Enhancing diabetic foot management: Advocating for independent prescribing rights for podiatrists in South Africa

Diabetic foot complications are serious issues resulting from uncontrolled diabetes, primarily affecting the feet. Common complications include diabetic neuropathy, ulcers, PAD, Charcot foot, and gangrene. Preventive measures include controlling blood glucose levels, regular foot inspections, proper foot care, wearing appropriate footwear, and seeking prompt medical attention. A holistic approach to diabetic foot management is crucial due to the complex interplay of physiological, psychological, and environmental factors. Glycaemic control is essential for mitigating neuropathy and vasculopathy, while cardiovascular risk factors like hypertension and dyslipidemia are crucial for preventing complications. In South Africa, podiatrists play a crucial role in diabetic foot care, offering specialized expertise in the assessment, management, and prevention of foot complications associated with diabetes mellitus. They collaborate closely with other healthcare professionals to ensure comprehensive and coordinated care.Pharmacological management is a crucial aspect of podiatric care in the UK, where podiatrists use various medications to treat foot conditions effectively. In South Africa, podiatrists lack prescribing authority, leading to limited treatment options, dependency on referrals, and disparities in access to care. This fragmented approach can compromise patient outcomes, especially in chronic conditions like diabetes. To improve patient outcomes and promote optimal foot condition management, policy reforms, interdisciplinary collaboration, and professional advocacy efforts are needed.Policy recommendations for expanding podiatrist prescribing privileges include legislative reforms, regulatory framework updates, and professional accreditation. Legislative reforms could involve amending existing healthcare laws or introducing new regulations that recognize podiatrists as authorized prescribers. Regulatory framework updates should involve working with regulatory bodies to establish prescribing standards, prescribing limitations, and mechanisms for ongoing oversight and accountability. Professional accreditation should ensure educational programs for podiatrists incorporate training in pharmacology, pharmacotherapy, and prescribing practices to prepare graduates for the expanded scope of practice.Stakeholders in South Africa can improve diabetes management by advocating for policy reforms, professional recognition, and patient empowerment initiatives. By aligning policy, practice, education, research, and advocacy efforts, stakeholders can create a supportive ecosystem that fosters innovation, collaboration, and continuous improvement in diabetic foot care.

Intervention to improve adverse event reporting in the emergency department: Protocol of a systematic review and meta-analysis

BACKGROUND

Adverse event reporting is crucial for improving patient safety and identifying areas for improvement in the emergency department. Many interventions have been employed in that regard, and have been found to increase adverse event reporting rates in various settings. All published research that studied the various interventions and their effectiveness on adverse event reporting in the Emergency Department will be reviewed in this paper.

METHODS

CINAHL, PubMed, Medline, Cochrane Reviews Library, EMBASE, Scopus, OVID, Science Direct and Web of Science will all be searched. Studies published since January 2000 that investigated the interventions to improve adverse event reporting will be included. Two independent reviewers will execute the selection and extraction process, and we will carry out a qualitative synthesis. A meta-analysis, if possible, will be undertaken.

DISCUSSION

The present study will summarize interventions to improve adverse event reporting. It will also determine effective approaches to enhancing adverse event reporting in the emergency department. The outcome of the study will provide novel dimensions into possible interventions to improve patient safety through adverse event reporting.

SYSTEMATIC REVIEW REGISTRATION

Protocol registration and reporting: PROSPERO CRD42023414795.

Capability as a concept in advanced practice nursing and education: a scoping review

OBJECTIVE

The objective of this review was to map the literature about the concept of capability in advanced practice nursing education and practice to achieve greater clarity on the concept and its application.

INTRODUCTION

Advanced practice nursing roles make up a growing segment of the global nursing workforce. Capability has been proposed as an overarching description of the attributes of advanced practice nursing roles within complex workplace environments. Capability includes knowing how to learn, and the ability to creatively integrate prior knowledge, skills, judgment, and experience in both new and familiar situations.

INCLUSION CRITERIA

This review looked at the literature about capability applied to advanced practice nursing in any setting globally. We were guided by the International Council of Nurses' definition of advanced practice nursing, which includes nurses with both graduate education and an expanded scope of practice. Drawing from an initial review of the literature, we used a working definition of capability, which was a combination of knowledge, skills, experience, and competencies that enables advanced practice nurses to provide appropriate care for patients in both known and unfamiliar clinical settings. We included literature about individual capability as a concept in any setting related to advanced practice nursing and education.

METHODS

We searched 18 electronic databases and included qualitative, quantitative, and mixed methods study design methodologies, reviews, and reports. The gray literature search included policy and practice documents from the World Health Organization, the International Council of Nursing, and websites of 48 nursing and health organizations. Two reviewers independently completed title and abstract screening prior to full-text review and data extraction. Conflicts were resolved via discussion or with a third reviewer. Extraction was completed by 2 reviewers using a piloted data extraction tool. Articles published in English from 1975 to the present were included. Sources in languages other than English were not included in the review due to the difficulties in accurately translating the concept of capability.

RESULTS

Thirty-five sources were included in the review with publication dates from 2000 to 2023. Most sources originated from Australia, the United Kingdom, and the United States of America. Sources included frameworks and clinical guidelines, peer-reviewed articles, and gray literature. Capability was discussed in a range of settings, including specialized clinical roles. Applications of capability in educational settings included the use of capability frameworks to guide nurse practitioner education, nursing practice doctorates, and postgraduate nurse practitioner training. Definitions of capability, where provided, were relatively consistent. Capability was proposed as a distinguishing characteristic of advanced practice nursing, as a descriptor of clinical proficiency that moved beyond competency, and as a framework that accounted for complexity in health care settings.

CONCLUSIONS

Capability was used as a concept and framework to describe advanced practice nursing within complex practice environments that necessitate flexible approaches. Capability frameworks were applied holistically and to specific areas of practice or education, including in pre- and postgraduate advanced practice nursing education. Strategies for teaching and learning capability focused on flexibility, student-directed learning, and development of flexible learning pathways.

SUPPLEMENTAL DIGITAL CONTENT

A Norwegian-language version of this abstract of this review is available: http://links.lww.com/SRX/A58.

Internationalization at home program significantly increases the self-efficacy of nursing students: A pre-post study

BACKGROUND

Internationalization at home strategies seek to achieve a more inclusive and equitable higher education. Evidence about the impact of these strategies on students' self-efficacy is still scarce, even though this psychological construct is essential for the performance and well-being of nursing students. The Global Nursing Care program was designed to provide nursing students with an internationalization at home experience, combining a virtual exchange and international clinical simulation.

AIM

To determine the impact of the Global Nursing Care program on nursing students' self-efficacy.

DESIGN

A quasi-experimental, analytic, and longitudinal study was conducted.

SETTINGS AND PARTICIPANTS

The virtual module was carried out online, and the international simulations were developed in the Simulation Centers of the San Juan de Dios School of Nursing and Physiotherapy (Universidad Pontificia Comillas, Spain) and the West Coast University (USA). Seventy students participated in the program and 57 completed the pre-post questionnaire.

METHODS

Data were collected using an online survey that included a sociodemographic questionnaire and the General Self-efficacy Scale. IBM's SPSS (version 28.0.1.1) was used to analyze data. Differences between self-efficacy levels were measured before and after the program, and according to sociodemographic characteristics.

RESULTS

General self-efficacy was significantly augmented following program participation (pre-intervention: mean = 32.39, SD = 3.87; post-intervention: mean = 34.44, SD = 3.86; p < 0.001). No differences based on nationality, previous international academic experience or academic year were found.

CONCLUSIONS

An internationalization at home program based on virtual exchange and simulation improves nursing students' general self-efficacy. Future research can explore to what extent this effect persists over time.

Education programmes for people with chronic kidney disease and diabetes

BACKGROUND

Adherence to complex regimens for people with chronic kidney disease (CKD) and diabetes is often poor. Interventions to enhance adherence require intensive education and behavioural counselling. However, whether the existing evidence is scientifically rigorous and can support recommendations for routine use of educational programmes in people with CKD and diabetes is still unknown. This is an update of a review first published in 2011.

OBJECTIVES

To evaluate the benefits and harms of education programmes for people with CKD and diabetes.

SEARCH METHODS

We searched the Cochrane Kidney and Transplant Register of Studies up to 19 July 2024 using search terms relevant to this review. Studies in the Register are identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Registry Platform (ICTRP) Search Portal, and ClinicalTrials.gov.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) and quasi-RCTs investigating the benefits and harms of educational programmes (information and behavioural instructions and advice given by a healthcare provider, who could be a nurse, pharmacist, educator, health professional, medical practitioner, or healthcare provider, through verbal, written, audio-recording, or computer-aided modalities) for people 18 years and older with CKD and diabetes.

DATA COLLECTION AND ANALYSIS

Two authors independently screened the literature, determined study eligibility, assessed quality, and extracted and entered data. We expressed dichotomous outcomes as risk ratios (RR) with 95% confidence intervals (CI) and continuous data as mean difference (MD) with 95% CI. Data were pooled using the random-effects model. The certainty of the evidence was assessed using the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach.

