The journal of nursing research : JNR最新文献

Background: Nursing is a highly demanding profession involving shift-work schedules around the clock. Rest time between shifts is an issue that has gained increasing research attention in recent years, with brief rest periods (< 11 hours) between shifts coined "quick-return." Quick-return work schedules have been linked to negative health outcomes such as poor sleep quality and stress, which may create a vicious cycle that can contribute to work-family conflict.

Purpose: This study aimed to investigate mediation models exploring the role of sleep quality in mediating the relationship between quick-return work shift schedules and work-family conflict among female nurses with children.

Methods: A cross-sectional approach was used, and data were collected from 131 female nurses with children under the age of 18 years between October 2020 and February 2021 in three hospitals. The participants completed a set of questionnaires to evaluate quick-return frequency within the past week, sleep quality between different types of shifts (morning [07:00-15:00]-night [23:00-07:00], evening [15:00-23:00]-morning, night-evening, morning-morning, evening-evening, night-night, and 2 days off), work-family conflict, workload, and sociodemographic factors. Seven mediation models were conducted using the SPSS PROCESS macro.

Results: Only one mediation model was supported. In the supported model, sleep quality between morning-night shifts mediates the relationship between quick-returns within the past week and work-family conflict. Specifically, shift-work schedules with higher numbers of quick-returns within the past week were significantly associated with poorer sleep quality between morning-night shifts (B = 1.047, SE = 0.457, 95% CI [0.142, 1.952]), which was in turn significantly associated with higher work-family conflict (B = -0.548, SE = 0.205, 95% CI [-0.953, -0.143]). Notably, whereas the indirect effect between quick-returns within the past week and work-family conflict was significant (B = -0.574, SE = 0.311, 95% CI [-1.301, 0.079]), the direct effect was not (p = .169).

Conclusions: The findings of this study show the potentially negative effects of a specific type of quick-return work schedule on sleep quality in nurses, which in turn has a significant impact on nurses' personal and family lives. Because sleep is a modifiable behavior, optimizing this behavior may result in better recovery between shifts. Furthermore, nurse managers should ensure their staff are not assigned work schedules that require quick-returns to work between morning and night shifts.

Background: Depression, poor sleep quality, and perceived lack of control all commonly impact women in the third trimester of pregnancy. Depression can influence sleep quality, whereas sense of control during pregnancy is correlated with both sleep quality and depression. However, the mediating effect of sleep quality on the relationship between depression and sense of control has not been examined in women in their third trimester.

Purpose: This study was designed to explore depression, sleep quality, and sense of control in pregnant women during the third trimester and determine the degree to which sleep quality mediates the relationship between depression and sense of control.

Methods: An exploratory correlational cross-sectional design was used to recruit 263 pregnant women with a gestational age of 35-36 weeks. Data were collected using questionnaires. Depression, sleep quality, and sense of control were respectively assessed using the Edinburgh Postnatal Depression Scale, Pittsburgh Sleep Quality Index, and Labor Agentry Scale. Data on the main outcomes were analyzed using the PROCESS macro for SPSS.

Results: Depression in pregnant women was found to correlate positively with poor sleep quality and negatively with sense of control (all ps < .001). Thus, higher levels of depression and poorer sleep quality were associated with lower sense of control. The results confirmed the relationship between depression and sense of control to be mediated by sleep quality (p < .001).

Conclusions: Pregnant women with lower levels of depression may experience better sleep quality and sense of control. Sleep quality mediates the relationship between depression and sense of control in women in the third trimester. Thus, prenatal counseling and psychological support should be provided to pregnant women to reduce depression while improving sleep quality and sense of control.

Background: Exercise is the most effective method of reducing visceral adipose tissue (VAT). However, the optimal exercise modality and strategy for reducing VAT have yet to be determined.

Purpose: This study was designed to identify the optimal sequence exercise strategy for reducing VAT in community residents with obesity.

