The journal of nursing research : JNR最新文献

Background: Depression, poor sleep quality, and perceived lack of control all commonly impact women in the third trimester of pregnancy. Depression can influence sleep quality, whereas sense of control during pregnancy is correlated with both sleep quality and depression. However, the mediating effect of sleep quality on the relationship between depression and sense of control has not been examined in women in their third trimester.

Purpose: This study was designed to explore depression, sleep quality, and sense of control in pregnant women during the third trimester and determine the degree to which sleep quality mediates the relationship between depression and sense of control.

Methods: An exploratory correlational cross-sectional design was used to recruit 263 pregnant women with a gestational age of 35-36 weeks. Data were collected using questionnaires. Depression, sleep quality, and sense of control were respectively assessed using the Edinburgh Postnatal Depression Scale, Pittsburgh Sleep Quality Index, and Labor Agentry Scale. Data on the main outcomes were analyzed using the PROCESS macro for SPSS.

Results: Depression in pregnant women was found to correlate positively with poor sleep quality and negatively with sense of control (all p s < .001). Thus, higher levels of depression and poorer sleep quality were associated with lower sense of control. The results confirmed the relationship between depression and sense of control to be mediated by sleep quality ( p < .001).

Conclusions: Pregnant women with lower levels of depression may experience better sleep quality and sense of control. Sleep quality mediates the relationship between depression and sense of control in women in the third trimester. Thus, prenatal counseling and psychological support should be provided to pregnant women to reduce depression while improving sleep quality and sense of control.

Background: Exercise is the most effective method of reducing visceral adipose tissue (VAT). However, the optimal exercise modality and strategy for reducing VAT have yet to be determined.

Purpose: This study was designed to identify the optimal sequence exercise strategy for reducing VAT in community residents with obesity.

Methods: A sequential multiple assignment randomized trial design was used to conduct a two-stage (8 weeks each) adaptive exercise for 40- to 64-year-old residents with obesity. In the first stage, the participants were randomly allocated into two groups, one of which did 30 minutes of moderate-intensity continuous training (MICT; n = 58) and the other which did 20 minutes of high-intensity interval training (HIIT; n = 58) three times per week. In the second stage, the nonresponders (with VAT decreases < 3%) were randomly reallocated into a group that performed MICT combined with an additional 10 minutes of resistance exercise or one that performed the opposite of the first-stage treatment (HIIT or MICT). Those who responded to the first-stage intervention (with VAT decreases of ≥ 3%) continued the same exercise treatment until 16 weeks.

Results: The MICT intervention was found to be more efficacious than the HIIT intervention in reducing VAT during the first 8 weeks (β = -4.10, p = .029). Among the nonresponders to MICT, the HIIT outperformed MICT combined with resistance exercise as the alternative choice in the second stage (β = -7.36, p = .006). On the contrary, there were no significant differences between MICT and MICT combined with resistance exercise for the nonresponders to HIIT (β = 1.34, p = .626). Those participants who repeated the same exercise modality (either MICT or HIIT) in both stages exhibited superior VAT reduction to those who changed exercise modalities after the first stage.

Conclusions/implications for practice: The optimal sequence exercise strategy for reducing VAT is captured by a two-stage sequential multiple assignment randomized trial design. Community residents with obesity are advised to reduce VAT efficiently through participation in an 8-week MICT program. For those preferring HIIT rather than MICT, a 16-week program without changing the modality midway is recommended.

Background: Nurses are frequently called upon to serve as first responders and care providers after natural hazards and disasters. As disaster relief nurses protect the health of and provide support to survivors who are forced to live in shelters, their experiences deserve to be analyzed. However, there is a paucity of research and systematic reviews (SRs) on this topic.

Purpose: This research was designed to systematically analyze the experiences of nurses providing care to people in shelters following natural hazards and disasters.

Methods: The authors searched CINAHL, PubMed, Scopus, Web of Science, and ProQuest Dissertations and Theses on July 2nd 2023 for qualitative studies published in English and Japanese since 1995 (the first year articles on this topic were published). After evaluating the methodological quality of the five included studies using the Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research and conducting a critical appraisal, the relevant qualitative data were extracted. The findings were categorized according to their quality and meaning. Based on these categories, a meta-synthesis was performed to produce a set of synthesized findings.

Results: The five qualitative studies included in this review covered the post-natural disaster care experiences of 45 participants. The meta-synthesis resulted in 25 findings, seven categories, and two synthesized findings, including (a) nurses play multiple roles for evacuees from affected communities and (b) nurses managing shelters to ensure the health and living conditions of evacuees. The synthesized findings explain the disaster relief experience of nurses comprehensively.