MAIN RESULTS

Eight studies (13 reports, 840 randomised participants) were included. The overall risk of bias was low for objective outcomes and attrition bias, unclear for selection bias, reporting bias and other biases, and high for subjective outcomes. Education programmes compared to routine care alone probably decrease glycated haemoglobin (HbA1c) (4 studies, 467 participants: MD -0.42%, 95% CI -0.53 to -0.31; moderate certainty evidence; 13.5 months follow-up) and may decrease total cholesterol (179 participants: MD -0.35 mmol/L, 95% CI -0.63 to -00.07; low certainty evidence) and low-density lipoprotein (LDL) cholesterol (179 participants: MD -0.40 mmol/L, 95% CI -0.65 to -0.14; low certainty evidence) at 18 months of follow-up. One study (83 participants) reported education programmes for people receiving dialysis who have diabetes may improve the diabetes knowledge of diagnosis, monitoring, hypoglycaemia, hyperglycaemia, medication with insulin, oral medication, personal health habits, diet, exercise, chronic complications, and living with diabetes and coping with stress (all low certainty evidence). There may be an improvement in the general knowledge of diabetes at the end of the intervention and at the end of the three-month follow-up (one study, 97 participants; low certainty evidence) in people with diabetes and moderately increased albuminuria (A2). In participants with diabetes and moderately increased albuminuria (A2) (one study, 97 participants), education programmes may improve a participant's beliefs in treatment effectiveness and total self-efficacy at the end of five weeks compared to routine care (low certainty evidence). Self-efficacy for in-home blood glucose monitoring and beliefs in personal control may increase at the end of the three-month follow-up (low certainty evidence). There were no differences in other self-efficacy measures. One study (100 participants) reported an education programme may increase change in behaviour for general diet, specific diet and home blood glucose monitoring at the end of treatment (low certainty evidence); however, at the end of three months of follow-up, there may be no difference in any behaviour change outcomes (all low certainty evidence). There were uncertain effects on death, serious hypoglycaemia, and kidney failure due to very low certainty evidence. No data was available for changes in kidney function (creatinine clearance, serum creatinine, doubling of serum creatinine or proteinuria). For an education programme plus multidisciplinary, co-ordinated care compared to routine care, there may be little or no difference in HbA1c, kidney failure, estimated glomerular filtration rate (eGFR), systolic or diastolic blood pressure, hypoglycaemia, hyperglycaemia, and LDL and high-density lipoprotein (HDL) cholesterol (all low certainty evidence in participants with type-2 diabetes mellitus and documented advanced diabetic nephropathy). There were no data for death, patient-orientated measures, change in kidney function (other than eGFR and albuminuria), cardiovascular disease morbidity, quality of life, or adverse events.

AUTHORS' CONCLUSIONS

Education programmes may improve knowledge of some areas related to diabetes care and some self-management practices. Education programmes probably decrease HbA1c in people with CKD and diabetes, but the effect on other clinical outcomes is unclear. This review only included eight studies with small sample sizes. Therefore, more randomised studies are needed to examine the efficacy of education programmes on important clinical outcomes in people with CKD and diabetes.

Beyond the Bedside: Decoding Patient Profiles for Smarter Virtual Patient Observation

BACKGROUND

Emerging evidence suggests that virtual patient observation (VPO) may help promote patient safety.

PURPOSE

The purpose of this study was to examine and describe the demographic and clinical characteristics of patients who incurred VPO.

METHODS

A retrospective analysis was conducted. Differences in total VPO hours between groups were examined, followed by a hierarchical regression to investigate the effect of predictor variables on VPO utilization variance.

RESULTS

A total of 286 patient charts were reviewed. Mean VPO hours were higher in patients with an intensive care unit admission history. Adjusted for gender and history of dementia/Alzheimer's/memory impairment, the prediction of total VPO hours increased with the patient's intensive care unit admission history and overall hospital length of stay.

CONCLUSIONS

Examining the prevalence and variability in the pattern of VPO utilization by specific patient characteristics is essential for identifying what patients could best benefit from this technology.

Barriers and facilitators for reducing low-value home-based nursing care: A qualitative exploratory study among homecare professionals

AIM

To explore barriers and facilitators for reducing low-value home-based nursing care.

DESIGN

Qualitative exploratory study.

METHOD

Seven focus group interviews and two individual interviews were conducted with homecare professionals, managers and quality improvement staff members within seven homecare organizations. Data were deductively analysed using the Tailored Implementation for Chronic Diseases checklist.

RESULTS

Barriers perceived by homecare professionals included lack of knowledge and skills, such as using care aids, interactions between healthcare professionals and general practitioners creating expectations among clients. Facilitators perceived included reflecting on provided care together with colleagues, clearly communicating agreements and expectations towards clients. Additionally, clients' and relatives' behaviour could potentially hinder reduction. In contrast, clients' motivation to be independent and involving relatives can promote reduction. Lastly, non-reimbursement and additional costs of care aids were perceived as barriers. Support from organization and management for the reduction of care was considered as facilitator.

CONCLUSION

Understanding barriers and facilitators experienced by homecare professionals in reducing low-value home-based nursing care is crucial. Enhancing knowledge and skills, fostering cross-professional collaboration, involving relatives and motivating clients' self-care can facilitate reduction of low-value home-based nursing care. Implications for profession and patient care: De-implementing low-value home-based nursing care offers opportunities for more appropriate care and inclusion of clients on waitlists.

IMPACT

Addressing barriers with tailored strategies can successfully de-implement low-value home-based nursing care.

REPORTING METHOD

The Consolidated Criteria for Reporting Qualitative Research checklist was used. No patient or public contribution.

Dispatcher nurses' experiences of handling drones equipped with automated external defibrillators in suspected out-of-hospital cardiac arrest - a qualitative study

BACKGROUND

Reducing the time to treatment by means of cardiopulmonary resuscitation (CPR) and defibrillation is essential to increasing survival after cardiac arrest. A novel method of dispatching drones for delivery of automated external defibrillators (AEDs) to the site of a suspected out-of-hospital cardiac arrest (OHCA) has been shown to be feasible, with the potential to shorten response times compared with the emergency medical services. However, little is known of dispatchers' experiences of using this novel methodology.

METHODS

A qualitative semi-structured interview study with a phenomenological approach was used. Ten registered nurses employed at an emergency medical dispatch centre in Gothenburg, Sweden, were interviewed and the data was analysed by qualitative content analysis. The purpose was to explore dispatcher nurses' experiences of deliveries of AEDs by drones in cases of suspected OHCA.

RESULTS

Three categories were formed. Nurses expressed varying compliance to the telephone-assisted protocol for dispatch of AED-equipped drones. They experienced uncertainty as to how long would be an acceptable interruption from the CPR protocol in order to retrieve a drone-delivered AED. The majority experienced that collegial support was important. Technical support, routines and training need to be improved to further optimise action in cases of drone-delivered AEDs handled by dispatcher nurses.

CONCLUSIONS

Although telephone-assisted routines for drone dispatch in cases of OHCA were available, their use was rare. Registered nurses showed variable degrees of understanding of how to comply with these protocols. Collegial and technical support was considered important, alongside routines and training, which need to be improved to further support bystander use of drone-delivered AEDs. As the possibilities of using drones to deliver AEDs in cases of OHCA are explored more extensively globally, there is a good possibility that this study could be of benefit to other nations implementing similar methods. We present concrete aspects that are important to take into consideration when implementing this kind of methodology at dispatch centres.

A systematic review of genomic education for nurses and nursing students: Are they sufficient in the era of precision health?

BACKGROUND

Integration of genomic content into nursing curricula and continuing education is limited.

PURPOSE

This systematic review aimed to identify educational strategies to deliver genomics content.

METHODS

CINAHL Plus, ERIC, Ovid MEDLINE, and Scopus electronic databases were searched from January 1, 2003 through July 6, 2023. The three domains of learning: cognitive, affective, and psychomotor were used to categorize educational outcomes. A narrative approach was used to synthesize the data using Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines.

DISCUSSION

Ten studies met inclusion criteria. Quality assessment for bias was conducted independently; study quality ranged from fair to poor. No study used a complete psychometrically tested instrument to measure genomic cognitive or affective knowledge; none measured the psychomotor domain.

CONCLUSIONS

Effective strategies to deliver genomic education are a priority. Development of reliable and valid instruments for the assessment of educational interventions, including the psychomotor skills needed for practice.

Mapping and Characterizing Instruments for Assessing Family Nurses' Workload: Scoping Review

BACKGROUND

The importance of knowing the workload of family nurses lies essentially in the possibility of improving health outcomes, care processes and the nurse's professional life. There is a lack of studies that fully describe the nursing workload in primary care, particularly, in the context of family health nursing, and the ideal metrics to be used remain unknown, making it impossible to characterize and therefore provide the necessary insight to acknowledge the different contributions of several aspects that embody the global workload of family nurses. The objective of this scoping review was to map the known evidence and characterize the instruments used to assess the workload of family nurses.

METHODS

Scoping review, according to the Joanna Briggs Institute, proposed a methodology for scoping reviews, consisting of three research stages: (1) an initial research in Medline and CINHAL; (2) an extended search, using keywords and search terms, in the following databases: JBI, CINAHL Complete, MEDLINE, Cochrane and Scopus; and (3) a search of the reference lists of the selected articles. No time limit was defined.

RESULTS

Fourteen studies referring to ten assessment instruments were included. Nine of them analyze workload as a dimension of a broader instrument, and two studies refer to an instrument that focuses exclusively on workload.

CONCLUSIONS

The diversity of professional competencies and contexts, the conceptual complexity of workload and the absence of a theoretical framework make it difficult to identify consensual instruments to assess the workload of family nurses. This study was prospectively registered with the Open Science Framework® on 6 September 2023, with the registration number: 3k6vr.

Insights Into Sociodemographic Influences on Type 2 Diabetes Care and Opportunities for Digital Health Promotion in Port Harcourt, Nigeria: Quantitative Study

BACKGROUND

A significant percentage of the Nigerian population has type 2 diabetes (T2D), and a notable portion of these patients also live with comorbidities. Despite its increasing prevalence in Nigeria due to factors such as poor eating and exercise habits, there are insufficient reliable data on its incidence in major cities such as Port Harcourt, as well as on the influence of sociodemographic factors on current self-care and collaborative T2D care approaches using technology. This, coupled with a significant lack of context-specific digital health interventions for T2D care, is our major motivation for the study.

OBJECTIVE

This study aims to (1) explore the sociodemographic profile of people with T2D and understand how it directly influences their care; (2) generate an accurate understanding of collaborative care practices, with a focus on nuances in the contextual provision of T2D care; and (3) identify opportunities for improving the adoption of digital health technologies based on the current understanding of technology use and T2D care.

METHODS

We designed questionnaires aligned with the study's objectives to obtain quantitative data, using both WhatsApp (Meta Platforms, Inc) and in-person interactions. A social media campaign aimed at reaching a hard-to-reach audience facilitated questionnaire delivery via WhatsApp, also allowing us to explore its feasibility as a data collection tool. In parallel, we distributed surveys in person. We collected 110 responses in total: 83 (75.5%) from in-person distributions and 27 (24.5%) from the WhatsApp approach. Data analysis was conducted using descriptive and inferential statistical methods on SPSS Premium (version 29; IBM Corp) and JASP (version 0.16.4; University of Amsterdam) software. This dual approach ensured comprehensive data collection and analysis for our study.

