The journal of nursing research : JNR最新文献

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.

Background: Continuous bright light (CBL) and dim light (DL) exposure in premature babies may adversely affect their physiological and vision development and interfere with parental sleep and quality of life.

Purpose: This systematic review and meta-analysis were conducted to investigate the effects of day/night cycled light (CL) exposure on weight gain and length of hospital stay (LOS) in premature infants.

Methods: MEDLINE, PsycINFO, PubMed, CINAHL, Cochrane, Airiti Library, and Google Scholar were searched using appropriate keywords for relevant English or Chinese articles published before April 7, 2023. Study quality was evaluated using RevMan software (version 5.4) and the Cochrane risk-of-bias assessment tool (version 2.0). The cohort was divided into two groups based on the light exposure cycle studied, namely the intervention (CL) and control (CBL and DL) groups.

Results: Ten studies were included in the meta-analysis, with the results revealing LOS was, respectively, 8.11 days (95% confidence interval [CI]=[-14.76, -1.46]; p =.02) and 7.21 days (95% CI=[-13.82, -0.60]; p =.03) less in the CL group than in the DL and CBL groups. Thus, the CL group recorded a total reduction of 7.52 days in LOS (95% CI=[-12.87, -2.17]; p =.006). Also, the standardized mean difference in weight gain between the CL and DL/CBL groups was 0.62 (95% CI=[0.00, 1.24]; p =.05).

Conclusion/implications for practice: The findings indicate that premature infants exposed to CL experience substantially less LOS and more weight gain than their peers exposed to either DL or CBL. As premature infants require CL exposure after discharge, its implementation in the neonatal intensive care unit should be transitional and timed appropriately. Notably, the studies included in this meta-analysis used small sample sizes and were affected by a number of quality concerns. Thus, large-scale studies should be conducted to confirm the optimal duration of CL exposure for premature infants in neonatal intensive care units.

Background: Work engagement in nurses is influenced by a variety of factors, with compassion fatigue identified as a negative predictor and resilience identified as a positive predictor. Although mindful self-care (MSC) may influence work engagement, this potential relationship has not been validated in the literature.

Purpose: This study was designed to examine the relationship between MSC and work engagement in a sample population of nurses in Israel and to investigate the potential mediating effects of compassion fatigue, resilience, and internal health locus of control (IHLC) on this relationship.

Methods: A quantitative cross-sectional study design was used, and data were collected from 845 nurses working in different clinical settings in Israel. A self-administered questionnaire was administered online between March and June 2023 to assess MSC, compassion fatigue, resilience, IHLC, and work engagement. A hypothesized model based on the Job Demands-Resources Theory was proposed. Descriptive statistics and path analysis were utilized in data analysis.

Results: The proposed model demonstrated a good fit with the empirical data, explaining 17.2% of the variance in work engagement. Direct relationships were identified between work engagement and, respectively, MSC, compassion fatigue, resilience, and IHLC (β=-0.131, p < .01; β=0.011, p < .01; β=0.116, p < .05; β=0.280, p < .01, respectively). The relationship between MSC and work engagement was shown to be mediated by compassion fatigue and resilience (β=0.068, p < .01), while compassion fatigue was shown to partially mediate the relationship between MSC and resilience (β=0.025, p <01). IHLC was not found to be significantly associated with work engagement.

Conclusions: MSC is a significant predictor of work engagement among nurses. Practicing MSC increases personal resilience and prevents compassion fatigue, leading to higher work engagement. Thus, we recommend nurse managers promote the regular practice of MSC, along with traditional self-care behaviors, among nurses to improve work engagement.