J Nurs Scholarsh [JOURNAL]
Sun
200 papers
Detection of Acute Deterioration in Care Home Residents: A Multicenter Qualitative Exploration of Barriers and Enablers.
MacAndrew M, Sriram D, Chambers S … +6 more , Spooner A, Schnitker L, Jack L, Yates P, Beattie E, Parker C
J Nurs Scholarsh · 2025 Jul · PMID 40090869 · Full text
INTRODUCTION: Delay in detecting acute deterioration in older adults in care homes is associated with avoidable hospitalizations and adverse outcomes, including premature death. OBJECTIVE: Underpinned by the Knowledge to...
INTRODUCTION: Delay in detecting acute deterioration in older adults in care homes is associated with avoidable hospitalizations and adverse outcomes, including premature death. OBJECTIVE: Underpinned by the Knowledge to Action Framework, this study aimed to understand the barriers and enablers to direct care staff detecting and responding to the early signs of acute deterioration in care home residents. STUDY DESIGN: Online focus groups or interviews with regulated (registered and enrolled nurses) and unregulated (assistants in nursing and personal care workers) direct care staff from participating care homes were conducted. Homes were recruited using disproportionate stratified random sampling to include metropolitan, inner regional, and outer regional care homes. Interview and focus group recordings were transcribed verbatim and analyzed using inductive thematic analysis. RESULTS: Eighty direct care staff (n = 48 regulated; n = 32 unregulated) from eight care homes participated. Fifteen focus groups (n = 7 unregulated staff, n = 8 regulated staff) and two interviews (n = 1 regulated staff, n = 1 unregulated staff) were conducted between July 2021 and October 2022. Four themes related to the barriers and enablers of detecting and responding to acute deterioration were generated: decision-making within the scope of practice; resource availability; streamlined communication; and teamwork. CONCLUSION: Findings highlight the challenges direct care staff encounter in being able to detect early signs of acute deterioration and implement appropriate care pathways. Perceived barriers and enablers highlighted in this study need to be considered when developing and implementing programs to optimize the timely detection of, and response to, acute deterioration in care homes. CLINICAL RELEVANCE: Workforce knowledge, experience, and confidence deficits are significant barriers to detecting acute deterioration, while the unique workforce mix in care homes poses additional challenges for the accurate detection of early signs of acute deterioration. Knowing the resident, working as a team, and valuing the contribution of aged care staff and families in managing acute deterioration are enablers to achieving better outcomes for residents experiencing acute deterioration.
An Exploration of Safety Culture, Second Victim Phenomenon and Negative Work Outcomes in Health Care Settings.
Lee H, Lee NJ
J Nurs Scholarsh · 2025 May · PMID 40082734 · Full text
PURPOSE: The aim of the study was to explore the impact of patient safety culture on nurses' negative work outcomes resulting from patient safety incidents, as well as the mediating roles of second victim support and dis...
PURPOSE: The aim of the study was to explore the impact of patient safety culture on nurses' negative work outcomes resulting from patient safety incidents, as well as the mediating roles of second victim support and distress. DESIGN: A cross-sectional survey was conducted. The participants included 208 nurses, each with over a year of clinical experience, working in hospitals across South Korea. METHODS: Data were collected through self-reported questionnaires on general characteristics, patient safety culture, second victim support and distress, and negative work outcomes. The collected data were analyzed using descriptive statistics, the t-test, ANOVA, the Scheffé test, and Pearson correlation coefficients. Additionally, model 6 of Hayes' PROCESS macro and the Sobel test were employed to determine the mediating effect. RESULTS: Mediation analysis revealed significant indirect effects of patient safety culture on the work outcomes experienced by nurses following patient safety incidents, mediated by second victim distress, after controlling for participants' marital status, position, and the severity of patient safety incidents. CONCLUSIONS: This study demonstrates that in healthcare settings, patient safety culture that supports the second victim and alleviates second victim distress mitigates the negative work outcomes resulting from patient safety incidents. The findings highlight the significance of culturally sensitive support systems, particularly considering the diverse impacts on Korean nurses. Based on this study, healthcare leaders are recommended to develop strategies to support nurses and reduce their second victim distress, which can ultimately improve patient safety and the quality of nursing care. CLINICAL RELEVANCE: The findings of this study can be used to develop strategies to support second victims in addressing their distress. Taking steps to alleviate the distress of second victims will help prevent negative work outcomes in nurses.
Mindfulness for Menopausal Women: Enhancing Quality of Life and Psychological Well-Being Through a Randomized Controlled Intervention.
Amin SM, El-Gazar HE, Zoromba MA … +3 more , El-Sayed MM, Awad AGE, Atta MHR
J Nurs Scholarsh · 2025 Jul · PMID 39992004 · Publisher ↗
BACKGROUND: Menopause is associated with significant physical, psychosocial, and emotional changes that can negatively affect women's quality of life (QoL). In response to this, psychological interventions like mindfulne...
