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To explore collaborative practice and perceptions and attitudes of key stakeholders on collaboration in type 2 diabetes management in a tertiary care setting.
Understanding collaborative practice in diabetes care in developing countries helps to design and provide patient-centred and cost-effective care.
An exploratory qualitative study.
Interviews were undertaken with 30 patients and 18 health professionals and policymakers. Thematic data analysis was undertaken to explore collaborative practice and examine participant perspectives on collaboration in diabetes management. We compared the findings with D'Amour's Collaboration Framework to determine the level of collaboration.
Most participants reported a lack of collaborative practice in diabetes management, while they appreciated its importance in improving care. Perceptions varied with respect to what constituted collaborative practice. Three themes were identified: (1) perspectives of key stakeholders on current practice of collaboration; (2) impediments to collaborative practice; (3) strategies to improve collaborative practice. Analyses of the themes using D'Amour's Collaboration Framework indicated a low level of collaboration among physicians, nurses, pharmacists and policymakers, which was attributed to workload and time pressures on health professionals, power dynamics and lack of role clarity of all actors in collaborative action. Participants commented on the need to improve collaboration by establishing strong leadership and governance at different healthcare structure levels, which is committed to coordinating collaboration and developing collaborative frameworks and policies that guide collaborative undertaking.
Perceived shortcomings of collaboration were attributed to inadequate resources, power dynamics, a lack of strong team functioning and policies. Participants' positive perceptions provide an opportunity to improve collaborative practice through incorporation of collaborative frameworks and policies.
The findings in this study inform development of tailored and patient-centred diabetes care in tertiary care settings in sub-Saharan Africa.
The study was reported in accordance with the COREQ checklist.
Patients or the public were not involved in the design, analysis or interpretation of the data in this study. However, patients and healthcare providers participated in pilot interviews, which helped refine the interview guides. The summary of the findings of the study was also discussed with patients and healthcare providers, where they provided feedback.
Current guidelines stress the importance of exercise, especially multicomponent exercise to older adults with chronic conditions.
To critically synthesise evidence that evaluates the effects of multicomponent exercise on quality of life, depression and anxiety after stroke.
Systematic review and meta-analysis followed the PRISMA 2020 statement.
A systematic search of PubMed, Embase, Web of Science, Cochrane Library, CINAHL and PsycINFO from inception to 12 June 2023 was performed. Risk of bias was assessed using the Revised Cochrane risk-of-bias tool for randomised trials (RoB 2). Meta-analyses were conducted using Review Manager 5.4 and narrative syntheses were adopted whenever meta-analysis was inappropriate. The overall certainty of the evidence was rated using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach.
Of 15,351 records identified, nine were eligible and data were available for seven randomised controlled trials, three of which were identified as having a high risk of bias, one as low risk, and five as having some concerns. Subgroup pooled analyses indicated that multicomponent exercise engaged in longer exercise sessions (>60 min) was effective in improving quality of life immediately post-intervention and through 3–6 months post-intervention. However, multicomponent exercise did not significantly affect depression and anxiety.
Multicomponent exercise with longer duration of exercise sessions has promising effects on both short- to medium-term quality of life among stroke survivors.
This does not apply to our work as it is a review paper.
Healthcare providers could consider encouraging the patients to participate in multicomponent exercise sessions for more than 60 min. It is important to note that stroke survivors should be supervised by trained personnel at the beginning of the training.
The protocol was registered on PROSPERO.
The aim of this cross-sectional study was to determine the point prevalence and associated risk factors of medical device-related pressure injuries (MDRPI) in intensive care patients in Turkey.
MDRPI remain a clinical problem that has garnered the attention of healthcare professionals.
This study used a cross-sectional design and was conducted over a single day in all intensive care units.
Data were collected through face-to-face interviews, observation, skin examination and detailed diagnosis of MDRPI development and influencing factors. Presence of pressure injuries on the skin in the areas where the patient's medical device was placed was defined. The study was reported according to the STROBE declaration.
MDRPI developed in 65 out of 200 patients included in the study (32.5%). The most frequent locations were on the face (71%). The MDRPIs were commonly associated with nasogastric tube (29.2%), endotracheal tube (18.5%) and CPAP mask (15.4%). A significant proportion of these injuries were mucosal (53.8%, n = 35). The majority of the skin pressure injuries were classified as Stage II (18.5%, n = 12). The risk increased 14 times in patients who were hospitalised for 9–16 days and 13 times in those who received mechanical ventilator support.
