Research in Nursing & Health最新文献

Emergency departments (EDs) frequently serve individuals who have experienced acute or cumulative trauma. While trauma-informed care (TIC) offers a framework to support healing and psychological safety, little is known about how nurses implement these principles in high-acuity emergency settings. This study explored how emergency nurses understand, deliver, and emotionally navigate trauma-informed care in the context of a tertiary hospital in Saudi Arabia. A qualitative phenomenological design was employed. Seventeen registered nurses from the emergency department of King Faisal university Hospital participated in in-depth, semi-structured interviews. Data were analyzed thematically using Braun and Clarke's six-phase framework and managed with NVivo 14 software. Four interrelated themes were identified: (1) Holding Emotional Space in Clinical Chaos-nurses created micro-moments of psychological safety amid trauma and time pressure; (2) Systemic Misalignment with Trauma-Informed Values-organizational structures constrained relational care; (3) Protective Empathy and Adaptive Strategies-nurses developed emotional boundaries and grounding rituals to sustain compassion; and (4) The Accumulated Emotional Toll-ongoing exposure to trauma resulted in moral injury and emotional exhaustion, countered by reflection and peer support. Trauma-informed care in emergency settings is relational, emotionally taxing, and often constrained by systemic factors. Institutions must invest in trauma-informed systems, staff supports, and educational infrastructure to sustain ethical, emotionally attuned care in acute environments. Patients were not directly involved in this study, which focused on healthcare provider perspectives. Findings may inform institutional strategies to enhance patient-centered, trauma-informed practice.

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.

Knowledge of association between violence and chronic pain in men is limited by neglect of violence experiences as perpetrator, disregard of heterogeneity in cumulative lifetime violence severity (CLVS), weak understanding of mediation pathways, and inattention to social determinants of health (SDOH). The CLVS-44 measure and identification of four distinct latent profiles of CLVS facilitated addressing these shortcomings. CLVS-44 data from a national cross-sectional community survey of 587 Canadian men who had violence experiences as target and/or perpetrator were used in parallel multiple mediation analysis with a multi-categorical profile antecedent. Differences among CLVS profiles for relative direct and indirect associations through injury, depression, and posttraumatic stress disorder (PTSD) to chronic pain disability were examined. Differences among profiles by SDOH were also explored. Compared to Profile 1 (Lowest CLVS), Profile 4 (Highest Target and Perpetrator) had significant relative direct and indirect effects through lifetime injuries and PTSD, with the highest mean scores for chronic pain disability and all mediators. Indirect effects through PTSD for Profiles 2 (second Lowest Target, Moderate Physical Partner Perpetrator) and 3 (second Highest Target, Low Psychological Perpetrator) were also significant. Masculine discrepancy stress, adverse housing, economic challenges, and substance use were significantly higher for Profile 4. These results demonstrate that high perpetration differentiates men most likely to have the highest chronic pain disability as indicated by direct and indirect pathways. Findings also highlight the need for trauma- and violence-informed approaches to chronic pain assessment and management to avoid re-traumatization. SDOH inequities may identify starting points for strength-based interventions.

Adverse childhood experiences (ACEs) are often positively associated with mental health conditions. We examined whether emotional support attenuates the association between ACE clusters and both social problem solving and mental health assessments (depression, anxiety, post-traumatic stress disorder (PTSD) symptoms). A convenience sample of 336 Latina immigrant women completed questionnaires about their ACEs, emotional support, social problem-solving, and depression, anxiety, and PTSD symptoms. Using PROCESS SPSS Macro version 4.0 we conducted four separate moderation analyses. We identified 5 ACEs clusters from our sample (n = 336): Global ACEs (15.5%), Community Violence and Physical Abuse (23.8%), Physical and Emotional Abuse (21.4%), Household Dysfunction with Physical and Emotional Abuse (16.7%), and Low ACEs (22.6%). Emotional support served as a protective moderator with differential effects, providing the greatest benefit to women who experienced high levels of abuse. For social problem-solving abilities, significant interactions emerged for the Physical and Emotional Abuse and Household Dysfunction clusters, indicating that as emotional support increases, the difference in social problem-solving between these high-ACE clusters and the Low ACEs cluster decreased. For PTSD symptoms, women in the Global ACEs cluster showed significantly higher symptoms than the Low ACEs group when emotional support was low. The clusters did not differ at high emotional support levels, indicating that adequate social support can reduce the negative effects of ACEs on both PTSD symptoms and effective problem-solving. These findings underscore the need for trauma-informed, culturally responsive care models that integrate ACE screening and guide future interventions to strengthen social support networks for ACE survivors.