BACKGROUND: Menopause is associated with significant physical, psychosocial, and emotional changes that can negatively affect women's quality of life (QoL). In response to this, psychological interventions like mindfulness-based interventions have shown promise in alleviating menopausal symptoms and improving psychological well-being. METHODS: A comprehensive randomized controlled trial was conducted from May to August 2024 at Damanhour University, Egypt. One hundred and twenty menopausal women were randomly assigned to either the intervention group (n = 60), which participated in seven mindfulness sessions, or the control group (n = 60), which received general health education. Pre and postintervention data were collected using the Menopause-Specific QoL questionnaire, the Depression Anxiety Stress Scale-21, and the Mindful Attention Awareness Scale. Independent samples t-tests were performed to compare groups, while paired t-tests assessed within-group changes post-intervention. Effect sizes were calculated using Cohen's d, ensuring a robust and reliable data analysis. RESULTS: The intervention group showed significant improvements across all domains of menopause-specific QoL, including vasomotor (d = 0.788, p < 0.01), psychosocial (d = 1.042, p < 0.01), physical (d = 0.809, p < 0.01), and sexual (d = 0.794, p < 0.01). Additionally, significant reductions were observed in anxiety (d = 1.221, p < 0.01), stress (d = 1.030, p < 0.01), and depression (d = 0.880, p < 0.01), along with a significant increase in mindfulness (d = 1.335, p < 0.01) postintervention. CONCLUSION: The MBIS significantly improved menopause-specific QoL and reduced anxiety, stress, and depression while enhancing mindfulness in menopausal women. These findings suggest that mindfulness-based interventions could be game changers in managing menopausal symptoms and improving overall psychological well-being, offering hope for a better QoL for menopausal women. CLINICAL RELEVANCE: The research will primarily impact healthcare providers working with menopausal women, particularly those offering psychological support or nonpharmacological treatments. It also impacts menopausal women themselves by providing evidence-based intervention options that could alleviate menopausal symptoms. Furthermore, researchers and policymakers focusing on women's health and mental well-being may use these findings to inform future studies and healthcare strategies. PATIENT OR PUBLIC CONTRIBUTION: Women from Damanhur University. TRIAL REGISTRATION: This trial was registered with the ClinicalTrials.gov database under the registration number NCT06421909.
Regarding the Role of Integrated Care Models in Patients With Stroke.
Lu X, Shen L, Zhao H … +3 more , Zhou Z, Tan L, Bai J
J Nurs Scholarsh · 2025 Mar · PMID 39981687 · Publisher ↗
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Application of Artificial Intelligence Software to Identify Emotions of Lung Cancer Patients in Preoperative Health Education: A Cross-Sectional Study.
Chen X, Xin Z, Yang D … +8 more , Song X, Zhong J, Weng J, Zhang Y, Liu D, Min W, Lu K, Juan Y
J Nurs Scholarsh · 2025 May · PMID 39957550 · Full text
AIM(S): To determine the correlation between preoperative health education and the emotions of lung cancer patients, artificial intelligence software was used. DESIGN: This was a cross-sectional study. METHODS: This stud...
AIM(S): To determine the correlation between preoperative health education and the emotions of lung cancer patients, artificial intelligence software was used. DESIGN: This was a cross-sectional study. METHODS: This study included 210 lung cancer patients from Sun Yat-sen University Cancer Center and examined the impact of health education on patient emotions using an AI-based emotion analysis tool. RESULTS: This study indicated a significant relationship between the tone and emotional content of health education materials and patient emotions. Specifically, educational materials with an explanatory tone and negative sentiment appeared to impact patients' emotional states. CONCLUSION: Quality improvements in health education can potentially benefit lung cancer patients' emotional well-being by minimizing the use of both explanatory tone and negative sentiment in educational content. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: This research suggests that the careful crafting of health education materials, taking into consideration tone and emotional expressions, can have a tangible positive effect on the emotional state of lung cancer patients. REPORTING METHOD: The study was reported in accordance with the STROBE guidelines. PATIENT OR PUBLIC CONTRIBUTION: No patients, service users, caregivers, or members of the public were involved in the design, conduct, collection, analysis, or interpretation of the data for this study, nor were they involved in writing the manuscript.
Response to the Letter to the Editor Regarding Our Published Article (JNU-05-24-410.R1).
Liu B, Cai J, Zhou L
J Nurs Scholarsh · 2025 Mar · PMID 39925197 · Publisher ↗
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The Effect of Toolbox Trainings on Nursing Sensitive Quality Indicators: A Randomized Controlled Trial.
Kara B, Sönmez B
J Nurs Scholarsh · 2025 May · PMID 39888187 · Full text
INTRODUCTION: Toolbox training or toolbox talks is short-term training to improve occupational health and safety practices in various sectors. These on-the-job trainings provide employees with opportunities to ask questi...
