The journal of nursing research : JNR最新文献

Background: Chronic kidney disease (CKD) refers to permanent damage to the kidneys that occurs gradually over time. Further progression may be preventable depending on its stage.

Purpose: This study was developed to evaluate the effect of a health literacy education program (HLEP) on mental health and renal functioning in patients with CKD.

Methods: A single-blind, randomized controlled trial study was conducted. Data were collected from March 25 to December 18, 2021. Participants were randomly assigned to either the experimental group (n = 42), which received multidisciplinary care and HLEP, or the control group (n = 42), which received multidisciplinary care only. Data were collected at baseline (T1), Month 3 (T2), and Month 6 (T3), and the data included patient characteristics, estimated glomerular filtration rate, and responses to the Mandarin Multidimensional Health Literacy Questionnaire and Beck Depression Inventory.

Results: After 6 months of the HLEP intervention, the results of generalized estimating equations analysis showed that, compared with the control group, the experimental group had significantly higher health literacy at Month 3 (β = -3.37, 95% CI [-5.68, -1.06]), significantly improved depression at Month 3 (β = -2.24, 95% CI [-4.11, -0.37]) and Month 6 (β = -4.36, 95% CI [-6.60, -2.12]), and a significantly higher estimated glomerular filtration rate at Month 6 (β = 5.87, 95% CI [1.35, 10.38]).

Conclusions/implications for practice: The findings of this study may provide a reference for healthcare providers to educate patients with Stage 3-4 CKD using the HLEP. Positive effects on health literacy, depression, and renal function in patients with Stage 3-4 CKD were observed in the short term. Findings from this study may facilitate the implementation of multidisciplinary and nurse-led strategies in primary care to reinforce patients' health literacy, self-care ability, and adjustment to CKD as well as delay disease progression.

Background: Genitourinary syndrome is commonly reported in postmenopausal women. Kegel's exercise is a noninvasive therapy that improves pelvic floor muscle parameters. However, the effect of Kegel's exercise on health-related quality of life (HRQoL) in postmenopausal women with genitourinary syndrome has not been synthesized or shown.

Purpose: This study was designed to systematically review and analyze the previous literature to determine whether Kegel's exercise enhances HRQoL in postmenopausal women with genitourinary syndrome of menopause.

Methods: A systematic review and meta-analysis of randomized controlled trials was conducted, and six databases were searched, including Embase, MEDLINE, Cochrane, CINAHL, Web of Science, and Scopus, from their dates of inception to November 2021. Eligible studies evaluated the effects of Kegel's exercise on HRQoL in postmenopausal women with urinary, sexual, or genital symptoms. Review Manager software was used to perform the meta-analysis using a random-effects model. Chi-square and I2 tests were used to evaluate heterogeneity among the studies. Meta-analysis was performed based on the symptoms (i.e., urinary, sexual, and genital) identified in the quality-of-life questionnaires.

Results: This systematic review covered five studies with 268 participants. The research appraisal found most of these studies had a low risk of bias. The intervention periods ranged from 4 to 12 weeks. Compared with non-Kegel's exercise or regular activity, Kegel's exercise was found to significantly improve HRQoL-related urinary symptoms (three studies, standardized mean difference = -0.95, 95% CI [-1.35, -0.54], I2 = 0%). However, the effect of this exercise on HRQoL-related sexual symptoms did not differ from non-Kegel's exercise or regular activity (two studies, standardized mean difference = 1.11, 95% CI [-0.25, 2.47], I2 = 94%). None of the covered studies examined the effect of Kegel's exercise on HRQoL-related genital symptoms.

Conclusions/implications for practice: Kegel's exercise is an effective intervention for improving HRQoL-related urinary symptoms in postmenopausal women. However, there remains insufficient evidence to assess the effectiveness of Kegel's exercise on HRQoL-related genital symptoms in this population. The results support using Kegel's exercise as a useful intervention to manage urinary symptoms in postmenopausal women.

Background: Poor functional status relating to heart failure (HF) negatively affects health-related quality of life (HRQOL). Patients with HF, especially those with New York Heart Association (NYHA) Class III or IV HF, often exhibit poor HRQOL because of physical limitations and HF-related symptoms. Although sense of coherence (SOC) has been reported to be a determinant of HRQOL, its role as a mediator between functional status and HRQOL remains unclear, and few studies have explored the prevalence of HF in patients in NYHA Classes I and II.

Purpose: This study was designed to investigate SOC as a mediator between different functional status classes and HRQOL in patients with HF.

Methods: A cross-sectional study was conducted on patients with HF recruited from a hospital in northern Taiwan from April 2020 to September 2020. The Minnesota Living with Heart Failure Questionnaire and a questionnaire on sociodemographic characteristics; functional classification in terms of NYHA Classes I, II, and III; and SOC were administered. The PROCESS v3.5 (by Andrew F. Hayes) macro was applied to analyze the effects, and Model 4 was used to examine the mediating role of SOC on the relationship between NYHA functional class and HRQOL.

