The journal of nursing research : JNR最新文献

Background: The definition of frailty is still debated, resulting in the development of various measurement tools. Having a convenient and accurate frailty screening instrument is essential to providing appropriate care to community-dwelling older adults in terms of facilitating the delayed onset of frailty and preventing disability.

Purpose: This study was conducted to develop a simple, convenient, and rapid screening method for frailty classification in community-dwelling older adults that incorporates the most significant predictive factors from the Study of Osteoporotic Fractures index components and the Kihon Checklist tool domains.

Methods: Convenience sampling was used to gather longitudinal data from 110 community-dwelling older adults at baseline (T0), 6 months (T1), and 1 year (T2) using three different frailty screening tools. The Fried frailty phenotype tool was used as the gold standard. Linear discriminant analysis was conducted to create an effective model for accurately classifying frailty states.

Results: The discriminant analysis generated three statistical significant functions, which respectively explained 33.6% ( Rc =.58; df =3; p <.0001), 26.0% ( Rc =.51; df =2; p <.0001), and 29.2% ( Rc =.54; df =2; p <.0001) of the predictive power of prefrail/frail risk. The discriminant functions demonstrated sensitivities of 64.6%-69.4% for identifying the prefrail/frail group and specificities of 77.1%-90.9% for identifying the robust group. The developed method successfully classified the correct robust and prefrail/frail states for 71.6%-79.1% of participants. The findings of this longitudinal study show weight loss, reduced energy levels, physical function, activities of daily living (IADL lifestyle), and eating function to be the most significant factors at baseline for accurately classifying community-dwelling older adults into robust and prefrail/frail states over a 1-year follow-up period.

Conclusions/implications for practice: Eating function was identified as the strongest factor of influence on the correct prediction of frailty status. Nurses may use the five questionnaire-based domains in initial assessments to classify frailty in community-dwelling older adults with a 1-year accuracy of at least 70%. Those identified as at-risk should be referred to physicians, nutritionists, rehabilitation specialists, and/or long-term care services to optimally delay or prevent the onset of frailty in this population.

Background: The lack of a comprehensive assessment tool to evaluate patient understanding of the benefits and risks of complementary therapies (CTs) in diabetes management may lead to the unsafe use of CTs alongside conventional treatments, increased risk of misinformed decision-making, potential adverse interactions, and compromised health outcomes.

Purpose: In this study, an instrument was developed to assess patient understanding of the benefits and risks of using CTs in diabetes management and its psychometric properties were evaluated.

Methods: A two-phase design, including scale development and psychometric validation, was used. In Phase 1, the initial scale items were revised and confirmed by a panel of experts for content validity. In Phase 2, a cross-sectional survey was conducted to assess the scale's psychometric properties, including reliability and validity analyses. A sample of 307 outpatients with diabetes who had used CTs all completed a sociodemographic, clinical characteristics, and CT usage data sheet, as well as the Understanding the Benefits-Risks of CT Use in Diabetes Scale and the Diabetes Empowerment Scale. The developed scale was validated using exploratory and confirmatory factor analyses that used structural equation modeling to confirm construct validity, Person correlation to confirm criterion-related validity, and Cronbach's α coefficient to confirm reliability.

Results: The initial 16-item Understanding the Benefits-Risks of CT Use in Diabetes Scale was assessed as having a content validity index of .88. Factor analyses reduced the scale to 15 items in four dimensions, including the patient's medical condition for CT use (four items), the benefit-risk assessment of CTs use (four items), the suitability of CT use (five items), and the support from health care professionals (two items). The model met all goodness-of-fit indices (GFI=.90, AGFI=.90, CFI=.94, NFI=.926, RMSEA=.08, and χ 2 / df =3.14). The reliability analysis indicated good internal consistency (α=.912) and correlation with the Diabetes Empowerment Scale ( r =.425).

Conclusions/implications for practice: The Understanding the Benefits-Risks of CT Use in Diabetes Scale offers valuable insights for both patients and health care professionals. By providing a comprehensive assessment of patient knowledge and awareness of their CT use, this tool helps health care professionals identify gaps in patient understanding, tailor patient education, and ensure safe and effective integration of CTs into diabetes management programs.

