The Journal of Nursing Research/護理研究
台灣護理學會,正常發行
選擇卷期
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Background: Differences in short-term cognitive function between mechanically ventilated patients treated with multi-component interventions and those receiving routine nursing care have not been established because of the lack of follow-up in previous studies. Purpose: This study was designed to evaluate the effects of the pain, agitation, and delirium (PAD) care bundle on delirium occurrence and clinical outcomes, specifically in terms of short-term cognitive function, in mechanically ventilated patients. Methods: Data on 243 patients with mechanical ventilation were analyzed from January 2017 to February 2019. The eligible patients were divided randomly into two groups. The control group (n = 120) received usual care, whereas the intervention group (n = 123) received the PAD bundle, including pain monitoring and management, light sedation and daily awakening, early mobility, sleep promotion, and delirium monitoring. The incidence and duration of delirium, ventilator time, and intensive care unit (ICU) length of stay were compared between the two groups. Upon discharge from the ICU and at 3 and 6 months after discharge, cognitive function was assessed using the Montreal Cognitive Assessment scale and compared between the two groups. Results: The incidence of delirium was reduced significantly in the intervention group, and significant decreases in the duration of delirium, ventilator time, and ICU length of stay were found. Cognitive impairment in the intervention group was significantly lower at the 3-month follow-up assessment. Conclusions/Implications for Practice: The PAD bundle was shown to be associated with a lower incidence of delirium and improved clinical outcomes. Short-term cognitive impairment occurred in fewer patients who were managed with the PAD bundle after ICU discharge. Our findings indicate that the PAD bundle has the potential to improve clinical outcomes. The administrative staff of ICUs should use strategies, such as interdisciplinary teamwork, to facilitate the buy-in and implementation of interventions.
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Background: Male nursing students face challenges in the nursing profession because of its female-centered nature. In particular, most male students in South Korea must complete military service while in college. Although these kinds of situations may make it difficult for them to adapt to college life, the number of male nursing students is gradually increasing. Therefore, it is important to identify the influencing factors to promote male nursing students' successful adaptation to college life. Purpose: This study was developed to investigate the relationship between self-efficacy, social support, stress coping, and adaptation to college life among male nursing students in Korea. Factors that influence their adaptation to college life were also analyzed. Methods: A cross-sectional study was conducted on 217 male nursing students from seven colleges in Korea. Participants completed a questionnaire that was designed to measure self-efficacy, social support, stress coping, and adaptation to college life. Data were analyzed using descriptive statistics, independent t test, one-way analysis of variance, Scheffé test, Pearson's correlation coefficient, and multiple regression. Results: Male nursing students' self-efficacy, social support, stress coping, and adaptation to college life were shown to all positively correlate with each other. The main factors influencing adaptation to college life were social support, self-efficacy, satisfaction with major, and problem-solving-centered stress coping. Conclusions: Strategies to enhance social support, self-efficacy, satisfaction with major, and problem-solving-centered stress coping should be developed to improve male nursing students' adaptation to college life.
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Background: The COVID-19 pandemic has caused conflicts in the world health system. The role of nurses is prominent because of their close contact with patients. Purpose: The aim of this study was to explore the experiences of nurses in providing care to patients with COVID-19. Methods: This phenomenological study was conducted in 2020. Purposive sampling was used and continued until data saturation. Semistructured interviews were conducted with 14 nurses at Tohid Hospital, Sanandaj, Iran, all of whom had experience providing care to patients with COVID-19. Interviews were transcribed verbatim and analyzed using Colaizzi's phenomenological method. Results: The participants included four men and 10 women. Data analysis revealed four main themes (14 subthemes) related to the experience of the participants in providing care to patients with COVID-19. These themes included (a) fear (fear of being infected, fear of being a carrier, fear of the disease, and high mortality of patients), (b) compulsion (compulsion to care, being under pressure), (c) distinct experience (need for self-care, working with personal protective equipment, and ambiguity in care/treatment), and (d) sacrifice (altruism, compassion, self-sacrifice, and being proud of yourself ). Conclusions/Implications for Practice: The experience of participants in caring for patients with COVID-19, in addition to the unique experience of care, was associated with fear, compulsion, and sacrifice. Because of the ongoing COVID-19 pandemic and the unique experience of nurses serving in COVID-19 units, it is necessary to educate and support nurses to deal effectively with this situation.
