Research in Nursing & Health最新文献

The COVID-19 pandemic created a crisis in healthcare throughout the world, which may have influenced perioperative nursing roles and responsibilities. The aims of this study were to assess the perioperative nurse's work experience during the COVID-19 pandemic and to evaluate the impact of their perceived stress, burnout, and job satisfaction on their intent to stay (ITS) in the workforce. A descriptive, exploratory design was conducted using an electronic survey methodology. The study was guided by the Job Demands-Resources model. The primary outcome variable was ITS. Data analysis included univariate and multivariate techniques. The mean age of respondents (N = 1436) was 50; 92% were female; 54% reported a BSN as their highest degree. Over half were clinical nurses (59%) and the majority (64%) reported working in their usual unit during COVID-19. Nurses providing direct care to COVID-19 patients reported significantly higher burnout and secondary traumatic stress (p < 0.001); however, there was no significant difference in ITS. Significant predictors of ITS included a greater number of years as a perioperative nurse, higher compassion satisfaction, and a positive perception of workload. Results support years in practice and higher compassion satisfaction as positive predictors of ITS in the workforce and a perception of heavier workload as negative. Perioperative nurses took on a variety of roles that could be helpful in the future support of pandemics. Institutional and policy support of actions to enhance perioperative nurses' perceived workload and compassion satisfaction is important to foster nurses staying within perioperative nursing and the organization.

Poor sleep quality and psychological stress are interrelated and disproportionately affect adults with multiple cardiovascular disease (CVD) risk factors. Maintaining an optimal home environment and engaging in healthy bedtime behaviors are important components of sleep hygiene practices that influence sleep health. This study sought to examine: (1) the association between sleep hygiene and psychological stress, and (2) the moderating effect of sleep quality in the relationship between sleep hygiene and psychological stress, among adults with multiple CVD risk factors. A cross-sectional study was conducted with 300 adults diagnosed with hypertension and diabetes. Individuals were recruited from a large academic health center and were asked to complete an online survey. Sleep hygiene was assessed by nine individual factors focusing on negative household environment (safety, physical comfort, temperature, noise, and light) and poor bedtime behaviors (watching TV, playing video games, using small screens, and eating), and by a composite score. Multivariable linear regression was employed to examine the associations. Of the sample, 78% reported poor sleep quality and 44% reported high psychological stress. The composite sleep hygiene score was significantly associated with higher psychological stress after controlling for sleep quality, and the relationship was not modified by sleep quality. Unsafe household, uncomfortable physical environment, uncomfortable temperature, and eating at bedtime were independently related to increased stress levels. The study highlights strong links between sleep hygiene and psychological stress. Current evidence suggests that promoting home environment and bedtime behaviors may alleviate psychological burdens in adults with multiple CVD risk factors.

The purpose of this study was to examine the association between hospital nurse staffing levels and 30- and 60-day readmissions among patients with intellectual and/or developmental disabilities (IDD). This cross-sectional correlational study utilized secondary data from 595 acute care, nonfederal hospitals in California, Florida, New Jersey, and Pennsylvania in 2016. Data were obtained from three sources: the American Hospital Association Annual Survey, the RN4CAST-US nurse survey, and state patient hospital discharge summaries. The analytic sample included 39,558 hospital stays for 28,446 adults with IDD aged 18 and older who were discharged alive. In adjusted models, every additional patient added to a nurse's workload was associated with 7% higher odds of 30-day readmission OR = 1.07 (95% CI [1.03, 1.12], p = 0.001) and 9% higher odds of 60-day readmission OR = 1.09 (95% CI [1.04, 1.13], p < 0.001) among patients with IDD. The average nurse staffing level across hospitals was 4.7 patients per nurse (SD = 0.99). Staffing levels varied by hospital characteristics, with large hospitals, major teaching hospitals, and hospitals in California having better staffing ratios. The study population had a 30-day readmission rate of 17.1%, which is 27% higher than the average adult hospital 30-day readmission rate in the US in 2018. This study demonstrates the association of nurse staffing levels with readmission odds for patients with IDD. Improving nurse staffing levels is a system-based solution that can potentially improve outcomes for patients with IDD, who often require intensive nursing care.

Black, Hispanic, and multiracial women in the U.S. experience higher rates of discrimination and mistreatment in perinatal care compared to White women, which can lead to fear, anxiety, and reduced engagement with obstetric healthcare providers. Black women are also more likely to experience high-risk pregnancies and health complications such as gestational diabetes and hypertensive disorders. As a result, Black women face a heightened risk of birth trauma and subsequent posttraumatic stress disorder (PTSD) in the postpartum period. Despite these inequities, little is known about Black birthing individuals' experiences of healthcare interactions. This study explores Black women's accounts of negative experiences of perinatal care in the context of high-risk pregnancy. Fourteen individuals from across the U.S. participated in semi-structured interviews conducted within 6 months postpartum between September 2022 and December 2024. Interview responses were analyzed using directed content analysis, with coding of their emotional distress guided by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) definition of PTSD. Their accounts aligned with the four DSM-5-TR symptom clusters: intrusive symptoms, avoidance, negative alterations in cognition or mood, and alterations in arousal and reactivity. PTSD-like symptoms resulted from pregnancy complications, traumatic birth experiences, mistreatment by clinicians or a combination of these factors. The findings suggest that birth trauma and mistreatment in perinatal care have significant emotional and behavioral impacts on Black women. The study results underscore the urgent need for trauma-informed, antiracist approaches in perinatal care to address these disparities and improve outcomes for Black birthing individuals.