Methods: A sequential multiple assignment randomized trial design was used to conduct a two-stage (8 weeks each) adaptive exercise for 40- to 64-year-old residents with obesity. In the first stage, the participants were randomly allocated into two groups, one of which did 30 minutes of moderate-intensity continuous training (MICT; n = 58) and the other which did 20 minutes of high-intensity interval training (HIIT; n = 58) three times per week. In the second stage, the nonresponders (with VAT decreases < 3%) were randomly reallocated into a group that performed MICT combined with an additional 10 minutes of resistance exercise or one that performed the opposite of the first-stage treatment (HIIT or MICT). Those who responded to the first-stage intervention (with VAT decreases of ≥ 3%) continued the same exercise treatment until 16 weeks.

Results: The MICT intervention was found to be more efficacious than the HIIT intervention in reducing VAT during the first 8 weeks (β = -4.10, p = .029). Among the nonresponders to MICT, the HIIT outperformed MICT combined with resistance exercise as the alternative choice in the second stage (β = -7.36, p = .006). On the contrary, there were no significant differences between MICT and MICT combined with resistance exercise for the nonresponders to HIIT (β = 1.34, p = .626). Those participants who repeated the same exercise modality (either MICT or HIIT) in both stages exhibited superior VAT reduction to those who changed exercise modalities after the first stage.

Conclusions/implications for practice: The optimal sequence exercise strategy for reducing VAT is captured by a two-stage sequential multiple assignment randomized trial design. Community residents with obesity are advised to reduce VAT efficiently through participation in an 8-week MICT program. For those preferring HIIT rather than MICT, a 16-week program without changing the modality midway is recommended.

Background: Population aging has led to a surge in elderly care needs worldwide. Bone aging, skeletal muscle degeneration, and osteoporosis pose critical health challenges for the elderly. The process of bone and skeletal muscle aging not only impacts the functional abilities but also increases fragility fracture risk. Although a negative correlation between handgrip strength and fragility fracture risk has been identified in elderly populations, there is a lack of related research in Taiwan.

Purpose: This cross-sectional study was designed to investigate the association between handgrip strength and two outcome variables, bone density and risk of fragility fracture, in Taiwanese individuals aged 65 years and older with low bone mass.

Methods: A total of 548 older adults, including 84 men and 464 women, were recruited between August 2019 and July 2021. Bone mineral density T -scores acquired using dual-energy X-ray absorptiometry scan, the total score for the Taiwan-specific Fracture Risk Assessment (FRAX) tool, and bilateral handgrip strength acquired using a digital hand dynamometer were recorded along with other factors such as comorbidities, dietary habits, and daily activities.

Results: In this study, the mean age was 70.9 ( SD = 5.6) years, mean bone mass index was 24.1 ( SD = 3.5) kg/m 2 , mean FRAX main fracture risk score was 19.5% ( SD = 8.3), and mean FRAX hip fracture risk score was 7.7% ( SD = 5.7). Lumbar and hip T -scores were both significantly correlated with both dominant and nondominant handgrip strength in older woman. Older age; both lower hip and spine T -scores; both lower dominant and nondominant handgrip strengths; having Type 2 diabetes, coronary artery disease, or chronic hepatic disease; and lacking a steady job were significantly associated with a higher risk of fragility fracture.

Conclusions/implications for practice: The results of this study provide important information regarding the correlation between handgrip strength and several variables, including bone mineral density T -score, FRAX score, comorbidities, and job status, among older adults. Notably, these correlations were found to be particularly strong in the female participants. This information may be used to facilitate the early identification of elderly individuals at a high risk of fragility fractures, enabling the timely development of preventive nursing strategies and the provision of targeted interventions.

Background: Although work engagement and job satisfaction are two important indicators associated with care quality, their mediating effects on the relationship between perceived staffing and quality of care have not been adequately clarified.

Purpose: This study was designed to determine the mechanism by which nurses' perceived staffing influences quality of care by clarifying the mediating roles of job satisfaction and work engagement.