The study findings suggest that MDRPI developed in approximately one of three patients hospitalised in the intensive care unit, and the length of hospital stay and mechanical ventilator support were important determining risk factors. The high prevalence of MDRPI may indicate inadequate nursing care quality. Therefore, it is recommended that nurses be aware of risk factors and evaluate the suitability and safety of medical devices.
No patient or public contribution was involved in this study.
The critical care nursing workforce is in crisis, with one-third of critical care nurses worldwide intending to leave their roles. This paper aimed to examine the problem from a wellbeing perspective, offering implications for research, and potential solutions for organisations.
Discursive/Position paper.
The discussion is based on the nursing and wellbeing literature. It is guided by the authors' collaborative expertise as both clinicians and researchers. Data were drawn from nursing and wellbeing peer-reviewed literature, such as reviews and empirical studies, national surveys and government and thinktank publications/reports.
Critical care nurses have been disproportionately affected by the COVID-19 pandemic with studies consistently showing critical care nurses to have the worst psychological outcomes on wellbeing measures, including depression, burnout and post-traumatic stress disorder (PTSD). These findings are not only concerning for the mental wellbeing of critical care nurses, they also raise significant issues for healthcare systems/organisations: poor wellbeing, increased burnout and PTSD are directly linked with critical care nurses intending to leave the profession. Thus, the wellbeing of critical care nurses must urgently be supported. Resilience has been identified as a protective mechanism against the development of PTSD and burnout, thus offering evidence-based interventions that address resilience and turnover have much to offer in tackling the workforce crisis. However, turnover data must be collected by studies evaluating resilience interventions, to further support their evidence base. Organisations cannot solely rely on the efficacy of these interventions to address their workforce crisis but must concomitantly engage in organisational change.
We conclude that critical care nurses are in urgent need of preventative, evidence-based wellbeing interventions, and make suggestions for research and practice.
To learn about the attitudes of nurses working in the Andalusian Public Health System regarding euthanasia and its legalisation.
Euthanasia often finds itself in the crosshairs of ethical and political debate on an international scale. Currently, the Spanish Organic Law 3/2021 of 24 March, 2021, recognises euthanasia as a fundamental right in Spain. It is of particular interest to know about the views, attitudes and stances that Andalusian nurses have of euthanasia as they are key players within the framework of euthanasia and administration of life-ending drugs. They play a central role in guiding patients through the euthanasia application process.
Observational descriptive study.
A study of Andalusian Public Health System nurses was carried out using non-probability convenience sampling. 518 nurses with an average age of 44.75 years answered in a questionnaire that was distributed on an online platform. Socio-demographic and occupational variables were assessed, together with the Death Anxiety Scale and the Euthanasia Attitude Scale. A bivariate analysis and a multivariate linear regression model were performed. The STROBE checklist was used.
The mean score obtained on the Euthanasia Attitude Scale was 75.95 (SD = 16.53). The mean score obtained on the Death Anxiety Scale was 7.56 (SD = 3.05). The variables age and work experience were negatively correlated with the total scores of the Euthanasia Attitude Scale and the categories ‘Ethical considerations’, ‘Practical considerations’ and ‘Treasuring life’. On the other hand, there was a significant positive correlation between age and work experience and ‘Spiritual beliefs’ category.
The current situation shows a worrying paradox. There is a stark difference between positive professional attitudes towards euthanasia and the desire to participate in its application.
It is vital that educational and healthcare institutions make the necessary efforts to ensure that nurses develop sound moral judgement, displaying the moral conscience and ethical commitment required of this established profession.
No patient or public contribution.
To examine the multidimensional properties of caregiver burden among family caregivers of patients with advanced cancer in a palliative context.
A sequential, explanatory, mixed-method study was performed.
Family caregivers of patients diagnosed with advanced cancer were recruited from a palliative care department of a third-level hospital in Sichuan Province, China. The Caregiver Burden Inventory, Social Support Rating Scale and Connor–Davidson Resilience Scale were used to collect quantitative data, and a total of 150 caregivers were recruited from January 2022 to September 2022. Qualitative data were collected through semi-structured interviews, and a total of 22 caregivers were interviewed from October 2022 to November 2022. Survey data were analysed using descriptive statistics, and the factors of caregiver burden were identified using the Mann–Whitney U test, Kruskal–Wallis H test and Spearman correlations. Interpretative phenomenological analysis was performed to analyse the interview data to initially explore the multidimensions of caregiver burden. The following-a-thread method and convergence coding matrix were used for triangulation to examine the multidimensional properties of caregiver burden.
