The journal of nursing research : JNR最新文献

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.

Background: Although compassion fatigue has received significant attention in nursing management, compassion satisfaction has been less studied.

Purpose: This study was designed to elucidate the positive and negative trends in nursing empathy from a dialectical perspective and investigate the impact of difficult nurse-patient relationship on compassion fatigue and satisfaction, and the underlying mechanisms.

Methods: A cross-sectional study was conducted from November to December 2022 at a tertiary hospital in a northeastern province of China on 1,756 nurses. A moderated mediation model was constructed using structural equation modeling, and multi-group comparative analysis was used to examine the differences in the proposed model.

Results: After adjusting for controlled variables, empathic concern and personal distress were shown to mediate the relationship between difficult nurse-patient relationship and, respectively, compassion satisfaction and burnout. Personal distress was found to mediate the relationship between difficult nurse-patient relationship and secondary traumatic stress, while self-reflection was found to moderate the effect of difficult nurse-patient relationship on empathic concern. Finally, differences in the structural model were detected between those with and without hospital traumatic experience.

Conclusions/implications for practice: The findings reveal the mechanisms and boundary conditions underlying difficult nurse-patient relationship that influence compassion fatigue and compassion satisfaction. Interventions that increase the level of self-reflection and empathic concern may help reduce burnout and increase compassion satisfaction in nurses.

Background: Adolescents exposed to secondhand smoke (SHS) and those living with parents who smoke are at higher risk for tobacco use and adverse health outcomes. School nurses are expected to support smoke-free policies on campuses and play a prominent role in health promotion. However, few nursing studies on SHS exposure prevention have included recommended strategies for advising family smokers (AFS).

Purpose: This study was developed to examine the prevalence of SHS exposure among adolescents in rural areas and assess the impact of implementing a pilot program that incorporates innovative strategies for AFS.

Methods: A school-based, educational intervention study was conducted in four middle schools in western coastal Yunlin County between March and September 2023. Innovative strategies for AFS were integrated into the school's health education curricula using a 6-hour secondhand smoke prevention program. Data were collected using self-administered, anonymous questionnaires. Descriptive and inferential statistical analyses were employed to examine the factors and barriers associated with AFS.

Results: Of the 1,202 adolescents who participated at baseline, 806 (51.4% boys; mean age=13.5 years) reported living with a smoker at home (67%). Among these 806, 91.4% reported family members smoked indoors, and, after completing the AFS program, 46.9% reported having attempted to advise their family members to quit smoking or smoke outdoors. The factors identified as significantly associated with AFS included being female, practicing avoidance behaviors, and witnessing smoking on campus. Only 8.1% felt their advice was successful, with common challenges including parental refusal, being scolded, and feelings of hopelessness. Also, many of the participants reported experiencing moral dilemmas, particularly with regard to cultural values such as filial piety, when advising parents.

Conclusions/implications for practice: Exposure to secondhand smoke among adolescents living in rural areas is a serious issue. Teaching them strategies on how to advise family smokers may help reduce home exposure, particularly among boys. However, in Eastern cultures, advising parents about smoking presents moral challenges due to cultural values. Regulatory changes are needed to protect youths from secondhand smoke at home.

Background: Open-heart surgery is effective but may involve significant postoperative complications and long recovery times that can be exacerbated by patient anxiety. Nonpharmacological approaches such as reflexology have gained attention in the field of medicine for their ability to alleviate anxiety without significant side effects.

Purpose: This systematic review and meta-analysis were designed to determine the effect of reflexology on anxiety in patients undergoing open-heart surgery.

Methods: The PubMed, EBSCO (including MEDLINE and CINAHL), OVID, Web of Science, and Cochrane databases were searched from May 15 to July 15, 2024. Randomized controlled trials that evaluated patients who had open-heart surgery were included in the analysis. Studies were appraised using the Critical Appraisal Checklists for Randomized Controlled Trials developed by the Joanna Briggs Institute (JBI). The meta-analysis was conducted using the Comprehensive Meta-Analysis Version 2, and heterogeneity between studies was assessed using the χ 2 test and I2 statistic. The results were reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.

Results: Eight studies encompassing 485 patients were included in the meta-analysis. All of the included studies used common measurement times for anxiety and compared intervention groups with either standard care or a placebo. In the meta-analysis performed using a random-effects model, reflexology was found to significantly reduce anxiety ( g =-1.49, 95% confidence interval (CI)=[-2.35, -0.63], with a statistically significant difference observed between the intervention and control groups ( z =-3.41, p =.001). However, the findings of the meta-analysis should be interpreted with caution.

Conclusions: Reflexology may be effective in reducing anxiety in patients undergoing open-heart surgery. However, the significant heterogeneity identified among the included studies indicates variability among study conditions. Therefore, their outcomes should be evaluated carefully. Reflexology may be used as an adjunct to standard patient care. Additional studies with more homogeneous methodologies are required to strengthen the evidence base for the efficacy of reflexology in reducing anxiety in this vulnerable patient population.

Background: The number of patients with end-stage renal disease (ESRD) in Taiwan continues to rise steadily, and hemodialysis is the primary treatment for these patients. More than 50% of patients on hemodialysis are over 65 years of age, indicative of an aging patient population. Changes in lifestyle, dietary habits, and social roles after commencing hemodialysis easily cause patients to feel uncertain, depressed, and/or lonely. However, a limited number of studies have examined the issue of loneliness among older adults on hemodialysis.