RESULTS

Results were categorized into 3 groups to address our research objectives. We found that men with T2D were significantly older (mean 61 y), had higher household incomes, and generally held higher academic degrees compared to women (P=.03). No statistically significant relationship was found between gender and the frequency of hospital visits (P=.60) or pharmacy visits (P=.48), and cultural differences did not influence disease incidence. Regarding management approaches, 75.5% (83/110) relied on prescribed medications; 60% (66/110) on dietary modifications; and 35.5% (39/110) and 20% (22/110) on traditional medicines and spirituality, respectively. Most participants (82/110, 74.5%) were unfamiliar with diabetes care technologies, and 89.2% (98/110) of those using technology were only familiar with glucometers. Finally, participants preferred seeking health information in person (96/110, 87.3%) over digital means.

CONCLUSIONS

By identifying the influence of sociodemographic factors on diabetes care and health or information seeking behaviors, we were able to identify context-specific opportunities for enhancing the adoption of digital health technologies.

The mediating effects of parenting self-efficacy between readiness for hospital discharge and post-discharge coping difficulty among mothers of preterm infants

Post-discharge coping difficulty presents a significant challenge for mothers of preterm infants. The readiness for hospital discharge and parenting self-efficacy are crucial factors influencing post-discharge coping difficulty. However, the pathways through which these factors impact post-discharge coping difficulty remain unclear. This study aims to investigate the impact of readiness for hospital discharge on post-discharge coping difficulty and the mediating role of parenting self-efficacy among mothers of preterm infants. A prospective study involving 462 mothers of preterm infants from six tertiary hospitals in Shandong Province was conducted. Mothers were evaluated on the day of discharge (using the Baseline characteristics and Readiness for Hospital Discharge Scale) and three weeks post-discharge (utilizing the Parenting Sense of Competence Scale-Efficacy subscale and Post-Discharge Coping Difficulty Scale). Structural equation modeling was employed to analyze the mediating effect. The results of this study revealed that readiness for hospital discharge significantly decreased post-discharge coping difficulty (β = - 0.533, P < 0.001), and parenting self-efficacy also significantly reduced post-discharge coping difficulty (β = - 0.419, P < 0.001). Furthermore, parenting self-efficacy partially mediated the relationship between readiness for hospital discharge and post-discharge coping difficulty, accounting for 25.35% of the total effect. Mothers reported a moderate level of post-discharge coping difficulty. In assisting mothers of premature infants to alleviate post-discharge coping difficulty, nurses could implement strategies focused on enhancing readiness for hospital discharge and parenting self-efficacy.

HybGrip: a synergistic hybrid gripper for enhanced robotic surgical instrument grasping

PURPOSE

A fundamental task of a robotic scrub nurse is handling surgical instruments. Thus, a gripper capable of consistently grasping a wide variety of tools is essential. We introduce a novel gripper that combines granular jamming and pinching technologies to achieve a synergistic improvement in surgical instrument grasping.

METHODS

A reliable hybrid gripper is constructed by integrating a pinching mechanism and a standard granular jamming gripper, achieving enhanced granular interlocking. For our experiments, our prototype is affixed to the end-effector of a collaborative robot. A novel grasping strategy is proposed and utilized to evaluate the robustness and performance of our prototype on 18 different surgical tools with diverse geometries.

RESULTS

It is demonstrated that the integration of the pinching mechanism significantly enhances grasping performance compared with standard granular jamming grippers, with a success rate above 98%. It is shown that with the combined use of our gripper with an underlying grid, i.e., a complementary device placed beneath the instruments, robustness and performance are further enhanced.

CONCLUSION

Our prototype's performance in surgical instrument grasping stands on par with, if not surpasses, that of comparable contemporary studies, ensuring its competitiveness. Our gripper proves to be robust, cost-effective, and simple, requiring no instrument-specific grasping strategies. Future research will focus on addressing the sterilizability of our prototype and assessing the viability of the introduced grid for intra-operative use.

Determinants of clinical nurses' patient safety competence: a systematic review protocol

INTRODUCTION

Patient safety has become a fundamental element of healthcare quality. However, despite the ongoing efforts of various organisations, patient safety issues remain a problem in the healthcare system. Given the crucial role of nurses in the healthcare process, improving patient safety competence among clinical nurses is important. In order to promote patient safety competence, it is essential to identify and strengthen the relevant factors. This protocol is for a systematic review aiming to examine and categorise the factors influencing patient safety competence among clinical nurses.

METHODS AND ANALYSIS

This review protocol is based on the Joanna Briggs Institute (JBI) Methodology for Systematic Reviews of Effectiveness and Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols. Four electronic databases, including Ovid-MEDLINE, CINAHL, Cochrane Library and EMBASE, will be used for the systematic review. After consulting with a medical librarian, we designed our search terms to include subject heading terms and related terms in the titles and abstracts. Databases from January 2012 to August 2023 will be searched.Two reviewers will independently conduct the search and extract data including the author(s), country, study design, sample size, clinical setting, clinical experience, tool used to measure patient safety competence and factors affecting patient safety competence. The quality of the included studies will be assessed using the JBI critical appraisal tool. Because heterogeneity of the results is anticipated, the data will be narratively synthesised and divided into two categories: individual and organisational factors.

ETHICS AND DISSEMINATION

Ethical review is not relevant to this study. The findings will be presented at professional conferences and published in peer-reviewed journals.

PROSPERO REGISTRATION NUMBER

CRD42023422486.

Use of an age-simulation suit as an empathy-building method for dental students: a pre-post study

Background

The aging of the population highlights the need to establish empathetic connections with older adults. To achieve this, age simulation suits have been designed, allowing users to experience the physical limitations associated with aging. This study aimed to evaluate the experience of dental students with these devices, using psychometric tools to measure the impact on their understanding and empathy.

Methods

A pre/post-test study was conducted with the participation of 63 dental students from Rey Juan Carlos University who were fitted with an age simulation suit and asked to perform different tasks. Psychometric tools were used to assess specific parameters. Empathy was measured using the Jefferson Empathy Scale, emotional intelligence was assessed with the Trait Meta-Mood Scale-24 (TMMS-24), and the emotional attention dimension was analyzed using the Positive and Negative Affect Schedule (PANAS).

Results

The scores on the Jefferson Empathy Scale significantly improved from 88.44 ± 6.8 to 91.06 ± 10.11 after using the simulation suit (P < 0.026). Pearson's product moment correlation analysis showed no significant positive association or correlation between age and scores from the three questionnaires. In the rest, a positive and significant correlation was observed (P < 0.0001).

Conclusions

Age simulation activities effectively enhance empathy among dental students. However, more studies are needed to foster positive attitudes toward aging and prevent negative stereotypes.

Unveiling the dynamics of older person care: a qualitative exploration of the intersection between formal and Informal Caregiving from the perspectives of registered nurses in Greece

In the evolving landscape of older person care, the imperative to explore holistic approaches persists, especially in regions with distinct societal norms around informal caregiving. The deeply ingrained tradition of familial caregiving, often led by female family members, has historically compensated for healthcare system gaps in less integrated systems. Hence, societal expectations may affect registered nurses' experiences and impact the quality of care for older persons. This study aims to describe the meaning of caring for older persons in care settings in Greece. Ten in-depth interviews with registered nurses in older person care settings underwent qualitative thematic analysis. Four themes emerged from the analysis: (i) Living and bonding with older people as a basis for caring, (ii) Caring as a double-faced fulfillment, (iii) A sense of insufficiency in the caring relationship, and (iv) The encounter of existential issues creating loneliness. This research provides insights into the meaning of caring for older persons, highlighting the experiences of the closest professional caregivers of older individuals. A specific capture of the entanglement of cultural norms, societal expectations, and their impact on professional caregivers' experiences may contribute to quality care provision in systems rooted in familial caregiving traditions.

Anthracycline-induced cardiotoxicity: An overview from cellular structural perspective

Anthracyclines are broad-spectrum anticancer drugs, but their clinical use is limited due to their severe cardiotoxicity. Anthracycline-induced cardiotoxicity (AIC) remains a significant cause of heart disease-related mortality in many cancer survivors. The underlying mechanisms of AIC have been explored over the past few decades. Reactive oxygen species and drug-induced inhibition of topoisomerase II beta are well-studied mechanisms, with mitochondria being a prominently investigated organelle. Emerging mechanisms such as ferroptosis, Ca2+ overload, autophagy and inflammation mediators have been implicated in recent years. In this review, our goal is to summarize and update the roles of various mechanisms in AIC, focusing on different cellular levels and further explore promising therapeutic approaches targeting these organelles or pathways.

Evaluation of oral mucositis level and affecting factors in cancer patients receiving chemotherapy

OBJECTIVES

This study aimed to evaluate the severity of oral mucositis and the contributing factors among cancer patients undergoing chemotherapy.

METHODS

This study was planned cross-sectional. The study was conducted at a medical oncology clinic between January and July 2022. The sample consisted of 245 patients with cancer receiving chemotherapy. Data were collected using a personal, oral health and disease-related characteristics questionnaire and the World Health Organization Oral Mucositis Assessment Scale by researchers. Intraoral examination of the patients was carried out by researchers. The data were analyzed by independent-sample t-tests, Chi-square tests, paired-sample t-tests, and multivariate logistic regression (p < 0,05).

RESULTS

The patients had mean age 62.31 ± 10.70. Patients of 32.7% were with lung cancer. 52%of the patients (n = 128) receiving chemotherapy developed oral mucositis. The independent variables the presence chronic disease(OR:1.85), chemotherapy protocol (OR:3.52) and the dependent variables ECOG performance score (OR:2.25) were variable that affected the development of oral mucositis (p < 0.05). Patients of 35.5% were oral mucositis score of 1. Patients those who had breast cancer, who received doxorubicin or cyclophosphamide chemotherapy protocols, and who had previously developed oral mucositis were found to have a higher rate of oral mucositis (p < 0.05). In addition, oral mucositis was more prevalent in patients with chronic diseases other than cancer (57%), those who used medication continuously (57.2%), those with oral and dental diseases (56.9%), those who had dental check-ups before cancer treatment (79.2%), and those who had information about oral mucositis(70.2%) (p < 0.05).

