AIM This study tested whether the mediation model of burnout could predict nurses' turnover intentions. BACKGROUND A better understanding of what factors support a commitment to a nursing career could inform both policies and workplace practices. The mediation model of burnout provides a way of linking the quality of a nurse's worklife to various outcomes, such as turnover. METHOD Data on areas of worklife, burnout, and turnover intentions were collected by surveying 667 Canadian nurses in the Atlantic Provinces. RESULTS The findings supported the mediation model of burnout, in which areas of worklife predicted burnout, which in turn predicted turnover intentions. Cynicism was the key burnout dimension for turnover, and the most critical areas of worklife were value conflicts and inadequate rewards. CONCLUSIONS The results of this study provide some new insights into how the intention of nurses to leave their job is related to particular aspects of their worklife and to burnout. IMPLICATIONS FOR NURSING MANAGEMENT These results suggest what may be the most appropriate areas to target for interventions to reduce the risk of nurses exiting early from their chosen career.
Nabila Elsayed Sabola, Ahmed Hussien Ahmed Kotb, Hayam Labib Matter
et al.
Abstract Background Spousal emotional abuse is a serious form of maltreatment that is highly prevalent. It threatens the well-being of elderly couples and negatively impacts family functioning. Therefore, this study aimed to evaluate the impact of a rehabilitative nursing intervention for elderly victims of spousal emotional abuse on stress level, life satisfaction, and family functioning. Methods A quasi-experimental research design was used in this study, which was conducted in Estabary and Ganzor villages in Menoufia Governorate, Egypt. A purposive sample of 50 elderly couples experiencing spousal emotional abuse (50 wives and 50 husbands) was recruited. Data were collected using four tools: the Multidimensional Emotional Abuse Questionnaire, the General Functioning 12-item subscale, the Satisfaction with Life Scale, and the Stress Scale. Results The mean scores of the elderly couples for total family functioning and total life satisfaction significantly increased in the post-intervention phase (34.68 ± 5.15, 25.4 ± 3.5, respectively) compared to the pre-intervention phase (20.04 ± 4.08, 19.2 ± 3.6, respectively). Additionally, the mean scores for total emotional abuse and total stress significantly decreased in the post-intervention phase (85.2 ± 20.3, 6.7 ± 1.9, respectively) compared to the pre-intervention phase (117.7 ± 21.4, 16.2 ± 3.1, respectively). Conclusion The rehabilitative nursing intervention for elderly victims of spousal emotional abuse was effective in reducing stress levels and improving life satisfaction and family functioning. Therefore, these interventions should be implemented with support from specialized professionals and institutions.
Kazuhiro Nouso, Akiko Wakuta, Shohei Shiota
et al.
ABSTRACT Aim The gut microbiome modulates immune responses, and butyrate‐producing bacteria have been linked to improved immune checkpoint inhibitor (ICI) efficacy. Conversely, proton pump inhibitors (PPIs) may negatively impact ICI outcomes by altering gut microbiota. This study aims to elucidate their effects in hepatocellular carcinoma (HCC). Methods This retrospective multicenter cohort study included 208 HCC patients treated with durvalumab plus tremelimumab at 25 hospitals in Japan. Patients were classified into a butyric acid group (n = 27), who ingested drugs containing butyrate‐producing enterobacteria, and a non‐butyric acid group (n = 181), as well as a PPI group (n = 107) and a non‐PPI group (n = 101). Overall survival (OS) was analyzed using inverse probability of treatment weighting, and risk factors were assessed with Cox proportional hazards modeling. Tumor response was evaluated by RECIST v1.1. Results No significant OS differences were observed between the butyric acid and non‐butyric acid groups (p = 0.921), or between PPI and non‐PPI groups (p = 0.917). The objective response rate was 3.7% in the butyric acid group versus 15.5% in the non‐butyric acid group (p = 0.543) and 15.8% in the PPI group versus 12.1% in the non‐PPI group (p = 0.222). Disease control rates were comparable. Multivariate analysis identified ECOG performance status (p = 0.019) and ALBI score (p < 0.001) as independent prognostic factors, while butyrate‐producing bacteria and PPI use were not associated with survival outcomes. Conclusion Neither butyrate‐producing bacteria nor PPI use significantly influenced the efficacy of durvalumab plus tremelimumab in HCC. The liver's immunotolerant microenvironment may limit the impact of microbiome modulation on ICI efficacy.
