Research in Nursing & Health最新文献

Nurses are required to decide on priorities; however, how they prioritize the interventions toward patients with delirium is still unclear. Therefore, expanding the knowledge on (a) how nurses prioritize interventions to manage episodes of delirium and (b) the underlying prioritization patterns were the aims of this study. The Q-methodology was applied in 2021. A systematic review to identify the recommended interventions for patients with delirium was performed, and a nominal group technique was used to select those interventions that are applicable in daily practice (35 out of 96 identified). Then, using a specific scenario, 56 clinical nurses working in hospital medical (n = 31), geriatric (n = 15), and postacute (n = 10) units were asked to order the 35 interventions (from -4 the lowest to +4 the highest priority) using a Q-sort table. Averages (confidence interval at 95%) were calculated at the group level, and a by-person factor analysis was applied to discover underlying patterns of prioritization at the overall and at the individual levels. At the group level, "Ensuring a safe environment (e.g., reducing bed height)" was ranked as the highest priority (2.29 out of four); at the individual level, three prioritization patterns accounting for a total variance of 50.21% have emerged: "Individual needs-oriented" (33.82% variance explained; 41 nurses); "Prevention-oriented" (8.47%; five nurses); and "Cognitive-oriented" (7.92%; six nurses). At the group level, nurses prioritize safety while caring for patients with delirium; however, at the individual level, they follow three different patterns of prioritization oriented toward diverse aspects, suggesting uncertainty in the actions to be taken-with potential implications for patients.

High blood pressure and excess weight during pregnancy can have adverse outcomes. This randomized controlled trial evaluated the effects of a nurse-led smartphone application-based lifestyle intervention on blood pressure, body weight, and pregnancy outcomes in pregnant women with gestational hypertension between August and December 2023. Pregnant women, between 20 and 28 weeks of gestation, were allocated to the intervention or control group. Control group (n = 99) received standard high-risk pregnancy management, while intervention group (n = 96) also received lifestyle guidance via a nurse-led smartphone application. Intervention group experienced longer gestations (p = 0.007), higher neonatal weights (p = 0.028), and lower incidences of pre-eclampsia (p < 0.001), small for gestational age infants (p = 0.003), and preterm births (p = 0.023) compared to control group. The mixed-effect models for repeated measures showed that the nurse-led smartphone application intervention had no impact on body mass index, while significantly reducing systolic and diastolic blood pressure measurements (β = -1.666, 95% confidence interval, CI: -2.814 to -0.519, p = 0.005 and β = -2.247, 95% CI: -3.349 to -1.145, p < 0.001, respectively). Both systolic and diastolic blood pressures showed a downward trend from 28 weeks (p < 0.05). The nurse-led smartphone application-based lifestyle intervention significantly reduced adverse pregnancy outcomes and positively influenced blood pressure management in pregnant women with gestational hypertension.

To identify the influencing factors of shoulder joint function after Arthroscopic Rotator Cuff Repair (ARCR) in patients with Type 2 Diabetes Mellitus (T2DM). A sequential explanatory mixed-methods design was conducted. Participants were recruited from the Northern Jiangsu People's Hospital from January 2023 to May 2023. Quantitative data were collected using the Constant-Murley Shoulder Joint Function Score, the General Self-Efficacy Scale, and the Perceived Social Support Scale. A total of 134 patients were recruited (120 participants for questionnaire survey, 14 participants for interview). Spearman's correlations were performed to initially identify the influencing factors of shoulder joint function. Qualitative data were collected through face-to-face interviews with 14 patients. To understand patients' experiences during the process of shoulder joint recovery, interpretative phenomenological analysis was employed. The triangulation was conducted using convergence coding matrix. Three themes and seven sub-themes were identified, including capability (postoperative pain management, self-management of T2DM), opportunity (medical supports, perceived social and family supports, demands of economic supports), and motivation (sense of benefits, psychological motivation). The recovery of shoulder joint function in patients with T2DM following ARCR is influenced by factors related to capability, opportunity, and motivation. Healthcare providers should enhance the timing and content of educational interventions and provide intensive psychological support to facilitate successful behavior change and optimize shoulder joint recovery in this patient population. The findings of this study can inform the development of an optimized care model for patients with T2DM following ARCR, empowering them to take control of their condition. Considering the long-term challenges of rehabilitation, which present physical and psychological difficulties for patients, it is essential to design interventions strategies that address physiological decline and pain management.

