Western Journal of Nursing Research

We surveyed 181 nursing research leaders from Magnet® hospitals, using mixed methods with the online Hospital-Based Nursing Research Clinical and Economic Outcomes survey, to describe the clinical and economic outcomes of nursing research conducted in hospital settings. We used descriptive statistics to analyze the quantitative findings and a qualitative descriptive approach to study the open-ended responses. Most respondents reported that findings from their hospital-based studies were implemented on their units (88.2%), improved health care processes (88.2%), and reduced hospital costs (79%). Over 50% reported positive impacts on core quality measures, including improving patient/family satisfaction (76.8%), nurse satisfaction (65%), length of stay (59.1%), and infection rates (56.5%). Four themes were identified: study evaluation, improvements in care delivery/clinical outcomes, economic impact, and intrinsic and extrinsic rewards. Much of the research reported by respondents focused on quality measures with findings that resulted in improved clinical and economic outcomes.

Self-management is essential for patients who require regular hemodialysis treatment. This study aimed to explore the relationships between social support, sense of coherence (SOC), and self-management in hemodialysis patients and to examine whether SOC plays a mediating role. In a cross-sectional study, 402 hemodialysis patients from four tertiary hospitals were recruited. Data were analyzed using structural equation modeling. Social support, SOC, and self-management were significantly correlated with each other. The proposed model provided a good fit to the data. Social support had a direct effect on self-management and SOC, partially mediated the effect of social support on self-management (β = 0.248, p = 0.001). Social support and SOC explained 69% of the variance in self-management. Our findings indicate that health care providers can enhance social support with an emphasis on strengthening SOC strategies to better improve self-management in hemodialysis patients.

Heart failure (HF) is a growing public health problem. Self-management (SM) of HF is an important component of chronic disease management. Guided by the Individual and Family Self-Management Theory (IFSMT), we examined the associations among complexity of condition, self-regulation, and self-efficacy mediation of SM behaviors in a population of HF outpatients. A cross-sectional design was used. Seventy-three outpatients with HF were enrolled. Simple and multiple linear regressions were run for each outcome variable. Only self-regulation was significantly associated with SM behavior. Complexity of condition was not significantly associated with SM behavior. There was no mediation by self-efficacy. Future nursing interventions should explore self-regulation in HF to provide a clearer understanding of the processes used to change health behavior. SM may be particularly useful in HF with preserved ejection fraction (EF), where there is no proven pharmacological treatment.

This study identified the effects of an integrated diabetes self-management program using smartphone application (app), based on the Information-Motivation-Behavioral skills (IMB) model. A randomized comparison, using a pre-and post-test design, was conducted with 32 participants in the experimental group and 36 in the control group. The integrated diabetes self-management program consisted of face-to-face educational sessions, a diabetes self-management smartphone app, and phone counseling. In the experimental group, diabetes self-management knowledge (Z=-2.70, p=.007), social motivation (Z=-1.97, p=.048), and behavior (t=3.22, p=.002) improved, with their hemoglobin A1c (Z=-4.83, p<.001) decreasing compared to the control group. At the post-test, the experimental group’s fasting blood sugar level (t=2.79, p=.009), total calorie intake (t=3.94, p=.001), carbohydrate intake (t=5.69, p<.001), and fat intake (t=2.54, p=.021) decreased compared to the pre-test. An integrated diabetes self-management program using smartphone app, based on the IMB model, should be utilized as a nursing intervention.

This systematic review details symptom clusters, their compositions, and associated factors and appraises the methodologies of studies that reported symptom clusters in patients with chronic obstructive pulmonary disease (COPD). Ten studies were eligible for inclusion in this study. Four common symptom clusters were identified. Two theoretical frameworks, four statistical methods, and various symptom assessment tools were used to identify symptom clusters. Factors associated with symptom clusters included demographic, clinical, and biological factors. No studies examined the subjective experiences of symptom clusters. Overall, inconsistencies were identified in the composition of symptom clusters across studies. This may be due to variations in study design, assessment tools, and statistical methods. Future studies should attempt to arrive at a common definition, especially that is theoretically derived, for symptom clusters, standardize the criteria for symptoms for inclusion in the clusters, and focus on patients’ subjective experience to inform which clusters are clinically relevant.

Inadequate transition to practice increases stress for new health care providers and threatens employment longevity. This integrative review aimed to synthesize the evidence on transition process for newly graduated registered nurses and advanced practice nurses in hospital settings and to identify enablers/barriers and mitigating strategies. Two databases were systematically searched for articles that described the process, strategies, participant perceptions, and implications of role transition with a final yield of 23 articles. Synthesis of the evidence revealed three major themes: (a) achieving competence for safe practice, (b) addressing stress during transition, and (c) reducing turnover. Emotional support for new graduates was instrumental to achieving clinical competence. Role transition adaptation was linked to anxiety, while emotional health was positively associated with retention. Developing best practices that address skill proficiency, attending to the emotional needs of new nurse graduates, and providing structured transition programs to improve clinical competence are the strategies of choice.