Positive childhood experiences (PCEs), such as supportive relationships and household routines, promote and protect well-being in later life. However, the mechanisms through which PCEs act remain unclear. This study examines whether emotion regulation mediates the association between PCEs and flourishing in a large sample of Chinese young adults. Data were collected from 9468 Chinese university students via online surveys (August-November 2020). Measures included the Chinese versions of the PCE Scale, Flourishing Measure (which characterized point-in-time flourishing and secure flourishing over an extended period), and Emotional Regulation Questionnaire (which assessed cognitive reappraisal and expressive suppression). Bivariate Pearson correlations assessed associations, and mediation analysis was conducted using the PROCESS procedure in SPSS 4.1. Experiencing more PCEs was correlated with greater cognitive reappraisal (r = 0.28, p < 0.01), lower expressive suppression (r = -0.11, p < 0.01), and greater flourishing (r = 0.49, p < 0.01). Cognitive reappraisal was correlated with greater flourishing (r = 0.43, p < 0.01), while expressive suppression was correlated weakly with lower secure flourishing (r = -0.02, p < 0.05). Mediation analysis showed cognitive reappraisal (indirect effect b = 0.06, 95% CI [0.05, 0.06]) and expressive suppression (b = 0.002, [-0.004, -0.001]) significantly mediated the PCEs-flourishing relationship. Similar results were found with secure flourishing. Findings suggest that emotion regulation, particularly cognitive reappraisal, may be a key psychological mechanism linking PCEs to flourishing later in life among young adults in China.

The primary prevention of stroke high-risk groups is contingent upon health behavior intervention, and the key to such interventions is health behavioral decision-making. The present study aims to explore the potential classification of the health behavior decision-making of high-risk stroke groups using latent profile analysis (LPA) and the key influencing factors of the LPA classes. A cross-sectional study was conducted from January to May 2023 with 264 high-risk individuals of stroke in Henan Province, China. Data were collected using the Behavioral Decision Assessment Scale of Stroke Patients, the Revised Health Promoting Lifestyle Profile-II and the Social Support Rating Scale. LPA showed that a three-profile model of health behavior decision-making best fit this study. Health behavior decision-making of stroke high-risk groups were divided into three latent classes: high-output behavior type (23.1%), influence-impervious type (60.6%), and influence-sensitive type (16.3%). Comparisons between the three LPA classes showed that living situation, per capita monthly household income, hypertension, overweight/obesity, health promoting lifestyle behavior were significantly different between the participants' latent classes of behavior decision-making. Clinical staff can develop targeted interventions according to different problems existing in the decision-making processes, and improve and implement the screening content and process among community high-risk stroke groups, which has practical significance for promoting their healthy behaviors. Patient or Public Contribution: In our study, survey questionnaires were completed by participants at high risk of stroke.

Extensive evidence demonstrates higher rates of anxiety and depression in sexual and gender minorities (SGM) compared to the general population. However, few studies have examined the intersection of sexual orientation and gender identity. Status as a multiple minority may further increase the risk for anxiety and depression. The goal of this study was to assess the extent to which anxiety or depression diagnosis, clinical cutoff, or symptom severity differed by gender identity, sexual orientation, or the intersection of the two. A sample of 554 US adults (75.6% White, between 18 and 65 years) were recruited through social media to complete an online survey. Of the sample, 44.2% were sexual minorities and 35.6% were gender minorities. Results from logistic regression analyses indicated that heterosexuals were 41% more likely to be diagnosed with anxiety, but sexual minorities were nearly three times more likely to be diagnosed with depression and 20 times more likely to meet PHQ-9 cutoffs. Based on analyses of covariance, gender minority participants reported significantly greater depression severity than cisgender participants. Sexual orientation and gender identity interacted in the depression, but not the anxiety symptom severity model. Cisgender sexual minorities had greater depression severity than cisgender heterosexuals, but lower depression severity than gender minorities who were also sexual minorities. These findings suggest that dual minorities experience greater minority stress, which worsens depression symptom severity. This has important clinical implications for nurses caring for SGMs. Future studies should consider intersectional analysis to elucidate further the compounding effects of dual minority status on SGMs.

Poststroke fatigue severely affects stroke survivors (SSs) physically and mentally. Although the literature acknowledges the critical role of care partners (CPs) in survivors' fatigue adaptation, this topic remains under-explored. This study, guided by the Adaptive Leadership Framework for Chronic Illness, explored how SSs and CPs managed fatigue collaboratively within 6 months poststroke. This longitudinal qualitative analysis included nine first-time ischemic SSs and their CPs who consented to interviews. Semistructured interviews were conducted during the index hospitalization (or within 10 days postdischarge) and at 1, 3, and 6 months poststroke. Directed content analysis was used to analyze the data. Four themes were identified. First, SSs and CPs engaged in collaborative work by achieving a mutual understanding of fatigue levels but misalignment was found during 3-6 months poststroke. Second, CPs provided emotional and practical support, exercising adaptive leadership to help survivors adapt to fatigue. The support squad, including informal and formal helpers beyond the primary CPs, also undertook adaptive leadership behaviors to facilitate the post-stroke adaptation to fatigue for both SSs and CPs. Third, the day-to-day realities of post-stroke fatigue presented persistent challenges for SSs. Fourth, SSs managed fatigue (adaptive work) by using self-awareness, resting, and pacing activities. Results suggested the need for SSs and CPs to develop a shared understanding of fatigue. Healthcare professionals should treat SSs and CPs as an adaptive unit, ensuring access to support resources at discharge to facilitate post-stroke adaptation to fatigue.