Clinical Nursing Research

The purpose of this study was to explore the relationship between the metabolic syndrome severity Z-score and kidney function by gender. We also examined the estimated glomerular filtration rate in relation to other known risk factors. The study used was a population-based prospective longitudinal research design. A total of 4,838 participants (2,683 females and 2,155 males) included individuals aged >30 years who were undergoing a health examination from 2006 to 2014 in Pingzhen City, Taiwan. In the initial generalized estimated equation model analysis, which included the covariates of age of first visit, period between the first and current visit, and metabolic syndrome severity Z-score, the results indicated that the interaction between age and metabolic syndrome severity Z-score is significantly related to the estimated glomerular filtration rate for males (p = .040). For females, the interaction between age and metabolic syndrome severity Z-score was not significant, but a higher metabolic syndrome severity Z-score was significantly associated with lower estimated glomerular filtration rate (p = .001). After controlling for the confounders, unhealthy behaviors, and comorbidities, the metabolic syndrome severity Z-score was still a negative predictor of estimated glomerular filtration rate in both the male (p = .005) and female (p = .023) models.

Patients with end-stage renal disease should be educated and trained to take care of their own arteriovenous fistula (AVF) with the purpose of developing self-care behaviors concerning vascular access. This was a prospective and observational study. We designed this research to identify clinically meaningful self-care behavior profiles in hemodialysis (HD) patients, and it was carried out in a private dialysis unit in the Lisbon region, Portugal, involving 101 patients. The proportion of male patients was 66.3%, the mean age was 60.9 years, and the frequency of self-care behaviors was 71%. Cluster analysis based on the subscale scores grouped patients in two clusters named “moderate self-care” and “high self-care.” Those profiles exhibit significant differences concerning gender, education, employment, dialysis vintage, AVF duration, and information on care with the AVF. Identification of self-care-behavior profiles in HD patients with AVF enables one to adjust education programs to the patients’ characteristics.

The purpose of this study was to evaluate the short-term effect of a virtual reality-based exercise program on fatigue in patients with end-stage renal disease (ESRD) who receive hemodialysis (HD). In this quasi-experimental study design, an experimental group (n = 32) received virtual reality training that promoted exercise, and a control group (n = 32) received routine care (advice on physical activities). Fatigue and physiologic parameters were assessed pretest (before intervention) as well as posttest (4 weeks after the onset of intervention). Our results showed that patients in the experimental group had significantly lower levels of overall fatigue, reduction in vigor and motivation, distress and loss of control in mood, and higher hemoglobin levels compared with the control group. ANCOVA revealed that there were no differences in overall fatigue and different domains of fatigue. Exercise only increased the blood urea nitrogen (BUN) and creatinine levels significantly in the intervention group.

The aim of this study was to identify the needs, beliefs, and practices of Muslim family members during the end-of-life care for a family member in the intensive care unit (ICU) in Saudi Arabia. This was a phenomenological study using in-depth individual interviews to gather data. Ten family members of adult ICU patients receiving end-of-life care were interviewed. The experiences of family members during end-of-life care were reflected in four major themes: (a) the spirituality of death, (b) family’s need for information, (c) being there, and (d) the ICU environment. Participants placed high value on religious practices such as prayer, and appreciated when these practices could be accommodated in the ICU. Family participants also detailed their need for frequent communication and opportunities to ask questions about the care of their critically ill loved one. Being able to spend as much time as desired in close proximity to the critically ill patient particularly as the end of life approaches was also important, with participants suggesting that visitation times should be waived. Finally, family participant suggested that changes were needed to the ICU environment to make accommodating large families easier and more comfortable particularly when they wish to spend significant time at the bedside of their loved one. Family should be prioritized as an extension of the care provided to critically ill ICU patients, particularly those approaching end of life. A model of care should be introduced to deliver supportive and holistic care during the end-of-life care journey, supported by appropriate education regarding family care at the end of life.

A systematic review was conducted to characterize assessments for caregivers of hospitalized older adults. Electronic literature searches of Medline, PsycINFO, and CINAHL of articles on caregiver assessments published in English between 2006 and present were completed. Thirty-three articles underwent full-text review; four included assessments designed to capture caregiver needs in hospital settings. Original articles on the development of these assessments were reviewed for quality appraisal. Four findings emerged from our review. Existing assessments (a) focus on caregivers of specific conditions of older adults, (b) contain a singular caregiving domain, (c) measure caregiver outcomes or simply describe caregiving experiences, and (d) neglect psychometric properties. Health care providers are limited in their selection of assessments with caregivers of hospitalized older adults. This barrier is problematic if we are to equip caregivers to be successful at providing care to older adults. Future research should develop a hospital assessment for caregivers.

Improving the efficiency of patient education can help improve patient’s satisfaction and alleviate the pressure of nurse shortage. This study aimed to develop and pilot an educational audio to improve the effectiveness of inpatient education. A primary literature review was conducted and educational materials were written and recorded by MP3. A pilot study was conducted in 713 adult patients in the department of respiratory medicine at a large urban Shanghai teaching hospital. Patients in the experimental group showed greater satisfaction with their health education. For the education to be effective during the admission, the asthma patients in the experimental group spent less time in face-to-face communication. The feedback rate for disease education among asthma patients in the experimental group was significantly higher. Wider applications of audio in patient education may be valuable to better adjust to nurse reduction and to improve nursing service quality.

The aim of this multiphase mixed-method study was to improve access, flow, and consistency of information transfer for multitrauma patients leaving the Emergency Department. Methods included literature review, focus group interviews, chart audits, staff surveys, and a review of international trauma forms to inform an intervention developed with a researcher-led, clinician stakeholder group. Analysis included descriptive and inferential statistics. Baseline data revealed variability existed in patient-care documentation, showing little standardization. Improvement strategies implemented included a gold standard for information embedded in handover tools, raising staff awareness of complexities for information transfer. Improvement was seen in communication between wards coordinating transfer, improved documentation, decreased information duplication, improved legibility, and increased ease and efficiency in navigating to key information. Improvement in communication at patient transition is essential to continuity of safe, effective care, and is impacted by complex interactions between multiple factors. Difficulty increases for patients with high acuity.

This study describes the fertility intention and explores factors related to fertility intention in reproductive-age women with breast cancer in Taiwan. In this cross-sectional study, women of childbearing age who had been diagnosed with breast cancer completed a face-to-face survey that included demographic, disease, and symptom-related data, and social support and fertility intention information. The mean fertility intention score among the 223 participants was “medium” (M ± SD = 41.18 ± 12.62). Higher symptom severity, especially for distress, was related to lower fertility intention. Instrumental support from families and friends was positively associated with fertility intention score. Younger women had better fertility intention scores than older women. The Sobel test showed that age mediated menopause and fertility intention. The findings offer the evidence of the needs to control symptoms and provide sufficient instrumental support regarding fertility after completing chemotherapy.