CONCLUSION

In conclusion, nearly half of the patients (52%, n = 128) receiving chemotherapy developed oral mucositis and of all patients of 35.5% had an oral mucositis score of 1 in the second round of chemotherapy. Patients those who had breast cancer, who received doxorubicin or cyclophosphamide chemotherapy protocols, and who had previously developed oral mucositis were found to have a higher rate of oral mucositis.

Determinants of self-care among Jordanian children with type 1 diabetes mellitus

BACKGROUND

Diabetes Self-Care Management (DSCM) is crucial for managing diabetes mellitus and improving patients' well-being. Research on the young age group in Jordan is limited, and there is a lack of studies using an evaluation tool for understanding diabetes pharmacotherapy. This study intends to fill the information gap by examining young Jordanian patients' knowledge and comprehension of type 1 diabetes mellitus (T1DM) and its treatment modalities, evaluating their psychological well-being, and examining the relationship between children's psychological health and self-care.

METHODS

This cross-sectional study was conducted in the Jordanian Ministry of Health hospitals in Amman from June 2021 to January 2022. A convenience sampling method was used to select Arabic-speaking diabetic patients aged 11-a8 years who provided signed consent. A sample size of 400 was estimated. A self-administered questionnaire was developed based on a literature review to assess sociodemographic characteristics and diabetes and insulin knowledge, and validated scales were used to assess self-management (SMOD-A) and psychological well-being (ChilD-S).

RESULTS

Analysis of the questionnaire responses revealed varying levels of knowledge among the participants. Approximately half of the children (49.0%) demonstrated a lack of knowledge of diabetes pharmacotherapy. Psychological well-being indicators indicated moderate levels of happiness and feeling fine. The analysis of self-management indicators highlighted areas for improvement. Positive weak but significant correlations were found between children's knowledge about diabetes (r = 0.255, p < 0.01), diabetes pharmacotherapy knowledge (r = 0.125, p < 0.05), psychological well-being (r = 0.112, p < 0.05), and their diabetic self-management scores. A multivariate regression analysis identified predictors of self-management, including the child's school year (p = 0.035), ability to express feelings (p = 0.039), recent HbA1c levels (p = 0.028), and diabetes knowledge score (p < 0.001).

CONCLUSION

Participants exhibited varying levels of knowledge about diabetes pharmacotherapy and self-management. Knowledge about diabetes was identified as a predictor for effective self-management. Moreover, glycemic control and diabetes mellitus awareness majorly impact overall self-management behaviors. Tailored education programs are necessary to fill knowledge gaps and enhance diabetes management among children.

Healthcare Professionals' Knowledge, Attitudes, and Practices in Providing Care to Southeast Asian Immigrants with Cardiometabolic Syndrome: A Scoping Review

OBJECTIVE

There is a growing emphasis on healthcare professionals' (HCPs) role in managing cardiometabolic risk factors to reduce health disparity for immigrants in developed countries. This scoping review aimed to analyse evidence about HCPs' knowledge, attitudes, and practices (KAP) of managing cardiometabolic risk factors among Southeast Asian (SEA) immigrants in developed countries.

DESIGN

Primary studies from inception to July 17, 2023, from four databases: PubMed/Medline, Embase, PsycINFO, and CINAHL were included. This review followed the Joanna Briggs Institute (JBI) scoping review methodology and reported in line with PRISMA-ScR.

RESULTS

Of 619 identified studies, seven met the inclusion criteria. All studies discussed HCPs' knowledge, six explored attitudes, and three described practices specific to SEA immigrants. The extracted data were analysed using descriptive qualitative content analysis and classified into barriers and facilitators. Barriers included cultural discordance and acculturation challenges (patient level); gaps in cultural understanding, communication and clinical skills (healthcare team level); limited immigrant-specific resources (organisation level); and funding constraints (environment level). Facilitators included community and provider support (patient level), awareness and desires to provide immigrant-specific care (healthcare team level), availability of culturally appropriate services (organisation level), and multicultural agendas and policies (environment level).

CONCLUSION

The barriers and facilitators faced by HCPs caring for SEA immigrants with cardiometabolic syndromes share similarities with other immigrant groups. Future research focused on co-production involving immigrant patients, their communities, and HCPs in healthcare service design is required to support HCPs in providing culturally appropriate care and promoting health equity regardless of ethnic, cultural, or linguistic backgrounds.

Exploring the MAPPING application to facilitate risk communication and shared decision-making between physicians and patients with gynaecological cancer

This is an observational study in which we evaluated current levels of risk communication (RC) among gynaecological oncologists and their view on the Mapping All Patient Probabilities in Numerical Graphs (MAPPING) application as a possible tool to facilitate RC and shared decision-making (SDM). In part A, we audio-recorded 29 conversations between gynaecological oncologists and patients when discussing treatment options. In part B, interviews were performed with eight gynaecological oncologists.RC and SDM were measured using two observer-based measures, that is, the RC content (RCC) tool (scale 0-2) and the OPTION-5 instrument (scale 0-100). We used CollaboRATE questionnaire (scale 0-10) and a self-developed survey to assess patient-reported RC and SDM. In part B, we evaluated physicians' attitudes regarding the use of the MAPPING application to support RC. Patients were minimally involved in the decision-making process (OPTION-5 25.9%±13.4 RCC 0.21±0.18). Patient-reported SDM was high (mean collaboRATE score 9.19±1.79) and patients preferred receiving numeric information, whereas most physicians used qualitative risk terms rather than exact numbers. In part B, gynaecologists had a positive attitude towards the MAPPING application. However, they stated that the app was difficult to use improvement of layout and better implementations are needed.

Multiple sclerosis and identity: a mixed-methods systematic review

PURPOSE

This systematic review addressed the following topics: (1) psychometric measures used to evaluate the identity/self in MS patients; (2) impact of MS on the identity/self of patients; (3) relationships between the identity/self and the adjustment to MS.

METHOD

Five electronic databases were searched for all peer-reviewed empirical studies published up to April 2024 (PROSPERO CRD42023485972). Studies were eligible if they included MS patients and examined identity/self through quantitative, qualitative, or mixed-method study design. MMAT (Mixed Method Appraisal Tool) checklist was used to assess the quality of included studies. After conducting narrative synthesis (quantitative studies) and thematic synthesis (qualitative studies), an integration was undertaken following a convergent segregated approach.

RESULTS

Forty-three studies were included (13 quantitative, 26 qualitative, and four mixed methods). Studies used measures of "self" to refer to specific domains, and of "identity" to highlight the individual's uniqueness and continuity of experience over time. MS causes a loss of various aspects of self (physical, working, family, and social self) and identity discontinuity. Maintaining a positive self-concept and integrating MS into one's identity are associated with better adjustment to MS.

CONCLUSION

Clinicians should consider the centrality of identity redefinition for the promotion of MS patients' adjustment to the illness.

Patterns of Physical Therapy Referral and Subsequent Attendance Among Childhood Cancer Survivors with Chemotherapy-Induced Peripheral Neuropathy at a Regional Childhood Cancer Survivorship Clinic

OBJECTIVES

Childhood cancer survivors are at risk for chemotherapy-induced peripheral neuropathy (CIPN). Physical therapy (PT) improves CIPN symptoms, but little is known about survivors' PT utilization. We described characteristics of survivors with ≥ grade 2 CIPN, investigated PT referral and attendance, and described characteristics of survivors who attended and did not attend PT.

METHODS

Childhood cancer survivors <21 years old at cancer diagnosis and ≥2 years posttherapy, living in the United States, evaluated at a regional survivorship clinic were included in this retrospective analysis if they had motor CIPN. Symptomatic CIPN (≥grade 2 by Common Terminology Criteria for Adverse Events) and PT referral/attendance were tabulated. Patient characteristics from the medical record, and neighborhood characteristics (retrieved using survivors' zip code from the National Neighborhood Data Archive) were described by group.

RESULTS

Among 91 survivors with CIPN (median 17.5 years old, 8.1 years postcancer diagnosis, 45.1% female), 35 (38.5%) had ≥ grade 2 CIPN. Survivors with ≥ grade 2 CIPN were 28.6% female, and 45.7% were <13 years old. Twenty-four (68.6%) survivors with ≥ grade 2 CIPN agreed to PT referral, and 15 (42.9%) attended PT. Among survivors who attended PT, 73.3% were <13 years old. Neighborhood characteristics of survivors included median percentage of adults without a high school diploma (6.7% PT attendees, 12.5% nonattendees), median percentage of adults who are foreign-born (11.5% PT attendees, 16.4% nonattendees), and median percentage of households with an annual income of <$15,000 (3.2% PT attendees, 6.5% nonattendees).

CONCLUSIONS

While 68.6% of survivors with ≥ grade 2 CIPN were referred to PT, only 42.9% attended. Studies to better understand barriers to PT attendance and interventions to improve attendance are needed, especially in older survivors.

IMPLICATIONS FOR NURSING PRACTICE

Nurses can play a key role in survivor education and care coordination to help optimize PT attendance.

Exploring Nurse Use of Digital Nursing Technology

Technological developments and nursing shortages have become global trends. To solve the problem of shortage of healthcare professionals, technology may be used as a backup. Nurses constitute the largest working group in the healthcare system. Therefore, nurses are very important to the success of implementing digitization in hospitals. This cross-sectional study used the characteristics and adoption roles of innovation diffusion theory to understand technology use within the organization. Data were collected through structured questionnaires and open-ended questions from March 21 to May 31, 2022, in two hospitals in Taiwan. In total, 159 nurses agreed to participate in the study. The results of this study revealed that observability, simplicity, advantage, trialability, and compatibility positively improved the acceptance of digital nursing technology. In the distribution of users' innovative roles, early adopters had a significant impact on innovation characteristics and technology acceptance. Nurses in acute and critical care units perceived a greater comparative advantage and trial availability of digital nursing technology use than did those in general wards and outpatient clinics. In addition, based on user opinions and suggestions, the development of smart healthcare and the use of digital technology are expected to improve the quality of nursing care.