The participants experienced a moderate level of caregiver burden (32.97 ± 13.09). Through triangulation, six meta-themes and nine meta-subthemes were identified as multidimensional properties of caregiver burden, including physical (too many caring tasks and poor health condition), emotional (strong negative emotions resulting from patients' suffering and insufficient and ineffective family communication), social (less social interaction and social role conflict) and economic burdens, factors that aggravate burden (prevention and control of COVID-19 and spousal relationship with patients) and factors that mitigate burden (social support).
Multiple dimensions of caregiver burden were experienced by family caregivers of patients with advanced cancer in the palliative context. Family-centred palliative care must be further developed.
It is important to develop family-centred palliative care. Therefore, the focus must be on developing a rational understanding of palliative care in public and a culture-oriented death education in palliative units.
This study adopted a mixed-method approach to comprehensively understand the phenomenon of and factors in caregiver burden in the Chinese palliative oncology context. Our findings suggest that family caregivers in palliative oncology experience a moderate level of caregiver burden, with dimensions including physical, emotional, social and economic burdens, among which emotional burden is the most prominent. The findings of this study provide policy makers and nurse practitioners with targets to be addressed in family-centred care in Chinese palliative units.
The results of this study are reported based on the guidelines of the Mixed-Methods Article Reporting Standards.
Eligible caregivers were invited to participate in the study and semi-structured interviews. Nurse managers of the palliative unit helped us access the patient-management system.
The aim of this research study is to collaboratively generate insights in the current institutional long-term care environment for activity and mobility of older adults, and of solutions that could be used to increase the activity and improve the mobility of the older adults.
This research constitutes a qualitative study with a critical approach.
Data were collected using photo-elicitation in four long-term care units in Finland during the spring of 2022. Older adults participated in individual data collection sessions which combined photographing and discussion. Staff members individually took photographs and later participated in a group discussion based on the photographs. Reflexive thematic analysis was used to analyse all data together.
Ten older adults and 12 staff members participated in the research study. Four themes were identified: (1) facilities should be designed and equipped for their users, (2) moving in the institutional environment, (3) passivity as a norm, and (4) nurses should act differently and have the resources to do so.
To increase the activity and improve the mobility of older adults, improvements are needed in terms of the design of facilities, opportunities for freedom of movement, outdoor activity, daily life activities, exercise, nurses' role in activating older adults and resources.
Increased attention to the support of activity and mobility could benefit older adults in institutional long-term care. Physical activity promotion should be incorporated as an integral part of nursing practice.
Directors of units were consulted when planning the study. Older adults and nurses contributed to the data collection and interpretation of data.
What problem did the study address? ○Older adults have recurrently been reported as living inactive lives in institutional long-term care. ○There is evidence of the relationship between the environment and the activity and mobility of older adults, but there seems to be a research-practice gap in terms of implementing activity- and mobility-promoting environments. ○Older adults and staff members are important in developing practice and change-oriented knowledge that can be used to increase the activity and improve the mobility of older adults in institutional long-term care.
What were the main findings? ○Various environmental improvements are recommended to increase the activity and improve the mobility of older adults in institutional long-term care settings. ○Improvements for the design of facilities, opportunities for freedom of movement, outdoor activity, daily life activities, exercise, nurses' role in activating older adults and resources for activity support would benefit older adults' activity and mobility.
Where and on whom will the research have an impact? ○Increasing the activity of older adults requires better activity promotion and mobility support by nurses in institutional care. Sufficient education and resources should be organized for activity promotion, in addition to a care and organizational culture that values activity. ○Environmental aspects to promote activity and mobility need to be considered already at the planning, building and renovating phases of facilities. ○Policymakers and care organizers should consider evidence of the harms and benefits of different institutional living environments when making decisions on organizing care.
The study is reported using the Consolidated Criteria for Reporting Qualitative Research (COREQ).
To explore emotional, mental health and physical symptoms up to 3 months after discharge for adults hospitalized with COVID-19.
