Research in Nursing & Health最新文献

The literature has documented that many women with disability (WWD) report barriers to obtaining reproductive health care as well as poor experiences with providers when care is received. This project sought to compare barriers and experiences in reproductive health care for WWD to those of women without disability in the United States. Using representative data from the National Survey of Family Growth (2017-2019), we present weighted estimates of poor or fair experiences with providers by disability status, as well as weighted estimates of the proportion of women reporting types of barriers to services by disability status, among individuals identifying as women between the ages of 15 and 49. We then used weighted logistic regressions to compare barriers and experiences with providers by disability status. After controlling for potential confounders, women with any disability had 2.6 times higher odds as women without disability to rate their providers' respect for them as "poor" or "fair" (95% CI: 1.1-6.2). WWD did not significantly differ from women without disability in whether they reported more than one type of barrier (AOR = 1.3, 95% CI: 0.8-2.1), yet WWD had higher odds of reporting financial barriers compared to women without disability (AOR = 1.5, 95% CI: 1.02-2.2). While access to reproductive health care and experience with providers needs to be improved for all, these findings suggest that targeted efforts are needed to eliminate inequities for WWD in the reproductive health care system.

Minimal progress has been made in narrowing disparities between patients with and without limited English proficiency (LEP). Using 2016 data from RN4CAST-US, New Jersey Discharge Data Collection System, and AHA Annual Hospital Survey, multivariable logistic regression models were employed to examine whether and to what extent the hospital nurse work environment, defined as the conditions that nurses work in, is associated with decreased disparities in 7-day hospital readmissions between patients with and without LEP. Existing literature has established associations between nurse work environments and outcomes disparities of various minoritized populations; however, no literature has examined this relationship in the context of hospitalized patients with LEP. In a sample of 424,745 hospitalized adults (n = 38,906 with LEP), patients with LEP, compared to those without LEP, were younger (63.4 vs 64 years old, p < 0.001), more likely to be insured by Medicaid (8.9% vs 5.5%) or uninsured (7.5% vs 2%, p < 0.001), and readmitted (4.5% vs 3.9%, p < 0.001). Adjusting for patient and hospital characteristics, LEP patients had 33% higher odds of a 7-day readmission, as compared to patients without LEP (OR 1.33, 95% CI [1.19-1.47]). A significant interaction was found between patients' LEP status and the nurse work environment (OR 0.83, 95% CI [0.70-0.99]), such that patients with LEP experienced lower odds of 7-day readmission in more favorable nurse work environments, compared to patients without LEP. Hospitals dedicated to providing equitable healthcare may consider enhancing nurses' working conditions as a potential way to reduce disparities in readmission rates.

The objectives of this study were to characterize burnout in five different health professions (i.e., pharmacists, nurses, occupational therapists, psychologists, and mental health counselors) as well as to determine if moral distress, ethical stress, and/or ethical climate were predictive of burnout and job satisfaction. Cross-sectional survey data were collected in the USA using validated measures from a sample of 291 in early 2022 (COVID-19 Omicron wave). The average age of participants was 51 years (s.d. = 12.59) and most identified as female (78%), White/Caucasian (82%), married/in a domestic partnership (72%), without dependents (57%), and had > 20 years of experience (53%). Results demonstrated that two of the three dimensions of burnout (i.e., emotional exhaustion and depersonalization) reached clinically significant levels among nurses, occupational therapists, and pharmacists, but not among psychologists or mental health counselors. In testing an exploratory structural equation model, moral distress, ethics stress, and ethical climate contributed significantly to the burnout and job satisfaction of all professionals (CFI = 0.905; SRMR = 0.056; Gamma hat scaled = 0.931). These findings support a theoretical framework for explaining associations between ethical indicators and burnout and job satisfaction. Future research should explore if professions with less burnout experience differences in the organizational environment, autonomy, and independence of clinical work, and/or professional identity. Exploration into professional socialization, such as strategies learned as part of training and development, may be warranted to identify factors that buffer or mitigate burnout risk.