Non-Maleficence toward Young Kidney Donors: A Call for Stronger Ethical Standards and Associated Factors in Multidisciplinary Nephrology Teams

BACKGROUND

The rising frequency of live kidney donations is accompanied by growing ethical concerns as to donor autonomy, the comprehensiveness of disclosure, and donors' understanding of long-term consequences.

AIM

To explore donors' satisfaction with the ethical competence of multi-professional nephrology teams regarding disclosure of donation consequences to live kidney donors.

METHODS

A cross-sectional study was performed among Israeli live kidney donors who had donated a kidney in two hospitals that belonged to the Ministry of Health's Transplantation Center one year after the donation, from December 2018 to December 2020. Data collection was conducted online and through face-to-face interviews with the donors in their native language (Hebrew or Arabic).

RESULTS

Overall, 91 live kidney donors aged 18-49 years were enrolled. Of those, 65.9% were males, and 54.9% were academic donors. Among the live kidney donors, 59.3% reported that the motivation behind the donation was a first-degree family member vs. 35.2% altruistic and 5.5% commercial. Only 13.2% reported that the provided disclosure adequately explained the possible consequences of living with a single kidney. Approximately 20% of the participants reported that the disclosure included information regarding their risk of developing ESRD, hypertension, and proteinuria. The donors reported a low mean of the index score that indicates a low follow-up by the physician after the donation (mean = 1.16, SD = 0.37). The mean GFR level was significantly lower in the post-donation period one year following a kidney donation (117.8 mL/min/1.73 m2) compared with the pre-donation period (84.0 mL/min/1.73 m2), p < 0.001.

CONCLUSION

Our findings display that donors' satisfaction with the ethical competence of multi-professional nephrology teams regarding the disclosure of donation consequences to live kidney donors is low. This study indicates that donors are at an increased risk of worsening kidney functions (creatinine and GFR), and BMI. Our findings underscore the imperative to advise donors that their condition may worsen over time and can result in complications; thus, they should be monitored during short and long-term follow-up periods. This study was not registered.

The relationship between hope level and self-management behaviors in Chinese patients with type 2 diabetes mellitus: a chain-mediated role of social support and disease perception

BACKGROUND

Type 2 diabetes mellitus is a chronic disease and one of the fastest- growing global health emergencies of the 21st century. The relationships between hope level, social support, disease perception, and self-management behaviors are still unclear. Therefore, this study aimed to create a structural equation model to investigate the underlying mechanisms of self-management behaviors in patients with type 2 diabetes mellitus and provide a theoretical basis for future interventions.

METHODS

By using cross-sectional studies and convenience sampling methods. A survey was conducted from June 2023 to April 2024 on 404 patients with type 2 diabetes mellitus at the First and Third Hospitals of Jinzhou Medical University. Data were collected using scales, including the General Information Questionnaire, the Herth Hope Scale, the Social Support Rating Scale, the Brief Disease Perception Questionnaire, and the Diabetes Self-Management Behavior Scale. Data were analyzed using descriptive analysis, Harman's one-way analysis of variance, Pearson's correlation test, structural equation modeling, and the bootstrap method to verify mediating effects.

RESULTS

Correlation analyses showed that all four variables were significantly correlated with each other (p < 0.01). Social support had the strongest correlation with self-management behavior (β = 0.554, p < 0.01), followed by hope level (β = 0.543, p < 0.01), and disease perception (β = -0.505, p < 0.01). The structural equation model indicated a strong overall fit (χ2/df = 3.378, GFI = 0.926, CFI = 0.924, IFI = 0.925, TLI = 0.903, RMSEA = 0.077).

CONCLUSION

Overall, the chain mediation of social support and disease perception was significant. In developing targeted intervention strategies, future research should prioritize enhancing hope, optimizing social support, and reducing negative perceptions of disease by patients as key areas of focus. At the same time, strengthening self-management abilities and health behaviors in patients with type 2 diabetes should not be neglected.

Effect of a context-specific health education intervention on knowledge of health risk behaviors among adolescents in Nigerian public and private secondary schools: a comparative study

OBJECTIVES

Health education programmes that utilizes multicomponent classroom teaching strategies have the potential to enhance knowledge, attitudes, and actions of adolescents concerning health risk behaviors (HRBs). This study assessed the effect of a school-based context-specific health education intervention (CsHEI) on knowledge of HRBs among in-school adolescents in public- and private-owned secondary schools in Nigeria.

METHODS

In-school adolescents were recruited into this quasi-experimental study using stratified random sampling from secondary schools in Ile-Ife, Osun-State, Nigeria. Knowledge of HRBs was assessed pre- and post-implementation of a CsHEI. The intervention was a four-week instructor-led health education class on HRBs, delivered over a 2-h class activity per week. Data was summarized using descriptive statistics as well as Inferential statistics.

RESULTS

With a mean age of 14.9 ± 1.56 years, a total of 145 females (54.3 %) and 122 males (45.7 %) participated in this study. Over 70 % of the participants had good knowledge of HRBs prior to the intervention with the pre-test mean general knowledge of HRB (t=-3.13, p=0.002) and knowledge of personal safety (t=-2.99, p=0.003) being significantly lower between students in public-schools compared to their private-school counterparts. Post-intervention, a significant improvement in participants' knowledge was observed in all HRB domains with over 90 % of participants having a good knowledge of HRBs.

CONCLUSIONS

The CsHEI improved knowledge of in-school adolescents in public- and private-owned secondary schools in Osun state, Nigeria in all domains of HRBs. Integrating the CsHEI with other health behavioral change strategies can mitigate prevalence of HRBs among adolescents, thereby improving health-outcomes and well-being of adolescents.

Effect of Mindfulness Intervention on Compassion Fatigue Among Nurses: A Randomized Controlled Trial Study

Compassion fatigue is a syndrome defined by both mental and physical restlessness. Mindfulness intervention can enhance one's emotions with nonjudgmental awareness and greater consciousness of thoughts and feelings. This study aims to examine the effect of mindfulness intervention on compassion fatigue among nurses. A randomized controlled trial was conducted, recruiting 100 nurses from three hospitals and dividing participants into an intervention and a control group. Increased mindfulness awareness was found in the comparison group in the research. The intervention group's mean burnout level was significantly lower than the comparison group. Age, gender, marital status, household size, and household income were among the sociodemographic factors that significantly correlated with compassion fatigue, which was determined through burnout and secondary traumatic stress. Nurses reported significant levels of compassion fatigue; however, this was significantly decreased through mindfulness intervention.

The effect of social skills-based blended education on social adjustment, self-esteem and social skills among new nursing students: An experimental study

INTRODUCTION

Social adjustment, self-esteem and social skills may influence students' professionalization and academic success. The aim of this study was to determine the effect of a social skills-based blended education on the social adjustment, self-esteem and social skills of new nursing students.

METHODS

First-year undergraduate nursing students in Tehran, Iran, participated in this experimental study in 2023. Participants were selected from two classrooms, one as a control group (26 people) and the other as an intervention group (26 people). The study instruments included the California Personality Test, the Coopersmith Self-Esteem Inventory and the Teenage Inventory of Social Skills. The social skills-based blended education was delivered in 10 sessions of blended education (traditional and virtual education). Data were collected at three stages including baseline, immediately and one month after the intervention. A significance level of 0.05 was used.

RESULTS

According to the results, the average score of social adjustment and social skills of the students in the intervention group increased significantly from baseline to one month after the intervention (P < 0.001). In the control group, this variable did not increase significantly. The results of the two-way repeated measures ANOVA (comparing the effect of time and group) showed that social skills-based blended education can improve the overall average score of students' social adjustment and social skills (P < 0.001 and P = 0.01 respectively), but it had no significant effect on their self-esteem.

CONCLUSION

The findings can be used by managers and educational planners to design and implement social skills-based blended education in order to improve the social adjustment and social skills of new nursing students.

Impact of activity limitations due to fear of falling on changes in frailty in Korean older adults: a longitudinal study

This study investigated the frailty change patterns among Korean older adults during 2006-2020 and the effect of activity limitations induced by the fear of falling (FOF) on these patterns. We employed a descriptive longitudinal design utilizing data from Waves 1 to 8 of the Korean Longitudinal Study of Aging. The exclusion criteria were a baseline age < 65 years, frailty index (FI) captured only at baseline, and death or unknown survival status. Multilevel modeling, combining regression equations at two levels, was used to examine the effect of activity limitations due to FOF on frailty, adjusting for other confounding factors. An increase in FI (1.97; p < .001) was demonstrated in participants who had experienced falls versus those who had not in the past 2 years. Notably, those facing activity limitations due to FOF exhibited a more significant increase in FI (4.62; p < .001) compared with those without; frailty progression intensified over time in the former (0.54, p < .001). Activity limitations due to FOF had a more pronounced impact on frailty than falls; moreover, these activity limitations accelerated the progression of frailty. Healthcare providers must prioritize addressing FOF by employing both physical and psychological interventions to mitigate activity limitations and ultimately decelerate frailty.

Posttraumatic growth and its associations with perceived stress and core beliefs in women after traumatic childbirth during the COVID-19 pandemic

BACKGROUND

The COVID-19 pandemic added new challenges and stressors to the childbirth period, potentially increasing the risk of traumatic childbirth experiences. There is little known about posttraumatic growth (PTG) in a childbearing population. This study describes PTG in women after traumatic childbirth during the COVID-19 pandemic and its association with sociodemographic, birth-related characteristics, traumatic childbirth events, perceived stress, and core beliefs, as well as explores what factors predict PTG.

METHODS

A cross-sectional study was conducted with 202 women who self-identified as having experienced traumatic childbirth. Measures included sociodemographic and birth-related characteristics, traumatic childbirth events, self-reported stress during childbirth, the PTG Inventory, and the Core Beliefs Inventory (CBI).

RESULTS

Perceived stress at the time of birth was very high in 70% of the respondents. CBI showed moderate disruption of core beliefs. 41.6% of mothers indicated substantial PTG. Education and type of birth were related to perceived stress levels; higher disruption of core beliefs was observed in individuals who experienced perineal trauma and lack of partners' presence during childbirth, and higher disruption of core beliefs was positively associated with PTG. Predictive models showed that perceived stress had a minimal effect, while the disruption of core beliefs showed a significant positive association with PTG.

