The journal of nursing research : JNR最新文献

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.

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.