The journal of nursing research : JNR最新文献

Background: Despite an overall decline in serious adverse events in hospitalized patients, approximately one third of inpatient mortality continues to relate to adverse events impacting patients on general wards. The preparedness of nurses, midwives, and nursing assistants (collectively referred to as ward-based staff) to recognize patient deterioration is therefore seen as critical.

Purpose: The aim of this study was to explore ward-based staff perspectives regarding their preparedness to recognize patient deterioration.

Methods: An interpretive description approach was utilized to interview 16 participants from a single-center regional hospital. The participants included nurses, midwives, and nursing assistants who worked exclusively on wards. The participants were purposely selected to complete semistructured interviews. Data were analyzed using a six-step thematic analysis, and the study followed the Standards for Reporting Qualitative Research checklist.

Results: Three main themes (with subthemes) were identified: (a) feeling prepared (experience, intuitive awareness, early warning systems), (b) promoting preparedness (multimodal education, debriefing, collegial support), and (c) being unprepared (undergraduate education, knowledge deficit, staffing related concerns, psychological response to incident, unforeseen barriers).

Conclusions/implications for practice: The findings suggest strategies for increasing knowledge and confidence in all ward-based staff, allowing them to feel better prepared to recognize clinical deterioration. Moreover, based on the results, ward-based staff strongly perceive experience, clinical shortfalls in undergraduate education, collegial support networks, mentorship, psychological response to incidents, and multimodal education to be key contributors to preparedness.

Background: Although work engagement and job satisfaction are two important indicators associated with care quality, their mediating effects on the relationship between perceived staffing and quality of care have not been adequately clarified.

Purpose: This study was designed to determine the mechanism by which nurses' perceived staffing influences quality of care by clarifying the mediating roles of job satisfaction and work engagement.

Methods: A cross-sectional questionnaire survey was implemented among 2,142 clinical nurses from 211 inpatient wards in 13 hospitals. Work engagement, job satisfaction, perceived staffing, and rated quality of care were measured.

Results: Most (89.7%) of the respondents rated quality of care as good or better, and 56.1% perceived staffing in the wards as adequate. The two main findings of this study are as follows: (a) Perceived staffing influenced quality of care via one direct and three indirect pathways, with the indirect effect greater than the direct effect (β direct = 0.09, β total indirect = 0.25), and (b) work engagement and job satisfaction were important mediators of the impact of staffing on quality of care.

Conclusion: Quality of care may be enhanced by improving the work engagement and satisfaction of nurses in their current job, suggesting an effective approach to alleviating the current nursing shortage.

Background: Menstruation is a physiological process that may be accompanied by pain, headache, edema, emotional changes, and other symptoms, all of which affect quality of life. Although the results of some studies indicate lifestyle habits can affect the menstrual cycle and associated symptoms, few have investigated this issue, and even fewer have explored the impact of these symptoms on quality of life, in Spanish women.

Purpose: The objectives of this study were to determine the prevalence of dysmenorrhea and premenstrual syndrome (PMS) among students at a Spanish university, assess the impact of these conditions on quality of life, and analyze the relationship among lifestyle habits, dysmenorrhea, and PMS.

Methods: A cross-sectional study was carried out on 743 women enrolled at the University of Extremadura in the 2021-2022 academic year. Data related to the menstrual cycle, pain, and PMS-related physical and emotional symptoms were collected. Quality of life related to menstruation was evaluated using the CVM-22 scale. Lifestyle data collected included adherence to a Mediterranean diet (PREDIMED [Prevención con Dieta Mediterránea] questionnaire), level of physical activity (International Physical Activity Questionnaire), and alcohol and tobacco consumption (Alcohol, Smoking, and Substance Involvement Screening Test Version 3). Also, other clinical data were recorded.

Results: In terms of the sample, the median age was 21 (19-23) years, the prevalence of dysmenorrhea was 57.9%, 92.7% reported premenstrual physical symptoms, and 55.6% reported experiencing premenstrual emotional changes. Having a low level of adherence to a Mediterranean diet was associated with the presence of dysmenorrhea, with an adjusted odds ratio (aOR) of 1.47 (95% CI [1.06, 2.03]). Having a low level of physical activity was strongly associated with the presence of premenstrual physical symptoms, with an aOR of 5.89 (95% CI [1.71, 20.26]). Also, an association was found between tobacco use and premenstrual emotional changes, with an aOR of 2.02 (95% CI [1.25, 3.25]). Furthermore, dysmenorrhea and PMS were both associated with a low quality of life, with pain and emotional changes being the most significantly associated factors, with ORs of 16.25 (95% CI [10.36, 25.47]) and 26.73 (95% CI [16.46, 43.40]), respectively.