Conclusions: This qualitative SR included five moderate-quality studies designed to explore the experiences of disaster relief nurses following natural hazards and disasters. Nurses worked with and managed several teams, including those involved in rescue, resource management, organization, and record management, in a flexible manner, thus involving them in the management of all events within and involving evacuee shelters. These nurses are responsible for providing medical and nursing care and protecting evacuees from danger, while respecting the pace of each individual in the disaster-stricken community. Notably, the nurses leveraged their personal and disaster nursing experiences to learn and develop nursing care strategies and techniques unique to shelters.

Background: The online flipped learning method, an innovative learning approach, helps develop critical thinking and self-directed learning skills and increases student interest in coursework.

Purpose: This study was developed to investigate the impact of a flipped learning model-based chemotherapy symptom management education course on levels of academic achievement, critical thinking, and self-directed learning skills in nursing students.

Methods: This randomized controlled trial comprised 68 students, who were randomly assigned to either the experimental or the control group. A traditional online learning-based training program was applied in the control group, while online flipped learning was applied in the experimental group. Each group underwent training on chemotherapy symptom management for 1 h every week for 6 weeks. The researchers evaluated the results for both groups using the Chemotherapy Symptom Management Knowledge Test, the Marmara Critical Thinking Dispositions Scale, and the Self-Directed Learning Skills Scale applied before, immediately after, and 1 month after training. The data were collected between January 2020 and July 2021.

Results: Academic achievement ( p < .001) and critical thinking dispositions increased during, immediately after, and 1 month after training ( p < .001) in the experimental group, while academic achievement increased 1 month after the training ( p < .001) in the control group. The degree of positive change in academic achievement in the experimental group was greater than that of the control group ( p = .028). Critical thinking disposition decreased during, immediately after, and 1 month after the training ( p < .001) in the control group, while no meaningful difference was found in self-directed learning skills in either group after the training ( p > .05).

Conclusion/implications for practice: The online flipped learning model-based education program improved academic achievement and critical thinking disposition.

Background: Research data on the extent of and protocols related to physical restraint (PR) in pediatric intensive care units (PICUs) are scarce. Most previous studies in China on this topic have focused on the prevalence, reasons, and background of PR use among adult patients.

Purpose: This study was designed to delineate the application of PR and the factors associated with PR use in PICUs in China.

Methods: A cross-sectional study was conducted in one PICU at West China Hospital, Sichuan University, from January 2020 to December 2020. A total of 1,086 pediatric patients in the PICU were included in this study. Data collection was performed over 11 months, utilizing PR observation forms and patient records. Descriptive statistical analysis was used to obtain the data, and logistic regression models were used to analyze the independent risk factors for PR.

Results: Of the 1,086 participants, 750 (69.1%) experienced being restrained, and 83.5% of the restrained participants who were pediatric patients were restrained for more than 50% of their time during their PICU stay. The results of logistic regression analysis identified age (1-6 years: OR = 2.090, 95% CI [1.508, 2.897], p < .001; 7-17 years: OR = 0.523, 95% CI [0.358, 0.765], p = .001), use of mechanical ventilation ( OR = 2.126, 95% CI [1.480, 3.055], p < .001), use of drainage tubes ( OR = 1.916, 95% CI [1.445, 2.541], p < .001), and sedation ( OR = 1.494, 95% CI [1.101, 2.026], p = .010) as significantly correlated with the use of PR in the PICU. For the 750 patients who experienced being restrained, PR initiation was documented with a written medical order, and in 604 cases (80.5%), the restraints were removed without similar documentation.

Conclusions: The use of PR is common in PICUs in China, with more than half of pediatric patients being restrained during their stay. Age, mechanical ventilation, use of drainage tubes, and use of sedative drugs were identified as significantly associated with PR use. Developing standardized procedures/guidelines for PR use in Chinese PICUs and enhancing medical staff education on PR practices are imperative.

Background: Symptoms of psychological distress such as depression and anxiety as well as gender are known to be associated with sleep quality in middle-aged and older adults. However, little is known about the effect on sleep quality of interactions among these factors.

Purpose: This study was developed to investigate the moderating effect of gender on the relationship between psychological distress and sleep quality in middle-aged and older adults.

Methods: A cross-sectional design, secondary data analysis of data on 5,590 individuals aged ≥ 45 years from the Taiwan Biobank database (2009-2018) was used. In this database, psychological distress was assessed using the Patient Health Questionnaire-4, and sleep quality was assessed using a self-report, one-question scale. Demographic data and health-related variables were evaluated as potential confounding factors. A hierarchical regression was conducted to examine the moderating effect of gender on the relationship between psychological distress and sleep quality after adjusting for potential confounders.