Diseases of the digestive system. Gastroenterology
This manuscript provides critical reflections on using reporting guidelines in qualitative research and examines the tensions that arise when universal checklists are applied across diverse methodological traditions. While transparency and rigor are essential, our manuscript supports that widely adopted tools such as COREQ-32 insufficiently capture the epistemological and procedural features of certain methodologies, particularly Constructivist Grounded Theory. Drawing on existing critiques and emerging methodology-specific frameworks, we argue that rigid, sometimes unvalidated criteria could impede methodological congruence and provide limitations to report Constructivist Grounded Theory research. This reflection contributes to methodological scholarship by advocating for reporting guidance that aligns with the philosophical and methodological stance of each qualitative approach. Therefore, we call for nuanced, method-congruent standards that enhance transparency while preserving the richness, reflexivity, and flexibility that underpin excellence in qualitative inquiry.
Hiske Joanna Brouwer, Elco Buurma, Esther de Groot
et al.
Introduction: Clinician-teachers are engaged in both clinical practice and education. They positively influence student learning by connecting clinical practice and education. Most research into clinician-teacher’s dual role was performed in the clinical settings where practice and teaching are intertwined. The benefits of clinician-teachers’ dual role in the classroom-setting have been underexplored, whilst a large part of medical education is classroom-based. Using boundary work theory as a lens, this study aimed to illuminate clinician-teachers’ observable boundary spanning behavior integrating the clinical practice and medical education in the classroom. Methods: A qualitative observation study of classroom-teaching within postgraduate general practitioner specialty training at three Dutch medical institutes was conducted. Video recordings and transcripts of classroom teaching were analyzed using a structured observation schedule. Boundary spanning behavior was categorized into: boundary bridging, boundary making and boundary maintenance. Distinctions were made between verbal- and non-verbal behavior. Results: All three categories of boundary spanning behavior were observed. Clinician-teachers demonstrated boundary bridging by integrating their own clinical experiences, by normalizing students’ reported clinical experiences, by encouraging students’ sharing of clinical experiences and by encouraging students to apply theory in practice. Clinician-teachers demonstrated boundary making by accentuating discontinuities between clinical practice and educational information, and boundary maintenance by allowing transient differences to exist between the two settings for didactic reasons. Discussion: This observational study contributes to an understanding of how clinician-teachers use their experience as a clinician in classroom-teaching. These insights may contribute to faculty development fostering boundary-spanning teaching practices.
Robin L. Whitney, Melissa Gosdin, Sabrina F. Loureiro
et al.
Abstract Background The COVID-19 pandemic caused profound and rapid changes in patient care and healthcare system organization. There is a compelling need for insight into the challenges that confronted physicians during the early phase of the pandemic to identify successful adaptations and strategies that minimize disruption to patient care and protect clinician wellbeing. The purpose of this study was to understand physicians’ lived experiences of providing patient care during the early COVID-19 pandemic. Methods This qualitative, descriptive study used a thematic analysis approach. The sample included 17 physicians from five specialties with direct care experience of COVID-19 patients (infectious disease, primary care, emergency medicine, critical care, and hospitalists). Participants were identified through snowball sampling. Data were collected through focus groups and interviews in May and June 2020 and analyzed with an inductive and deductive approach using thematic analysis. Results Three overarching themes relating to patient care delivery during the ongoing COVID-19 pandemic were identified: facilitators, barriers, and acute stressors. Facilitator subthemes included: organizational logistical and operational support, organizational support for self-care and wellness, and peer and family support/debriefing. Barrier subthemes included: lack of clear and consistent governmental guidelines and organizational support, uncertainty resulting from poor communication or lack of information, and interpersonal barriers to physician self-care and wellbeing. Stressor subthemes included: concern about exposure, feeling unprepared, and anticipating the worst. Conclusions Physicians reported that both patient care and their own wellbeing were greatly impacted by organizational and systems level facilitators and barriers. Findings from this study can inform the creation of best practices, tools, and strategies that can assist with future emergency preparedness and pandemic response planning efforts.