e-Pulse is an electronic personal health record system known as e-Nabız in Turkey. This study compares the effect of European Health Literacy-based e-Pulse education and e-Pulse instructional materials on the health literacy levels of adults aged 45-64 with inadequate and problematic-limited health literacy levels. This single-blind, randomized controlled trial was conducted from June 2023 to September 2023. It included 140 participants, assigned to either the intervention group (n = 70) or the active control group (n = 70). The intervention group received HLS-EU-based e-Pulse education, which consisted of two 45-min sessions over 6 weeks, along with the e-Pulse user guide and introduction video. The active control group only received the e-Pulse user guide and introduction video, and each participant was individually briefed on the e-Pulse system content for 5-10 min. Results were measured using the European Health Literacy Survey Questionnaire (HLS-EU-Q47) and the eHealth Literacy Scale (eHEALS) at baseline and the sixth week. Both the intervention and active control groups showed an increase in health literacy and eHealth literacy scores, but the mean change was greater in the intervention group. A statistically significant difference was found in the effects of HLS-EU-based e-Pulse education and e-Pulse instructional materials on both health literacy (F (1, 137) = 25.215; p < 0.001) and eHealth literacy (F (1, 137) = 36.134; p < 0.001). HLS-EU-based e-Pulse education significantly improved health literacy (d = 0.8492; p < 0.001) and eHealth literacy (d = 1.0175; p < 0.001) compared to e-Pulse instructional materials. The intervention group demonstrated significantly higher rates of sufficient (32.9%) and excellent (12.9%) health literacy. Notably, a medium correlation (r = 0.602; p < 0.001) was observed between health literacy and eHealth literacy. Trial Registration: ClinicalTrials.gov (ID: NCT05831254) https://clinicaltrials.gov/study/NCT05831254.

Malpractice, which occurs when a reasonable standard of service cannot be provided, is a critical situation in nursing care and interventions. Nurses' tendency toward medical errors and burnout levels are important due to their impact on patient safety and the quality of care. This study was conducted to investigate nurses' malpractice tendencies and burnout levels and the relationship between the two. The data of this descriptive, cross-sectional, and correlational study were collected from 292 nurses working in a training and research hospital in Istanbul province between January and February 2021. A Descriptive Information Form, the Malpractice Trend Scale in Nursing (MTSN), and the Maslach Burnout Inventory (MBI) were used to collect data. In data analysis, internal consistency coefficient, descriptive, non-parametric comparisons, and correlation analyses were performed. The mean age of the nurses participating in the research was 31.13 ± 7.87 years; 79.8% were women, 50.7% were single, and 68.5% had an undergraduate degree. When nurses' opinions about malpractice were examined, it was determined that 88.7% had not committed malpractice before and 53.4% had witnessed someone who committed malpractice. Nurses' overall MTSN score was 233.48 ± 15.32. Their Maslach Burnout Inventory score was 18.20 ± 8.83 on the emotional exhaustion subscale, 8.07 ± 3.86 on the depersonalization subscale, and 21.31 ± 4.00 on the personal accomplishment subscale. The reliability coefficients of the scales and subscales ranged between 0.61 and 0.95. There was a significant difference between the MTSN scale and MBI subscales according to nurses' positions and satisfaction with the environment (p < 0.05). A negative correlation was found between the mean scores on the total MTSN and the MBI emotional exhaustion (r = -0.314) and depersonalization (r = -0.293) subscales, and a positive and statistically significant relationship (p < 0.001) existed between the MTSN total scale and the personal accomplishment (r = 0.359) subscale. The level of burnout is associated with a tendency to malpractice. Taking measures to prevent nurses from experiencing burnout may be important for reducing medical errors. These measures will be reflected in better care service and quality.