Background: Malnutrition significantly impacts mortality and morbidity in patients with chronic diseases. Accurate screening tools are necessary for the early identification and management of this condition. However, limited meta-analyses on screening tools designed to assess malnutrition in patients with chronic diseases exist.

Purpose: This study was designed to evaluate the clinical efficacy of several screening tools widely used to detect malnutrition in patients with chronic diseases in clinical settings. Three tools were addressed in this meta-analysis, including the Malnutrition Screening Tool (MST), Malnutrition Universal Screening Tools (MUST), and Nutritional Risk Screening 2002 (NRS-2002).

Methods: Seven electronic databases, including CINAHL-EBSCO, Cochrane, Embase, OVID-MEDLINE, PubMed, Scopus, and Web of Science, were searched systematically from their respective inception dates to October 29, 2023. Studies designed to evaluate the sensitivity and specificity of malnutrition using the Patient-Generated Subjective Global Assessment as the reference standard were included. Bivariate and random effects were used to summarize the following outcome variables: sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, and area under the curve. All of the statistical analyses were conducted using STATA software.

Results: Twenty-six studies were included in the analysis. The sensitivity of MST in detecting malnutrition (.78, 95% confidence interval [CI] [.62, .88]) was higher than that of either MUST (.74, 95% CI [.68, .80]) or NRS-2002 (.67, 95% CI [.61, .71]). The respective specificities of NRS-2002, MST, and MUST were comparable (.88, 95% CI [.83, .92] vs. .82, 95% CI [.64, .90] vs. .80, 95% CI [.73, .89]). Similarly, in terms of malnutrition detection accuracy, the three tools had similar areas under curve (.82, 95% CI [.79, .85] vs. .87, 95% CI [.84, .90] vs. .79, 95% CI [.75, .82], respectively). However, Fagan nomograms showing positive and negative likelihood ratios of <10 and >0.1 indicate all three screening tools have a minimal effect rating with regard to detecting malnutrition.

Conclusions: MST, MUST, and NRS-2002 all present a good level of accuracy in detecting malnutrition in patients with chronic diseases. Thus, it is recommended that nurses, physicians, dieticians, and other health care workers use these tools in daily practice. Further investigations are warranted to validate these findings.

Background: Although clinical preceptors (CPs) are vital to the retention of new nurses, evaluations of post-training changes in their teaching behavior are limited. The Objective Structured Teaching Examination (OSTE), designed to assess and enhance the instructional skills of CPs, is underutilized in nursing education.

Purpose: This study was developed to evaluate the effectiveness of the OSTE in improving teaching competencies in CPs, with effectiveness tracked longitudinally at 3 and 6 months postintervention.

Methods: A nonrandomized allocation, longitudinal, parallel design was used in this quasi-experimental study. One hundred twenty-two CPs working at one Taiwanese medical center were enrolled as participants and assigned to experimental (n=63) and control (n=59) groups. The experimental group completed seven OSTE sessions based on core competencies. Teaching competencies were measured using the Clinical Teaching Behavior Inventory (CTBI) at four time points: pre-OSTE, post-OSTE, and 3 and 6 months post-OSTE. Data were analyzed using generalized estimation equations.

Results: The experimental group showed significant improvements in all CTBI domains immediately after the intervention (all p ≤ .003), with the CTBI total score remaining significantly elevated at 3 months (p=.026) and 6 months (p=.004) postintervention. The improvements in the control group were shown to be uneven and not significant until 6 months post-test. In all participants, clinical ladder level was found to relate positively to CTBI total score.

Conclusions: OSTE effectively enhances teaching competencies in CPs in the short term, with these effects declining but remaining significant through at least 6 months postintervention. Ongoing training and integrated assessment tools are necessary to realize and sustain improvements in CP clinical teaching efficacy over the long term.