CONCLUSION

Traumatic childbirth experiences during the COVID-19 pandemic were positively related to PTG. Health professionals should create an environment where women can explore their feelings and emotions. Changes in current practices are also necessary as cesareans have been shown to be highly associated with high levels of perceived stress.

Assessment of Nursing Workload and Complexity Associated with Oncology Clinical Trials: A Scoping Review

OBJECTIVES

Clinical trials (CTs) play a crucial role in advancing medical knowledge and patient care but are increasingly complex and resource-intensive. This scoping review aims to explore the current approaches for evaluating workload (WL) in oncology CTs and identify tools for measuring clinical research nurses' WL.

METHODS

The search was conducted through MEDLINE, Scopus, CINAHL, and COCHRANE databases and carried out through the framework developed by Arksey and O'Malley and revised by the Joanna Briggs Institute. Data extraction and synthesis were performed to analyze instruments used for WL assessment and their dimensions.

RESULTS

Of the 1,005 records identified, 12 meet the inclusion criteria. The complexity and WL associated with CTs can be attributed to five main domains: (1) protocol, (2) single case, (3) data management, (4) regulatory, and (5) worker-related. These instruments varied in their approaches, scoring systems, and domains assessed. Notably, the protocol-related domain was prevalent across most instruments, highlighting its importance in WL evaluation. Furthermore, findings revealed a wide range of WL scores across different studies, emphasizing the complexity and variability in WL management within CTs.

CONCLUSIONS

This scoping review underscores the importance of evaluating WL in CTs and provides insights into existing tools and approaches. Nurses, as integral members of clinical research teams, bear significant responsibilities in trial management, necessitating a balanced approach to WL allocation. Future research should focus on validating and standardizing assessment tools to optimize resource allocation and enhance research efficiency in CT centers.

IMPLICATIONS FOR NURSING PRACTICE

Understanding WL dynamics in CTs is essential for nurses involved in research delivery. By utilizing validated WL assessment tools, nurses can advocate for appropriate staffing levels and promote efficient trial management, ultimately improving patient outcomes and research quality in CT settings.

Challenges of distance learning encountering nursing students after the COVID-19 pandemic: a study from the Middle East

BACKGROUND

The COVID-19 pandemic necessitated an abrupt transition to online learning in nursing education, presenting unprecedented challenges. This research aims to comprehensively assess the challenges faced by nursing students during this transition, exploring key issues, recommending strategies, and analyzing their impact on student perceptions.

METHODS

Using a cross-sectional design, the study surveyed 941 nursing students across eight Arab countries-Jordan, Iraq, Lebanon, Palestine, Oman, KSA, UAE, and Egypt-to ensure a representative sample and enhance external validity. Data collection involved a thorough survey covering academic, technological, and administrative challenges. Reliability analysis, descriptive statistics, and variance analysis using Kruskal -Wallis and Mann-Whitney tests were conducted to examine differences between countries and sociodemographic variables.

RESULTS

Descriptive statistics revealed significant demographic disparities. Single individuals in Jordan and those with lower family income in Palestine and Lebanon reported notably higher challenges. Female students in Iraq and Lebanon perceived greater challenges compared to males. Students pursuing diplomas in Jordan and bridging programs in Lebanon faced elevated difficulties. Governmental university students in Lebanon and private university students in Jordan encountered distinct challenges. Lack of available internet was particularly challenging in Jordan and Lebanon, whereas students using tablets in Lebanon and laptops in Palestine reported heightened challenges. Economic disparities, notably in family income, further hindered engagement with online learning materials. Across countries, academic challenges included managing coursework and accessing resources, exacerbated by administrative inefficiencies, especially in Palestine and Lebanon. Students in the UAE reported fewer challenges, facilitated by robust internet infrastructure and comprehensive institutional support.

CONCLUSION

This study provides critical insights into the challenges faced by nursing students during the Middle East's online learning transition. Key challenges encompass technological issues, academic workload, and administrative inefficiencies, with significant disparities across countries. The findings underscore the urgent need for targeted interventions, particularly in Palestine, to enhance online learning experiences. Policymakers and educational institutions can leverage these insights to advocate for student-centric approaches and policy development aimed at improving online learning across the region.

Psychological Distress and the Needs of Family Members of Critically Ill Patients in Emergency Departments During the COVID-19 Pandemic: A Cross-Sectional Study

INTRODUCTION

The literature highlights the importance of the needs of family members of critical patients in emergency departments. Understanding these needs helps to alleviate psychological distress and contribute to the patients' recoveries. This study aimed to examine the psychological distress and needs of family members of critical patients in emergency departments.

METHODS

A cross-sectional design was used to collect data using the Depression, Anxiety, and Stress Scale-21, the Critical Care Family Needs Inventory for the Emergency Department, and the Needs Met Inventory questionnaire from a convenience sample of 170 family members of critical patients. Descriptive analysis and importance-performance analysis were applied to analyze the data.

RESULTS

The results showed that 52.4% of family members reported mild to extremely severe levels of depression, 60% reported mild to extremely severe levels of anxiety, and 53.5% had mild to extremely severe levels of stress. Anxiety showed a significant negative correlation with comfort needs (r = -0.17) and support needs being met (r = -0.16). The importance-performance analysis showed that the coordinates for support needs were in quadrant IV, signifying a higher level of importance perceived by family members but a lower level of the needs being met.

CONCLUSION

Providing the assessment and necessary support to alleviate psychological distress will help enhance the ability of the emergency department to meet families' needs.

Prevalence of plagiarism in hijacked journals: A text similarity analysis

BACKGROUND

The study examines the prevalence of plagiarism in hijacked journals, a category of problematic journals that have proliferated over the past decade.

METHODS

A quasi-random sample of 936 papers published in 58 hijacked journals that provided free access to their archive as of June 2021 was selected for the analysis. The study utilizes Urkund (Ouriginal) software and manual verification to investigate plagiarism and finds a significant prevalence of plagiarism in hijacked journals.

RESULTS

Out of the analyzed sample papers, 618 (66%) were found to contain instances of plagiarism, and 28% of papers from the sample (n = 259) displayed text similarities of 25% or more. The analysis reveals that a majority of authors originate from developing and ex-Soviet countries, with limited affiliation ties to developed countries and scarce international cooperation in papers submitted to hijacked journals. The absence of rigorous publication requirements, peer review processes, and plagiarism checks in hijacked journals creates an environment where authors can publish texts with a significant amount of plagiarism.

CONCLUSIONS

These findings suggest a tendency for fraudulent journals to attract authors who do not uphold scientific integrity principles. The legitimization of papers from hijacked journals in bibliographic databases, along with their citation, poses significant challenges to scientific integrity.

Translating Open-Ended Questions in Cross-Cultural Qualitative Research: A Comprehensive Framework

INTRODUCTION

Globalization has increased the importance of multicultural research to address health disparities and improve healthcare outcomes for underrepresented communities. The International Nursing Network for HIV Research (The Network) serves as a platform for researchers to collaborate on cross-cultural and cross-national HIV studies. This article discusses the Network's approach to overcoming barriers in multicultural and multinational research in a qualitative context.

METHODS

The network created a protocol to guide decision-making throughout the translation process of qualitative data collected from participants in their native languages. The protocol includes aspects of why, when, what, who, how, where, and by what means the translation is completed.

RESULTS

The protocol has allowed researchers to enhance the validity, reliability, and cultural sensitivity of translation process, ensuring the clarity and impact of their research findings.

DISCUSSION

Rigorous translation practices promote cross-cultural understanding and respect for participants' perspectives, fostering global collaborations and knowledge exchange.

The Adolescent Insomnia Questionnaire: the Turkish validity and reliability study

OBJECTIVE

This study aimed to evaluate the Turkish validity and reliability of the Adolescent Insomnia Questionnaire.

METHODS

The study was carried out with 265 adolescents. Data were collected with the Adolescent Insomnia Questionnaire and the Cleveland Adolescent Sleepiness Questionnaire. Exploratory factor analysis and confirmatory factor analysis were used to analyze the construct validity of Adolescent Insomnia Questionnaire. The scale reliability was tested using test-retest, Cronbach's α test, Pearson correlation analysis, and inter-item correlation analysis.

RESULTS

The Cronbach's α coefficients were found to be above 0.80 for all sub-dimensions and the total scale. Correlations between Adolescent Insomnia Questionnaire and Cleveland Adolescent Sleepiness Questionnaire scores were positively highly significant. The test-retest correlation analysis of Adolescent Insomnia Questionnaire was 0.675. The results of confirmatory factor analysis were χ2/df=2.861, comparative fit index=0.966, incremental fit index=0.966, Tucker-Lewis index=0.956, normed fit index=0.949, root-mean-square error of approximation=0.084. The suitability of the data for exploratory factor analysis was evaluated with Bartlett's test of sphericity (p<0.05), and the sample adequacy was evaluated with the Kaiser-Meyer-Olkin test (0.77).

CONCLUSION

The Adolescent Insomnia Questionnaire Turkish version is a valid and reliable tool for measuring insomnia in adolescents aged 11-18 years. Adolescent Insomnia Questionnaire is a brief, practical, self-reported, age-appropriate, easily applicable, valid, and reliable tool in Turkish. This is the first Turkish validity and reliability study of Adolescent Insomnia Questionnaire.

Describing a programme of implementation-effectiveness research on the organization and implementation of frontline nursing care delivery into diverse heath systems

AIMS

The longitudinal programme of research described in this paper seeks to generate knowledge about factors influencing the implementation of a system-level intervention, the clinical nurse leader care model, involving nurses as leaders at the frontlines of care and the outcomes achievable with successful implementation. The research programme has the following aims, (a) to clarify clinical nurse leader practice, (b) develop and empirically validate a translational model of frontline care delivery that includes clinical nurse leader practice and (c) delineate the patterns of and critical outcomes of successful implementation of the clinical nurse leader care model.

DESIGN

This programme of research follows a knowledge-building trajectory involving multiple study designs in both qualitative (grounded theory, case study) and quantitative (descriptive, correlational and quasi-experimental) traditions.

METHODS

Multiple mixed methods within a system-based participatory framework were used to conduct this programme of implementation-effectiveness research.

