Research in Nursing & Health最新文献

Respiratory disease is one of the main causes of morbidity and mortality in adults with cerebral palsy (CP). The main objective of the study was to investigate the maintenance over time of improvements in respiratory parameters achieved with inspiratory muscle training (IMT). This was a randomized, controlled, double-blind trial and with allocation concealment performed on 27 institutionalized CP patients randomly distributed in two groups: "high intensity training group" (HIT) trained with a load of 40% of the maximum inspiratory pressure (MIP) and "low intensity training group" (LIT) with 20%. Respiratory strength and pulmonary function were evaluated throughout the study. Four weeks after IMT most improvements persisted. Twelve weeks after IMT, only HIT maintained significant improvements (p = 0.001) in MIP; 24 weeks after IMT, in the HIT group, MIP was 10% higher than the initial results and pulmonary function parameters were 1% lower. In the LIT group, respiratory strength and pulmonary function were lower than at baseline. Improvements achieved with IMT are reduced over time once the treatment ends. During the first 4 weeks posttreatment, the benefits persist but from the 12th week there was a progressive loss of the improvement reaching a total loss at 24 weeks. To be most effective, a higher MIP load is suggested for respiratory treatment, which must be maintained over time and interruptions should not be longer than 4 weeks. Clinical trial registration. The study was registered in the clinical trials database of the United States National Library of Medicine (www.clinicaltrials.gov) with the number of registration NCT04915170.

Advancing evidence-based practice requires nurses to have competence in the spectrum of evidence-translation process known as evidence-based healthcare. A scoping review was conducted to identify the instruments used to measure nurses evidence-based healthcare competence and map the associated background factors. The review followed the JBI guidelines with a search made to seven databases CINAHL (EBSCO), PubMed, Scopus, Medic and gray literature EBSCO Open Dissertations & MedNar in 2021 and 2023. A total of 52 studies were included. Nurses' evidence-based healthcare competence related areas were measured with various instruments (n = 23). A total of 24 background factors were examined of which the six most frequently examined with reported associations to nurses' evidence-based competence were: educational level, work experience, EBP education, age, clinical setting, and research experience. Future research should examine the relation of measurement instruments to evidence-based healthcare competence, healthcare requirements and nursing roles, with further exploring the significance of background factors.

The Practice Environment Scale of the Nursing Work Index (PES-NWI) is widely used to assess nursing practice environments; however, existing versions available for primary health care still need to capture the unique aspects of this healthcare setting fully. This study aimed to develop and validate an adapted PES-NWI version tailored for primary health care. A cross-sectional study and a test-retest design were conducted among primary health care nurses. Structural validity was assessed using confirmatory factor analysis, while internal consistency and test-retest reliability were evaluated through Cronbach's alpha and Intraclass Correlation Coefficients (ICCs), respectively. A total of 528 nurses participated, achieving a response rate of 78% with minimal missing data (0-0.6%). The confirmatory factor analysis showed a good model fit, with subscale Cronbach's alpha values between 0.70 and 0.95. Test-retest reliability was strong, with ICCs above 0.70. The adapted PES-NWI demonstrated adequate structural validity, internal consistency, and reliability, supporting its use in primary health care. This adapted measurement tool can support nursing workforce policies by improving the assessment of work environments in primary health care settings. PATIENT OR PUBLIC CONTRIBUTION: No direct patient or public involvement. Primary health care nurses contributed to the content validity assessment of the adapted PES-NWI.

To evaluate the effects of social network-based health education on self-management, self-efficacy and HbA1c of older adults with type 2 diabetes mellitus (T2DM). A convenience sample of 64 elderly T2DM patients with poor glycemic control was randomly divided into two groups. The intervention group received social network-based health education with their nominated social network member for 12 weeks, while the control group received health education alone. The scores of Summary of Diabetes Self-Care Activities (SDSCA), Diabetes Self-Efficacy Scale (DSES), and HbA1c were compared between groups at the baseline and after 12 weeks by using RM-ANOVA. Sixty older adults with T2DM, 30 cases in each group, completed the study. The diet and blood glucose testing dimensions of C-SDSCA had an interaction effect on group-by-time (F were 4.700 and 4.752, respectively, p < 0.05). The mean diet dimension score increased by 1.55 in the intervention group, while 0.76 in the control group, and the score of blood glucose testing dimension increased by 3.5 in the intervention group, while 0.75 in the control group. No significant group-by-time differences were found in C-DSES (F = 1.667, p > 0.05) and HbA1c (F = 0.553, p > 0.05). Social network-based health education effectively promotes self-management in diet and blood glucose testing of the elderly T2DM patients with poor glycemic control. Trial Registration: China Clinical Trial Registration Center (ChiCTR2000038177).