Background: Despite its status as a prevalent clinical concern, vertigo lacks an effective treatment, especially one that addresses the factors commonly associated with women affected by this condition.

Purpose: This study was designed to clarify the relationship between Traditional Chinese Medicine Body Constitution (Yang-Xu, Yin-Xu, and Phlegm stasis) and vertigo in adult women.

Methods: A cross-sectional study was conducted on 1,423 women enrolled in the Taiwan Biobank between 2012 and 2017. The participants completed the 44-question Body Constitution Questionnaire (BCQ), developed in Taiwan, to assess their body constitution. To investigate the relationship between body constitution and vertigo prevalence, a stepwise-forward multiple-regression analysis was conducted to investigate the influence of three specific body constitutions (Yang-Xu, Yin-Xu, and Phlegm stasis) on the risk of contracting vertigo.

Results: Nearly one out of 10 (9.0%) participants had experienced vertigo, with an average onset age of 56.23 years, with vertigo sufferers showing a significantly higher mean BCQ score compared to those who had not experienced vertigo (Yang deficiency: adjusted Odds Ratio [a OR ]=1.033, Yin deficiency: a OR =1.049, and Phlegm stasis: a OR =1.041). Age, having migraines, and having endometrial polyps were identified as factors influencing the risk of experiencing vertigo.

Conclusions/implications for practice: Unbalanced constitution types were independently associated with a higher risk of vertigo in women, alongside age, migraine, and endometrial polyps. These findings suggest that the constitution serves as an important underlying susceptibility factor. Incorporating constitution assessment into routine health evaluation may facilitate earlier identification of at-risk women and provide a foundation for preventive or constitution-balancing strategies in clinical care.

Background: Human immunodeficiency virus (HIV) remains a serious challenge to public health. Stress is a primary issue affecting HIV care because it is highly prevalent among people living with HIV and negatively affects quality of life in this population.

Purpose: This study was designed to examine the efficacy of a yoga intervention in reducing stress and enhancing coping self-efficacy in people with HIV.

Methods: A parallel-group, randomized controlled trial with single blinding and repeated measures was used. The intervention group engaged at home in eight biweekly online Hatha yoga classes of 120 min (two 60-min sessions) in length. The effects were assessed at baseline, at the end of the 2-month intervention, and at 1 month after the end of the intervention.

Results: Sixty-six people were enrolled as participants, five of whom were lost to follow-up at the second assessment. Sixty-one participants took part in the third assessment. After practicing yoga for 8 weeks, the intervention group had lower mean stress scores and higher mean coping self-efficacy scores than the control group.

Conclusions/implications for practice: The yoga intervention applied in this study was shown to effectively reduce perceived stress and strengthen coping self-efficacy in patients with HIV. This study adds evidence gathered in a new social context (Bali, Indonesia) to existing research showing practicing yoga to be effective in reducing stress in patients with HIV. Yoga is a promising complementary intervention that may be offered to patients with HIV suffering from stress.

Background: Despite global population aging, fragmented care remains a significant obstacle to the provision of effective health care, particularly to older adults with complex health needs.

Purpose: This study was designed to synthesize current qualitative research on nurses' experiences with care fragmentation in caring for aging populations.

Methods: A comprehensive search of two electronic databases was conducted to identify relevant literature published in English. A total of 20 articles covering a total of 296 nurse participants were included in this synthesis. The extracted data were thematically synthesized.

Results: Four main themes and 10 subthemes were identified in the synthesis. The themes included (1) challenges in accessing and delivering health care services, (2) challenges in communications and coordination, (3) the need to advance nurses' roles and recognize their contributions, and (4) the importance of providing patient-centred care.

Conclusions/implications for practice: The findings of this study highlight the complexities and challenges of providing care to aging populations within fragmented health care systems. The difficulties faced by nurses in accessing resources, coupled with communication and coordination barriers, underscore the need for systemic improvements to facilitate effective care delivery. The theme related to nurse recognition highlights the need for greater support and acknowledgement of the contributions of nurses, which is essential to ensuring care quality and patient outcomes. Moreover, the emphasis on patient-centered care reinforces the importance of adopting individualized care strategies that cater to the unique needs of older adults. Health care systems should prioritize initiatives aimed at improving communication and coordination among health care providers, supporting nursing staff, and implementing patient-centered care practices. These efforts are crucial to overcoming the challenges of fragmented care and ensuring older populations receive the comprehensive and effective care they deserve.

