The journal of nursing research : JNR最新文献

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.

Background: In Taiwan's aging society, age-related sarcopenic obesity has gradually become an important health issue. Sarcopenic obesity is associated with functional limitations, falls, disabilities, mental health problems, and even mortality.

Purpose: The aim of this meta-analysis was to examine the effects of resistance exercise on body composition and physical functioning in older adults with sarcopenic obesity.

Methods: A search of randomized controlled trials was conducted in six electronic medical databases from their inception to December 2023.

Results: Twelve studies were included in the systematic review and meta-analysis, with results indicating a significant increase in grip strength (effect size=1.560, 95% confidence interval [CI]=[0.178, 2.941]; p =.027) and significant reduction in body fat percentage (effect size=-1.737, 95% CI=[-2.563, -0.912], p <.001) in the experimental group versus the control group. However, gait speed and body mass index were not significantly improved by resistance exercise interventions.

Conclusions: The findings support a positive effect of resistance exercise on grip strength and body fat percentage in older adults with sarcopenic obesity.

Background: The prevalence of diabetes is a significant concern and is particularly impactful on the older adult population. Auricular acupressure is recognized as an effective complementary treatment for Type 2 diabetes.

Purpose: The purpose of this study is to examine the effect of auricular acupressure on glycemic markers, stress, and sleep quality in older adults with Type 2 diabetes in South Korea.

Methods: The study involved weekly acupressure therapy sessions for 8 weeks, with 25 participants in the intervention group and 26 in the placebo group. Specific acupoints associated with diabetes, sleep, and stress were targeted in the intervention group, while unrelated acupoints were used in the control group. Subjective indicators such as stress and sleep scales, along with objective measures such as blood tests, heart rate variability, and sleep activity recorders, were employed in the analysis.

Results: Significant differences were observed in blood sugar ( F =5.20, p <.001) and glycated hemoglobin ( Z =-2.345, p= .019) between the two groups after administration of the acupressure therapy. However, no significant between-group differences were found in either glycated albumin or fructosamine. Also, activity in the sympathetic and parasympathetic nerves showed significant between-group variation. Although no significant between-group differences were found for subjective sleep indicators, notable changes in the number of awakenings, duration of awakening, REM sleep, and deep sleep conditions were identified.

Conclusions: Although the effects are not strong, the findings suggests auricular acupressure influences glycemic index, stress, and sleep quality in older individuals with Type 2 diabetes positively. The results of this study support the potential of using auricular therapy as a nursing intervention in diabetes management.

Background: The factors of influence on caregiver burden with regard to dementia care provided in residential care homes are multifaceted. Few studies in the literature have simultaneously investigated the variables related to residential care recipients with dementia and their formal caregivers.

Purpose: This study was designed to assess caregiving burden in formal caregivers of residential care recipients with dementia and to identify significant predictors of this burden associated with these care recipients and their caregivers.

Methods: This prospective cross-sectional study enrolled 206 registered nurses and nursing assistants working as formal caregivers, as well as 256 residents with dementia across 6 residential care homes. Structured questionnaires were used to collect data on the sociodemographic characteristics, attitudes, dementia care knowledge, and caregiver burden of nursing staff, as well as data on the sociodemographic characteristics, daily functional ability, cognitive functioning, and neuropsychiatric symptoms of residential care recipients with dementia.

Results: The formal caregivers in this study reported experiencing mild to moderate care burden. Stepwise linear regression analysis identified prior dementia care training, confidence in care provision, and attitude in the formal caregivers and number of medications and agitation/aggression levels in the residents as significant predictors of caregiving burden, explaining 32% of the variance. Unexpectedly, the basic dementia care knowledge of the caregivers and the physical dependence and other neuropsychiatric symptoms of the residents were not identified as significant predictors of caregiver burden.

Conclusions/implications for practice: The findings of this study underscore the critical importance of caregiver attitude, confidence, and coping skills in determining caregiving burden, noting that not all behavioral and psychological symptoms impact this burden equally. These insights emphasize the need to enhance confidence and positive attitudes in formal caregivers and to effectively manage residents' aggressive behaviors through both pharmacological and nonpharmacological approaches to ameliorate the high caregiver burden associated with dementia care.

Background: Food avoidance, common in patients with inflammatory bowel disease (IBD), impacts their recovery and psychological health. However, limited insight is provided in the literature regarding the food avoidance experiences and perceptions of patients. A systematic qualitative synthesis exploring these experiences and perceptions may be expected to enhance scholarly understanding of their implications for IBD.

Purpose: This study was developed to review and characterize existing qualitative studies on food avoidance in patients with IBD and to use relevant data from previous studies to guide and optimize diet management strategies for patients.

Methods: Eight databases (PubMed, Embase, Cochrane Library, Web of Science, EBSCO, and three Chinese databases) were searched to identify qualitative studies on the food avoidance experiences and perspectives of patients with IBD. Critical Appraisal Skills Program (CASP) Qualitative Checklists were applied to appraise the included studies, and a meta-synthesis approach was used to analyze the data. The findings and quotations from the studies were recharacterized into new themes and categories using inductive thematic synthesis and reciprocal interpretation.

Results: Of the 1,224 studies retrieved, 19 were included in this meta-synthesis. The experiences and feelings of food avoidance in patients with IBD included the four categories of Coping Strategies, Disruption of Life and Mood, Needs and Expectations, and Social Alienation, from which the following eleven themes were derived: (a) motivations and perspectives, (b) safe recipes updated in failure, (c) positive impact, (d) reshaping life planning and increasing life stress, (e) negative emotional challenges, (f) the role of family and friends in dietary management, (g) workplace support deficiencies, (h) lack of professional dietary guidelines, (i) alienation from intimacy, (j) alienation of culinary culture, and (k) social distancing.

Conclusions/implications for practice: The findings of this study highlight the complexities that underlie food avoidance behaviors in people with IBD and reveal the challenges faced by patients in managing their diet and emotions. The importance of personalized dietary guidance based on food avoidance, negative emotion de-escalation, and strong social support for disease management is highlighted.