Depressive symptoms in youth are influenced by psychosocial stressors and cognitive vulnerabilities. Perceived everyday discrimination (PED) is a common stressor linked to mental health issues, while dysfunctional attitudes (DAs), per Beck's cognitive theory of depression, may mediate these effects. Additionally, depressive symptoms have been associated with physical health outcomes, such as inflammation. We examined relationships between PED, DAs, depressive symptoms, and interleukin-6 (IL-6), a marker of inflammation, in a sample of 98 youth (13-16 years old; 36.4% female, 63.6% male) from diverse racial/ethnic backgrounds (41.4% Black/African American, 34.8% White/European American, 7.1% Multiracial, 2% Hispanic, 1% Native American, 1% Other). Measures included the Everyday Discrimination Scale, Dysfunctional Attitudes Scale, Center for Epidemiological Studies Depression Scale, and saliva samples. Our regression analyses demonstrated that PED was significantly associated with both DAs and depressive symptoms as well as that DAs were significantly associated with depressive symptoms and IL-6, while neither PED nor depressive symptoms were significantly associated with IL-6. Consistent with the regressions, our mediation analyses revealed no significant indirect effects of PED on IL-6 through DAs, depressive symptoms, or their sequential combination. Our findings support the role of PED as a stressor within Beck's cognitive theory and expand the theory's application by linking DAs to inflammatory processes. Given these connections, nurses can play a crucial role in implementing cognitive interventions to mitigate the effects of DAs and advocating for systemic change to reduce discrimination.

Artificial Intelligence (AI)-based applications have significant potential to differentiate between pressure injuries (PI) and incontinence-associated dermatitis (IAD), common challenges in nursing practice. Within the KIADEKU overall project, we are developing an AI-based application to aid in the nursing care of PI and IAD and to facilitate personalized, evidence-based nursing interventions. The KIADEKU clinical sub-study described in this study protocol is a controlled, non-randomized clinical pilot intervention study investigating the effects of the AI-based application, fully developed in the KIADEKU overall project, on the duration of wound assessment, dressing change and documentation, guideline adherence, and nurse task load. The study utilizes a pre-post design with two data collection periods. During the initial phase, we will observe and survey nurses in the control group as they provide conventional wound care without AI support to adult patients with PI or IAD in the pelvic area across eight wards at the LMU University Hospital. In the following intervention phase, the AI-based application will assist nurses in wound assessment and deliver guideline-based nursing interventions for documented wound types. Observations and surveys will be repeated. Measurements will include the duration of wound assessment, dressing changes, and documentation, adherence to wound care guidelines, and the accuracy of AI predictions in clinical settings, validated by an on-site expert assessment. The survey will assess nurses' task load and other covariates, such as professional experience, overall workload during the shift, and wound severity. Linear regression models will be used to analyze the effects of AI usage on the aforementioned aspects, taking into account these covariates. The accuracy of AI predictions regarding wound type and classification will be measured using the on-site expert's assessment as the ground truth. The usability of the AI-based application and standard clinical documentation systems will be evaluated further. The deployment of the AI application in clinical settings aims to reduce the duration of wound assessments, dressing changes, and documentation; decrease nurse task load; enhance guideline adherence in wound care; and promote AI utilization in nursing. German Clinical Trials Register (DRKS) (DRKS00031355). Registered on April 5th, 2023. TRIAL REGISTRATION: German Clinical Trials Register (DRKS) DRKS00031355. Registered on April 5^th 2023. PATIENT OR PUBLIC CONTRIBUTION: Patient representatives contributed to the development of the AI-based application through the use of Delphi methodology, as part of the KIADEKU qualitative sub-study.

Body mass index (BMI) is an inexpensive, easy-to-calculate, and noninvasive marker of malnutrition. Few studies have examined the longitudinal effects of BMI on the incidence of unfavorable physical health outcomes (UPHOs) among older adults receiving homecare nursing. Therefore, this prospective cohort study examined the longitudinal effects of low BMI on the occurrence of UPHOs at multiple time points (i.e., 1-, 3-, and 6-months) among older adults (≥ 75 years) receiving homecare nursing across Japan. Using an online questionnaire, homecare nurses reported clients' height and weight, as well as socio-demographic characteristics (e.g., age and gender) and health conditions (e.g., diagnosis and dependency level). The occurrence of seven UPHOs (urinary tract infection, respiratory infection, pressure ulcer or skin tear, dehydration, poor dyspnea control, poor pain control, and traumatic fall) was also reported. The longitudinal effects of low BMI on the total number of UPHOs at 1-, 3-, and 6-months follow-ups were examined using a Restricted Moment Model (RMM) with a log link function. Among 660 participants included in the analysis, 42.12% were males, 36.96% had dementia, and 44.09% had low BMI. Adjusting for client's characteristics and the number of UPHOs at the baseline, low BMI at the baseline could increase the incidence of UPHOs at 1-, 3- and 6-month follow-ups (incidence rate ratio [95% confidence interval]:1.59 [1.21, 2.07], 1.57 [1.18, 2.07], 1.35 [1.02, 1.79], respectively). Adequate management of low BMI among older adults receiving homecare nursing would have a favorable effect on reducing the occurrence of UPHOs, thereby reducing the deterioration of overall physical conditions.