity, which, in turn, elevated diabetes-related distress after controlling for obstructive sleep apnea severity, age, sex, marital status, race, education level, and financial difficulty. These findings suggest that sleep duration may be a modifiable factor for improving insomnia severity, reducing diabetes-related distress, and enhancing glycemic control in T2D. Optimizing sleep duration as part of clinical diabetes management may help improve glucose regulation.

Mixed-methods research is increasingly used in healthcare to understand complex issues, yet integration of qualitative and quantitative findings remains challenging, particularly for novice researchers. This paper provides a practical guide for nursing researchers to integrate survey and interview data effectively. Using a sequential explanatory design exemplar with an embedded quasi-experimental component, we demonstrate key integration strategies, including joint displays and narrative weaving. The paper emphasizes that robust integration must be planned from the outset, with clear goals specifying how data types will address research questions. We illustrate how purposeful integration points, carefully constructed joint displays, and narrative synthesis of meta-inferences can generate deeper insights than either method alone. By providing concrete examples and step-by-step guidance, this resource equips novice researchers with essential skills for achieving rigorous, cohesive integration in mixed-methods studies.

Youth in psychiatric residential treatment (RT) are a highly vulnerable population in which parent involvement is critical to optimizing long-term outcomes. However, existing parent programs rarely address the unique challenges faced by families navigating RT. This study aimed to identify parent support needs and develop an adapted parenting program, Parenting Wisely for RT (PW^RT). Using qualitative interviews with parents and input from an RT staff advisory board, we explored the informational, instructional, and emotional support needs of families with youth in RT. Findings guided the development of PW^RT, a 6-week program that combines web-based modules (i.e., existing parent training program) with facilitated parent groups (i.e., adapted component). Parents expressed needs for education, skill generalization to complex RT-related situations, and reduction of social isolation. The advisory board co-developed the parent groups to include strengths-based, real-time skill practice, peer connection, and tailored psychoeducation that fosters shared learning and addresses challenges unique to the RT context. Facilitators provide coaching and help parents apply skills in diverse family situations, enhancing engagement and relevance. PW^RT represents a promising adaptation of parent training for families with youth in RT, designed to enhance parent knowledge, skills, and connectedness. Future research should evaluate its feasibility, effectiveness, and implementation to support families during and after RT.

The Pathway to Excellence (Pathway) program administered by the American Nurses Credentialing Center, recognizes organizations that foster positive nursing practice environments. However, evidence linking Pathway designation to nurse-reported outcomes remains limited. This cross-sectional study integrated data from the Penn 2024 Nurses4All Study and the American Hospital Association Annual Survey. The sample included 16,979 direct care nurses from 1672 hospitals in 10 US states (866 nurses in 63 Pathway hospitals and 16,113 nurses in 1609 non-Pathway, non-Magnet hospitals). The independent variable was Pathway status. Outcomes included nurse-reported work environment, care quality, patient safety, and hospital recommendations. Multilevel linear and logistic regression models estimated associations. Pathway hospitals showed more favorable work environments (γ, the fixed-effect coefficient from multilevel linear models = 0.08, 95% confidence interval [CI] = 0.01-0.16), driven by responsive administration (γ = 0.15, 95% CI = 0.05-0.24) and a clear philosophy of nursing (γ = 0.11, 95% CI = 0.01-0.20). Pathway hospitals also demonstrated a more favorable patient safety climate (γ = 0.51, 95% CI = 0.02-0.99), including more positive perceptions of a non-punitive response to mistakes (γ = 0.12, 95% CI: 0.02-0.23), discussions about error prevention (γ = 0.12, 95% CI: 0.03-0.21), and leadership prioritization of safety (γ = 0.14, 95% CI: 0.02-0.26). Nurses in Pathway hospitals had higher odds of rating the overall work environment as excellent/good (adjusted odds ratio [aOR] = 1.32, 95% CI: 1.06-1.63), quality of nursing care as excellent/good (aOR = 1.35, 95% CI: 1.06-1.71), and of "definitely" recommending their hospital (aOR = 1.32, 95% CI: 1.03-1.69). These results underscore the central role of positive practice environments in delivering high-quality, safer patient care.

Adolescent suicide and suicidal thoughts and behaviors (STB) are an escalating public health crisis, especially among Black adolescents. Parents play a central role in suicide prevention efforts and are primarily responsible for ensuring their child's safety after a suicidal crisis. However, their needs in caring for children with STB are often overlooked. Parental self-efficacy (PSE) is a parent's belief in their ability to effectively fulfill their parenting role and is a strong predictor of parenting competence and child well-being. PSE in adolescent suicide prevention (PSE-SP) will be explored in this study and is conceptualized as a parent's perceived ability to support their child in crisis, keep them safe, and prevent future suicidal behavior. There is limited research on how parent and adolescent characteristics influence PSE-SP. This paper describes the protocol for a mixed-methods study to understand the psychosocial factors associated with PSE-SP among parents of adolescents following an emergency department visit for suicidal behavior. Data will be collected through cross-sectional surveys, medical record data extraction, and qualitative interviews. Given the disproportionate increase in STB among Black adolescents and the paucity of research that seeks to understand the experience of Black parents in this context, this study will oversample parents who identify as Black/African American. Results will address a clinical research gap on how to best equip and support parents caring for children with STB, informing the development of culturally responsive parent-centered interventions for adolescent suicide prevention.