INTRODUCTION: Toolbox training or toolbox talks is short-term training to improve occupational health and safety practices in various sectors. These on-the-job trainings provide employees with opportunities to ask questions and share experiences, facilitating the enhancement of workplace safety practices. The aim of this study is to determine the impact of toolbox trainings provided to nurses on nursing-sensitive quality indicators (pain management, pressure ulcer, patient falls, peripheral venous catheter complications, and adverse event reporting) in the workplace. DESIGN: Randomized controlled, pre-test, post-test, and control group design. METHODS: Before the toolbox training, pretest measurement instruments were used for the nurses in both the experimental and control groups, and the nursing-sensitive quality indicators were monitored by two independent observers. Toolbox training was provided to nurses in the intervention group on their shift in the respective units. Both groups were followed up at the 8th and 12th weeks after the training. Descriptive tests, independent sample t-tests for intergroup comparisons, and repeated and mixed ANOVA for intragroup comparisons were utilized in data analysis. RESULTS: Significant differences were found between pre-test and post-test scores of the nurses in the group who received toolbox training in terms of falls, pressure ulcers, pain management, peripheral venous catheter, and adverse event reporting (p < 0.01). It was observed that the application scores significantly differed among all nurses who received toolbox training according to the findings of both observers, generally increasing in the second follow-up compared to the first, but decreasing in the third follow-up (p < 0.05). Evaluated according to unit quality indicators, it was determined that the number of patient falls (mean 4.04, 2.32, and 1.95 respectively), pressure ulcer occurrences (mean 4.48, 2.69, and 2.45 respectively), and the number of patients experiencing peripheral venous catheter complications decreased (mean 26.79, 16.46, and 15.42 respectively) in the units where nurses who received toolbox training worked. The average number of correctly managed pain patients (mean 37.82, 71.61, 69.07 respectively) and the number of reported adverse events (mean 2.79, 6.60, 6.42 respectively) were observed to increase in the second follow-up but decrease in the third follow-up. CONCLUSIONS: As a result, it was determined that on-the-job trainings increased nurses' knowledge level regarding nursing-sensitive quality indicators, improved their practices, and enhanced unit quality indicators. According to the findings of this study, on-the-job trainings provided to nurses were found to be an effective method, and it is recommended to use them in addition to traditional training methods in nurses' in-service education. CLINICAL RELEVANCE: There is a growing demand for shorter and different training methods in nurses' education. In addition to classical in-service training methods, this training method, which was applied for the first time in the field of nursing, contributed to the improvement of quality indicators sensitive to nursing. Our findings emphasize that it will be useful to use this training method in future studies on improving and developing nursing-sensitive quality indicators. TRAIL REGISTRATION: The study has been registered with ClinicalTrials.gov (NCT05853588).
Predictors of Nurses' Job Satisfaction in Home Care Settings: Findings From the AIDOMUS-IT Study.
Marcomini I, Di Nitto M, Zaghini F … +14 more , Caponnetto V, Cesare M, Iovino P, Longobucco Y, Alvaro R, Lancia L, Manara DF, Rasero L, Rocco G, Cicolini G, Zega M, Mazzoleni B, Bagnasco A, Sasso L
J Nurs Scholarsh · 2025 May · PMID 39887835 · Publisher ↗
INTRODUCTION: Nurses' job satisfaction in hospitals is fundamental for the quality of care and the safety of patients. However, sociodemographic trends require moving care to patients' homes, and the predictors of job sa...
INTRODUCTION: Nurses' job satisfaction in hospitals is fundamental for the quality of care and the safety of patients. However, sociodemographic trends require moving care to patients' homes, and the predictors of job satisfaction for nurses working in the home care settings remain largely unknown. Therefore, the aim of this study was to investigate job satisfaction of nurses working in Italian home care settings and its determinants. DESIGN: Multicenter observational cross-sectional study. METHODS: This study was conducted in the districts of 70 local health authorities in Italy. Data on the characteristics of the organization and nurses were collected. Nursing job satisfaction was evaluated on a four-point scale ranging from "very satisfied" to "very dissatisfied." Additionally, the following variables were assessed: workload, quality of leadership, work-private life conflict, burnout symptoms, possibility for development, staffing and resource adequacy, nurse manager ability, safety climate, and teamwork climate. A logistic regression analysis was conducted to identify factors influencing job satisfaction. RESULTS: Only organizational variables had a predictive value for nurses' job satisfaction. Workload (OR = 1.01; p = 0.033), work-private life conflict (OR = 1.02; p < 0.001), burnout (OR = 1.02; p < 0.001), and staffing inadequacy (OR = 1.44; p = 0.003) predicted higher levels of nurse dissatisfaction. Instead, high-quality leadership (OR = 0.981; p < 0.001), possibility for development (OR = 0.973; p < 0.001), and good teamwork climate (OR = 0.994; p = 0.003) were predictors of better levels of satisfaction. CONCLUSIONS: This study suggested that home care nurses are generally satisfied with their jobs. To enhance job satisfaction, it is essential to improve nurses' work environment, the leadership quality and ensure professional development. CLINICAL RELEVANCE: Our results are globally relevant as they contribute to the limited evidence available on this topic in home care settings. This study emphasizes the need of measuring nurses' job satisfaction and implementing interventions to promote healthy work environments.
Adverse Childhood Experiences and Subjective Cognitive Decline Among Transgender Adults.
Chiow J, Cicero EC
J Nurs Scholarsh · 2025 May · PMID 39878054 · Full text
INTRODUCTION: Adverse childhood experiences (ACEs) are associated with an increased risk of developing chronic health conditions, including Alzheimer's disease and related dementias (ADRD) and subjective cognitive declin...
