The journal of nursing research : JNR最新文献

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.

Background: Effective leadership by nursing unit managers can empower nurses, which is known to positively affect their performance and organizational commitment. However, a paucity of studies has investigated the mediating role of empowerment on the relationship between ethical leadership and the performance and organizational commitment of nurses.

Purpose: This study was designed to investigate empowerment as a mediator between the ethical leadership of nursing managers and the professional performance and organizational commitment of clinical nurses.

Methods: Two hundred and twenty nurses working in tertiary general hospitals in South Korea participated in an online survey conducted from August 1 to September 30, 2020. Mediation analysis was performed using the Hayes PROCESS macro for SPSS.

Results: Empowerment was found to mediate the relationship between ethical nursing leadership and, respectively, clinical nurse performance and organizational commitment. Notably, ethical nursing leadership was also found to directly influence organizational commitment in clinical nurses.

Conclusions/implications for practice: Empowerment significantly and positively mediates the influence of ethical nursing leadership on key nursing productivity outcomes such as nursing performance and organizational commitment. Thus, empowering clinical nurses is critical to improving their performance and organizational commitment. Ethical leadership by nursing unit managers can help empower nurses and improve their performance.

Background: Concurrent with a growing shortage of nurses, the number of older adults living with chronic conditions and disabilities in the community is increasing. Emerging technologies present solutions that may impact nurses' training and patient care.

Purpose: This study was designed to explore (a) the familiarity of nurses with emerging technologies, their need for additional training, and their perception of the effects of these technologies on the care of older adults in the community and (b) the relationships between the research variables and, respectively, sociodemographic and professional data.

Methods: A descriptive, cross-sectional design was used, and a structured questionnaire was distributed to community nurses throughout Israel between November 2022 and February 2023.

Results: Positive associations were found between nurses' familiarity with technology, the need for additional training, and the perceived general and specific effects of these technologies on older adult care. Moreover, technological familiarity and the need for training predicted the perceived impact of these technologies on older adult care.

Conclusions/implications for practice: The results highlight the importance of familiarizing nurses in community settings with emerging and advanced technologies. This may promote and improve the quality of care provided to older adults in the community. Moreover, continuing training and education for nurses on emerging technologies are essential to familiarize nurses with new technologies, increase technology acceptance, and enhance the quality of care provided to older adults in the community.

Background: Chronotype, also referred to as morningness and eveningness, describes the natural preference of the body for wakefulness or sleep at different times during a 24-hour period. Individuals demonstrating late chronotypes and low resilience tend to have poor sleep quality, and the association between late chronotypes and sleep quality is known to be moderated by sleep reactivity. The mediating roles of sleep reactivity and psychological resilience in the association between chronotype and sleep quality in college students under situations of high stress have yet to be investigated.

Purpose: This study was designed to evaluate the degree to which resilience moderates the moderating role of sleep reactivity on the association between chronotype and sleep quality in college students undergoing clinical placement.

Methods: A cross-sectional study involving 225 college students undergoing clinical placement was conducted. The Chinese version of the Pittsburgh Sleep Quality Index was used to assess sleep quality, chronotype was assessed using the Morningness-Eveningness Questionnaire, sleep reactivity and resilience were respectively assessed using Ford's Insomnia Response to Stress Test and Brief Resilience Scale, and the SPSS PROCESS macro Version 4.3 (Hayes) was employed in moderated moderation analysis.

Results: Resilience was shown to moderate the relationship between sleep reactivity and sleep quality (β=0.079, p =.039) as well as the moderating role of sleep reactivity in the chronotype-sleep quality relationship (β=-0.002, p =.027).

Conclusions: In this study, sleep reactivity and chronotype both exhibited inverse effects on sleep quality in the moderate- and high-resilience groups. However, those in the low-resilience group with high sleep reactivity exhibited low sleep quality regardless of chronotype. Considering these findings, sleep reactivity and resilience should be adequately monitored during interventions designed to enhance sleep quality.

Background: Competency-based education is essential for training nurse practitioners (NPs). Although entrustable professional activities (EPAs) have been widely used to assess competency in health professionals, a valid EPA-based assessment scale is required to assess the clinical competencies of NPs in acute care settings.

Purpose: The aim of this study was to develop and examine the reliability and validity of an EPA-based assessment scale for NPs.

Methods: A psychometric study with a cross-sectional survey was used in this study. The participants included NP instructors as evaluators and novice NPs currently in clinical practice as test takers. Convenience sampling was used to recruit participants from among members of the Taiwan Association of Nurse Practitioners. First, five EPA focus groups were used to develop five EPAs using a template and following the suggested steps. Second, a consensus validation was conducted using the Delphi study. Third, content validity was performed through a national study involving 218 novice NPs as test takers and 57 certified clinical NP educators serving as observers to test the EPAs. The Cronbach's alpha and intraclass correlation coefficient were calculated to examine EPA-based assessment scale reliability, and exploratory factor analysis, concurrent validity, and discriminant validity were applied to assess the validity of the EPAs. Finally, the EPA-based assessment scale of NP care for patients with fever was used in data analysis.

Results: The final version of the EPA-based assessment scale included a 22-item observable checklist scale designed to evaluate the clinically independent performance (1-5) of nine key NP competencies. The Cronbach's alpha coefficient for the overall scale was .95. The results revealed that the EPA-based assessment scale addressed two key factors of direct patient-centered care and communication/time management. Factor loadings for each item ranged from .58 to .83, accounting for 70.83% of the total variance in the EPA-based assessment scale. Concurrent validity indicated a high correlation between the developed EPA-based assessment scale and the Ottawa Clinic Assessment Tool ( r  = .96, p  < .001). The results of the discriminant validity analysis indicated a statistically significant difference between novice and expert NPs ( F  = 7.84, p  < .001).

Conclusions/implications for practice: The novel EPA-based assessment scale developed in this study demonstrated satisfactory reliability and validity, thereby supporting its application in evaluating the clinical competencies of NPs.