Methods: A cross-sectional questionnaire survey was implemented among 2,142 clinical nurses from 211 inpatient wards in 13 hospitals. Work engagement, job satisfaction, perceived staffing, and rated quality of care were measured.

Results: Most (89.7%) of the respondents rated quality of care as good or better, and 56.1% perceived staffing in the wards as adequate. The two main findings of this study are as follows: (a) Perceived staffing influenced quality of care via one direct and three indirect pathways, with the indirect effect greater than the direct effect (β direct = 0.09, β total indirect = 0.25), and (b) work engagement and job satisfaction were important mediators of the impact of staffing on quality of care.

Conclusion: Quality of care may be enhanced by improving the work engagement and satisfaction of nurses in their current job, suggesting an effective approach to alleviating the current nursing shortage.

Background: Menstruation is a physiological process that may be accompanied by pain, headache, edema, emotional changes, and other symptoms, all of which affect quality of life. Although the results of some studies indicate lifestyle habits can affect the menstrual cycle and associated symptoms, few have investigated this issue, and even fewer have explored the impact of these symptoms on quality of life, in Spanish women.

Purpose: The objectives of this study were to determine the prevalence of dysmenorrhea and premenstrual syndrome (PMS) among students at a Spanish university, assess the impact of these conditions on quality of life, and analyze the relationship among lifestyle habits, dysmenorrhea, and PMS.

Methods: A cross-sectional study was carried out on 743 women enrolled at the University of Extremadura in the 2021-2022 academic year. Data related to the menstrual cycle, pain, and PMS-related physical and emotional symptoms were collected. Quality of life related to menstruation was evaluated using the CVM-22 scale. Lifestyle data collected included adherence to a Mediterranean diet (PREDIMED [Prevención con Dieta Mediterránea] questionnaire), level of physical activity (International Physical Activity Questionnaire), and alcohol and tobacco consumption (Alcohol, Smoking, and Substance Involvement Screening Test Version 3). Also, other clinical data were recorded.

Results: In terms of the sample, the median age was 21 (19-23) years, the prevalence of dysmenorrhea was 57.9%, 92.7% reported premenstrual physical symptoms, and 55.6% reported experiencing premenstrual emotional changes. Having a low level of adherence to a Mediterranean diet was associated with the presence of dysmenorrhea, with an adjusted odds ratio (aOR) of 1.47 (95% CI [1.06, 2.03]). Having a low level of physical activity was strongly associated with the presence of premenstrual physical symptoms, with an aOR of 5.89 (95% CI [1.71, 20.26]). Also, an association was found between tobacco use and premenstrual emotional changes, with an aOR of 2.02 (95% CI [1.25, 3.25]). Furthermore, dysmenorrhea and PMS were both associated with a low quality of life, with pain and emotional changes being the most significantly associated factors, with ORs of 16.25 (95% CI [10.36, 25.47]) and 26.73 (95% CI [16.46, 43.40]), respectively.

Conclusions: Similar to previous studies, the findings of this study indicate a high prevalence of dysmenorrhea and PMS among young university students in western Spain, with both of these symptoms impacting quality of life significantly and negatively. In addition, lifestyle habits, diet, physical activity, and tobacco use seem to influence the occurrence of these symptoms. Promoting lifestyle changes may be an effective strategy to reduce the incidence of dysmenorrhea and PMS and improve the quality of life of young women.

Background: Critical illness not only threatens the life of the patient but also may profoundly impact the lives of their loved ones. For teenagers with a critically ill parent, these impacts may have significant, developmentally impactful effects. A descriptive understanding of these effects may advance scholarly understanding of the challenges these teenagers face.

Purpose: In this study, we sought to understand this overlooked population, i.e., teenagers with a critically ill parent, using a descriptive analysis of their experiences.

Methods: Individual and group interviews were conducted with the participants (n = 9). Interviewers presented standardized semistructured interview questions to all of the participants. The questions explored situational, emotional, relational, and dynamic phenomena related to the experience of having a critically ill parent.