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Background: Although 5-year colleges account for 41.7% of all nursing graduates in Taiwan, most of these graduates go on to university and earn a bachelor's degree. In 2015, four universities received approval from the Ministry of Education of Taiwan and started to enroll students in the academic-hospital partnership nursing program to guide nursing graduates from 5-year colleges into the nursing workplace. The effects of this program have never been examined, especially from the perspective of the students. Purpose: The aim of this study was to explore the experiences of students currently participating in the academic-hospital partnership nursing program. Methods: A qualitative approach was used in this study. Twelve students were invited to participate in a focus group that met for five sessions over 3 years to understand the motivations for and experiences of participating in the academic-hospital partnership nursing program. Data were analyzed using thematic analysis. Results: Six themes were identified: (a) incentives for participating in the academic-hospital partnership nursing program, (b) worries about making the wrong decision, (c) worries about future adaptation, (d) facing the real workplace, (e) confusion about role perception and benefits, and (f) administrator support. Conclusions/Implications for Practice: The findings of this study enhance the general understanding of nursing student experiences and the changes over time in the academic-hospital partnership nursing programs. Moreover, the findings may be used to help teachers and nursing administrators at healthcare institutes better support the needs of students at each program stage. In addition, the findings may serve as a reference for the government in refining the design of these programs in the future.
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Background: Hospital-based child protection teams play an important role in the multidisciplinary assessment, treatment, care, and rehabilitation of abused children and their families. However, the process by which these teams are built and promoted has not been explored adequately in the literature. Purpose: This study was developed to examine the process used to promote child protection team case management and to evaluate the related results. Methods: An action research model was adopted in this study. The participants and the investigator were members of a child protection team at a medical center in southern Taiwan. Qualitative and quantitative assessments were used to identify problems related to organizational structure, intervention procedures, and evaluation effectiveness. Thereafter, the study program was implemented, and the results were evaluated. Content analysis of the qualitative data, including transcribed interviews with external benchmark members and members of the hospital's team and text entries from the investigator's reflective journal, was conducted. Quantitative data, including monitoring indicators for team case management, were analyzed using descriptive statistics. Results: Three important concepts emerged related to changes in the promotion of case management by hospital child protection teams. These included formulation of a team operation model through visits to benchmark hospitals, establishment of the case management and monitoring mechanism based on team consensus, and expansion of collaboration with external agencies through the establishment of a child and adolescent protection medical regional integration center. The results of the promotion process were affected by factors that included member willingness, teamwork, hospital support, and national policy. Conclusions/Implications for Practice: Use of the hospital child protection team case management model developed in this study was shown to facilitate the provision of consultation services, integrate the opinions and resources of experts from various fields, and allow the timely provision of acute care, follow-up family environment support, and social resources required by children and their family members. These measures help prevent the reoccurrence of child abuse and enable children to grow up healthily and free from violence.
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Background: Many hemodialysis patients experience fatigue as a result of not achieving dialysis adequacy. Purpose: This study was designed to determine the effect of intradialytic range-of-motion exercises on dialysis adequacy and fatigue in patients undergoing hemodialysis. Methods: In this two-arm experimental study with repeated measures, participants were allocated to treatment (n = 25, 23 completed) and control (n = 25, 24 completed) groups using computerized simple random sampling. Participants in the treatment group performed 30-minute weekly intradialytic exercise sessions in addition to receiving standard care, whereas those in the control group received standard care only. Results: Fatigue and dialysis characteristics were reported at baseline, at the midpoint (end of Week 4), and at the end of Week 8. Whereas mean Kt/V (dialysis adequacy) and urea reduction ratio increased and the fatigue level decreased in the treatment group, these variables did not change in the control group. Significant mean differences in Kt/V, urea reduction ratio, and fatigue between the groups were observed at the end of Week 8. Conclusions: Intradialytic range-of-motion exercises are recommended for patients undergoing hemodialysis to increase dialysis adequacy and reduce fatigue.