Background: Patients undergoing open heart surgery may experience negative emotions such as anxiety, fear, panic, and anger in the preoperative period that may negatively affect their postoperative recovery.

Purpose: This study was designed to compare the effects of preoperative fear and anxiety on postoperative pain and complications in a referral group and on a non-referral group.

Methods: This descriptive study was conducted at a cardiovascular surgery hospital in Turkey from July 1, 2020, to December 31, 2020, on 96 patient participants. The referral group ( n = 48) comprised patients who were diagnosed in another hospital and received cardiovascular surgery at our hospital, while the non-referral group ( n = 48) comprised patients who received their angiography and cardiovascular surgery in our hospital. A Personal Information Form, Surgical Fear Questionnaire, and the Beck Anxiety Inventory were administered to all of the participants in the preoperative period. In the postoperative period, pain levels were determined using the Visual Analog Scale, and complications were recorded.

Results: No statistically significant difference were found in the overall occurrence of complications between the two groups ( p > .05). However, those in the referral group who developed lung-related complications exhibited significantly higher levels of surgical fear ( p < .05). No statistically significant differences were observed between the groups in terms of length of stay in the intensive care unit, length of intubation, length of mobilization, length of hospitalization, pain levels, or mean anxiety and surgical fear scores ( p > .05). A significantly positive relationship was observed between anxiety and surgical fear levels in both groups ( p < .05).

Conclusions/implications for practice: The results indicate neither the timing of surgical treatment decision nor preoperative fear and anxiety are associated with postoperative pain and certain complications. However, a significant relationship was detected between preoperative anxiety and surgical fear. No relationship between the way patients are taken to surgery and levels of anxiety and surgical fear or postoperative complications was found. The literature should be further expanded by conducting different studies on this subject.

Background: The rising global incidence of dementia is an escalating public health issue. In 2021, the rate of dementia cases in Indonesia had already risen to 27.9%. Dementia literacy, which refers to the ability to acquire, assess, and apply knowledge about dementia, is crucial for increasing public awareness and improving dementia care. However, obstacles persist in advancing dementia literacy owing to difficulties in obtaining information and a lack of awareness regarding the importance of dementia knowledge. Addressing these challenges is essential to enhance dementia care at a societal level.

Purpose: This study was implemented to translate and adapt the Consumer Access, Appraisal, and Application of Services and Information on Dementia (CAAASI-Dem) instrument into Indonesian (CAAASI-Dem-INA) and to evaluate its psychometric properties to ensure it is a valid and reliable tool for assessing dementia literacy in Indonesia.

Methods: In this cross-sectional study, a two-stage translation procedure followed by psychometric testing was used. A sample of 319 older adults aged 60 years or older was recruited from Semarang, Central Java, Indonesia, using a convenience sampling method. Data were analyzed using descriptive statistics and confirmatory factor analysis (CFA) to assess the validity and reliability of the translated instrument.

Results: The results of the psychometric evaluation indicate that CAAASI-Dem-INA offers satisfactory validity and reliability. Moreover, the good model fit obtained in the CFA confirms the construct validity, while the Cronbach alphas obtained demonstrate strong internal consistency (.934), and composite reliability (.744-.930), further supporting the reliability of this tool.

Conclusions: The CAAASI-Dem-INA is a valid and reliable tool for measuring dementia literacy among older adults in Indonesia. Thus, it represents an important addition to existing dementia literacy assessment tools and may be used to gain a comprehensive understanding of dementia literacy levels in Indonesia. As a tool to help assess and promote improvements in dementia literacy, the CAAASI-Dem-INA can contribute to improving care and support for the growing number of people affected by dementia in Indonesia.