RESULTS

Findings are demonstrating how the clinical nurse leader care model, as a complex system-level intervention, can be implemented in diverse healthcare contexts to make a difference to patient care quality and safety. Findings also contribute to implementation science, helping to better understand the dynamic interdependencies between implementation, the interventions implemented and the contexts in which they are implemented.

CONCLUSION

Findings translate into sets of evidence-informed implementation 'recipes' that health systems can match to their specific contexts and needs. This allows health systems to take on strategies that both maximize resource impact within their existing structures and support achieving intended outcomes.

IMPLICATION

This programme of research is producing actionable implementation and outcome evidence about ways to organize nursing knowledge and practice into care models that can be successfully adopted within real-world healthcare settings to achieve safer and higher quality patient care.

The effect of preoperative education on postoperative pain and function after orthopedic surgery: A systematic review and meta-analysis

OBJECTIVES

To systematically review the effect of preoperative education on reducing postoperative pain and disability in the short-term and long-term for patients undergoing orthopedic surgery.

METHODS

Pertinent randomized controlled trials were retrieved from PubMed, Cochrane Central, Embase, Medline, Scopus and CINAHL from their inception until September 10, 2023. Two authors independently conducted study selection, data extraction, and methodological quality assessment. This review was registered in PROSPERO (CRD42023470282).

RESULTS

A total of 37 RCTs were included with 27 of them being pooled for meta-analysis. Low certainty of evidence indicated that there was a small effect of preoperative education (standardized mean difference = - 0.23, 95 % CI = [- 0.39, - 0.07], p = 0.004) or combined preoperative intervention (standardized mean difference = - 0.25, 95 % CI = [- 0.41, - 0.09], p = 0.003) on postoperative pain relief.

CONCLUSIONS

Preoperative education and combined preoperative intervention only had a short-term effect on postoperative pain relief, while they were not superior to usual care in postoperative functional recovery, either short-term or long-term.

PRACTICE IMPLICATIONS

Both preoperative education and combined preoperative intervention are effective in pain control around a week postoperatively. However, optimal contents, durations, and dose of education warrant further investigation.

Understanding nurses' perceptions of sexual health and function in people requiring haemodialysis

BACKGROUND

Sexual dysfunction is common for adults receiving chronic haemodialysis; however, renal nurses seldom discuss this topic with patients.

OBJECTIVES

This study aimed to identify renal nurses' attitudes towards providing sexual healthcare and to determine their confidence in discussing sexual dysfunction with adults who are receiving haemodialysis.

DESIGN

An online cross-sectional study.

PARTICIPANTS

Renal nurses across Australia and New Zealand (n = 65) who were members of the Renal Society of Australasia provided direct care to adults receiving haemodialysis.

MEASUREMENTS

Two questionnaires measuring (1) the frequency of sexual health discussions, levels of knowledge and competence, barriers to discussing sexual dysfunction and views on accountability (Van Ek survey) and (2) communication, practical knowledge, and attitude (sexual health educator for professionals scale) were used. Demographic characteristics were also collected.

RESULTS

Most participants were females (60%) with postgraduate qualifications (61.4%). The average nephrology nursing experience was 13.10 ± 9.14 years. Most renal nurses identified as having positive attitudes (77.2%) about providing sexual healthcare and were confident in communicating with patients about sexual concerns (42.9%), although many nurses (64.35%) rarely did so. Less than one-half (48.6%) indicated feeling competent to discuss sexual dysfunction, and less than one-third (30%) had sufficient knowledge about sexual dysfunction. Barriers were lack of practical training (74.2%) and insufficient time (57.1%). Younger nurses (≤45 years old) and male nurses were significantly more confident in discussing sexual health matters.

CONCLUSIONS

Overall, renal nurses had positive attitudes towards discussing sexual health concerns with patients however they rarely did so.

Insomnia mediates the relation between empathy and anxiety among nursing students: a latent moderated mediation model of self-compassion

BACKGROUND

Nursing students are faced with multiple challenges and have a higher probability of suffering from anxiety. The current study aims to explore the relation between empathy and anxiety, examining the mediation and moderation effects of insomnia and self-compassion, respectively.

METHODS

This study employed a convenient sampling method, recruiting 1,161 nursing students (female = 923, male = 238, Meanage = 18.37, SDage = 2.38) from three universities in China. These students completed the questionnaires online, including General Anxiety Disorder -7 (GAD-7), Jefferson Scale of Physician Empathy-Nursing student (JSPE-NS), Youth Self-rating Insomnia Scale -8 (YSIS-8), and Self-Compassion Scale (SCS). The study employed latent variable structural equation models to analyze the relation and mechanisms between empathy and anxiety. Then, the mediated role of insomnia and the moderated role of self-compassion were examined.

RESULTS

The prevalence rates of anxiety and insomnia in the current sample are 18.24% and 26.76%, respectively. The results showed that empathy could negatively predict anxiety, with a significant mediating effect of insomnia between them (B = -0.081, p < 0.05, 95% CI [-0.197, -0.063]). Additionally, it was proven that self-compassion moderated the positive relation between insomnia and anxiety. With a higher level of self-compassion, the indirect effect of empathy on anxiety through insomnia was weaker (B = -0.053, p < 0.01, 95% CI [-0.095, -0.019]). When individuals showed a lower level of self-compassion, the indirect effect of empathy on anxiety through insomnia was stronger (B = -0.144, p < 0.01, 95% CI [-0.255, -0.059]).

CONCLUSION

The analysis of this research proved that empathy was negatively related to anxiety, and insomnia served as a mediator between empathy and anxiety. Besides, the protective role of self-compassion on individuals' mental health was identified. The findings of the study suggest that the education of nursing students should highlight the significance of fostering empathy and self-compassion. The intervention on insomnia may be helpful in reducing the levels of anxiety since insomnia is a risky factor for anxiety.

What is the authentic underlying reason of childbirth worries in Turkish population?: An observational study

This study aims to determine women's childbirth worries during antenatal. The research was carried out with 532 pregnant women in the antenatal clinic in Turkey as an observational study. Sociodemographic characteristics and scores of the Oxford Worries about Labor Scale of pregnant women were evaluated quantitatively. In addition, the answers given by the pregnant women to the open-ended question were themed. Although working status and receiving antenatal education reduce the fear of childbirth, birth scenes/stories on TV or social media, birth stories in the pregnant women's friends/family, being stressed in daily life, and dysmenorrhea increase the worries about childbirth (WaC). In addition, primiparas experience more WaC than multiparas. The reasons for WaC in pregnant women were classified as birth pain, artificial pain, cesarean section/receiving anesthesia, intervention/examination, pandemic, people's thoughts/experiences, birth process/insufficiency in birth, hospital/staff, fears about the baby, complications/death, and ignorance of the birth process. The results of this study reveal that WaC is a pivotal issue for pregnant women, for which managing the labor process, labor pain and labor fear is important. The stipulation of support for pregnant women is essential to enhance labor outcomes.

Atraumatic care practice from the child and parent perspective: The case of a pediatric phlebotomy unit

PURPOSE

This study aimed to determine the effect of the child's self-selected distraction methods used during the phlebotomy procedure on the feeling of fear and pain in children and parental satisfaction.

METHODS

The study, planned as a randomized controlled trial, was conducted with 219 children aged 5-10 years and their parents in the pediatric phlebotomy unit between March and June 2023. Different distraction methods (foam balloon, stress ball, musical book) were applied to the children in the intervention group during the phlebotomy procedure. The data were analyzed with the SPSS 22.0 package program.

RESULTS

There was a statistically significant difference between the scores of the children in the intervention and control groups on the Children's Fear Scale before the phlebotomy, and on the Wong-Baker Faces Pain Rating Scale after phlebotomy according to self- and parental assessment (p < 0.05). A statistically significant difference was found between the satisfaction levels of the parents after the procedure in the intervention and control groups with the health care service provided during the phlebotomy process (p < 0.05).

CONCLUSION

Distraction methods, one of the atraumatic nursing interventions used before the phlebotomy procedure, were determined to be effective in reducing the child's fear and the pain experienced due to the procedure. The study also showed that the satisfaction of parents was positively affected by the atraumatic care provided to their children.

PRACTICE IMPLICATIONS

The atraumatic care approach should be used to prevent anxiety and fear experienced by parents and children and to reduce the child's pain.

A qualitative study on the experiences of family caregivers of children with End Stage Kidney Disease (ESKD)

BACKGROUND

Family caregivers, mostly parents, are greatly involved in the care of their children with end stage kidney disease (ESKD) globally. Yet, the experiences of these caregivers and the demands placed on them by the caregiving role have not been explored or documented in Ghana. This study explored how caregiving affects the psychological, physical, social, and spiritual well-being of family caregivers of children with end stage kidney disease (ESKD) in Ghana.

METHODS

A phenomenological approach with the purposive sampling technique was used to gather data from 12 family caregivers of children with ESKD at a pediatric renal unit in Ghana. A semi-structured interview guide was constructed based on the constructs of the City of Hope Quality of Life (QoL) Family Caregiver Model and the research objectives. Colaizzi's thematic analysis approach was utilized to analyze data for this study. Themes were organized under the domains of the chosen model, and a new theme outside these domains was also generated.

RESULTS

The majority of the family caregivers experienced anxiety, fear, uncertainty, and hopelessness in response to the children's diagnosis and care. The thought of the possibility of the children dying was deeply traumatizing for our participants. Most participants reported bodily pains and physical ailments because of lifting and caring for the children. Financial constraint was also a key issue for all the family caregivers. Most of them received diverse support from their families and loved ones. Due to the demanding nature of the care, most family caregivers had to change or quit their jobs. They coped with the challenges through prayers, participating in religious activities, and being hopeful in God for healing.

CONCLUSION

All the family caregivers had their psychological well-being compromised as a result of the challenges they encountered physically, socially, and spiritually. Continuous psychosocial support, funding support, and review of policies on leave for civil workers with children diagnosed with ESKD are urgently required.

The effect of the case-based learning approach on the level of satisfactions and learning of nursing students in Iran: A randomized controlled trial

Introduction

Nurses must have sufficient knowledge and skills in the field of medications and medication management. This study was designed to investigate the effect of the case-based learning (CBL) approach on the level of satisfaction and learning of nursing students.