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Background: Multiple factors affect treatment adherence in individuals with cardiovascular disease. However, information on the relationships among treatment adherence, family functioning, and self-care agency in these patients and their families is limited. Purpose: This study was developed to determine the relationships among treatment adherence, family functioning, self-care agency, and sociodemographic variables in patients with cardiovascular disease. Self-care agency, as defined by Orem, is the dynamic process patients use to engage in their own healthcare that involves discerning and addressing factors that allow their making decisions that improve self-care abilities. Methods: This cross-sectional, observational-analytical study enrolled 151 adult patients with cardiovascular diseases who had undergone pharmacological and nonpharmacological treatments and 108 family members of these patients who had consented to participate. Measurements were performed using the ＂Questionnaire for measuring treatment adherence in patients with cardiovascular disease,＂ the ＂Family Functioning Assessment Scale,＂ and the ＂Self-care Agency Scale.＂ Results: Of the 151 patients, 119 (78.8%) were assessed as having a low risk of nonadherence, 60 (39.7%) as having low family functioning, and 131 (86.8%) as having high self-care agency. Treatment adherence and self-care agency showed a moderate and significant correlation (r = .66, p ＜ .001). Similarly, treatment adherence and family functioning showed a low but significant correlation (r = .35, p ＜ .001). Moreover, significant multivariate associations were found among the variables of interest. Patients with a low risk of nonadherence were found to be more likely to have a secondary or postsecondary education, not to have vision or hearing problems, and to have a contributory affiliation mode with the health system or private health insurance. In addition, participants with moderate or high levels of family functioning were less likely to be workers or to not have hearing or vision problems. Finally, significant differences were noted between patients with low self-care agency and those with high self-care agency in terms of kinship relationship with family members and affiliation mode with the health system. Conclusions/Implications for Practice: The results of this research help clarify the issue of treatment adherence in patients with cardiovascular disease. Although family functioning and self-care agency were found to be low to moderately correlated with treatment adherence, relevant information regarding these variables and sociodemographic variables is presented in this study. Nurses may use these results as a reference to design nursing care plans and interventions to address the conditions of their patients more appropriately.
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Background: Evaluating nurses' perceived quality of care and safety culture is an essential part of the nursing practice and critical to improving the quality of nursing care. Purpose: This study aimed to examine the relationship between perceived quality of care and Turkish nurses' patient safety culture. Methods: This was a descriptive cross-sectional study. The data were collected from a foundation university hospital in Istanbul. The sample consisted of 116 nurses, and data were collected using the Caring Behaviors Inventory-24 and Patient Safety Culture Scale. The nurses were asked to complete the questionnaires. Results: The mean age of participating nurses was 25.95 (SD = 6.72) years. The mean duration of professional experience of the participants was 6.37 (SD = 6.05) years. Most (72.4%) of the participants were women who had graduated from vocational high schools (52.6%) and were working in the neonatal intensive care unit (37.9%). The highest mean subdimension score on the Caring Behaviors Inventory-24 was 5.78 (SD = 0.43) for the knowledge and skills subdimension. The highest mean subdimension score on the Patient Safety Culture Scale was 3.55 (SD = 0.48) for the unexpected event and error reporting subdimension. Statistically significant correlations were found between Caring Behaviors Inventory-24 and Patient Safety Culture Scale scores (r = .553, p ＜ .01), with the lowest correlation found between the employee behavior and knowledge and skills dimensions (r = .305, p = .001). The highest statistically significant correlation coefficients that were found were between the Patient Safety Culture Scale total scores and the connectedness dimension of the Caring Behaviors Inventory-24 (r = .58, p ＜ .001). Conclusions/Implications for Practice: Nurses perceive patient care positively and have a positive perception of safety culture. Evaluating the perceived quality of care and patient safety culture perceptions will help prevent adverse events related to patient care and improve the quality of care.
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Background: Working conditions in public hospitals in Mexico City are highly demanding. The need for healthcare is pressing, materials and instruments are scarce, and exposure to pain and suffering is constant. These adverse conditions have an adverse impact on the physical and mental health of healthcare professionals. The nursing staffs are among those who are most affected, and they frequently experience burnout syndrome or one of its several dimensions, including emotional exhaustion, depersonalization, and reduced personal accomplishment. Purpose: The aim of this research was to analyze the relationship among working conditions, related stress, and the dimensions of burnout syndrome in a tertiary care public hospital in Mexico City. Methods: A cross-sectional design was applied on a random sample of 190 nurses in a public hospital in Mexico City. Working conditions and burnout syndrome were evaluated using standardized instruments. Adjusted prevalence ratios were calculated. Three clusters, one for each burnout dimension, were generated and then evaluated using a correspondence analysis with labor characteristics. Results: One quarter (25%) of the participants self-reported a sense of personal accomplishment, and 12% reported emotional exhaustion and depersonalization. The labor variables that were found to be associated with the dimensions of burnout were workload, performing potentially hazardous work, and conducting tedious tasks. Positive conditions were shown to decrease the prevalence of burnout in all three dimensions. Conclusions/Implications for Practice: Working conditions for nursing staff impact the mental health of nurses and affect the quality of the healthcare they provide. The set of work demands and stressors to which they are exposed should be controlled and modified to ensure a healthy work environment.