Conclusions: Similar to previous studies, the findings of this study indicate a high prevalence of dysmenorrhea and PMS among young university students in western Spain, with both of these symptoms impacting quality of life significantly and negatively. In addition, lifestyle habits, diet, physical activity, and tobacco use seem to influence the occurrence of these symptoms. Promoting lifestyle changes may be an effective strategy to reduce the incidence of dysmenorrhea and PMS and improve the quality of life of young women.

Background: Virtual games developed for educational purposes have an important place in the education of nursing students.

Purpose: This study was designed to investigate the experiences of nurse educators regarding the use of virtual games in nursing education.

Methods: A descriptive qualitative design was used in this research, which was conducted between June and August 2022. The participants included 18 nurse educators, all of whom were working in the nursing department at several universities in Turkey and selected using purposeful sampling. The data were collected using the Educator Information Form and the Semi-Structured Interview Form. The participants were contacted by e-mail. Participant interviews, which took approximately 30-45 minutes to complete, were conducted online via Zoom. The interviews were recorded with participant approval and then transcribed verbatim. Braun and Clarke's method and MAXQDA 2022 software were used to analyze the data.

Results: Five themes were identified: (a) opinions of the nurse educators, (b) feedback received by nurse educators from students, (c) nurse educator experiences, (d) nurse educator suggestions for the use of virtual games, and (e) nurse educator suggestions for virtual game developers.

Conclusions/implications for practice: The participants expressed support for using virtual games in nursing education; received both positive and negative related feedback from students; reported positive and negative experiences with these games; made suggestions for gaming methods and dissemination; and offered related planning, professional support, and other recommendations to game developers. The use of games in nursing education should be expanded, training programs should be organized for nurse educators considering game development, and similar studies should be conducted on larger study samples. The findings provide important information to nurse educators who are considering developing virtual games. The experiences of nurse educators regarding the use of virtual games are quite interesting, and the number of nurse educators involved in developing these games is quite low.

Background: Critical illness not only threatens the life of the patient but also may profoundly impact the lives of their loved ones. For teenagers with a critically ill parent, these impacts may have significant, developmentally impactful effects. A descriptive understanding of these effects may advance scholarly understanding of the challenges these teenagers face.

Purpose: In this study, we sought to understand this overlooked population, i.e., teenagers with a critically ill parent, using a descriptive analysis of their experiences.

Methods: Individual and group interviews were conducted with the participants (n = 9). Interviewers presented standardized semistructured interview questions to all of the participants. The questions explored situational, emotional, relational, and dynamic phenomena related to the experience of having a critically ill parent.

Results: Themes describing the participants' lived experiences related to having a parent with a critical illness were examined using a three coding framework. Four themes emerged, including parental health interference on teenagers-fallout, worsening, and interference; emotional experience and how emotions were processed-emotions, cognitive strategies, and behavioral strategies; relationships with others-sharing feelings, company, and relationships; and information and secrecy-learning, secrecy, and history.

Conclusions/implications for practice: All of the teenagers in this study were found to suffer from both situational and emotional interference. Parentification, use of selective distraction as an emotion regulation skill, and reliance on support from others were also observed. These results shed light on the overall experience of teenagers who have a critically ill parent. The fallout effects of a parent's health can encompass situational, logistical, emotional, and relationship aspects. Importantly, attention must be paid to how teenagers cope with the emotions experienced during a parent's critical illness. This framework may inform how to more effectively support teenagers through strategies such as providing peer support opportunities.

Background: In light of the rising incidence of mild cognitive impairment in women, an appropriate cognitive reserve enhancement program is urgently needed for women experiencing climacteric symptoms.

Purpose: The purpose of this study was to develop a cognitive reserve enhancement program for climacteric women based on cognitive reserve theory (CRT) and to verify its effectiveness.