INTRODUCTION: Adverse childhood experiences (ACEs) are associated with an increased risk of developing chronic health conditions, including Alzheimer's disease and related dementias (ADRD) and subjective cognitive decline (SCD), self-reported confusion/memory loss, and an early clinical manifestation of ADRD. While ACEs and SCD have both been individually studied in transgender and nonbinary (TGN) adults, no study has examined the relationship between the two among this population. This study sought to establish the prevalence of ACEs and their association with SCD among TGN adults. DESIGN: Cross-sectional, secondary analysis of publicly available data. METHODS: 2019-2021 Behavioral Risk Factor Surveillance System data, representing 16 US states that assessed ACEs, SCD, and self-reported gender identity were used to determine the association between ACEs and SCD among TGN adults aged 45+ (N = 206). Pearson's chi-squared/Fisher's exact tests assessed the association between ACEs (individual, categorical, sum score) and SCD. Crude and adjusted odds ratios (aORs) along with 95% confidence intervals (CIs) were calculated to investigate the associations between ACEs and SCD. RESULTS: 18% (n = 38) of TGN adults in the sample endorsed SCD, 60% (n = 120) experienced any ACE, 20% (n = 41) 1 ACE, and 18% (n = 37) experienced > 4 ACEs. Nearly 50% experienced childhood abuse (n = 94) or household dysfunction (n = 92). Among those with SCD, 34% (n = 13) reported > 4 ACEs, and 73% (n = 26) reported childhood abuse or household dysfunction (n = 27). Most ACES were associated with and increased the risk of SCD, even after adjusting for BRFSS year, age, race, education, and employment. The odds of SCD increased 40% as the number of ACEs increased (aOR = 1.4, 95% CI: 1.2-1.6, p < 0.0001). The odds of SCD were higher with childhood abuse (aOR = 4.3, 95% CI: 1.88-10.02, p < 0.01) or household dysfunction (aOR = 4.7, 95% CI: 2.00-11.07, p < 0.01). CONCLUSION: ACEs increase the risk of SCD among TGN adults. Gender-affirming and trauma-informed nursing care are important, and screening and interventions for ACEs and SCD are needed to help reduce the risk of SCD and ADRD. CLINICAL RELEVANCE: Examining how adverse childhood experiences impact different aspects of health, including brain health, is important to nursing practice as it can provide clinical care strategies and identify interventions to specifically address ways to improve the health and well-being of transgender and nonbinary people.
Evidence-Based Teaching Strategies for Assessing Pressure Injuries in Older Nursing Home Residents With Darker Skin Tones.
Sugathapala RDUP, Balasuriya A, Gillespie BM … +2 more , Chaboyer W, Latimer S
J Nurs Scholarsh · 2025 May · PMID 39816000 · Full text
AIM: To describe the development and implementation of evidence-based teaching strategies for assessing and classifying pressure injuries in older nursing home individuals ≥ 60 years old with darker skin tones. DESIGN: P...
AIM: To describe the development and implementation of evidence-based teaching strategies for assessing and classifying pressure injuries in older nursing home individuals ≥ 60 years old with darker skin tones. DESIGN: Pressure injury assessment learning interventions based on pre- and post-test assessments. METHODS: The learning interventions were developed by experts in pressure injury education and were based on empirical evidence, international clinical practice guidelines, and underpinned by social constructivism theory and the integrated interactive teaching model. The teaching strategy was developed to educate research assistants in the assessment of pressure injuries in darker skin tone individuals. The content included requisite knowledge and skills for pressure injury assessment and classification in darker skinned individuals. Using evidence-based teaching strategies, the content was delivered through face-to-face lectures, small group discussions, and practical application sessions delivered using classroom and practical-based activities. Photographic images were used to assess their knowledge and skills in classifying pressure injuries. Four Bachelor of Nursing-qualified registered nurses in Sri Lanka were recruited as research assistants using the new education resource. Using scores from 1 to 20 points, mastery of the theory and practice components was assessed. RESULTS: The mean pre-test score was 9 ± 1.6 (95% confidence interval 6.4-11.6), demonstrating that assessment and classification of pressure injury knowledge were lacking. The mean post-test score was 16 ± 0.8 (95% confidence interval 14.7-17.3) indicating an improvement in the participants' ability to assess and staging pressure injuries. CONCLUSION: Early pressure injury detection among older individuals with darker skin tones is challenging. This evidence-based teaching approach can be used to educate clinical nurses and research assistants in assessing pressure injuries in individuals with darker skin tones. CLINICAL RELEVANCE: This study contributes to the body of knowledge by improving the early detection and accurate classification of pressure injuries in older nursing home residents with darker skin tones, addressing a significant gap in current nursing practice.
Determinants of Prolonged Hospitalization in Children and Adolescents: A Retrospective Observational Study.
Cesare M, D'Agostino F, Nurchis MC … +4 more , Magliozzi E, Damiani G, Nursing and Public Health Group, Cocchieri A
J Nurs Scholarsh · 2025 May · PMID 39803927 · Publisher ↗
INTRODUCTION: Ensuring an appropriate length of stay (LOS) is a primary goal for hospitals, as prolonged LOS poses clinical risks and organizational challenges. Children and adolescents are particularly susceptible to pr...
