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: 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.

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.