Results: Of the 295 participants, SOC was found to mediate the effects of functional status on HRQOL more significantly in patients in Class II than those in Class III but not more significantly in patients in Class I than those in Class III. A weaker mediating effect of SOC was noted on the relationship between functional status and HRQOL in patients with HF in NYHA Class II than those in Class III.

Conclusions: In patients with HF, poor functional status often reduces HRQOL significantly. SOC mediates the relationship between functional status and HRQOL more significantly in those in NYHA Class II than those in Class III. Nursing staff should work to increase patients' SOC by strengthening their coping capacity and improving their functional status to improve their HRQOL.

Background: Disaster nursing deploys professional nursing knowledge and skills systematically to reduce disaster-related risks to life and health. Disaster nursing education requires providing simulations using standardized patients.

Purpose: The purpose of this study was to develop, based on the International Council of Nurses' Framework of Disaster Nursing Competencies, a simulation-based disaster nursing education program for nursing students that employed standardized patients.

Methods: A nonequivalent, control group, pretest-and-posttest design was used. Participants were senior nursing students from two universities, with 70 assigned to the experimental group, 35 assigned to the comparison group, and 35 assigned to the control group. Data were collected from January 25 to April 3, 2019. The simulation-based disaster nursing education program consisted of a 60-minute theoretical lecture on disaster management and two scenarios. The effectiveness of the simulation-based disaster nursing education program was measured using levels of disaster nursing competencies, disaster triage competency, disaster preparedness, critical thinking disposition, and confidence in disaster nursing.

Results: Significant differences were found between the experimental and comparison/control groups in terms of disaster nursing competencies ( F = 20.06, p < .001), nursing triage ( F = 17.35, p < .001), disaster preparedness ( F = 60.37, p < .001), critical thinking disposition ( F = 19.63, p < .001), and confidence in disaster nursing ( F = 20.24, p < .001).

Conclusions: Simulation-based disaster nursing education programs using standardized patients can be useful in disaster nursing education. They can contribute to future changes in nursing education and practice by improving the disaster nursing capabilities and preparedness of students.

Background: Heart failure is an intense, unpredictable, and stressful chronic disease caused by the decline in cardiac pumping function. The influence of heart failure affects patients not only in terms of physical capabilities but also in terms of their emotional and social dimensions, with patients in different functional classes experiencing different levels of effect. Although resilience and health-related quality of life have been studied in populations with heart failure, the scholarly understanding of different functional classes is limited.

Purpose: This study was designed to investigate the relationship between resilience and health-related quality of life among patients with heart failure in different physical functional classes in Taiwan.

Methods: A cross-sectional design was applied to study patients with heart failure in northern Taiwan. Two structured questionnaires, including the Resilience Scale for Adults and the 12-item Short Form Health Survey, were used to assess resilience and health-related quality of life. New York Heart Association functional class was used to determine physical function status, and canonical correlation analysis was used to determine the weight of each resilience and quality-of-life domain for the different functional classes.

Results: The 100 participants had an average age of 65.52 years. Slightly over half (56%) were classified as Functional Class II. A group difference in health-related quality of life was observed. Personal strength (rs = .759) and social competence (rs = -.576) were found to influence the resilience and emotional role dimension of quality of life (rs = -.996) in the Functional Class II group. In addition, family cohesion (rs = -.922), dominant resilience, physical function (rs = .467), and bodily pain (rs = .465) were found to influence quality of life in the Functional Class III group.

Conclusions/implications for practice: The efficacy of measures taken to increase resilience to heart failure varied in patients in different functional classes. Functional Class II individuals were better able to manage the disease using their personal strength, whereas Functional Class III individuals relied more heavily on family support and assistance for this effort. Furthermore, participant feelings about quality of life also varied by functional class, with physical function and bodily pain taking on significantly more importance for Functional Class III individuals.

Background: Multiple role theory has proven effective in predicting variations in health, and a growing body of research has shown the importance of taking women's roles into account when analyzing physical activity levels. Nonetheless, researchers have yet to characterize the interaction between the various roles played by women and their physical activity.

Purpose: The objectives of this study were to elucidate the relationship between multiple roles and leisure-time physical activities (LTPAs) and to determine whether LTPA varies among women across different roles.

Methods: Data were derived from the 2013 National Health Interview Survey database provided by the Health Promotion Administration of Taiwan's Ministry of Health and Welfare, which includes 5,147 working-age women. The current study focused on women aged 20-50 years. The roles considered in this study included living with a partner, living with children, and employment status. LTPA levels were categorized as regular, inactive, or insufficient based on the LTPA metabolic equivalent in the previous week. The associations among level of LTPA, multiple roles, and demographic characteristics were analyzed using multiple regression analysis.