Purpose: This study was designed to better understand loneliness and its associated factors among older patients receiving hemodialysis.

Methods: A cross-sectional research design with convenience sampling was employed with a total of 146 patients. Eligible participants aged 65 years or older and receiving hemodialysis for more than 3 months were recruited from two hospitals in northern Taiwan. Structured questionnaires, including a demographic characteristics questionnaire, the Hemodialysis Patient Fatigue Scale, Social Support Scale, and UCLA Loneliness Scale version 3, were used to collect data.

Results: The mean loneliness score was 41.5 out of a maximum of 80. A significant positive relationship was found between fatigue and loneliness, and a significant negative relationship was found between social support and loneliness. Gender, fatigue, and social support were identified as predictors of loneliness.

Conclusions/implications for practice: The results indicate that older patients receiving hemodialysis have a moderate level of loneliness. Based on the identified predictors, nurses should pay particular attention to patients who are female, are experiencing a higher fatigue level, and/or have lower social support. Future studies may use these results to develop strategies for preventing and improving loneliness among older adults receiving hemodialysis.

Background: Since the outbreak of the COVID-19 pandemic in 2019, frontline health care workers have experienced significant stress due to concerns about their own infection risk, fear of transmitting the virus to their families, societal stigmatization, changes in work hours, and uncertainties regarding disease progression. However, the related studies in the literature focus predominantly on psychological distress among nurses, physicians, and administrative staff during the pandemic and its factors of influence, with few studies exploring this issue in nurses during the postpandemic period. This study was developed to address this gap.

Purpose: This study was designed to investigate psychological distress among nurse practitioners during the post-COVID-19 pandemic era and its associated factors.

Methods: This cross-sectional study was conducted in a hospital in southern Taiwan from May 1 to July 31, 2023. The cohort included 98 nurse practitioners. Study data were collected using a personal demographics datasheet, the Depression, Anxiety, And Stress Scale-21 (DASS-21), and the stress scale of caring for highly-infectious-disease patients. Data were analyzed using descriptive statistics, the independent samples t test, one-way analysis of variance, Pearson's correlation, and multiple linear regression.

Results: The mean DASS-21 score was 14.17 ( SD = 9.56), with mean scores for depression, anxiety, and stress of 8.18 ( SD = 6.9), 6.92 ( SD = 6.32), and 13.24 ( SD = 8.14), respectively; all indicative of normal levels of depression, anxiety, and stress. The mean stress scale of caring for highly-infectious-disease patients was 48.89 ( SD = 18.50). The results of a multiple linear regression analysis revealed participants aged 35-44 and older than 45 years experienced higher levels of stress while caring for highly-infectious-disease patients than their counterparts aged 25-34 years (β = 0.64, p = .006; β = 0.56, p = .027). Also, participants with 11-20 years of work experience reported lower stress in caring for highly-infectious-disease patients than their counterparts with <10 years of work experience (β = -0.46, p = .049).

Conclusion/implications for practice: In this study, nurse practitioners aged 35 years and above and those with <10 years of work experience experienced greater stress following the COVID-19 pandemic. As the first study to explore psychological distress among nurse practitioners in the aftermath of the COVID-19 pandemic and its associated factors, these findings highlight the need for hospital administrators to implement support measures to support nurse practitioners tailored to age group and family status to mitigate long-term psychological distress and its impact on fatigue and care quality.

Backgrounds: In China, emergency department (ED) nurses frequently face high turnover rates and emotional exhaustion, phenomena that are intensified by the demanding nature of their roles. While emotional exhaustion significantly influences nurses intention to leave, the potential mitigating effects of factors such as emotional support have not been thoroughly explored.

Purpose: This study was designed to investigate the mediating role of emotional support between emotional exhaustion and turnover intention among ED nurses in China and to examine the factors of influence on turnover intention.

Methods: A cross-sectional research design was used to collect data from 427 ED nurses from different hospitals across China using convenience sampling. The research instruments used included the Emotional Support Scale, Emotional Exhaustion Scale, Self-Rated Mental Health Status Scale, and Turnover Intention Scale.

Results: The findings showed not proactively having chosen a career in nursing (β=0.096, p<.05), greater emotional exhaustion (β=0.318, p<.001), satisfactory economic status (β=-0.196, p<.001), better physical condition (β=-0.128, p<.05), and more emotional support (β=-0.092, p=.032) to correlate negatively with turnover intention and emotional support to mediate the relationship between emotional exhaustion and intention to leave (β=-0.095, Bootstrap 95% CI [-0.152, -0.046], p<.001), accounting, collectively, for 34.8% of the total effect (β=-0.273, Bootstrap 95% CI [-0.364, -0.175], p=.002).

Conclusions: Enhancing emotional support reduces turnover intention by mitigating the effects of emotional exhaustion on ED nurses in China. Targeted interventions that bolster emotional support systems, together with strategies that address financial satisfaction and physical well-being, will be essential to enhancing both nursing staff retention and overall patient care quality in China's demanding health care environment.

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.