This study evaluated the effects of a critical reflection program utilizing the Lasater Clinical Judgment Rubric (LCJR) reflective questions based on the Clinical Judgment Model (CJM) on newly graduated nurses' clinical judgment skills. A total of 153 newly graduated nurses scheduled for on-site training in a ward nursing unit were divided into a control group (receiving only the usual on-site training with preceptorship) and an experimental group (receiving the developed program with the same on-site training with preceptorship as the control group). Data were collected at baseline, 6 weeks, and 3 months after the intervention. A comparison of the scores of the two groups at each measurement time point revealed that the experimental group showed significantly higher scores than the control group in clinical judgment (z = 3.25, p = 0.003) and stage of noticing (z = 2.78, p = 0.015) at 6 weeks postintervention. Clinical reasoning competence (experimental χ² = 24.57, p < 0.001; control χ² = 41.12, p < 0.001) and clinical judgment (experimental χ² = 12.74, p = 0.002; control χ² = 10.54, p = 0.005) significantly improved scores across the three time points in both groups. The change in scores in the responding stage of clinical judgment from preintervention to 6 weeks postintervention showed a significant difference between the two groups (z = -2.44, p = 0.045). A critical reflection program based on the CJM can help newly graduated nurses enhance their clinical judgment over a short period during the early stages of clinical adaptation.

Behavioral management is essential to preventing recurrence after stroke, but its adherence is limited worldwide. We aimed to assess the impact of the behavior intervention based on the Recurrence risk perception and Behavioral decision Model for ischemic stroke patients' health behavior. This study was a single-blind, randomized, controlled trial with a 3-month follow-up. The outcome measures were the perception of the risk of stroke recurrence, behavioral decision, and health behavior. A total of seventy participants were randomized to the intervention group (n = 35) or control group (n = 35). The former received a twelve-week theory-based intervention in addition to the routine education, while the control group received only the routine education. The generalized estimating equations results indicated that the intervention group had significantly greater improvements in perception of the risk of stroke recurrence compared to the control group at all T1 (B = 0.13, 95% CI: 0.03 to 0.23), T2 (B = 0.18, 95% CI: 0.07 to 0.28), and T3 (B = 0.16, 95% CI: 0.07 to 0.25) after adjusting for stroke frequency. Statistically significant improvements were found in behavioral decision for the intervention group compared with the control group at T2 (B = 0.25, 95% CI: 0.09 to 0.41) and T3 (B = 0.26, 95% CI: 0.10 to 0.43). Results also showed a significantly higher increase in health behavior at T1 (B = 0.29, 95% CI: 0.09 to 0.48) and T2 (B = 0.22, 95% CI: 0.04 to 0.40). The intervention can improve the perception of the risk of stroke recurrence, behavioral decision, and health behavior in ischemic stroke patients. IMPLICATIONS: This study provides a reference point for promoting healthy behaviors in patients with ischemic stroke. A recurrence risk perception and behavioral decision model-based intervention was deemed to be feasible and useful in practice. PATIENT OR PUBLIC CONTRIBUTION: Patients and their caregivers agreed to participate in the study and shared their experiences of participating in research with us.

Varicose veins in the lower extremities significantly impairs patients' quality of life, highlighting the importance of targeted quality of life assessments for specific diseases. The Aberdeen Varicose Vein Questionnaire (AVVQ) was specifically designed to assess the impact of lower extremity varicose veins on quality of life. This study comprised two phases: in the first phase, the AVVQ was translated and culturally adapted, and the second phase was an evaluation of the psychometric characteristics of the Chinese version of AVVQ in 328 patients with varicose veins of lower extremities. Confirmatory factor analysis revealed that the Chinese AVVQ comprises 13 items distributed across four dimensions, accounting for a total variance of 61.74%, with a Cronbach's α of 0.745 and a content validity index of 0.908. Furthermore, there was a negative correlation between the AVVQ scores and the SF-36. In addition, the difference in AVVQ scores by CEAP classification was statistically significant. These findings affirmed the Chinese version of the AVVQ as both reliable and valid, making it a valid tool for evaluating the quality of life in Chinese patients with varicose veins and applicable across various international contexts and diverse patient populations.