Objetivo: validar a escala de fatores de evasão em cursos de graduação em Enfermagem. Método: estudo psicométrico de validação de propriedades psicométricas. A amostra foi constituída por 315 estudantes dos cursos de graduação em Enfermagem de três universidades públicas do Sul do Brasil. A coleta de dados ocorreu em agosto e setembro de 2021, após a aprovação do Comitê de Ética. Foram realizadas análises fatoriais exploratória e confirmatória, com obtenção de solução tetrafatorial, com cargas fatoriais (chr(38)gt;0,400). Resultados: foram identificados quatro fatores: problemas de saúde e da experiência acadêmica; sobrecarga de atividades e falta de recursos econômicos; necessidade de reorganização familiar; e processo de ensino-aprendizagem. O instrumento apresentou consistência interna e externa satisfatórias com alfa de Cronbach de 0,93. Conclusão: a escala utilizada é um instrumento válido e fidedigno para ser utilizada na avaliação dos motivos que podem levar os estudantes do curso de graduação em Enfermagem à evasão
Grant M. Tinsley, Kyung-Shin Park, Catherine Saenz
et al.
BackgroundTo date, body composition assessments in Hispanics, computed via bioimpedance devices, have primarily focused on body fat percent, fat mass, and fat-free mass instead of total body water (TBW). Additionally, virtually no information is available on which type of bioimpedance device is preferred for TBW assessments in Hispanic populations.PurposeThe purpose of this study was to validate two bioimpedance devices for the estimate of TBW in Hispanics adults when using a criterion deuterium oxide (D2O) technique.MethodsOne-hundred thirty individuals (males: n = 70; females: n = 60) of Hispanic descent had TBW estimated via D2O, single-frequency bioimpedance analysis ([SF-BIA] Quantum V, RJL Systems) and bioimpedance spectroscopy ([BIS] SFB7 Impedimed).ResultsThe mean values for SF-BIA were significantly lower than D2O when evaluating the entire sample (37.4 L and 38.2 L, respectively; p < 0.05). In contrast, TBW values were not statistically significant when comparing D2O against BIS (38.4 L, p > 0.05). Bland–Altman analysis indicated no proportional bias when evaluating the entire sample for SF-BIA or BIS. The standard error of estimate and total error values were ≤ 2.3 L and Lin’s concordance correlation coefficient were ≥ 0.96 for all comparisons.ConclusionThe SF-BIA and BIS devices evaluated in the current study hold promise for accurate estimation of TBW in Hispanic adults. While both methods demonstrated relatively low errors relative to the D2O criterion, BIS exhibited a more consistent performance, particularly at the group level. These findings provide essential information for researchers and clinical nutrition practitioners assessing TBW in Hispanic adults.
Bailey M. DeBarmore, Jessica K. Zègre-Hemsey, Anna M. Kucharska-Newton
et al.
Background: Our objective was to describe characteristics of patients presenting with and without ischemic pain among those diagnosed with acute myocardial infarction (MI) using individual-level data from the Atherosclerosis Risk in Communities Study from 2005 to 2019. Methods: Acute MI included events deemed definite or probable MI by a physician panel based on ischemic pain, cardiac biomarkers, and ECG evidence. Patient characteristics included age at hospitalization, sex, race/ethnicity, comorbidities (smoking status, diabetes, hypertension, history of previous stroke, MI, or cardiovascular procedure, and history of valvular disease or cardiomyopathy) and in-hospital complications occurring during the event of interest (pulmonary edema, pulmonary embolism, in-hospital stroke, pneumonia, cardiogenic shock, ventricular fibrillation). Analyses were stratified by MI subtype (STEMI, NSTEMI, Unclassified) and patient characteristics and 28-day case fatality was compared between MI presenting with or without ischemic pain. Results: Between 2005 and 2019, there were 1711 hospitalized definite/probable MI events (47 % female, 26 % black, and age of 78 [6.7 years]). A smaller proportion of STEMI patients presented without ischemic pain compared to NSTEMI patients (20 % vs 32 %). Race, sex, age, and comorbidity profiles did not differ significantly across ischemic pain presentations. Patients presenting without ischemic pain had a higher 28-day all-cause case fatality after adjusting for age, race, sex, and comorbidities. However, after further adjustment, time from symptom onset to hospital arrival, time to treatment, and in-hospital complications explained the difference in 28-day case fatality between ischemic pain presentations. Conclusions: Future research should focus on differences in treatment delay across ischemic pain presentations rather than sex differences in acute coronary syndrome presentation.