10%–30% of adults with COVID-19 experience physical and psychological symptoms 3 months or more following infection. Knowing symptoms can help direct early intervention.
A longitudinal descriptive design to study COVID-related symptoms 2 weeks, 6 weeks and 3 months after hospitalization.
Sixty-six patients were recruited from a hospital system in Midwestern US (October 2020–May 2021). Participants self-reported demographics, hospital and post discharge symptoms, PROMIS measures (depression, anxiety, fatigue, cognitive function, satisfaction social roles, sleep disturbance) and Impact of Event Scale-Revised (IES-R). Hospital length of stay, comorbidities, lowest oxygen saturation, respiratory support and resources used were collected. Descriptive and nonparametric statistics described the sample and identified correlations between variables. The STROBE checklist was used.
Data from 1 (T1) and 3 months (T2) post discharge were analysed (N = 52). A majority were female, white and married; 96% experienced ≥1 COVID-related symptoms at T1; 85% at T2. Fatigue was most prevalent, followed by shortness of breath, muscle weakness and foggy thinking. More physical symptoms during hospitalization correlated positively with number of symptoms at T1 and T2; a majority stated these impacted their normal routine ‘somewhat’ or ‘a lot’. T1 depression highly correlated with all T2 PROMIS and IES-R scores and number of physical symptoms. More symptoms at T1 were associated with worse fatigue, lower cognitive function and lower satisfaction with social roles at T2.
This study adds to the growing knowledge of mental, physical and emotional symptoms and relationships between these early after hospitalization with COVID-19.
Findings can help identify holistic nursing interventions to improve health and mitigate symptoms for people with long COVID.
Patients contributed via study participation.
To examine the predictors and outcomes of patient safety culture (PSC) among oncology nurses working in public Saudi hospitals according to participant characteristics and evaluate the relationship between PSC domains.
PSC is crucial in healthcare systems, particularly in oncology and chemotherapy units, and its assessment can enhance the standard service provided and cancer care quality. There is currently limited research on the status, predictors and outcomes of PSC in cancer care settings in developing countries, including Saudi Arabia.
A cross-sectional correlational study.
A convenience sample of 101 oncology nurses working in two large Saudi tertiary care hospitals participated in this study. The Hospital Survey on Patient Safety Culture validated instrument and demographic and work surveys were completed by the participants. The study methods were compliant with the STROBE checklist. Descriptive statistics and multiple linear regressions were used to analyse the data.
The areas of PSC strength were related to organizational learning–constant improvement, feedback and communication about errors, and transitions and handoffs. Manager/supervisor actions and expectations, hospital management support, communication openness, experience in the current unit and oncology unit/area were the predictors of PSC. In terms of PSC outcomes, the oncology nurses reported either no or one to two adverse events and a substantially good patient safety rating.
The level of PSC was lower than expected. Communication openness, experience in the current unit and oncology unit/area were the strongest predictors of PSC. Investing in oncology nursing practice that addresses these concerns and prioritizes patient safety is critical in Saudi cancer care settings to increase patient safety.
The findings contribute to a better understanding of the predictors and outcomes of PSC, which should be considered when establishing effective nursing interventions or strategies for PSC in cancer care settings.
No patient or public contribution.
To identify changes in mental health status among nursing professionals in a Brazilian municipality during the COVID-19 pandemic.
An observational and longitudinal study.
Using the Patient Health Questionnaire-9, the presence of depressive symptoms was evaluated among 690 nursing professionals in the city of Pelotas, Brazil, at two moments: June/July 2020 and June/July 2021.
13.0% incidence of depressive symptoms was identified; as well as 12.2% remission; 24.1% persistence and 50.7% absence. Among the factors associated with the worst prognoses we can mention female gender, greater workload, feeling of overload, illness of family members or friends due to COVID-19 and use of psychotropic drugs
There was significant mobility in the diagnosis of depression among the professionals studied during the period analysed, with incidence of new cases of significant depression and greater than the number of remissions. In addition to sociodemographic aspects, traumatic experiences and exposure to continuous overload were associated with persistence and incidence of new cases.
With the advent of the COVID-19 pandemic, several studies have shown an increase in depressive symptoms among nursing professionals; however, understanding the long-term effects of this scenario is still a challenge.
What problem did the study address? This study investigates changes in the mental health status of nursing professionals working at different care levels, taking the prevalence of screening for depression as a proxy, during a period of a year during the COVID-19 pandemic.
