Research in Nursing & Health最新文献

To estimate the pooled prevalence of feeding difficulties among persons with dementia and to explore heterogeneity, including regional differences and study characteristics. Feeding difficulties, including impaired ability to feed oneself, swallowing problems, reduced appetite, and behavioral resistance to eating, are common among individuals with dementia, leading to malnutrition, and caregiver burden. Evidence on the prevalence of feeding difficulties is fragmented, with no prior meta-analysis available. Six databases were searched until April 2025 for observational studies. This systematic review and meta-analysis followed MOOSE and PRISMA guidelines with PROSPERO registration (CRD420251024333). Studies were included if they reported feeding difficulty prevalence in dementia using validated instruments or clinical observation. Two reviewers independently screened studies, extracted data, and assessed quality using the Newcastle-Ottawa Scale. Pooled prevalence and 95% prediction intervals were calculated using a random-effects model with Freeman-Tukey double arcsine transformation. Subgroup analyses and meta-regression explored heterogeneity. Fifteen studies involving 3175 participants were included. The pooled prevalence of feeding difficulties among persons with dementia was 48% (95% PI: 38%-59%), with significant heterogeneity (I² = 97%). Prevalence was notably higher in studies conducted in Asia (59%) compared to non-Asian regions (32%). Neither publication year nor mean participant age significantly moderated prevalence estimates. Nearly half of individuals with dementia experience feeding difficulties, with particularly high prevalence in Asia. This regional disparity stresses the importance of routine assessment. High heterogeneity and inconsistent disease staging reporting call for standardized assessments and further research across dementia stages to improve care globally.

Timely and adequate prenatal care (PNC) is essential for optimizing maternal and infant health outcomes. However, persistent disparities in PNC utilization exist in the United States, particularly among ethnic/racial minority populations. While discrimination has been recognized as a barrier, its multifaceted influence across social and structural contexts remains underexplored. This systematic review, guided by the Social-Ecological Model, synthesizes evidence on how various forms of discrimination affect PNC utilization. We conducted comprehensive searches in PubMed, Web of Science, and CINAHL for peer-reviewed studies published in the United States between 2010 and 2024. After screening 342 records, 11 studies met the inclusion criteria. Five studies employed qualitative methods, five used quantitative methods, and one utilized a mixed-methods approach. Findings revealed that structural discrimination, such as language barriers and institutional policies, was associated with delayed or insufficient PNC utilization. Interpersonal dynamics, including negative patient-provider interactions and implicit bias, discouraged engagement with care. Additionally, intrapersonal factors, like internalized discrimination, shaped perceptions of care quality and trust in healthcare systems. The review highlights how discrimination operates across multiple levels to influence PNC behaviors and outcomes. Addressing discrimination requires culturally responsive care models, provider training in cultural humility, and institutional reforms aimed at equity. Future research should explore protective factors, such as social support and resilience, that may buffer the negative effects of discrimination. Understanding these dynamics is crucial for developing interventions that promote equitable and effective PNC utilization.

Increasing reliance on Internationally Educated Nurses (IENs) in the U.S. healthcare system, particularly in Long-Term Care (LTC) settings, necessitates an in-depth exploration of their transition experiences. The primary purpose of this qualitative study was to understand how IENs describe their experiences transitioning to work with older adults in LTC settings in the United States and the policies and practices that contribute to the successful integration of IENs. A qualitative descriptive design was used, including one-time individual interviews with 22 IENs working in various LTC settings across the United States via Zoom using a semi-structured interview guide. Demographic data were analyzed using descriptive statistics, while NVivo 14 software was utilized to organize the data; verified verbatim transcripts were subjected to thematic analysis. Three key themes were identified: Systemic and Practice-Based Barriers to IEN Integration, Structural and Social Enablers of IEN Integration, and Role of Structured Support Systems in the IENs' Transition. This study highlighted the critical challenges and facilitators that influence IENs during their integration into LTC settings in the United States. Participants reported concerns, specifically noting experiences of racial discrimination and xenophobia perpetrated by co-workers, patients, and patients' families. These experiences highlight the complex interpersonal dynamics faced by IENs, underscoring the need for proactive strategies to mitigate discriminatory practices and provide culturally sensitive orientation and mentorship programs to support the smooth integration of IENs into LTC settings. Addressing these challenges can have profound implications for strengthening inclusivity and enhancing the overall resilience of the U.S. nursing workforce, particularly within LTC environments.