Type 2 diabetes mellitus (T2DM) affects the patient's quality of life. Currently, hypoglycemic drugs are mainly used for the standard care for T2DM, but they appear to cause many adverse reactions. As a traditional therapy, acupuncture has been gradually applied to the treatment of T2DM. However, the best acupuncture regimen is still uncertain. Therefore, we evaluated the clinical efficacy of various acupuncture therapies in the treatment of T2DM. Up to December 2nd, 2024, eight databases were searched. The data were analyzed using Stata 15.1 and R 4.2.1 software. The included studies were assessed for bias using the Cochrane risk of bias tool (RoB2.0). A total of 139 randomized controlled trials were included, involving 12,231 patients with T2DM. The results showed that compared with conventional treatment (CT), body acupuncture + CT had the best effect on improving fasting blood glucose (FBG) (MD = -0.84, 95% CI: -1.01, -0.67; SUCRA = 84.44%) and HbA1c (MD = -1.08, 95% CI: -1.42, -0.76; SUCRA = 87.44%); auricular acupuncture + CT had the best effect on improving 2 h postprandial blood glucose (2hBG) (MD = -1.56, 95% CI: -2.05, -1.06: SUCRA = 82.10%), and laser acupuncture + CT had the best effect on improving homeostasis model assessment for insulin resistance (HOMA-IR) (MD = -2.46, 95% CI: -5.85, 0.96; SUCRA = 83.95%), fasting insulin (FINS) (MD = -7.21, 95% CI: -19, 4.54; SUCRA = 82.00%) and overall response rate (RR = 1.45, 95% CI: 0.97, 2.31; SUCRA = 84.00%) Acupuncture can effectively improve diabetes related indicators. Body acupuncture, auricular acupuncture, and laser acupuncture appear to be the most advantageous options for managing T2DM. However, due to the low quality of the included studies, more evidence may be needed to verify the conclusions.

Men who have sex with men (MSM) in Thailand continue to experience a disproportionate HIV burden, with persistent challenges related to antiretroviral therapy (ART) adherence, quality of life, and self-management. Stigma and the scarcity of culturally adapted interventions further hinder sustained engagement in care. This study evaluated the effectiveness of the HIV/AIDS Self-Management Education Program-Thai (HASMEP-T), a culturally adapted, nurse-delivered, peer-supported intervention, on immunologic and patient-reported outcomes among Thai MSM living with HIV. A randomized controlled trial with a pretest-posttest design was conducted at a tertiary HIV clinic, where 64 MSM living with HIV were randomized to either the intervention or control group (n = 32 each). The intervention included four biweekly, 3 h group sessions over 7 weeks, in addition to routine services, while the control group received routine care only. Outcomes measured at baseline, immediately post-intervention, and at the 12-week follow-up included CD4 count, ART adherence, quality of life (WHOQOL-BREF), and HIV self-management. Paired and independent t-tests and repeated-measures ANOVA were employed. At 12 weeks, the intervention group showed significantly greater improvements than the controls in CD4 count (+84.5 cells/mm³), ART adherence (+8.9%), quality of life (+14.7 points), and self-management (+9.1 points) (all p < 0.05). No adverse events were observed. The findings indicate that HASMEP-T is effective in enhancing immunologic, behavioral, and psychosocial outcomes among Thai MSM living with HIV and has the potential to be integrated into routine HIV care to strengthen ART adherence, reduce stigma, and improve quality of life in resource-limited settings.

Hope and hopelessness are sometimes considered to be two ends of a spectrum. Hope is associated with positive health outcomes in healthy and ill populations. Conversely, hopelessness has been associated with increased adverse clinical events and death in patients with ischemic heart disease (IHD). The aim of the study was to determine the discriminant validity of the Dunn State-Trait Hopelessness Scale and the Snyder Adult State Hope and Adult Trait Hope Scales. A total of 156 participants were enrolled in a randomized controlled trial testing a motivational intervention to promote physical activity and reduce hopelessness in adults hospitalized with ischemic heart disease. Data were collected 2 weeks after hospital discharge. Participants were male (68%), white (88.2%), married (60.8%), with a mean age of 62 years. There were moderately strong negative correlations (r = -0.54 to -0.66) between total Dunn State-Trait Hopelessness Scale and Snyder Adult State and Trait Hope scales. Correlations were virtually unchanged adjusting for age, sex, diagnosis, and marital status (r = -0.5 to -0.63, p < 0.001) indicating that as hopelessness increases, hope decreases. Principal components analysis revealed four factors that explained 64.7% of the variance in scores while demonstrating conceptual distinctions between the Dunn State-Trait Hopelessness Scale and Snyder Hope scales. We found a proportion of patients with hopelessness who still expressed hope for the future. Discriminant validity was supported by inverse correlations and factor analyses indicating conceptual distinctions between the two instruments. Findings suggest important implications for assessment of both hope and hopelessness in patients recovering from an IHD event since the two are conceptually distinct yet can occur simultaneously, and state hopelessness may improve through recovery.