What were the main findings? Between both data collection moments, 2020 e 2021, there was a significant percentage of professionals with persistent depression, in addition to a significant proportion of incident cases that slightly exceeded the number of remissions and the factors associated with the worst prognoses were sociodemographic aspects such as gender and emotional stressors like illness of family members or close friends due to COVID-19, in addition to those related to the organisation and support provided by the services, such as workload and feeling of overload.
Where and on whom will the research have an impact? This study will impact the nursing professionals and in role of the health services in order to establishing actions that contribute to minimising the deleterious effects of the pandemic on the mental health of their Nursing teams.
The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines were adopted in this study.
No Patient or Public Contribution.
To identify and map out existing nurse-led models of care for treatment and prevention of metabolic syndrome in primary care settings.
A scoping review.
Conducted in accordance with the JBI methodology.
A search of the databases PubMed, CINAHL Complete, Cochrane Library, Scopus, handsearch and a grey literature search was conducted in June 2022 and updated in March 2023.
Title and abstract screening was performed on 926 articles resulting in 40 articles for full text screening. Full text screening yielded seven articles that met inclusion criteria.
Additional research is needed on nursing models of care to prevent and treat metabolic syndrome. Future studies should concentrate on rigour with clearly defined objective inclusion criteria.
This review contributes a synthesis of the evidence on nurse-led models for metabolic syndrome in primary care.
This scoping review addresses metabolic syndrome, the precursor to non-communicable disease. The review mapped the evidence for nurse-led models of care for metabolic syndrome in the primary care setting. These findings promote the development and evaluation of novel nurse-led models of care which can mitigate the effect of the current epidemic.
PRISMA checklist for scoping reviews.
No patient or public contribution was part of this study.
Protocol Registration: Open Science Framework accessible at: https://osf.io/jfpw7/.
Mental distress, non-specific symptoms of depression and anxiety, is common in chronic pelvic pain (CPP). It contributes to poor recovery. Women's health nurses operate in multidisciplinary teams to facilitate the assessment and treatment of CPP. However, valid cut-off points for identifying highly distressed patients are lacking, entailing a gap in CPP management.
This instrumental cross-sectional study identified a statistically derived cut-off score for the Depression Anxiety Stress Scale-8 (DASS-8) among 214 Australian women with CPP (mean age = 33.3, SD = 12.4, range = 13–71 years).
Receiver operator characteristic curve, decision trees and K-means clustering techniques were used to examine the predictive capacity of the DASS-8 for psychiatric comorbidity, pain severity, any medication intake, analgesic intake and sexual abuse. The study is prepared according to the STROBE checklist.
Cut-off points resulting from the analysis were ordered ascendingly. The median (13.0) was chosen as an optimal cut-off score for predicting key outcomes. Women with DASS-8 scores below 15.5 had higher analgesic intake.
CPP women with a DASS-8 score above 13.0 express greater pain severity, psychiatric comorbidity and polypharmacy. Thus, they may be a specific target for nursing interventions dedicated to alleviating pain through the management of associated co-morbidities.
At a cut-off point of 13.0, the DASS-8 may be a practical instrument for recommending a thorough clinician-based examination for psychiatric comorbidity to facilitate adequate CPP management. It may be useful for evaluating patients' response to nursing pain management efforts. Replications of the study in different populations/countries are warranted.
To analyse and describe the changes in the image of nurses perceived by the public pre- and post-COVID-19 in Korea.
Nurses play an important role in disaster situations such as COVID-19. In such disaster situations, we aim to confirm the image of nurses projected in the mass media and promote the professionalism of nurses through the image of nurses as professionals.
Qualitative media keyword networks analysis.
To understand the change in the image of nurses pre- and post-COVID-19, the big data program TEXTOM was used to collect data. From 19 January to 31 May 2020, data were set as ‘post-COVID-19’, and 1 year before 18 January 2020, data were set as ‘pre-COVID-19’. The keywords from 9533 articles were refined, frequency analysed and social networks analysed using TEXTOM and MS office excel, and the analysis results were visualised using UCINET 6 and the NetDraw program.
As for keywords related to nurses pre-COVID-19, those with the most frequent appearance and the highest networking degree in centrality were ‘work’, ‘older adults’, ‘care’, ‘time’, ‘care worker’, ‘caring labor’. As for keywords related to nurses post-COVID-19, those that appeared most often and had the highest degree of centrality networking were ‘COVID-19’, ‘USA’, ‘China’, ‘check’, ‘patient’, ‘work’.