Type 2 diabetes (T2D) is a growing global health concern, including in Israel. Effective Diabetes self-management (DSM) is critical for achieving glycemic targets and preventing complications. While several tools exist to assess DSM, none have been translated for Hebrew-speaking populations. This study aimed to translate the Diabetes Self-Management Questionnaire (DSMQ) into Hebrew (H-DSMQ) and evaluate its psychometric properties. The DSMQ was translated into Hebrew using a standard forward-backward translation procedure. A convenience sample of 220 community-dwelling adults with T2D in Israel was recruited via PANEL4ALL. Internal consistency was tested with Cronbach's α. Construct validity was examined via Confirmatory Factor Analysis and known-groups validity, and criterion validity through correlations between H-DSMQ scores, HbA1c, and BMI. The H-DSMQ construct validity was supported by CFA. In addition, known-groups validity was established, with participants with less than 7% reporting significantly higher self-management in glucose monitoring, dietary control/nutrition management, and healthcare use compared to those with above 7.1% HbA1c levels. Criterion validity was demonstrated by significant negative correlations between HbA1c and healthcare use/glucose monitoring, and between BMI and nutrition management/physical activity. The reliability of the H-DSMQ subscales ranged from poor (healthcare use, α = 0.461) to good (physical activity, α = 0.83). The H-DSMQ is a reliable and valid tool for clinical and research purposes to assess self-care behaviors related to blood glucose management in Hebrew-speaking adults with T2D. The H-DSMQ may support nurses by encouraging constructive and comprehensive dialog for assessing DSM.

Pain and pain-related functional limitations are common in fibromyalgia patients. In this regard, attempts to cope with pain and related symptoms are important. This study was conducted to investigate the effect of progressive muscle relaxation exercises on pain, kinesiophobia and functional status in fibromyalgia patients. This randomized controlled study has been conducted with 85 individuals diagnosed with fibromyalgia between November 2022 and June 2023. The study consisted of experimental and control groups. Progressive relaxation exercise was applied to the experimental group 2 days a week for 8 weeks. Data have been collected with Descriptive Information Form, Visual Analogue Scale, Tampa Scale of Kinesiophobia, and Revised Fibromyalgia Impact Questionnaire. In this study, it has been determined that Visual Analogue Scale, Tampa Scale of Kinesiophobia and Fibromyalgia Impact Questionnaire total mean scores of the progressive muscle relaxation exercise group have decreased significantly compared to the control group (p < 0.01). This study has shown that progressive muscle relaxation exercises improve pain, kinesiophobia and functional status in fibromyalgia patients. It is recommended to be applied by individuals with chronic pain and in clinics. Trial Registration: This study is registered in the Clinical Trial Registry (registration number NCT05695274).

Acute kidney injury (AKI) affects approximately 20% of hospitalized patients and is associated with higher mortality, extended hospital stay, and increased costs. While various strategies have been proposed to improve AKI management, the impact of nursing resources on AKI outcomes has not been explored. We sought to examine the association between nursing resources and 30-day mortality among patients hospitalized with AKI. Using a cross-sectional study design, we linked data from the CMS Medicare Provider Analysis and Review file, American Hospital Association Annual Survey, and RN4CAST-NY/IL survey of registered nurses. We identified 24,368 Medicare beneficiaries aged 18-99 years with a primary diagnosis of AKI hospitalized in 155 hospitals in New York and Illinois in 2021. The primary outcome was 30-day mortality. Key independent variables included nurse staffing (patient-to-nurse ratio) and nurse education (proportion of nurses holding a bachelor's degree or higher). Covariates were patient demographics, comorbidities, and hospital characteristics. The 30-day mortality rate was 10.5%. In adjusted logistic regression models, each additional patient per RN increased the odds of 30-day mortality by 7% (OR = 1.07, 95% CI [1.01-1.13], p < 0.05). For each 10-point increase in the proportion of nurses with a bachelor's degree or higher, the odds of 30-day mortality decreased by 9% (OR = 0.91, 95% CI [0.88-0.95], p < 0.001). Better nurse staffing and higher proportions of nurses with a bachelor's degree or higher are associated with lower 30-day mortality among patients hospitalized with AKI. These findings underscore the significance of nursing in AKI outcomes and suggest that hospitals should prioritize investing in nursing resources to enhance AKI outcomes.

Breast cancer is the most prevalent cancer among women and a leading cause of cancer-related mortality in Indonesia. Many Indonesian women diagnosed with advanced breast cancer experience physical, emotional, cultural, and spiritual challenges, yet limited research has examined how spirituality shapes their coping experiences. This qualitative study explored the lived spiritual experiences of Indonesian women with advanced breast cancer using a descriptive phenomenological approach. Seven women aged 30-55 receiving care at a palliative clinic participated in in-depth, semi-structured interviews conducted between September and December 2023. Most participants were Muslim and married. Thematic analysis generated five overarching themes: (1) Contend with Guilt from Physical and Social Changes and Cope Through Sunnah devotion, (2) Surrender to divine will and maintain commitment to family as spiritual fulfillment, (3) Illness as a Divine Journey Toward Spiritual Redemption, (4) Gain spiritual support from family and other prayers, and (5) Connect with spiritual power from daily worship. Participants described their spiritual practices such as prayer, dhikr, Qur'anic recitation, and religious gatherings as critical coping resources that fostered emotional resilience, peace, and meaning. These findings underscore the importance of integrating spiritual care as culturally sensitive practice when supporting Indonesian women with advanced breast cancer.

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.

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.