Diseases of the circulatory (Cardiovascular) system
Razieh Zahedi, Leila Nemati-Anaraki, Shahram Sedghi
et al.
Background & Aim: Patient decision aids are detailed and personalized health education materials that assist patients in decision making. According to expert viewpoints, this study aimed to determine important factors in implementing the prenatal screening decision aid in Iran.
Methods & Materials: In this qualitative study, 24 experts, including seven obstetricians, four information scientists, five managers or policymakers, and eight midwives, were selected using purposive and snowball sampling approaches. Semi-structured interviews were conducted to collect the data between January 2020 and June 2020 in Tehran, Iran. A prenatal screening decision aid was presented to the participants, and we asked them to raise their concerns and thoughts regarding the factors influencing the implementation of patient decision aids. We used MAXQDA 10 and applied conventional content analysis for data analysis.
Results: Two organizational and personal factors themes were identified to implement Iran's prenatal screening decision aids.
Conclusion: We identified the viewpoints of experts regarding major factors in patient decision aids implementation for prenatal screening. Before implementing prenatal screening decision aids in Iran, it would be helpful to consider these organizational and personal factors. Prenatal screening decision aids can provide better information for pregnant women and strengthen their decision-making ability.
With people's increasing demand for disease prevention and management, Traditional Chinese Medicine(TCM) nursing clinics have attracted widespread attention for their unique advantages, but there are some problems in TCM nursing clinics, such as weak foundation of TCM , poor communication between nurses and patients, and poor coordination between doctors and nurses. In order to further simplify the treatment process, solve existing problems, increase data sharing, and promote the communication and cooperation between medical staff and patients, our hospital has developed an intelligent auxiliary diagnosis system through the integration of "Internet + technology" and TCM nursing. It has been applied to the operation of TCM nursing outpatient clinics, and achieved good results. The auxiliary diagnosis system is supported by classical Chinese medical literature and has two service ports, which are divided into medical and nursing ports and patient ports. Medical staff can realize medical record management, differential nursing, treatment management and effect evaluation through the medical ports, and patients can make appointments for treatment time and beds, receive remote health guidance and view medical records through the patient ports. Intelligent auxiliary diagnosis system constructs in-depth TCM nursing outpatient information system from big data intelligent diagnosis, dominant disease diagnosis and treatment scheme, doctor-patient interaction tracking, and result evaluation and analysis. TCM nursing informationization can assist nurses to carry out differential nursing and provide more optimized TCM nursing programs for patients, thereby improving the operation efficiency of TCM nursing practice. Innovation of TCM nursing management mode can provide better TCM nursing service for patients. (随着人们对疾病的预防与管理的需求不断增加, 中医护理门诊以其独特优势得到大众的广泛关注, 但中医护理门诊存在人员中医基础薄弱、护患沟通不畅、医护不协同等问题。 为了进一步简化就诊流程, 解决现存问题, 增加数据共享, 促进医护患三者之间的交流与合作, 本院通过“互联网＋”技术与中医护理贯通融合开发了智能辅诊系统, 并将其应用于中医护理门诊的运行, 并取得良好的成效。该辅诊系统以中医经典古籍文献为底层支撑, 共设置有两个服务端口, 分为医护端和患者端。医护人员通过医护端能够实现病案管理、辨证施护、治疗管理、效果评估, 患者通过患者端可以预约就诊时间和床位、接受远程健康指导、查看就诊病历。智能辅诊系统从大数据智能诊断、优势病种诊疗方案、医患交互跟踪、结果评估分析, 深入建设中医护理门诊信息系统。中医护理信息化能够辅助护理人员进行辨证施护, 为患者提供更加优化的中医护理方案, 从而提高中医护理实践工作的运行效率。创新中医护理管理模式能够为患者提供更优质的中医护理服务。)
Abstract Background Although some previous studies have reported the impact of cultural factors on individuals’ cognition and decision making, a shortage of research has led to this comparison study for Chinese and Korean elderly, a growing population with depression. This study aimed to explore depression levels in Chinese and South Korean elderly individuals by focusing on testing the generalizability of the Geriatric Depression Scale (GDS). Methods The data of 493 community-dwelling Chinese and Korean elderly individuals over the age of 60 years were used to examine GDS. To test the dimensionality, item quality, and reliability of the GDS, the item response theory, Rasch analysis was performed. The detection of differential item functioning (DIF) of the GDS between the two countries was determined by performing a hybrid ordinal logistic regression. Results The four-dimensional framework of the GDS, categorized into agitation, cognitive concerns, dysphoria, and vigor/withdrawal was fit for measuring depression levels in Chinese and Korean elderly individuals. In addition, good item quality and reliability of the GDS indicate that almost all items in this scale contribute to measuring the intended trait. Meanwhile, 18 out of 28 items of the GDS were detected as country-related DIF with five items having a large effect size. Conclusions Although China and Korea are close geographically and culturally, the item bias shown by severe country-related DIF implies that different cultural backgrounds impact how the elderly interpret GDS items. The cultural issues related to the specific DIF items, the implication to accuracy of individual scores estimation, and the optimal decision to treat individuals were discussed.