This study shows that the public image of nurses has changed more positively after COVID-19 due to the media. Individual nurses and nursing organizations should pay attention to the deficiency in the image of nurses and provide a way to reform the public image of professional nurses.
The effects of global crises such as COVID-19 on nurses were confirmed, and information delivered through the media was an important way to improve the nursing profession.
The aim of this study is to generate empirical evidence, drawing from clinical records, with the goal of elevating the level of evidence supporting the nursing diagnosis (ND) of ‘chronic pain’.
Chronic pain is a prevalent condition that affects all age groups. Patients often feel disbelieved about their pain perception, leading to adverse psychological effects, difficulty accessing healthcare and poor rehabilitation outcomes.
Retrospective descriptive study. Standards for Reporting Diagnostic Accuracy Studies guidelines were followed in this study.
Data were extracted from Electronic Health Records (EHR) of patients admitted to the University Hospital of Perugia, Italy, between March 2016 and December 2022. The study sample comprised individuals without a specific medical diagnosis or high-risk population. Out of 1,048,565 EHR, 43,341 clinical-nursing diaries with the keyword ‘pain’ were identified, from which 283 clinical-nursing notes were selected based on a keyword-based retrieval technique and diagnostic definition for further analysis.
Our study findings support the diagnostic descriptors of the ‘chronic pain’ ND in clinical-nursing diaries. We observed the presence of 9 out of 11 defining characteristics, 7 out of 10 related factors, 4 out of 8 at-risk populations and 11 out of 17 associated conditions.
The study validated diagnostic criteria for chronic pain and proposed ‘haematological pathology’ as a new associated condition. The findings were presented to the Diagnosis Development Committee of NANDA-International for further review. However, limitations of the study prompted the need for further analysis using natural language processing and artificial neural network techniques. As a result, a new research direction using artificial intelligence (AI) tools was initiated.
The study validates diagnostic descriptors for chronic pain and proposes future directions in semantic analysis and AI tools, aiming to enhance clinical practice and decision-making in nursing care.
No patient or public contribution.
To examine the relationship among eHealth literacy, empowerment and self-management and the mediating effects of empowerment in diabetic kidney disease (DKD) patients in the eHealthcare context.
Self-management is an essential aspect of healthcare in delaying disease progression for DKD. In the eHealthcare era, health services providing self-management are transforming. The ability and confidence of patients to use eHealth services is a critical issue that impacts the effectiveness of self-management, but little is known about the role of eHealth literacy and empowerment in self-management.
A cross-sectional study guided by the STROBE.
Overall, 127 Taiwanese patients were enrolled using convenience sampling. Data collection used structured questionnaires and chart reviews. Multiple regression was used to infer self-management predictors, and SPSS PROCESS macro and bootstrapping verified the mediating effects.
Empowerment and eHealth literacy both showed significant positive correlations with self-management. Empowerment was the main predictor of self-management and had a complete mediating effect between eHealth literacy and self-management.
Increasing patients' eHealth literacy can improve empowerment and prevent health inequality issues. Healthcare providers should consider improving patients' eHealth literacy to enhance their self-management.
Healthcare service systems need to create user-friendly eHealthcare environments, and healthcare professionals can provide multifaceted instructions that fit patients' eHealth literacy levels to enhance their motivation and confidence in disease care, thus cultivating positive self-management behaviours.
The popularity of eHealthcare services aimed at promoting self-management behaviours is increasing. However, the level of eHealth literacy is an essential factor that affects the effectiveness of self-management in the healthcare environment. In addition, empowerment is a major critical influence factor of self-management and a completely mediating variable between self-management and eHealth literacy. Consequently, healthcare providers should consider promoting patients' eHealth literacy to empower people using eHealthcare services for implementing self-management.
The Strengthening the Reporting of Observational Studies in cross-sectional studies (STROBE) checklist was used to ensure comprehensive reporting.
Patients were diagnosed with DKD in the study hospital. Physicians and case managers transferred patients to research assistants who screened them for the inclusion criteria and invited them to participate in this study if they met the requirements. After participants signed informed consent, the research nurse encouraged participants to respond to the research questionnaire face to face.
FreshRSS 