The journal of nursing research : JNR最新文献

Background: The Diabetes Obstacles Questionnaire-Short Version is a tool for measuring the quality of life in patients with diabetes mellitus. However, the validity and reliability of this tool has never been tested in Indonesia.

Purpose: This study was designed to adapt and validate a Bahasa Indonesia version of the Diabetes Obstacles Questionnaire-Short Version for Indonesians with type 2 diabetes mellitus.

Methods: This was a cross-sectional study. Data were collected from July to November 2023, and accidental sampling was used to recruit and enroll 1,116 participants. Convergence testing used the Diabetes Quality of Life questionnaire. The validity test used construct and convergent validities with significant Pearson correlations, and construct validity included exploratory factor analysis and confirmatory factor analysis. Reliability testing used Cronbach's alpha, composite reliability, and average variance extracted.

Results: The results of the exploratory factor analysis showed nine factors with a factor loading per item of >.45, a Kaiser-Meyer-Olkin test score of .915, and significant Bartlett's test of sphericity results. The Cronbach's alpha value for all items was .930, and those of individual factors ranged from .730 to .848. The test-retest results with interclass correlation coefficients ranged from .910 to .973. The results of the confirmatory factor analysis indicate that this instrument has an acceptable model fit.

Conclusions/implications for practice: The Bahasa Indonesia Diabetes Obstacles Questionnaire-Short Version produces valid and reliable results for measuring quality of life in people with type 2 diabetes mellitus in Indonesia. The sufficient but small number of items allows the questionnaire to be completed relatively quickly, making it useful in clinical settings. The subscales in this instrument may be used simultaneously or separately based on individual needs.

Background: Enhanced awareness/understanding of menstrual cycle characteristics and the ovulation period can help raise the rate of natural conception among women planning to conceive. The multidimensional nature of menstrual characteristics and their relationship with conception have been rarely addressed in the literature.

Purpose: This study describes five menstrual cycle characteristics and explores their association with conception and time to pregnancy (TTP).

Methods: This prospective longitudinal study was conducted between August 2018 and September 2019, with a total of 289 women participating. All of the participants were planning to become pregnant and were interviewed in person during the baseline examination. Menstrual cycle characteristics were recorded from the time participants joined the study through a minimum of three subsequent cycles. Five cycle characteristics were recorded, including overall length, number of days of bleeding, signs of ovulation, occurrence of dysmenorrhea, and occurrence of blood clots. Signs of ovulation were defined as a drop in basal body temperature lasting 1-2 days accompanied by a positive ovulation test result. Pregnancy outcomes and TTP were recorded over the first 6 months after enrollment as a participant in this study.

Results: Nearly half (44.6%) of the participants became pregnant during the 6-month observation period, and the mean TTP of the sample was 81.9 ( SD =38.1) days. Based on the 1,321 menstrual cycles recorded in this study, the Cox proportional hazards regression results identified participants aged 30-35 years as more likely to become pregnant than those under 30. Having a menstrual cycle length of 27-32 days, bleeding for 5-6 days, signs of ovulation on Days 13-16, and lack of dysmenorrhea or blood clots in the menstrual period were identified as predictors of pregnancy.

Conclusions/implications for practice: Health care providers should assist women planning to conceive in monitoring their menstrual cycles and devising strategies to optimize them, reduce dysmenorrhea and blood clots, and use ovulation test strips to enhance natural conceptions.

Background: Optimizing end-of-life (EOL) quality is crucial for patients with cancer. However, most studies in the literature explore EOL quality in the last month of life for these patients and use retrospective investigations based on information from bereaved family caregivers.

Purpose: In this study, the authors aimed to investigate the underexplored changes in EOL quality perceived by patients with cancer during their last 6 months of life.

Methods: A longitudinal approach was used to investigate a convenience sample of 229 patients recruited at 2 medical centers in northern Taiwan from January 2020 to July 2023. The Quality of Dying and Death Questionnaire was used to measure EOL quality, and changes in EOL quality were analyzed using multivariate generalized estimating equations.