Background: Providing care for patients in Persistent Vegetative State (PVS) by family caregivers without enough training and knowledge may be problematic both for the patients and for the caregivers. Therefore, the present study tries to explain the experiences of family caregivers of patients with PVS of seeking information needed to provide adequate care. Materials and Methods: Twenty two participants, including 17 family caregivers and 5 professional caregivers were enrolled by purposive sampling into this qualitative content analysis study, carried out between 2013 and 2015. Unstructured interviews and field notes were used to gather the data. Data collection was stopped when data saturation was achieved. Data analysis was performed by content analysis based on Graneheim and Lundman's approach. Results: As a result of the analysis of the collected data a main theme emerged labeled as “Seeking constructive education” with three categories including “Neglected requisite education,” “Greedy search for useful education” and “Dynamic independence in care.” Conclusions: In this study, information seeking by family caregivers of patients with PVS was constructive. Family caregivers insistently sought needed information from various sources. Ultimately, they found these insistent efforts beneficial and fruitful, because their efforts made them independent in providing care for their patients.
Oliva Bazirete, Manassé Nzayirambaho, Aline Umubyeyi
et al.
Abstract Background Reduction of maternal mortality and morbidity is a major global health priority. However, much remains unknown regarding factors associated with postpartum hemorrhage (PPH) among childbearing women in the Rwandan context. The aim of this study is to explore the influencing factors for prevention of PPH and early detection of childbearing women at risk as perceived by beneficiaries and health workers in the Northern Province of Rwanda. Methods A qualitative descriptive exploratory study was drawn from a larger sequential exploratory-mixed methods study. Semi‐structured interviews were conducted with 11 women who experienced PPH within the 6 months prior to interview. In addition, focus group discussions were conducted with: women’s partners or close relatives (2 focus groups), community health workers (CHWs) in charge of maternal health (2 focus groups) and health care providers (3 focus groups). A socio ecological model was used to develop interview guides describing factors related to early detection and prevention of PPH in consideration of individual attributes, interpersonal, family and peer influences, intermediary determinants of health and structural determinants. The research protocol was approved by the University of Rwanda, College of Medicine and Health Sciences Institutional Ethics Review Board. Results We generated four interrelated themes: (1) Meaning of PPH: beliefs, knowledge and understanding of PPH: (2) Organizational factors; (3) Caring and family involvement and (4) Perceived risk factors and barriers to PPH prevention. The findings from this study indicate that PPH was poorly understood by women and their partners. Family members and CHWs feel that their role for the prevention of PPH is to get the woman to the health facility on time. The main factors associated with PPH as described by participants were multiparty and retained placenta. Low socioeconomic status and delays to access health care were identified as the main barriers for the prevention of PPH. Conclusions Addressing the identified factors could enhance early prevention of PPH among childbearing women. Placing emphasis on developing strategies for early detection of women at higher risk of developing PPH, continuous professional development of health care providers, developing educational materials for CHWs and family members could improve the prevention of PPH. Involvement of all levels of the health system was recommended for a proactive prevention of PPH. Further quantitative research, using case control design is warranted to develop a screening tool for early detection of PPH risk factors for a proactive prevention.