INTRODUCTION: Ensuring an appropriate length of stay (LOS) is a primary goal for hospitals, as prolonged LOS poses clinical risks and organizational challenges. Children and adolescents are particularly susceptible to prolonged LOS due to frequent hospitalizations and unique vulnerabilities, including developmental disabilities that may necessitate additional care and monitoring. This study aims to describe the LOS of children and adolescent patients and identify the sociodemographic, organizational, clinical, and nursing care factors contributing to prolonged LOS in this population. DESIGN: Observational, retrospective, monocentric study. METHODS: A sequential sampling approach was used to select the clinical records of 1538 children and adolescent patients admitted to an Italian university hospital in 2022. The study included all children and adolescents aged 3-18 who were hospitalized for a minimum of 2 days. Patients from outpatient units and those with LOS shorter than 2 days were excluded. The Neonatal Pediatric Professional Assessment Instrument (PAIped) and the Hospital Discharge Register were used to collect sociodemographic, organizational, clinical, and nursing care patient data, including nursing diagnoses (NDs) and nursing actions (NAs). A forward stepwise regression approach was used to identify predictors of LOS among the selected variables. A mediation analysis was conducted to explore the role of nursing predictors, identified in the stepwise regression, as mediators between the number of medical diagnoses and LOS. RESULTS: Positive correlations between the number of medical diagnoses, NDs, NAs, and LOS were discovered (r = 0.262, p = < 0.001; r = 0.114, p = < 0.001; r = 0.384, p = < 0.001, respectively). Longer hospital stays were associated with an increased number of medical diagnoses, NDs, and NAs. The number of NAs emerged as an independent predictor of LOS (β = 0.516; p < 0.001). Other significant determinants of LOS included a higher number of NAs and medical diagnoses, the presence of a medical DRG category, increased DRG weight, emergency admissions, residency in rural areas, and older age (F = 122.222, p < 0.001, R = 0.361, adjusted R = 0.358). The mediation analysis showed that the number of medical diagnoses positively predicted the number of NAs (β = 2.774, p < 0.001), which, in turn, positively affected LOS (β = 0.162, p < 0.001). A significant indirect effect of the number of medical diagnoses on LOS through NAs was observed (β = 0.448, 95% CI [0.34, 0.55]), along with a significant direct effect of medical diagnoses on LOS, even with the mediator in the model (β = 0.633, p < 0.001), indicating partial mediation (F = 321.6892; R = 0.295; p < 0.001). These results highlight the influence of medical diagnoses on LOS through the mediating role of NAs. CONCLUSIONS: Our study highlights the significant interplay between determinants of LOS in children and adolescent patients, emphasizing the need for targeted interventions, resource planning, and the integration of clinical nursing information systems to enhance care quality and support evidence-based practices. CLINICAL RELEVANCE: Optimizing resource distribution and implementing specific interventions for patients at risk of prolonged LOS could help mitigate this negative outcome and enhance the quality of care. Incorporating nursing data into DRG systems could improve reimbursement accuracy and benefit the nursing profession, which may result in better patient outcomes and lower hospital expanses.
Artificial Intelligence in Nursing: Catalyzing Change Across Clinical, Educational, and Administrative Domains.
Barbosa SFF, Topaz M, Pruinelli L
J Nurs Scholarsh · 2025 Jan · PMID 39740055 · Publisher ↗
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Nurses' work environment and health promotion in relation to psychological distress symptoms, and sleep disturbance: A structural equation modeling approach.
Edwin HS, Trinkoff A, Holmes S … +2 more , Zhu S, Mills ME
J Nurs Scholarsh · 2025 May · PMID 39692045 · Publisher ↗
BACKGROUND: The healthcare work environment has numerous stressors that can contribute to distress and poor health outcomes among nurses. The impact of distress can be detrimental, resulting in nurses leaving the profess...
BACKGROUND: The healthcare work environment has numerous stressors that can contribute to distress and poor health outcomes among nurses. The impact of distress can be detrimental, resulting in nurses leaving the profession. Thus, it is critical to explore factors in the work environment that contribute to the distress symptoms and behaviors that promote nurses' health. OBJECTIVE: This study aimed to examine the constructs associated with the conceptual model of distress, such as the work environment, specifically workload and the practice environment (quality of care, salary, staffing, time, and satisfaction) and associations with psychological distress, sleep disturbance, and health promotion behaviors in nurses, using structural equation modeling. DESIGN: This study was a cross-sectional survey design collected as part of the Nurse Worklife and Wellness Study (NWWS) using balanced stratified sampling methods. METHODS: A confirmatory factor analysis tested the factorial structure of the latent constructs using weighted least squares estimation with missing data (WLSMV) for the sample (n = 1170). A structural equation modeling approach examined the direct and indirect associations between workload, practice environment, health promotion behaviors, psychological distress symptoms, sleep disturbance, and health. RESULTS: Based on the confirmatory factor analysis, the measurement model reported adequate model fit (CFI = 0.96; TLI = 0.95; SRMR = 0.048 and RMSEA = 0.039). The structural model showed that the workload was related to significantly increased psychological distress (β = 1.47, p < 0.001), sleep disturbance (β = 1.22, p < 0.01), and decreased overall health (β = -1.36, p < 0.01). Similarly, a positive practice environment was associated with significantly higher psychological distress (β = 1.61, p < 0.001), sleep disturbance (β = 1.31, p < 0.01), and lower overall health (β = -1.51, p < 0.01). Workload and the practice environment were associated with significantly increased health promotion behaviors such as interpersonal relations, spiritual growth, stress management, physical activity, and nutrition. A statistically significant indirect relationship was found between workload and psychological distress, mediated by health promotion behaviors. Psychological and physical health promotion had restorative effects in relation to decreasing the impact of distress and sleep disturbance while increasing overall health. CONCLUSIONS: Our results highlight the need to improve the work environment by decreasing the nurses' workload and using health promotion behaviors to mitigate nurses' psychological distress. Future studies should focus on exploring distress in the context of non-pandemic work conditions and finding ways to promote coping behaviors in nurses. In addition, healthcare organizations should develop policies and strategies to incentivize nurses' participation in health promotion behaviors to promote their well-being and ultimately stabilize the nursing workforce.
Reducing sedentary behavior improves depressive symptoms among patients with heart failure enrolled in a home-based mobile health app cardiac rehabilitation.
Saleh ZT, Aslanoğlu A, Almagharbeh WT … +9 more , Fadila DES, Nagoor Thangam MM, Al-Dgheim R, Oleimat B, Eltayeb MM, Sobeh DE, Saifan AR, Elshatarat RA, Ebeid IA
J Nurs Scholarsh · 2025 May · PMID 39663212 · Publisher ↗
BACKGROUND: Depressive symptoms are common, worsening heart failure (HF) progression and reducing quality of life. While supervised structured exercise training is effective for managing depressive symptoms, it often dem...