Results: As the participants approached their terminal stage, EOL-quality total scores gradually declined (from 71.41±7.56 to 65.27±10.04), and the proportion of scores classified as "good to almost perfect" (i.e., ≥70) declined from 68.6% to 34.6% over the same period. After controlling for covariates, EOL-quality subdomains and total scores exhibited variable trends, with total EOL-quality scores significantly lower in the last 2 months than in the 91-180 days before death. In terms of the subdomains, "symptoms and personal control" had the lowest average scores and substantially decreased over the last 3 months, while scores for "death preparation" (the second-lowest), "time with family," and "whole-person concerns" significantly declined over the last 1 or 2 months, with similar patterns observed in the proportion of scores categorized as "good to almost perfect." Treatment preferences remained unchanged.

Conclusions/implications for practice: Based on the findings, different aspects of EOL quality decline at different rates as patients approach death. In terms of the most poorly rated subdimensions, "symptoms and personal control" exhibited a substantial and accelerating decrease across the 6 months before death, while "death preparation" exhibited a gradual decline close to death only. Health care professionals should prioritize symptom management and death preparation for patients with terminal cancer by carefully assessing and promptly identifying their needs and developing effective, individualized care plans.

Background: Nurse practitioners (NPs) play a pivotal role in controlling rising health care expenses and addressing patient preferences and emerging health disparities. However, their work may lead to work-related stress, low well-being, low resilience, and a decreased sense of personal accomplishment.

Purpose: The aim of this study was to examine the relationships between well-being and resilience, respectively, with sense of personal accomplishment in the context of NPs.

Methods: A cross-sectional correlational study was conducted on NPs in a medical center in southern Taiwan. The three instruments used to collect study data included the Well-being Index for well-being, the Connor-Davidson Resilience Scale (CD-RISC-25) for resilience, and the Maslach Burnout Inventory-Human Services Survey-Chinese version for personal accomplishment.

Results: Good well-being, moderate resilience, and a high level of personal accomplishment were found in the 126 NP participants. Those who were married had a higher mean level of personal accomplishment, explaining 6.2% of the total variance. Well-being and two dimensions of resilience (1) personal competence and high standards and (2) positive acceptance of change and secure relationships were also identified as significant predictors of personal accomplishment, explaining 48.5% of the total variance.

Conclusions/implications for practice: Sense of personal accomplishment is significantly impacted by well-being and several aspects (i.e., personal competence, high standards, and acceptance of change) of resilience. Health care managers should develop and implement strategies focused on reinforcing resilience and well-being to strengthen the sense of personal accomplishment in NPs.

Background: Patients with cancer and their families anticipate that innovative treatment options such as immunotherapy may improve survival and quality of life. Qualitative interviews have rarely been used to examine the immunotherapy-related decision-making experiences of cancer patients and their family caregivers.

Purpose: This study was developed to explore the factors and reasons influencing the decisions of patients with cancer and their family caregivers to accept immunotherapy.

Methods: Between October 2019 and January 2021, data were collected using in-depth interviews that were conducted face-to-face in a semistructured format and audio-recorded. Content analysis was performed, and the Consolidated Criteria for Reporting Qualitative Research checklist was applied.

Results: Fifteen patients with cancer in Taiwan who had received immunotherapy and 17 family caregivers were enrolled as participants. Three main themes were common among the considerations of patients and caregivers with regard to their decision-making to undergo immunotherapy. These included (a) putting decisions in the hands of health professionals, (b) the value of life surpasses all other considerations, and (c) practical considerations such as treatment side effects, financial burden, and the effects of immunotherapy.

Conclusions/implications for practice: The immunotherapy decision-making experiences of patients with cancer and their family caregivers in Taiwan were explored in this study. The generally low level of medical expertise identified among the participants emphasizes the importance of fostering a shared approach to immunotherapy decision-making. Also, oncology nurses should prioritize the inherent worth of patients and the emotions of their family caregivers to bolster their confidence and sense of self-worth. Notably, experiencing severe side effects with previous treatments was found to be a strong predictor of immunotherapy choice, highlighting the critical importance of regular assessment of patients' immunotherapy experiences in clinical practice. Also, financial concerns were confirmed as an important factor affecting patient-centered care. Thus, when needed, additional financial support should be provided.

