Western Journal of Nursing Research

Depression, a known comorbidity in coronary heart disease (CHD), is associated with adverse cardiac events, mortality, symptom burden, physical limitation, and poor quality of life (QOL). Evidence has shown that depression impedes self-care behaviors, including physical activity. Similarly, regular physical activity has been shown to lessen depressive symptoms and improve cardiovascular health.

The aim of our study was to investigate the direct effect of depressive symptoms on physical activity and QOL. We also sought to investigate the mediator effects of physical activity and depressive symptoms on QOL and to test the moderator effects of depressive symptoms on physical activity and QOL.

In this cross-sectional study, 20-year follow-up survey data were collected from 126 survivors from the Heart and Soul prospective cohort study. A mediation test was conducted using the steps described by Baron and Kenny.

Physical activity significantly predicted QOL (β = 0.13, P = .02) and significantly predicted depressive symptoms (β = −0.19, P < .001). Depressive symptoms significantly predicted QOL (β = −0.76, P < .0001). The average causal mediation effect was statistically significant (0.15, P < .001). Depression was not a moderator of physical activity and QOL.

This study demonstrated that depression mediated the effect of physical activity on QOL. Identifying and treating depressive symptoms simultaneously while addressing physical activity may be of importance to improving QOL in patients with chronic CHD.

Models of rounding are different across institutions and nurses do not always participate or feel involved during daily rounds.

The purpose of this analysis was to examine nurses’ contributions during family-centered rounds in a children’s hospital.

This study is a secondary analysis of 50 video-recorded conversations between families of pediatric patients and clinicians during daily rounds in a Midwest children’s hospital. Children were patients of one of the 4 participating medical teams: 2 general pediatric hospitalist services, the pulmonary service, or the hematology/oncology service. Data were analyzed using conversation analysis and content analysis. We identified and categorized the “action” of nurse utterances or what they were “doing” in the conversation.

Nurses contributed to daily rounds to accomplish a variety of actions. Although it was most common for nurses to provide information and assessments, nurses were also active in making recommendations and correcting information that was shared. Nurses also asked clarifying questions, either for themselves or on behalf of the family. However, when solicited to ask a general question or add information at the end of the conversation, nurses most often passed on the opportunity to participate, or at times, first denied having questions before asking a question or adding information.

Nurse contributions to daily rounds demonstrate that a normative role for nurses is to provide information or assessments, with limited question-asking. We also found that nurses displayed their role as an advocate by asking questions to the team on behalf of the family.

Family caregivers often struggle to track daily caregiving tasks (eg, managing medications, appointments). To address this, our team developed CareMobi, a mobile app designed to make caregiving more organized, collaborative, and manageable.

We sought to evaluate early user satisfaction, real-world utility, and perceived value of CareMobi among informal caregivers.

A cross-sectional survey was administered between October 2023 and January 2024 to CareMobi users. The survey included Likert-scale items assessing satisfaction and usability, and open-ended prompts exploring use cases and improvement suggestions. Descriptive statistics summarized quantitative data, and open-ended responses were analyzed using inductive content analysis.

Among respondents (N = 51), 82% reported being satisfied or very satisfied with the app, and 76% found it easy or very easy to use. Highly valued features included appointment/calendar tracking (32 selections), health progress monitoring (30 selections), and file storage (20 selections). Caregivers use CareMobi across diverse contexts, from elder care to self-management, to coordinate care among multiple individuals and streamline information access. Open-ended responses revealed 3 primary areas of impact: improved communication, centralized information management, and support for symptom and medication tracking. Users requested enhancements to support care team coordination, emphasizing the importance of simple, functional tools for daily caregiving.

Preliminary findings, based on a small, self-selected sample, suggest CareMobi is a user-friendly tool that supports informal caregivers and facilitates care coordination. Results highlight the importance of caregiver-centered app design and indicate the need for further evaluation through longitudinal, mixed-methods research to assess long-term outcomes and integration into care routines.

Aging can increase stress, making effective stress management strategies essential for promoting healthy aging. However, many older adults face difficulties because of low health literacy, which negatively impacts their well-being. Few studies have explored the relationship between health literacy, well-being, and stress management.

We aimed to examine relationships between health literacy (including digital health literacy), well-being, and stress management among older adults. Specifically, we sought to: (1) assess levels of health and digital health literacy; (2) examine differences according to age, gender, education, and senior university attendance; and (3) analyze the associations between health literacy, stress management, and well-being, including the potential role of stress management in this relationship.