The patient activation measure (PAM), a recognized measure of how active patients are in their care, is one of the most extensively used, widely translated, and tested instruments worldwide in measuring patient activation. This study aimed to assess the psychometric properties and construct validity of the Italian version of the 13-item Patient Activation Measure (PAM13-I) among patients undergoing elective laparoscopic cholecystectomy. A multicenter study was conducted across 111 surgical units in Italy. This study involved the preoperative administration of the PAM questionnaire to 4532 patients. The psychometric properties of the PAM were evaluated using Rasch analysis. The PAM13-I demonstrated good internal consistency (Cronbach's α = 0.95) and reliability indices. While fit statistics were acceptable, ceiling effects were observed. No significant differential item functioning was found. However, issues with targeting and local response dependency were identified. The Italian PAM-13 showed promising psychometric properties among surgical patients, indicating its potential utility in assessing patient activation. However, concerns regarding ceiling effects and targeting suggest the need for further refinement and validation in surgical populations.

In health professional shortage areas (HPSAs), primary care providers face challenges due to high workloads and limited resources, impacting their ability to provide comprehensive care to patients with multiple chronic conditions (MCCs). In addition, patients in HPSA compared to non-HPSA settings experience poorer outcomes. Nurse practitioners (NPs) play a crucial role in meeting MCC patients' needs, but some work in unfavorable care environments (e.g., lacking teamwork, support, and autonomy) that hinder their capacity to manage complex chronic diseases. This study examines the effect of NP care environments on the relationship between HPSA status and hospitalizations or emergency department (ED) visits among patients with MCCs. We conducted a secondary analysis of merged Medicare claims, NP survey data, and Health Resources and Services Administration data. Our sample included 779 practices with 394,424 Medicare beneficiaries aged 65+ who had at least two of 15 chronic conditions. We used logistic regression to evaluate the impact of HPSA status and the NP care environment on ED visits or hospitalizations. NP care environments moderate the association between HPSA status and hospitalization (AOR 1.165, 95% CI [1.037-1.309], p = 0.010) but not ED use. Improved care environments are associated with lower odds of hospitalization in non-HPSAs (β = -0.148, 95% CI [-0.225, -0.072], p = 0.0001), while in HPSAs, improved care environments have no effect on hospitalization odds (β = 0.0047, 95% CI [-0.086, 0.096], p = 0.920). Addressing provider shortages in HPSAs may allow an improved NP care environment to produce maximal benefits for patients.

The management of heart failure in patients presents a significant challenge to global public health, marked by an increase in unaddressed needs due to the extended deterioration of health. It is crucial to conduct comprehensive assessments of patients with heart failure, thereby providing personalized care. The purpose of this study was to translate, adapt, and validate the Needs Assessment Questionnaire for people with heart failure in Mainland China and to evaluate its reliability and validity within a population of people with heart failure. A cohort of 246 individuals diagnosed with heart failure was recruited from two medical facilities in China during the period from January 2023 to June 2023. The scale was translated into Chinese using the forward post-translation technique, followed by an evaluation of its reliability and validity. Descriptive statistics, content validity assessment, and Confirmatory Factor Analysis were utilized for validation. Internal consistency, split-half reliability, and test-retest reliability assessments were conducted to assess overall reliability. The Chinese version of the Heart Failure Needs Assessment Questionnaire consists of 4 dimensions and 30 items. The Cronbach α coefficient of the overall scale was 0.90. In the validation factor analysis, the model fit results were χ²/df = 2.259, CFI = 0.933, IFI = 0.933, TLI = 0.927, RMSEA = 0.072, all of which fell within acceptable ranges. The HFNAQ demonstrates strong reliability and validity in assessing the unmet needs of patients with heart failure.