This umbrella review systematically synthesises the evidence on the impact of natural disasters on adult mental health from existing systematic reviews and/or meta-analyses. Nine electronic databases were searched for peer-reviewed systematic reviews and/or meta-analyses published between 2008 and 2024. The Measurement Tool to Assess Systematic Reviews (AMSTAR) 2 was used to evaluate the methodological quality of the study. Of the 16 included systematic reviews and/or meta-analyses, most of the time, they described the impact of natural disasters generally as a mix of any natural disaster, earthquakes, hurricanes/typhoons/cyclones, floods, wildfires, bushfires, and tsunamis on general mental health, post-traumatic stress disorder, depression, stress, and anxiety. The review found that adults exposed to natural disasters either directly or indirectly can experience the impact on their mental health for a long time. Older people, women, those with lower income, and African Americans exhibited greater vulnerability to mental health issues than others. Findings on the impact of each type of natural disaster on adult mental health from the included systematic reviews and/or meta-analyses were also described in detail. Findings of this review may inform the development of targeted policies and strategies by policymakers and health care professionals to support adults affected by natural disasters. Findings of this review should be interpreted considering its limitations. Several research gaps were identified, underscoring the need for further research.

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.

Missed infection control practices may impact quality healthcare and patient safety. Hence, research is urgently needed to examine infection control practices left undone by nursing personnel, especially in Arab countries. This study aimed to identify missed infection control nursing practices and the underlying reasons among nurses working in medical and surgical wards in Jordan. A cross-sectional design was utilized. The study involved a convenient sample of 514 nurses from seven hospitals (six public and one tertiary hospital) in the North of Jordan during the period of October 2022 and August 2023. The Missed Nursing Care Infection Prevention and Control (MNCIPC) Survey was employed to collect the data. Data were analyzed using descriptive inferential and multivariate regression analysis. The results of this study revealed that nurses working at the medical ward reported more missed care infection activities compared to nurses working at the surgical ward. Nurses working overtime, with less clinical experience, and without formal training or qualifications reported more missed infection control. The most perceived reasons for the missed infection control activities related to labor resources, including inadequate staffing, urgent patient situations, or unexpected rise in patient volume and/or acuity. There is a need to recognize missed infection control activities and the reasons for their occurrence. The interventions to reduce missed infection control measures should aim at increasing staffing levels to manage increased and unexpected surges in nursing workload.

The aim of this study was to investigate organizational and practitioner-related factors influencing the panel size of primary care nurse practitioners (PC-NPs) in Quebec (Canada). Cross-sectional study. This secondary analysis was based on a cross-sectional study that used a self-administered online questionnaire available from March to April 2022 to assess the work conditions of NPs in Quebec. A multiple regression analysis was conducted on a subset of 321 PC-NPs to predict panel size and associated factors. Among 321 PC-NPs, with a mean of 4.6 years of experience as NP, the average panel size was 344 patients. Factors significantly associated with a greater panel size were a higher number of years of experience as a NP (p < 0.001), a higher number of years spent in the current organization (p < 0.001) and a higher number of patients seen in an average day (p < 0.001). Our study provided a measure of the PC-NP panel size in the province of Québec highlighting their essential role in primary health care. The results suggest that policymakers and administrators should focus on enhancing the experience of their PC team, ensuring employment stability and providing adequate time for patient appointments to optimize PC-NP panel size and enhance service capacity to increase access to primary health care.

In South Korea, hypertension (HTN) is prevalent among deaf individuals, with a reported rate of 63.9%, which is higher than in the general population. To manage this condition effectively, a self-management education intervention is needed. In particular, since deaf individuals generally exhibit low levels of health literacy, it is essential to develop interventions that consider their limited health literacy. This study evaluates the impact of the Hypertension Self-Management Education for the Hearing Impaired Using Sign Language (H-SMILE) program. Using a quasi-experimental, nonequivalent control group design, 16 deaf participants received the 6-week H-SMILE program, whereas 17 participants attended a single traditional lecture session. Outcomes measured included depression, quality of life, HTN knowledge, health literacy, self-care, medication adherence, and clinical indicators, assessed at baseline, post-intervention, and 2 months post-intervention. Immediately post-intervention, the H-SMILE group showed improvements in self-care management, self-care confidence, and functional health literacy, alongside an increase in depression compared to controls. These effects did not persist at the 2-month follow-up. The H-SMILE program shows initial effectiveness but requires strategies for long-term sustainability of outcomes.