Background: The physical and psychological challenges faced by postpartum women adversely affect their health-related quality of life (HRQoL). However, the influence of urinary incontinence (UI), sexual dysfunction, and depressive symptoms on HRQoL across the first postpartum year remains unclear.

Purposes: This study was designed to investigate the association of UI, sexual dysfunction, and depressive symptoms with HRQoL and to examine changes in HRQoL across the initial 12-month postpartum period.

Methods: The participants ( n =613) completed the study questionnaire at four time points: 4-6 weeks and 3, 6, and 12-months postpartum. The questionnaire was mailed from a medical center maternity unit and included the International Consultation on Incontinence Questionnaire Urinary Incontinence Short Form, Female Sexual Function Index, the Center for Epidemiologic Studies Depression Scale, and the 36-item Short-Form Health Survey.

Results: Moderate to severe UI (β =-2.99), sexual satisfaction (β =-0.43), and lubrication (β =0.44; all p <.05) were associated with physical HRQoL over the 12-month postpartum period. Mental HRQoL was influenced by moderate to severe UI (β =-1.3), sexual satisfaction (β =0.61; both p <.05), and depressive symptoms (β =-11.07; p <.001). The lowest p hysical and mental HRQoL scores were identified in the first month postpartum (all p <.001). Physical HRQoL increased more significantly at 6 and 12 months than at 3-months postpartum (both p ≤.001).

Conclusions/implications for practice: The first month postpartum represents a critical period for assessing HRQoL, when it is lowest. UI severity, sexual satisfaction, lubrication, and depressive symptoms were all shown to impact HRQoL significantly, indicating the need for proactive evaluations and tailored interventions by healthcare providers. Future research should identify interventions that effectively improve HRQoL during the postpartum period.

Background: Frailty may result in decreased physical functioning and worsen the prognosis of chronic diseases. Chronic obstructive pulmonary disease (COPD) is associated with an increased risk of concurrent frailty. Although pulmonary rehabilitation has demonstrated improvements in COPD outcomes, its impact on patients with frailty and COPD remains unclear.

Purpose: This study was designed to examine the effects of the pulmonary rehabilitation exercise package (PREP) on frailty, dyspnea, lower extremity muscular endurance (LEME), and walking ability (WA) in older adult COPD patients with frailty.

Methods: A single-blind experimental design was used to study 100 elderly COPD patients with frailty, randomly assigned to either the experimental or control group. The experimental group (EG) received the PREP intervention, while the control group (CG) received routine care. The Clinical Frail Scale (CFS) was used to measure frailty, the Modified Medical Research Council scale was used to measure dyspnea, LEME was measured using the 30-second chair stand test, and functional exercise capacity (i.e., walking ability or WA) was measured using the 6-minute walk distance. All measurements were taken at three time points: baseline (preintervention), 1 week postintervention, and 1 month postintervention. Between-group and within-group differences and variations in repeated measurements over time were compared using independent t tests, paired t tests, and generalized estimating equations (GEE).

Results: A total of 91 participants completed the study, with 9 participants lost to follow-up. No significant between-group differences were found at baseline in terms of characteristics, frailty, dyspnea, LEME, and WA. Applying difference-in-differences, the EG outperformed the CG in terms of dyspnea and WA at both 1-week and 1-month follow-ups, while the EG significantly outperformed the CG on all measures at the 1-month follow-up. Within-group comparisons also revealed significant improvements in the EG compared with the CG. Using GEE to examine the interaction, the EG demonstrated significantly better improvements in dyspnea, LEME, and WA than the CG at the 1-month mark.

Conclusions/implications for future practice: The results show that PREP has the potential to significantly improve health in older adults with frailty and COPD by addressing frailty, dyspnea, LEME, and WA. PREP may be implemented as a subacute health care model to manage COPD-related debilitation in hospital settings.