Materials and methods

This study was conducted using a randomized controlled trial on 70 Iranian third-semester nursing students during a pharmacology internship in 2023. After considering the inclusion criteria, the samples were entered into the study by census method and then they were placed in either the control (35 people) or intervention (35 people) groups by simple random method. Pharmacology training was done in the control group by the usual method (lectures by the instructor and conferences with students) and in the intervention group by the Kaddoura case-based learning method. Data collection tools included a demographic questionnaire, satisfaction of educational approach questionnaire, and exam scores before and after the internship. SPSS version 26 software was used for statistical analysis.

Results

There was no statistically significant difference (P = 0.88) in the mean scores of the pharmacology pre-test in the control (10.54 ± 2.74) and intervention groups (10.6 ± 3.49) before the intervention. Also, there was no statistically significant difference (P = 0.19) between the pharmacology post-test scores in the control (17.7 ± 1.15) and intervention groups (18.07 ± 0.91). A comparison of pre-test and post-test scores in both control and intervention groups showed that the post-test scores in both groups increased significantly (P < 0.001). The results showed that the intervention group was significantly (P = 0.008) more satisfied with the learning method.

Conclusion

The case-based educational approach resulted in improved satisfaction among students in the pharmacology course. It is recommended to incorporate this learning method alongside traditional teaching methods, in nursing education, particularly in pharmacology instruction.

Nurturing ethical insight: exploring nursing students' journey to ethical competence

BACKGROUND

Ethical competence is a key competence in nursing and the development of the competence is a central part in nursing education. During clinical studies, nursing students face ethical problems that require them to apply and develop their ethical knowledge and skills. Little is known about how ethical competence evolves during students' initial clinical placements. This study explored the development of ethical competence in first-year nursing students during their first clinical placements in nursing homes.

METHODS

This exploratory-descriptive qualitative study used focus group interviews to collect data and a phenomenological hermeneutical method for analysis. Twenty-eight first-year nursing students participated in six focus groups. The data were collected between March and April 2024 at Oslo Metropolitan University in Norway.

RESULTS

The naïve reading of the data involved an awareness of the students applying their prior knowledge, modifying their prior knowledge and developing skills that allowed them to manoeuvre ethical practices that, in some cases, appeared excellent and, in other cases, grim. The structural analysis identified three themes: (i) ethical competence forges in practice, (ii) ethical competence evolves at the intersection of knowledge and skills and (iii) ethical competence unfolds through meaningful discussions. A comprehensive understanding of the data was formulated as 'Being on a journey towards ethical competence'. This presents a metaphor illustrating that nursing students embark on a journey towards ethical competence; from their point of departure, their clinical experiences forge the essential waypoints along their path, knowledge and skills fuelling their navigation in rugged terrain towards their destination.

CONCLUSIONS

Nursing students' ethical competence evolved in intricate ways during their initial clinical period. Being informed bystanders or participants in the care of nursing home residents in situations of ethical tension may be a unique position enabling students to evaluate care options differently from those immersed in the ward culture. The findings indicate that organised professional development in nursing homes needs to focus on more reflexively driven ways of supervising students in their first clinical study period. Educational institutions need to continue and further develop reflection-based learning activities and meeting points with students and their peers during their clinical placement periods.

Translation and psychometric validation of the Patient Participation Culture Tool for healthcare workers in Chinese nursing context

BACKGROUND

Promoting patient participation stands as a global priority in nursing care. Currently, there is a lack of a standardized tool to assess the culture of patient participation from the perspective of nurses in China.

AIMS

To translate and examine the validity and reliability of the Patient Participation Culture Tool for healthcare workers (PaCT-HCW) on general hospital wards in Chinese nursing context.

METHODS

A cross-sectional research study was conducted among 812 nurses. Brislin's recommendations were adhered to during the translation of the scale. Validity was assessed using construct validity, content validity, and face validity. Split-half reliability, test-retest reliability, and internal consistency reliability were used to evaluate dependability. The study was guided and reported following the STROBE checklist and recommendations for reporting the results of studies of instrument and scale development and testing.

RESULTS

The Chinese version of PaCT-HCW (the PaCT-HCW-C) exhibits good face validity and content validity. A rigorous exploratory factor analyse verified a six-factor (competence, support, perceived lack of time, information sharing and dialogue, response to questions and acceptance of a new role) scale structure with a cumulative variance contribution of the factors with 44 items of 68.840%. With a Cronbach's α coefficient of 0.962, split-half reliability of 0.866, and intraclass correlation coefficients of 0.989, the instrument demonstrates great reliability. Confirmatory factor analysis results validated the consistency of the six factors with the structure of the PaCT-HCW-C scale.

CONCLUSIONS

The 44-item PaCT-HCW-C is a valid and reliable instrument with satisfactory psychometric properties. It could serve as a tool for assessing the effectiveness of international programs aimed at fostering patient participation from the perspective of nurses, while also providing insights from China's practical experiences.

On clinical nurses' views about diversities- A qualitative study

It is a must for nurses to provide healthcare to people from diverse cultures, ethnicities, religions, and genders. This descriptive qualitative study aimed to explore nurses' approaches to various people. The study collected data via semi-structured interviews and contacted 40 nurses through snowball sampling. Most nurses were between the ages of 25-40 and female, 22 of them had postgraduate degrees, and 18 had undergraduate degrees in nursing. Only 10 of them had received special training related to diversity. MaxQda software program was used for content analyses, and four basic themes were determined respectively, "Nurses' perceptions of diversity," "Nurses' perceptions of diversity towards patients," "Nurses' perceptions of diversity towards healthcare professionals," and "Nurses' perceptions of diverse towards the institution." Participant nurses mainly revealed that although legal and organizational procedures aimed to prevent discriminative attitudes in clinical environments, discriminatory attitudes of nurses and healthcare professionals toward diverse people still occurred.

The relationship between anxiety and depression in adolescent depression patients: The mediating effect of hope level and coping modes

Background

Adolescents diagnosed with depression are particularly susceptible to anxiety and depressive symptoms, this vulnerability often diminishes their future expectations and overall outlook on life. The objective of this research was to scrutinize the associated risk factors of adolescent depression and delineated the interplay between anxiety and depressive symptoms. Concurrently, it sought to ascertain the latent mediating effects of hope levels and coping strategies within this framework.

Methods

A mixed-methods research approach was employed. For the qualitative component, 18 adolescents with depression were interviewed following a semi-structured interview guide, with sessions audio-recorded. The data were subsequently transcribed and subjected to thematic content analysis. In the quantitative phase, a cross-sectional online survey was administered to 210 adolescents diagnosed with depression using Questionnaire Star, with data analysis performed using SPSS25.0 and AMOS 24.0.

Results

The qualitative analysis identified three major themes and nine categories as key risk factors influencing the onset of adolescent depression. Three major themes were generated: school factors, family factors, and other factors. Nine categories were generated: heavy academic load, strained peer, and teacher-student relationships; unstable family structures, internal familial conflicts, and high parental expectations; a strong sense of social isolation, insufficient sexual education, and prevalent suicidal ideation or attempts. A nurturing and supportive school environment significantly bolsters adolescents' sense of hope and coping abilities, while a warm and encouraging family setting effectively mitigates psychological stress. Conversely, heightened loneliness and the onset of suicidal ideation are frequently linked to diminished hope and the adoption of maladaptive coping strategies. Hence, to comprehensively understand the intricate interplay of these factors, this study concentrated on the levels of hope and coping mechanisms, investigating their potential mediating role in adolescent anxiety and depression. Quantitative analysis revealed a positive correlation between anxiety and depression (r = 0.767, p＜0.01). Additionally, it was found that hope levels and coping strategies mediated the relationship between anxiety and depressive symptoms (β = -0.24-0.84 = 0.20, p < 0.001; β = 0.19-0.51 = -0.10, p < 0.01), with the mediating influence of hope levels being more significant than that of coping strategies.

Conclusion

Enhancing hope levels and fostering positive coping strategies are instrumental in aiding adolescents with depression to alleviate their anxiety and depressive symptoms. Moreover, this study underscored the importance of focusing on adolescents' mental health and providing them with emotional support, thereby increasing their hope levels and encouraging the adoption of positive coping mechanisms to effectively address their challenges.

Balancing confidentiality and care coordination: challenges in patient privacy

BACKGROUND

In the digital age, maintaining patient confidentiality while ensuring effective care coordination poses significant challenges for healthcare providers, particularly nurses.

AIM

To investigate the challenges and strategies associated with balancing patient confidentiality and effective care coordination in the digital age.

METHODS

A cross-sectional study was conducted in a general hospital in Egypt to collect data from 150 nurses across various departments with at least six months of experience in patient care. Data were collected using six tools: Demographic Form, HIPAA Compliance Checklist, Privacy Impact Assessment (PIA) Tool, Data Sharing Agreement (DSA) Framework, EHR Privacy and Security Assessment Tool, and NIST Cybersecurity Framework. Validity and Reliability were ensured through pilot testing and factor analysis.

RESULTS

Participants were primarily aged 31-40 years (45%), with 75% female and 60% staff nurses. High compliance was observed in the HIPAA Compliance Checklist, especially in Administrative Safeguards (3.8 ± 0.5), indicating strong management and training processes, with an overall score of 85 ± 10. The PIA Tool showed robust privacy management, with Project Descriptions scoring 4.5 ± 0.3 and a total score of 30 ± 3. The DSA Framework had a mean total score of 20 ± 2, with Data Protection Measures scoring highest at 4.0 ± 0.4. The EHR assessments revealed high scores in Access Controls (4.4 ± 0.3) and Data Integrity Measures (4.3 ± 0.3), with an overall score of 22 ± 1.5. The NIST Cybersecurity Framework had a total score of 18 ± 2, with the highest scores in Protect (3.8) and lower in Detect (3.6). Strong positive correlations were found between HIPAA Compliance and EHR Privacy (r = 0.70, p < 0.05) and NIST Cybersecurity (r = 0.55, p < 0.05), reflecting effective data protection practices.

CONCLUSION

The study suggests that continuous improvement in privacy practices among healthcare providers, through ongoing training and comprehensive privacy frameworks, is vital for enhancing patient confidentiality and supporting effective care coordination.