BACKGROUND: Depressive symptoms are common, worsening heart failure (HF) progression and reducing quality of life. While supervised structured exercise training is effective for managing depressive symptoms, it often demands a substantial time commitment or intensive activity that may discourage participation. OBJECTIVE: Evaluate the impacts of reducing sedentary time with short bouts of light physical activities or greater intensity levels on depressive symptoms after HF patients' enrollment in a home-based intervention. METHODS: A total of 127 HF patients participated in an experimental two-group design, randomly allocated to either delayed or immediate decreasing sedentary time intervention. The immediate group started the intervention immediately, while the delayed group began after the first group finished their intervention. The 8-week intervention, guided by the Theory of Planned Behavior, focused on interrupting 30 min of sedentary behavior with short bouts of light- or greater intensity physical activities. Demographic and clinical variables were collected at baseline. Depressive symptoms were assessed at baseline, pre-intervention, and post-intervention. Physical activity (daily steps) was monitored daily during the study period using the Samsung mobile health app. RESULTS: Both groups demonstrated reduced sedentary time during the intervention, with improvements in HF symptom burden. Repeated measures analysis of variance revealed a significant reduction in depressive symptoms in both groups post-intervention, with a greater reduction seen in the immediate group before the delayed group began the intervention. CONCLUSION: The study highlights the effectiveness of interrupting sedentary behavior with light- or greater intensity activities in managing depressive symptoms among HF patients. The home-based intervention, facilitated by mobile technology, provides a feasible and accessible approach to improving mental well-being. CLINICAL RELEVANCE: The findings support the broader implementation of home-based interventions addressing sedentary time reduction as a valuable strategy for enhancing the mental health of HF patients, particularly those facing challenges with traditional rehabilitation programs or intense exercise.
Relationship between social identity and cultural competence among Mexican nursing professionals.
Molina-Sánchez JW, Pedrero V, Guevara-Valtier MC … +1 more , Bernales M
J Nurs Scholarsh · 2025 May · PMID 39660439 · Publisher ↗
INTRODUCTION: Cultural competence in nursing is crucial for providing effective health care. Social Identity is the degree to which they identify with their professional group. Identifying with the group of nursing profe...
INTRODUCTION: Cultural competence in nursing is crucial for providing effective health care. Social Identity is the degree to which they identify with their professional group. Identifying with the group of nursing professionals allows nurses to connect with norms and values that favor the development of cultural competence. The objective of this study is to analyze the relationship between social identity and the level of cultural competence of nursing professionals. METHODOLOGY: This was a cross-sectional correlational study (n = 211). Sociodemographic data were measured, and Cameron's social identity scales and a cultural competence measurement scale were used. The data were analyzed using correlations and a structural equation model. RESULTS: The structural equation model demonstrated good fit (CFI = 0.94, TLI = 0.928 WRMR = 0.952, RMSEA = 0.058). The model indicated positive and significant relationships between social identity, cultural skills, and knowledge. However, it also revealed a negative and significant relationship between social identity and cultural awareness. CONCLUSIONS: The findings suggest that greater identification with the nursing profession by nursing professionals is associated not only with higher levels of cultural knowledge and skills but also with lower levels of cultural awareness. This finding may be due to the fact that individuals seek to reinforce their professional identities when they feel that acknowledging their own personal biases represents a threat. CLINICAL RELEVANCE: This study contributes to the understanding of how social identity can be related in a different way to the components of cultural competence. This work recognizes the challenges in developing cultural awareness in nursing and suggests that its findings can inform interventions to improve patient care and relationships.
Evaluating the effectiveness of the education program developed for the empowerment of new graduate nurses: A randomized controlled trial.
Sarıköse S, Çelik SŞ
J Nurs Scholarsh · 2025 May · PMID 39655622 · Full text
PURPOSE: To evaluate the effectiveness of the education program developed based on the structural empowerment (SE) and psychological empowerment (PE) theories and flipped classroom model for the empowerment of new gradua...
PURPOSE: To evaluate the effectiveness of the education program developed based on the structural empowerment (SE) and psychological empowerment (PE) theories and flipped classroom model for the empowerment of new graduate nurses (NGNs). DESIGN: Single-center, parallel-group, randomized controlled trial. METHODS: The study was conducted between June 2021 and September 2023 in two phases: developing the education program to empower NGNs and evaluating its effectiveness. An education program consisting of two parts, online and face-to-face, was developed. The online part consists of eight modules implemented for two weeks. The face-to-face part was implemented for two days and included the in-class activities. NGNs were randomly assigned to the intervention group (n: 32) and control group (n: 32). An education program was applied to the intervention group, whereas the control group continued their routine orientation program. A range of outcome measures of SE, PE, and education programs' effectiveness were evaluated. Data were analyzed using descriptive, chi-squared, and t-tests. RESULTS: The study determined that the intervention and control groups showed homogeneous distribution in the pretest. A statistically significant difference was identified between the intervention and control groups regarding the mean scores of PE and SE three months following the implementation of the education program, and the total mean score of the intervention group was higher. CONCLUSION: The education program developed to empower NGNs was a highly effective intervention in increasing nurses' perceptions of SE and PE. There is a need to carry out studies and activities to disseminate this program. CLINICAL RELEVANCE: The findings of this study will guide educators, researchers, and administrators in future strategies and innovative programs for empowering NGNs.