Nutritional therapy, also known as clinical treatment is an important component of modern treatment of patients in each of the Polish hospital wards. It includes nutritional assessment, evaluation nutritive requirements and nutritive, an adequate supply of proteins, fats, electrolytes, trace elements and water, taking advantage of the way the gastrointestinal tract, or by intravenous administration [4,5]. In Poland in the Regulation of the Minister of Health of 15 September 2011, the assessment of the nutritional status of the patient, taken on the hospital ward is mandatory excluding patients from emergency departments [6,7,8]. Malnutrition is a disease of multifactorial etiology, in the diagnosis, which plays a very important role cooperation of the whole therapeutic team - nutrition. The nurse, as a member of the team, plays an essential role in the prevention and diagnosis of malnutrition in patients staying in intensive care. Nursing staff, the first to have direct contact with patients, exercising care over him. Direct contact and careful observation, to allow diagnosis of early symptoms of malnutrition [10].
Keywords: malnutrition, nurse, prevention
Mina Behzadi, Maryam Rassouli, Leila Khanali Mojen
et al.
Background: Posttraumatic growth resulting from a stressful factor such as the diagnosis and treatment of cancer can positively affect various aspects of a mother’s life as the child’s main caregiver. The present study aims to determine the level of posttraumatic growth in the mothers of the children with cancer.
Methods: In the present descriptive study, the statistical population consisted of the mothers of the children with cancer referring to oncology clinics or hospitalized in the oncology departments of selected hospitals from June 2016 to October 2016. The samples included 180 eligible mothers selected by convenient sampling. The data were collected using “Posttraumatic Growth Inventory” (PTGI) that determines the psychological growth following exposure to traumatic events with 21 items in 5 domains of new possibilities, relationship with others, appreciation of life, personal strength, and spiritual changes and scored by 6-point Likert scale, ranging from 0 to 105; the higher scores indicate greater growth. The data were analyzed in SPSS-20 using descriptive and inferential statistical tests.
Results: The mean age of the participating mothers was 34±5.3, 83.3% of whom were housewives. The majority of the children suffered from leukemia, and cancer onset age was between 3 and 6 in 33.9% of the children. The mothers’ mean score of posttraumatic growth was 62.4±18.9, and the highest percentage of scores in various dimensions belonged to “spiritual change” (3.59), “appreciation of life” (3.04), and “relating to others” (3.02).
Conclusion: Results showed that the experience of having a child with cancer can lead to posttraumatic growth in mothers
francisca jessica lima dos santos costa, joseneide teixeira camara, Kelly Rodrigues Costa
et al.
Objetivo: Avaliar a assistência pré-natal na perspectiva da integralidade. Metodologia: Trata-se de um estudo avaliativo cujo objeto é a integralidade da assistência pré-natal, com foco na dimensão da organização dos serviços, onde foram analisadas duas dimensões. Participaram da pesquisa, profissionais que atuavam diretamente na assistência pré-natal e os gestores de saúde nesse âmbito. Resultados: Foram analisadas as dimensões garantia de recursos e modelo de vigilância em saúde e a partir das respectivas notas foi possível obter a nota da gestão onde respectivamente foram obtidas notas consideradas regulares(1° dimensão 7,3, 2° dimensão 5,4 nota da gestão6,5).Conclusão: Infere-se para este município no que tange a assistência pré-natal que são necessárias intervenções nesta área para alcançar um padrão de qualidade pautado na integralidade, a gestão municipal precisa prover os recursos necessários para que se tenha uma assistência mais estruturada. Descritores: Assistência pré-natal, Integralidade em saúde, Avaliação de programas.