Results: Themes describing the participants' lived experiences related to having a parent with a critical illness were examined using a three coding framework. Four themes emerged, including parental health interference on teenagers-fallout, worsening, and interference; emotional experience and how emotions were processed-emotions, cognitive strategies, and behavioral strategies; relationships with others-sharing feelings, company, and relationships; and information and secrecy-learning, secrecy, and history.

Conclusions/implications for practice: All of the teenagers in this study were found to suffer from both situational and emotional interference. Parentification, use of selective distraction as an emotion regulation skill, and reliance on support from others were also observed. These results shed light on the overall experience of teenagers who have a critically ill parent. The fallout effects of a parent's health can encompass situational, logistical, emotional, and relationship aspects. Importantly, attention must be paid to how teenagers cope with the emotions experienced during a parent's critical illness. This framework may inform how to more effectively support teenagers through strategies such as providing peer support opportunities.

Background: Spinal muscular atrophy can cause progressive physical disability and difficulties with self-care. Self-care motivation can enhance patient persistence in self-care behavior and maintain health.

Purpose: This study was designed to explore and describe motivations for self-care among school-aged children and adolescents with spinal muscular atrophy and the perspectives of their primary caregivers.

Methods: Husserl's phenomenological research method was adopted, and data were collected using in-depth, face-to-face, open-ended interviews with patients and their primary caregivers aged 8-18 years with spinal muscular atrophy. A total of eight patient-caregiver dyads were recruited via purposeful sampling from a hospital clinic and through the Muscular Dystrophy Association of Taiwan. The interviews were conducted in the participants' homes and transcribed verbatim. Data were then thematically analyzed using the Giorgi analysis method.

Results: Six themes were identified from the patients' perspective: (a) adapting to dietary restrictions, (b) proactive measures for physical safety, c3) pursuing social connection and peer support, (d) navigating emotional well-being, (e) seeking independence, and (f) achieving success motivation. From the caregivers' perspective, the motivations for patient self-care were identified as follows: (a) ensuring safe and enjoyable eating for patients, (b) facilitating patient autonomy in health risk management, (c) facilitating patient engagement with peers, (d) balancing support with encouraging independence, (e) assessing and balancing independence and safety in patient caregiving, and (f) admiring patients' resilience and self-care innovation.

Conclusions/implications for practice: This study highlights the vital roles of caregivers in adapting to the dynamic self-care motivations of children and adolescents and of healthcare professionals in facilitating communication and care strategies. Personalized approaches are essential for enhancing autonomy and well-being in pediatric patients.

Background: Chronic kidney disease (CKD) is a progressive disease impacting the physical function and mental health of sufferers. Depression is known to negatively impact quality of life, whereas handgrip strength and demoralization are important factors affecting physical and mental health. Lower handgrip strength has been associated with sarcopenia and higher risk of hospitalization in patients and higher workloads for nurse caregivers. Few studies have investigated the complex relations among these factors in patients with CKD.

Purpose: This study was designed to investigate the mediating effects of grip strength and demoralization on the relationship between depression and quality of life in patients with CKD.

Methods: Two hundred fifty patients with CKD comprised the study sample. The hypotheses were tested using the PROCESS macro.

Results: Depression was found to be negatively associated with handgrip strength and quality of life but positively associated with demoralization. The results indicate that both handgrip strength and demoralization mediate the association between depression and quality of life. Moreover, the results of multiple mediation model analysis showed handgrip strength and demoralization both play important roles in the link between depression and quality of life.

Conclusions: The results of this study indicate that handgrip strength and demoralization mediate the relationship between depression and quality of life in patients with CKD. Thus, increasing handgrip strength and decreasing demoralization levels may mitigate the impact of depression on quality of life. Therefore, nurses should better appreciate the importance of handgrip strength for patients with CKD and evaluate handgrip strength. Nurses should also develop physical and mental interventions to increase handgrip strength and decrease demoralization.