Results: The participants with severe psychological distress were found to have a lower mean quality of sleep than those without ( p < .01), and males returned a better mean quality of sleep score than females ( p < .01). Moreover, a significant interaction effect between psychological distress and gender on sleep quality score was found ( b = 0.123, SE = 0.022, p = .03). In terms of participants with severe psychological distress, males reported significantly poorer sleep quality than females.

Conclusions: The findings provide evidence that gender moderates the relationship between sleep quality and psychological distress. Also, in terms of individuals with severe psychological distress, males reported worse sleep quality than women, indicating psychological distress impacts sleep quality in men more than women. Nurses should be aware of these findings when working with clinical professionals to tailor gender-specific education interventions to improve sleep quality and psychological health.

Background: Population aging has led to a surge in elderly care needs worldwide. Bone aging, skeletal muscle degeneration, and osteoporosis pose critical health challenges for the elderly. The process of bone and skeletal muscle aging not only impacts the functional abilities but also increases fragility fracture risk. Although a negative correlation between handgrip strength and fragility fracture risk has been identified in elderly populations, there is a lack of related research in Taiwan.

Purpose: This cross-sectional study was designed to investigate the association between handgrip strength and two outcome variables, bone density and risk of fragility fracture, in Taiwanese individuals aged 65 years and older with low bone mass.

Methods: A total of 548 older adults, including 84 men and 464 women, were recruited between August 2019 and July 2021. Bone mineral density T -scores acquired using dual-energy X-ray absorptiometry scan, the total score for the Taiwan-specific Fracture Risk Assessment (FRAX) tool, and bilateral handgrip strength acquired using a digital hand dynamometer were recorded along with other factors such as comorbidities, dietary habits, and daily activities.

Results: In this study, the mean age was 70.9 ( SD = 5.6) years, mean bone mass index was 24.1 ( SD = 3.5) kg/m 2 , mean FRAX main fracture risk score was 19.5% ( SD = 8.3), and mean FRAX hip fracture risk score was 7.7% ( SD = 5.7). Lumbar and hip T -scores were both significantly correlated with both dominant and nondominant handgrip strength in older woman. Older age; both lower hip and spine T -scores; both lower dominant and nondominant handgrip strengths; having Type 2 diabetes, coronary artery disease, or chronic hepatic disease; and lacking a steady job were significantly associated with a higher risk of fragility fracture.

Conclusions/implications for practice: The results of this study provide important information regarding the correlation between handgrip strength and several variables, including bone mineral density T -score, FRAX score, comorbidities, and job status, among older adults. Notably, these correlations were found to be particularly strong in the female participants. This information may be used to facilitate the early identification of elderly individuals at a high risk of fragility fractures, enabling the timely development of preventive nursing strategies and the provision of targeted interventions.

Background: Vertical transmission from mother to child during the perinatal period is a key route of hepatitis B infection. The infection rate among children of mothers who are hepatitis B carriers is high.

Purpose: This study was designed to investigate the hepatitis-B-related preventive health behavior of pregnant women and related factors.

Methods: A cross-sectional study design was used, and 184 pregnant women aged 20 years or above were recruited at obstetrics clinics as participants. The Demographic Characteristics Questionnaire, Hepatitis B Knowledge Questionnaire, Hepatitis B Health Beliefs Questionnaire, and Preventive Health Behavior Questionnaire were used to collect study data between October 2017 and March 2018.

Results: Most of the participants had received a hepatitis B test because of either a pregnancy checkup (38.0%) or a health examination (32.1%), and most (77.7%) were not hepatitis B carriers. Using multiple linear regression, four significant determinants of hepatitis B preventive health behavior were identified, including marital status (β = 2.45, p = .008, 95% CI [0.66, 4.25]), test for hepatitis B infection status (β = -2.83, p = .013, 95% CI [-5.06, -0.60]), hepatitis B knowledge (β = 0.21, p = .001, 95% CI [0.09, 0.33]), and hepatitis B health beliefs (β = 0.11, p < .001, 95% CI [0.05, 0.16]).

Conclusions: The participants who were not married or had never received a hepatitis B test exhibited better hepatitis-B-related preventive health behavior. Moreover, both hepatitis B knowledge and hepatitis B health belief scores were found to relate positively to preventive health behavior. Healthcare providers should strengthen health education in outpatient clinics and provide post-hepatitis B health-related materials in the community. In particular, internet resources such as hepatitis-B-related health education apps and other channels should be used to increase hepatitis B knowledge in perinatal women and eliminate hepatitis B.