A quantitative cross-sectional study was conducted with 579 participants aged 65 to 98 years, of whom 64.1% were women.

Older adults with lower education levels and those who do not attend a senior university had lower levels of health literacy. Internet use for health-related purposes was also limited. Stress management skills fully mediated the relationship between both traditional and digital health literacy and well-being, indicating that higher health literacy is associated with better well-being through improved stress management.

Strengthening health literacy can promote well-being by improving stress management. Interventions should include informational sessions, tailored educational materials, and skill-building workshops. Senior universities can play a key role by offering technology and health-related classes that empower older adults to access reliable online health information and improve their overall health knowledge.

Bedside whiteboards serve as communication tools that contribute to improved patient outcomes by supporting information sharing, improving patient participation, and facilitating communication between patients and health care teams.

This quasi-experimental study aimed to compare pain and anxiety levels between surgical patients who used bedside whiteboards and those who received standard care.

The study was conducted in the general surgery department of a university hospital between August 2022 and December 2024. The intervention group consisted of 52 patients, and the control group included 54 patients. The data collection tools used included a patient demographic form, the Visual Analog Pain Scale (VAS), the Anxiety Specific to Surgery Questionnaire (ASSQ), and the State-Trait Anxiety Inventory (STAI-I and II).

The mean VAS score in the intervention group was 5.3 ± 2.9, the mean ASSQ score was 16.5 ± 6.0, and the mean STAI-I score was 34.4 ± 13.8. In contrast, the control group reported a mean VAS score of 6.6 ± 2.9, a mean ASSQ score of 21.9 ± 5.7, and a mean STAI-I score of 39.2 ± 8.2. Comparative analysis revealed statistically significant differences between the intervention and control groups in terms of VAS, ASSQ, and STAI-I scores.

The results indicate that patients in the intervention group who were exposed to bedside whiteboards had lower pain and anxiety scores than those in the control group. The use of bedside whiteboards may support patient education and enhance the overall quality of nursing care.

Internet gaming disorder (IGD) has become a growing mental health problem, especially among young people. eHealth literacy, the ability to find, understand, and assess health information from electronic platforms and apply acquired knowledge to address health problems, may play a crucial role in improving mental health and promoting help-seeking behaviors.

This study aimed to test the role of eHealth literacy in IGD symptoms and help-seeking intentions for IGD and the mediating role of illness representations in these relationships.

A cross-sectional survey was conducted online using a convenience sample of university students in Hong Kong (N = 370). Data were collected using the Brief Illness Perception Questionnaire, 9 diagnostic criteria proposed in the DSM-5, the Mental Help Seeking Intention Scale, and the eHEALS tool.

Among participants, 28.9% met criteria for probable IGD, yet only 10.8% self-declared as having IGD. Male students (β = 0.123, P = .018) and those with higher education levels (β = 0.120, P = .021) exhibited elevated IGD symptoms, while higher education (β = 0.128, P = .014) and fewer gaming hours (β = 0.135, P = .009) predicted stronger help-seeking intentions. eHealth literacy was negatively associated with IGD symptoms (β = −0.110, P = .034) and positively correlated with perceptions of treatment control (β = 0.106, P = .040). Path analysis revealed that eHealth literacy indirectly enhanced help-seeking intentions through increased treatment control beliefs (β = 0.031; 95% CI, 0.003-0.074).

Findings highlight eHealth literacy’s protective role against IGD and its indirect effect on help-seeking through treatment control beliefs. Interventions targeting eHealth literacy and perceived treatment efficacy may reduce IGD risk and promote help-seeking.

Hospital falls can be reduced through patient and staff education, yet limited evidence exists about how staff can systematically implement patient falls prevention education. Planning implementation with staff may enhance their acceptance, engagement, and delivery of falls education to hospital patients.

The objective of the study was to design an implementation plan with hospital staff to guide the successful delivery of patient falls education.

Three participatory workshops using a world café methodology were conducted in 1 Western Australian and 2 Victorian hospitals. Participants were presented with information about a patient falls education program called “Safe Recovery” and discussed program implementation strategies. Conversation topics were staff education and training needs, ward support, and organizational requirements. Table discussions were captured on paper and analyzed iteratively at the forum. Subsequently, workshop field notes were analyzed using inductive content analysis.

Sixty-two hospital staff (n = 42 nurses, n = 12 allied health, n = 8 other) participated in the workshops. Participants considered the implementation process would be enabled at: (1) individual level, by providing accessible and flexible training to optimize staff engagement; (2) ward level, by establishing clear implementation protocols, engaging and supporting team leaders, and (3) ensuring clear communication between staff, patients, and families; and (4) organizational level, by leadership supporting sustained implementation. Group consensus was that it was important to have a single, agreed vision to implement the Safe Recovery Program.