Methods: A nonequivalence control group, pre- and post-quasi-experimental design was used. The 58 climacteric women with subjective memory deterioration enrolled as participants were divided into the experimental group (28 women), which received a 24-session CRT-based cognitive reserve enhance program, and the control group (30 women), the members of which received the cognitive training via a mobile application after completion of the study. Valid data from 24 experimental and 26 control participants were available for analysis. Objective cognitive functions, including overall cognitive, memory, attention, and language, were measured pretest and posttest using the following tools: Everyday Cognition Scale (subjective cognitive function), Center for Epidemiologic Studies Depression Scale (depression), and World Health Organization Quality of Life-Brief Version (quality of life).

Results: The experimental group showed a statistically significant increase in overall cognitive function (t = 3.82, p = .001), memory (t = 2.63, p = .012), attention: number of correct answers (t = 2.12, p = .040), language high-frequency response speed (Z = -2.49, p = .013), and language low-frequency response speed (Z = -2.77, p = .006) in objective cognitive function after 8 weeks in comparison to the control group.

Conclusions/implications for practice: The intervention program tested in this study to enhance cognitive reserve in climacteric women includes cognitive training, emotional and social support, and group physical activity components was found to be effective in enhancing cognitive function.

Background: Chronic pain and sleep disorders are commonly seen symptoms in community-dwelling older adults at traditional Chinese medicine (TCM) clinics. TCM modalities such as herbal medication and acupuncture have side effects and usage limitations. Therefore, nonpharmacological and noninvasive interventions may be applied to relieve the symptoms of these conditions.

Purpose: This study was designed to test the effect of Qigong Wuqinxi exercise on chronic pain, sleep quality, TCM constitutions, and tongue features in community-dwelling older adults.

Methods: This was a cluster randomized controlled trial. Older adults in two community care centers who met the inclusion criteria were assigned by drawing lots to either the experimental group (n = 32) or the control group (n = 31). Experimental group members practiced the Qigong Wuqinxi exercise for 50 minutes three times each week for 12 weeks, whereas those in the control group maintained their normal daily routine. Before and after the 12-week study, data on chronic pain, sleep quality, TCM constitutions, and tongue features were collected from all participants to assess the effectiveness of the intervention. Between-group pretest and posttest comparisons were analyzed using independent samples t tests, and within-group differences were analyzed using paired t tests.

Results: The experimental group reported significantly greater average posttest improvements in chronic pain, yang deficiency, phlegm-stasis, thick fur, and red dots than the control group (all ps < .05). The maximum change in pretest to posttest pain scores favored the experimental group (-0.56 ± 0.76 vs. 0.39 ± 1.91, p = .011). Also, the experimental group had a significantly better change in the pain interference index (-3.31 ± 3.30 vs. -0.58 ± 1.91, p < .001). In addition, the experimental group exhibited greater improvements in yang-deficiency tendency (-2.38 ± 4.89 vs. 0.35 ± 4.67, p = .027), phlegm and stasis tendency (-2.19 ± 4.52 vs. 1.77 ± 2.47, p < .001), thick fur (1.44 ± 11.28 vs. 6.03 ± 6.04, p = .049), and red dots (-5.09 ± 21.45 vs. 2.81 ± 4.03, p = .048). However, no significant between-group difference in posttest sleep quality (p = .357) was observed.

Conclusions/implications for practice: The Qigong Wuqinxi exercise was found to positively improve chronic pain and TCM constitutions in community-dwelling older adults and may be promoted in community care centers to improve the health status of older adults.

Background: Chronic kidney disease (CKD) is a progressive disease impacting the physical function and mental health of sufferers. Depression is known to negatively impact quality of life, whereas handgrip strength and demoralization are important factors affecting physical and mental health. Lower handgrip strength has been associated with sarcopenia and higher risk of hospitalization in patients and higher workloads for nurse caregivers. Few studies have investigated the complex relations among these factors in patients with CKD.

Purpose: This study was designed to investigate the mediating effects of grip strength and demoralization on the relationship between depression and quality of life in patients with CKD.

Methods: Two hundred fifty patients with CKD comprised the study sample. The hypotheses were tested using the PROCESS macro.