Applying natural language processing to understand symptoms among older adult home healthcare patients with urinary incontinence.
Scharp D, Song J, Hobensack M … +3 more , Palmer MH, Barcelona V, Topaz M
J Nurs Scholarsh · 2025 Jan · PMID 39601443 · Full text
INTRODUCTION: Little is known about the range and frequency of symptoms among older adult home healthcare patients with urinary incontinence, as this information is predominantly contained in clinical notes. Natural lang...
INTRODUCTION: Little is known about the range and frequency of symptoms among older adult home healthcare patients with urinary incontinence, as this information is predominantly contained in clinical notes. Natural language processing can uncover symptom information among older adults with urinary incontinence to promote holistic, equitable care. DESIGN: We conducted a secondary analysis of cross-sectional data collected between January 1, 2015, and December 31, 2017, from the largest HHC agency in the Northeastern United States. We aimed to develop and test a natural language processing algorithm to extract symptom information from clinical notes for older adults with urinary incontinence and analyze differences in symptom documentation by race or ethnicity. METHODS: Symptoms were identified through expert clinician-driven Delphi survey rounds. We developed a natural language processing algorithm for symptom identification in clinical notes, examined symptom documentation frequencies, and analyzed differences in symptom documentation by race or ethnicity using chi-squared tests and logistic regression models. RESULTS: In total, 39,179 home healthcare episodes containing 1,098,419 clinical notes for 29,981 distinct patients were included. Nearly 40% of the sample represented racially or ethnically minoritized groups (i.e., 18% Black, 14% Hispanic, 7% Asian/Pacific Islander, 0.3% multi-racial, and 0.2% Native American). Based on expert clinician-driven Delphi survey rounds, the following symptoms were identified: anxiety, dizziness, constipation, syncope, tachycardia, urinary frequency/urgency, urinary hesitancy/retention, and vision impairment/blurred vision. The natural language processing algorithm achieved excellent performance (average precision of 0.92). Approximately 29% of home healthcare episodes had symptom information documented. Compared to home healthcare episodes for White patients, home healthcare episodes for Asian/Pacific Islander (odds ratio = 0.74, 95% confidence interval [0.67-0.80], p < 0.001), Black (odds ratio = 0.69, 95% confidence interval [0.64-0.73], p < 0.001), and Hispanic (odds ratio = 0.91, 95% confidence interval [0.85-0.97], p < 0.01) patients were less likely to have any symptoms documented in clinical notes. CONCLUSION: We found multidimensional symptoms and differences in symptom documentation among a diverse cohort of older adults with urinary incontinence, underscoring the need for comprehensive assessments by clinicians. Future research should apply natural language processing to other data sources and investigate symptom clusters to inform holistic care strategies for diverse populations. CLINICAL RELEVANCE: Knowledge of symptoms of older adult home healthcare patients with urinary incontinence can facilitate comprehensive assessments, health equity, and improved outcomes.
The efficacy of behavioral sleep intervention on sleep problems among children with attention-deficit hyperactivity disorder: A randomized controlled trial.
El-Monshed AH, Loutfy A, El-Boraie H … +6 more , El-Gilany AH, Fayed SM, Elzeiny A, El-Gazar HE, Ali AS, Zoromba MA
J Nurs Scholarsh · 2025 May · PMID 39587035 · Publisher ↗
BACKGROUND: Attention-deficit hyperactivity disorder (ADHD), affecting 5% of global children, presents inattention, hyperactivity, and impulsivity. Sleep problems, prevalent in 70% of cases, exacerbate long-term psychoso...
BACKGROUND: Attention-deficit hyperactivity disorder (ADHD), affecting 5% of global children, presents inattention, hyperactivity, and impulsivity. Sleep problems, prevalent in 70% of cases, exacerbate long-term psychosocial challenges. AIM: This study aimed to assess the efficacy of behavioral sleep intervention in alleviating sleep problems, enhancing quality of life (QoL), and reducing ADHD symptom severity among children diagnosed with ADHD. METHOD: A randomized controlled trial was conducted from June 2022 to April 2023. The intervention group (n = 47) engaged in a hybrid approach, participating in both face-to-face and Zoom sessions, while the control group (n = 45) received standard care. Data collection involved administering the Children's Sleep Habits Questionnaire (CSHQ), Pediatric Quality of Life Inventory (PedsQL), and ADHD Rating Scale IV (ADHD-RS-IV). RESULTS: Significant enhancements were observed in CSHQ (p ≤ 0.001, effect size = 1.913), PedsQL (p ≤ 0.001, effect size = 1.862), and a notable reduction in ADHD-RS-IV (p ≤ 0.001, effect size = 1.548). These findings highlight the intervention's efficacy in improving sleep quality, QoL, and reducing ADHD symptomatology. CONCLUSION: This trial contributes substantially to understanding behavioral sleep interventions' impact on ADHD-affected children, enhancing quality of life and ADHD symptomatology. The study highlights the importance of individualized care for optimal outcomes in children with ADHD. CLINICAL RELEVANCE: The study's findings underscore the potential for integrating behavioral sleep interventions into routine nursing practices, offering a valuable approach to address sleep-related challenges in children with ADHD. By focusing on sleep improvement, nurses can contribute to enhancing overall well-being and emotional regulation in these children within the context of comprehensive healthcare.
PICOT questions and search strategies formulation: A novel approach using artificial intelligence automation.