Increasing attention has been paid to investigations on how social determinants of health (SDOH; e.g., income, employment, education, housing, etc.) impact health outcomes. However, these variables are often not collected in routine clinical practice. As a consequence, researchers may attempt to link retrospective medical records to those datasets that can provide additional SDOH information, such as the Area Deprivation Index (ADI). However, time-consuming geographic calculations can deter these analyses. To reduce this burden, the ezADI R package performs batched geocoder mapping on inputted addresses, constructs Federal Information Processing Series (FIPS) codes, and then merges these data with ADI scores. The applicability and feasibility of this ezADI tool was tested on a sample of patients with sickle cell disease (SCD). Individuals with SCD are at risk for developing serious comorbidities; disadvantageous SDOH may increase this risk, in turn leading to higher rates of hospital utilization and longer lengths of stay on admission. In this sample of 1,105 individuals with SCD in Tennessee (53.8% female, 97.5% African American), higher ADI scores (i.e., more neighborhood disadvantage) were significantly associated with increased hospital utilization (rho = 0.093, p = 0.002) and longer lengths of stay (rho = 0.069, p = 0.021). These areas could be targeted with neighborhood-level interventions and other resources to improve SDOH. This study provides proof of concept that the ezADI tool simplifies geocoding calculations to allow researchers to link datasets with the ADI and assess associations between SDOH factors and health outcomes.

This study aimed to determine microbial colonization in indwelling urinary catheters (UCs) and identify patient-specific risk factors associated with this colonization. This cross-sectional study involved 61 hospitalized intensive care unit patients with indwelling UCs. Bacterial colonization and susceptibility were assessed in the indwelling UCs from the second day onwards following urinary catheterization. The average duration of catheterization was 13.62 ± 13.72 days. Colonization of 10⁵ CFU/mL and above was determined in all indwelling UCs from the second day of catheterization onwards. The catheter was colonized by the following microorganism species: Pseudomonas aeruginosa, Acinetobacter baumannii, Proteus mirabilis, and Staphylococcus aureus. 47.9% of clinical isolates showed multi-drug resistance (MDR). Clinical isolates did not show significant differences based on patient variables such as age, Body Mass Index, and duration of urinary catheterization (p > 0.05). There was a weak correlation (rs:≤ 0.206; p > 0.05) between the species of clinical isolates and patient laboratory variables. Colonization was determined in all indwelling UCs, with nearly half of isolates exhibiting MDR. These findings highlight the urgent need for improved strategies to manage and prevent catheter-associated infections, particularly in high-risk patient populations.

Previous research indicates that most living kidney donors (LKDs) are content with their decision to donate and seldom experience regret. Nevertheless, a small percentage of donors report adverse experiences, such as psychological distress and reduced vitality. Therefore, it is essential to explore the experiences of LKDs, particularly within the context of their decision-making process both before and following kidney donation. This study aimed to examine the decisional conflict and decisional regret experienced by LKDs from the evaluation stage to 12 months post-donation and to identify the associated factors. A longitudinal study design was implemented, and the initial data collection took place when potential LKDs visited the hospital for evaluation (n = 50). Subsequent data collection was conducted at 3 (n = 49), 6, and 12 (n = 46) months post-donation. Variables, including basic demographics, decisional conflict, decisional regret, perceived control, psychological distress, and healthcare orientation, were collected. Generalized estimating equations were used to obtain inferential statistics. Results showed that perceived control characterized by personal control orientation, lower psychological distress, and better healthcare orientation were associated with reduced decisional conflict among LKDs. Meanwhile, lower decisional regret was associated with better self-perceived health status, perceived control inclined toward interpersonal control, and less psychological distress among LKDs. Nurses should assess the decisional conflict and mental health of potential LKDs, and provide clear information to support their decision regarding kidney donation. They should also offer self-care information and stress-coping strategies related to living donor nephrectomy to aid in reducing decisional conflict and regret.