Staff engagement facilitated the development of a shared vision and structured plan to implement a patient falls prevention education program on hospital wards.

Insomnia is highly prevalent during pregnancy, but the role of modifiable cognitive and behavioral factors remains understudied.

We aimed to investigate factors associated with insomnia symptoms in pregnant women, with a focus on sleep-related psychological and behavioral factors.

A cross-sectional study was conducted among 545 pregnant women recruited from 2 tertiary hospitals in Eastern China (December 2023-March 2024). Participants completed self-reported questionnaires assessing insomnia severity, pregnancy-related rumination, physical discomfort, anxiety symptoms, depressive symptoms, presleep arousal, dysfunctional sleep-related cognitions, maladaptive sleep habits, and demographic information. Univariable and binary logistic regression were used to identify factors associated with insomnia symptoms.

Among the 545 participants (mean age = 29.1 years), 27.0% reported insomnia symptoms. In the regression model, insomnia was significantly associated with prepregnancy insomnia symptoms (OR = 2.82; 95% CI, 1.69-4.70; P < .001), increased physical discomfort (OR = 1.05; 95% CI, 1.01-1.09; P = .012), higher presleep arousal (OR = 1.13; 95% CI, 1.07-1.20; P < .001), dysfunctional sleep-related cognitions (OR = 0.95; 95% CI, 0.92-0.98; P < .001), and maladaptive sleep habits (OR = 1.03; 95% CI, 1.01-1.05; P = .005).

Insomnia during pregnancy is associated with prepregnancy insomnia, physical discomfort, and key modifiable perpetuating factors including presleep arousal, dysfunctional sleep-related cognitions, and maladaptive sleep behaviors. Interventions targeting these modifiable factors are needed to improve insomnia symptoms in pregnant women.

Artificial intelligence (AI), particularly generative and large language models, is being used in nursing education, practice, and scholarly writing. Generative AI applications have been specifically examined for their use in conducting literature reviews with evidence supporting reduced production time of scholarly work. However, there has been limited investigation of their levels of accuracy with identifying references for a literature review.

The purpose of this study was to compare human-generated citations of literature reviews with AI literature-review generated citations.

Using a comparative exploratory design, references from 4 human-written literature reviews, 2 published and 2 unpublished, on 4 different topics, were compared to references derived from 2 AI literature applications, Consensus and Elicit. Three prompting strategies were utilized, including prompts generated using ChatGPT-4. Agreement between the AI and human references was evaluated.

The percent of agreement between AI and human generated reference lists ranged from 0% to 63.6%. The Consensus application had a greater overall mean rate of match (21.3%) as compared to Elicit (3.7%). The use of a ChatGPT-4 prompt did not significantly impact results, and there were no differences based on published or unpublished literature reviews.

The 2 literature-based applications examined in this study offered a glimpse of their potential use and limitations. The use of an AI literature review application may support but not replace human work.

Nursing interns are the next generation of nurses, and their employment status affects nursing team stability. Interns often face career development difficulties and attrition. Cognitive flexibility may help students adapt to the workplace and clarify their work self-definition, and future work self-salience may relate to career adaptability. However, these relationships are unclear in the Chinese context.

We aimed to explore the mediating effect of future work self-salience between cognitive flexibility and career adaptability among nursing students during their internship.

Using a cross-sectional study design with convenience sampling, nursing interns from a tertiary general hospital in Nanjing, China, were selected between November and December 2024. Data were collected using a general information questionnaire, the Cognitive Flexibility Inventory (CFI), the Future Work Self-Salience Scale (FWSS), and the Career Adapt-Abilities Scale (CAAS). Of 201 questionnaires distributed, 195 were valid (97.0%). Descriptive statistics, Spearman’s correlation, and structural equation modeling were used to test the mediating effect.

The CFI, FWSS, and CAAS scores were 68.74 ± 10.22, 13.45 ± 2.91, and 91.97 ± 16.58, respectively. Cognitive flexibility positively predicted career adaptability, and future work self-salience played a partial mediating role (mediation effect: 20.92%).

Cognitive flexibility is directly associated with nursing interns’ career adaptability and also is indirectly associated through future work self-salience. Nursing educators may enhance interns’ career adaptability by fostering both cognitive flexibility and future work self-salience.