Results: We found single mothers with children to be more inactive than partnered mothers, and women living with a partner and those living with children were more likely to be inactive, whereas women working full-time were not at risk of inactivity. Women who assumed a larger number of roles were at a greater risk of inactivity. These findings are consistent with role strain theory.

Conclusions: Single mothers with children are more inactive than partnered mothers, and appropriate social support programs are necessary to reduce further disparities. Second, multiple demands on working-age women limit the time available for LTPAs, particularly among women living with a partner and children and engaged in full-time work. A physical activity intervention is a program or initiative designed to promote physical activity and improve health outcomes. We should develop and provide sustainable physical activity resources through the help of partners' housework to better promote physical activity intervention for working-age women.

Background: Hemodialysis is the most common therapy for managing patients with end-stage renal disease. Depression is one of the most common psychological problems faced by dialysis patients, and there is limited research on the influences of religion and spirituality on dialysis patients.

Purpose: This study was designed to compare religion and spiritual health status between hemodialysis patients with and without depressive symptoms.

Methods: A cross-sectional survey was conducted on 137 hemodialysis patients living in Taiwan. The self-report instruments used included the Religious Beliefs Scale, Spiritual Health Scale-Short Form, and Beck Depression Inventory-II. Data were analyzed using t test, chi-square test, point-biserial correlation of variance, and logistic regression.

Results: Most (63.5%) of the participants were classified with depression, of which most were male (70.1%), older (mean = 62.56 years), and unemployed (73.6%) and had less formal education. Fifty-two of the participants with depression had a 1- to 5-year duration of hemodialysis, whereas the nondepressed group had a higher mean score for number of religious activities, positive religious beliefs, and total score for spiritual health. Logistic regression showed an increased odds ratio ( OR ) of depression for participants with a duration of hemodialysis of 1-5 years ( OR = 3.64, 95% CI [1.01, 13.15]). Participants with higher scores for spiritual health had a lower risk of depression ( OR = 0.82, 95% CI [0.75, 0.90]), indicating a positive association between spiritual health and lower depression risk.

Conclusions/implications for practice: The prevalence rate of depression in hemodialysis patients is higher than that in the general population. Providing screenings for spiritual health and depression as part of routine medical care for hemodialysis patients is recommended to detect spiritual distress and depression early.

Background: Electronic health (eHealth) literacy is a relatively new concept used to determine health outcomes. However, it is not well known how eHealth literacy relates to health outcomes such as diabetes self-management.

Purpose: This study was designed to examine the relationships among eHealth literacy, self-efficacy, social support, and self-management in people with Type 2 diabetes.

Methods: A cross-sectional design was used to examine secondary data from a field survey of people with Type 2 diabetes recruited from outpatient clinics from August to December 2021 ( N = 453). A structural equation model was used that first analyzed the measurement model using confirmatory factor analysis and then tested the hypothesized structural model to estimate the expected relationships among the study variables. The significance of the statistical estimates for the model was assessed based on the 95% bias-corrected bootstrap confidence interval from 5,000 bootstrap resamples.

Results: Significant, indirect relationships were found between eHealth literacy and self-management via self-efficacy (β = 0.26, B = 0.17, 95% CI [0.10, 0.24]) and via social support and, in turn, self-efficacy (β = 0.08, B = 0.05, 95% CI [0.04, 0.08]). eHealth literacy, social support, and self-efficacy together explained 58.1% of the variance in self-management.

Conclusion/implications for practice: This study provides new evidence regarding how eHealth literacy relates to self-management in people with Type 2 diabetes via two indirect pathways, including self-efficacy alone and social support and self-efficacy in series. An eHealth literacy program for self-management should be developed in clinical practice that includes strategies for inducing synergistic effects from self-efficacy and social support on self-management in people with Type 2 diabetes.

Background: Professional values provide a road map for guiding the behaviors of nursing students during practice and are considered standards for acceptable actions during the provision of nursing care. Nursing educators play a vital role in helping their students embrace professional values in their future career.

Purpose: This study was designed to assess and compare professional values among Jordanian and Palestinian undergraduate nursing students.

Methods: In this descriptive, cross-sectional study, 182 Jordanian and 353 Palestinian nursing students completed the Nurses Professional Values Scale-Revised (NPVS-R), which covers five domains (caring, trust, justice, activism, and professionalism).

Results: The mean age of the participants was 22.5 years, and most (56.6%) were female. The mean total score for the NPVS-R was 3.85, with the "justice" dimension receiving the highest mean score (4.07) and the "activism" dimension receiving the lowest mean score (3.63). The differences in mean NPVS-R total and dimension scores between the Jordanian and Palestinian students were not statistically significant.

Conclusions: The results of this study support that Jordanian and Palestinian undergraduate nursing students have an acceptable level of professional values, with the NPVS-R justice domain scoring relatively high and the NPVS-R activism domain scoring relatively low. The authors hope that the results of this study encourage nursing educators to continue improving professional values among their students, especially with regard to the relatively low-rated dimensions.