Gosak L, Štiglic G, Pruinelli L … +1 more , Vrbnjak D
J Nurs Scholarsh · 2025 Jan · PMID 39582233 · Full text
AIM: The aim of this study was to evaluate and compare artificial intelligence (AI)-based large language models (LLMs) (ChatGPT-3.5, Bing, and Bard) with human-based formulations in generating relevant clinical queries,...
AIM: The aim of this study was to evaluate and compare artificial intelligence (AI)-based large language models (LLMs) (ChatGPT-3.5, Bing, and Bard) with human-based formulations in generating relevant clinical queries, using comprehensive methodological evaluations. METHODS: To interact with the major LLMs ChatGPT-3.5, Bing Chat, and Google Bard, scripts and prompts were designed to formulate PICOT (population, intervention, comparison, outcome, time) clinical questions and search strategies. Quality of the LLMs responses was assessed using a descriptive approach and independent assessment by two researchers. To determine the number of hits, PubMed, Web of Science, Cochrane Library, and CINAHL Ultimate search results were imported separately, without search restrictions, with the search strings generated by the three LLMs and an additional one by the expert. Hits from one of the scenarios were also exported for relevance evaluation. The use of a single scenario was chosen to provide a focused analysis. Cronbach's alpha and intraclass correlation coefficient (ICC) were also calculated. RESULTS: In five different scenarios, ChatGPT-3.5 generated 11,859 hits, Bing 1,376,854, Bard 16,583, and an expert 5919 hits. We then used the first scenario to assess the relevance of the obtained results. The human expert search approach resulted in 65.22% (56/105) relevant articles. Bing was the most accurate AI-based LLM with 70.79% (63/89), followed by ChatGPT-3.5 with 21.05% (12/45), and Bard with 13.29% (42/316) relevant hits. Based on the assessment of two evaluators, ChatGPT-3.5 received the highest score (M = 48.50; SD = 0.71). Results showed a high level of agreement between the two evaluators. Although ChatGPT-3.5 showed a lower percentage of relevant hits compared to Bing, this reflects the nuanced evaluation criteria, where the subjective evaluation prioritized contextual accuracy and quality over mere relevance. CONCLUSION: This study provides valuable insights into the ability of LLMs to formulate PICOT clinical questions and search strategies. AI-based LLMs, such as ChatGPT-3.5, demonstrate significant potential for augmenting clinical workflows, improving clinical query development, and supporting search strategies. However, the findings also highlight limitations that necessitate further refinement and continued human oversight. CLINICAL RELEVANCE: AI could assist nurses in formulating PICOT clinical questions and search strategies. AI-based LLMs offer valuable support to healthcare professionals by improving the structure of clinical questions and enhancing search strategies, thereby significantly increasing the efficiency of information retrieval.
Low-value and high-value care recommendations in nursing: A systematic assessment of clinical practice guidelines.
Bahlman-van Ooijen W, Giesen J, Bakker-Jacobs A … +2 more , Vermeulen H, Huisman-de Waal G
J Nurs Scholarsh · 2025 May · PMID 39567352 · Full text
INTRODUCTION: The World Health Organization defines quality of care as providing effective, evidence-based care, and avoiding harm. Low-value care provides little or no benefit to the patient, causes harm, and wastes lim...
INTRODUCTION: The World Health Organization defines quality of care as providing effective, evidence-based care, and avoiding harm. Low-value care provides little or no benefit to the patient, causes harm, and wastes limited resources. In 2017, shortly after the start of the International Choosing Wisely campaign, the first Dutch nursing "Do-not-do" list was published and has become a widely used practical tool for nurses working in daily practice. However, over the last years new guidelines are published. Therefore, an update of the list is necessary with an addition of high-value care recommendations as alternative care practices for low-value care. DESIGN/METHODS: In this study, a combination of designs was used. First, we searched Dutch clinical practice guidelines for low-value or high-value care recommendations. All nursing care recommendations were assessed and specified to several healthcare sectors, including hospital care, district care, nursing home care, disability care, and mental health care. Second, a prioritization among nurses regarding low-value care recommendations was done by a cross-sectional survey for each healthcare sector. RESULTS: In total, 66 low-value care recommendations were found, for example, "avoid unnecessary layers under the patient at risk of pressure ulcers" and "never flush the bladder to prevent urinary tract infection." Furthermore, 414 high-value care recommendations were selected, such as "use the Barthel Index to assess and to evaluate the degree of ADL independence" and "application of cold therapy may be considered for oncological patients with pain." In total, 539 nurses from all healthcare sectors prioritized the low-value care recommendations, resulting in a top five low-value care practices per healthcare sector. The top five low-value care recommendations differed per healthcare sector, although "do not use physical restraints in case of a delirium" was prioritized by four out of five sectors. CONCLUSIONS: Assessing low-value and high-value care recommendations for nurses will help and inspire nurses to deliver fundamental care for their patients. These initiatives regarding low-value and high-value care are essential to generate a culture of continuous quality improvement based on evidence. This is also essential to meeting the current challenges of the healthcare delivery system. CLINICAL RELEVANCE: This paper provides an update of low-value care recommendations for nurses based on Dutch guidelines from 2017 to 2023, specified to five healthcare sectors, including hospital care, district care, nursing home care, disability care and mental health care, with an accompanying prioritization of these low-value care recommendations to facilitate de-implementation. This paper provides a first overview of high-value care recommendations to reflect on and create alternative care practices for low-value care. The recommendations regarding low-value and high-value care are essential to generate a culture of continuous improvement of appropriateness based on evidence, finally leading to better quality of care and improving patient outcomes.
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