Results: Depression was found to be negatively associated with handgrip strength and quality of life but positively associated with demoralization. The results indicate that both handgrip strength and demoralization mediate the association between depression and quality of life. Moreover, the results of multiple mediation model analysis showed handgrip strength and demoralization both play important roles in the link between depression and quality of life.

Conclusions: The results of this study indicate that handgrip strength and demoralization mediate the relationship between depression and quality of life in patients with CKD. Thus, increasing handgrip strength and decreasing demoralization levels may mitigate the impact of depression on quality of life. Therefore, nurses should better appreciate the importance of handgrip strength for patients with CKD and evaluate handgrip strength. Nurses should also develop physical and mental interventions to increase handgrip strength and decrease demoralization.

Background: The importance of online educational resources enhancing self-management among patients is underscored by the growing prevalence of diabetes. It is crucial to comprehend how patients with diabetes in China seek diabetes-related information and use mobile applications (apps) designed for diabetes management. Although the Knowledge-Attitude-Practice theory plays an integral role in diabetes management, in-depth studies on eHealth literacy (eHL) and Knowledge-Attitude-Practice in populations with diabetes remain scarce.

Purpose: This study was developed to provide insights into the online information-seeking behaviors of and diabetes apps used by individuals living with diabetes by exploring the relationships among eHL, diabetes knowledge, self-efficacy, and self-care behaviors.

Methods: A cross-sectional survey was conducted from November 2022 to June 2023 on 380 inpatients with diabetes at the Yantai Yuhuangding Hospital in Shandong Province. The participants voluntarily completed surveys covering sociodemographic characteristics, diabetes status, diabetes app usage, online diabetes information searching, eHL, diabetes knowledge, self-efficacy, and self-care behaviors. Structural equation modeling analyses were employed to assess model fitness and the interrelationships between latent constructs and observable variables.

Results: Of the 380 participants, 57.1% (217/380) reported actively seeking diabetes information online, whereas only 3.7% (14/380) had used diabetes apps. eHL was shown to have a direct effect on diabetes knowledge (β = 0.377, p < .001) but no direct impact on self-care behaviors (β = 0.017, p = .860). However, an indirect effect on self-care behaviors was observed via diabetes knowledge and self-efficacy.

Conclusions/implications for practice: The results of this study indicate that, despite widespread online information-seeking behavior, diabetes app utilization remains limited in China. Also, the findings indicate enhancing patients' eHL contributes to more comprehensive diabetes knowledge. Furthermore, eHL was shown to influence self-care behaviors via diabetes knowledge and self-efficacy. A self-managed intervention strategy should be developed to improve eHL that utilizes internet resources to improve patients' knowledge and self-efficacy and promote better self-care behaviors.

Background: Approximately 50% of residents living in institutions have insufficient fluid intake, and 20%-30% experience dehydration. Implementing strategies that effectively increase fluid intake is crucial to preventing dehydration-related complications and reducing complications and comorbidities in this population.

Purpose: This study was designed to explore the effects on fluid intake and hydration status of a hydration game-based learning program in institutional residents.

Methods: A single-blind, cluster, randomized controlled trial was conducted. Sixty-four subjects from five long-term care facilities in northern Taiwan were randomly assigned to either an experimental or control group. The experimental group received a 40-minute game-based hydration care program intervention twice weekly for 8 weeks. The control group received routine care. The data obtained were analyzed using generalized estimating equation analysis to verify changes in observed variables in the two groups at 4 and 8 weeks (during and immediately after the intervention).

Results: The results showed a significant improvement in fluid intake in the experimental group at 4 and 8 weeks (p = .002 and p < .001, respectively). In terms of dehydration-related indicators, although total body water was significantly improved at 8 weeks in the experimental group (p = .009), no significant improvement was found in urine-specific gravity. In terms of signs of possible urinary tract infection, the experimental group showed significant improvement in urine leukocytes (p = .029) and nitrites (p = .004) at 8 weeks.

Conclusions/implications for practice: The findings of this study support the positive effects of applying the concept of uncertain rewards and game-based learning in institutional group activities. Specifically, the interventions increased social interaction and enhanced enjoyment of drinking. The findings call for nursing professionals at institutions to offer similar hydration game-based learning programs as part of residents' daily activities to improve fluid intake.