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The study aims to investigate patients' perceptions of recurrence risk associated with atrial fibrillation, with the goal of establishing a theoretical foundation for developing future measurement scale and intervention strategies.
A qualitative interview study.
Seventeen patients diagnosed with atrial fibrillation at a Grade-A tertiary hospital participated in semi-structured, in-depth interviews conducted between October and December 2024. Participants were selected via purposive sampling. The data were analysed employing thematic analysis in accordance with Colaizzi's method. The study adhered to the Consolidated Criteria for Reporting Qualitative Research checklist.
The perceptions of recurrence risk among patients with atrial fibrillation can be summarised into five themes: (1) perceived likelihood of recurrence, (2) perceived severity of recurrence, (3) perceived triggers of recurrence, (4) emotional reaction to recurrence, and (5) efficacy perception of managing recurrence risk.
Perceptions of recurrence risk among patients with atrial fibrillation are diverse and often underestimated due to limited knowledge and subjective symptom interpretation, affecting health behaviours. Understanding patients' subjective appraisals, emotions, and perceived efficacy is essential. Validated assessment tools and tailored risk communication may enhance self-management and support targeted interventions.
This study provides critical insights into how atrial fibrillation patients perceive their risk of recurrence. It also provides a theoretical foundation for creating validated assessment tools and tailoring individualised health education and intervention programmes.
Patients were involved in the study design, data collection, and interpretation of findings. Their contributions included providing feedback on the initial interview guide to ensure relevance and clarity, participating in in-depth interviews to share their lived experiences with atrial fibrillation recurrence, and offering reflections on key themes emerging from the data.
This study aimed to validate the mediating role of nurses' AI trust in the relationship between AI uncertainties and AI competence.
A cross-sectional study.
A purposive sample of 550 registered nurses with at least 1 year of clinical experience from three tertiary and two secondary hospitals in Jinan and Hangzhou, China, was used. Data were collected using structured questionnaires assessing AI uncertainty, trust and competence. Demographic data included gender, age, education level, years of clinical experience, professional title and hospital level. Mediation analysis.
Most nurses were from tertiary hospitals (88.9%), held a bachelor's degree (87.6%), and had over 6 years of experience. The mediating role of AI trust between AI uncertainties and AI competence is validated. AI uncertainties affected AI trust (B = 0.39, p < 0.0001), explaining 10% of the variance. AI uncertainties and AI trust affected AI competence (B = 0.25 and 0.67, p < 0.0001), explaining 63% of the variation. AI trust's total effect was 0.51, comprising direct and indirect effects of 0.25 and 0.26, respectively.
Hospitals can reduce uncertainty through an AI-transparent decision-making process, providing clinical examples of AI and training nurses to use AI, thereby increasing trust. Second, AI systems should be designed to consider nurses' psychological safety needs. Hospital administrators utilise optimised AI technology training and promotional techniques to mitigate nurses' resistance to AI and enhance their positive perceptions of AI competence through trust-building mechanisms.
Impact: Enhancing nurses' AI trust can reduce uncertainty and improve their competence in clinical use. Strategies such as transparency, explainability and training programmes are crucial for improving AI implementation in healthcare.
This study focused solely on clinical nurses and did not include patients or the public.
The study adhered to STROBE guidelines.
To explore the experiences, perceptions, and role adaptation of nursing PhDs in hospital settings in China.
A descriptive phenomenological qualitative study.
Individual in-depth interviews were conducted with eight female nursing PhD holders from eight tertiary hospitals across five provinces between November 2024 and February 2025. Data were concurrently collected and analysed using NVivo 11.0, guided by Colaizzi's seven-step analysis.
Four main themes were identified: (1) Multidimensional motivations for choosing hospital work; (2) professional challenges; (3) perceived professional value and benefits; and (4) career expectations and developmental recommendations. Fifteen subthemes further detailed these dynamics.
This study offers a nuanced understanding of the career development of nursing PhDs within hospital settings. The findings reveal the complex interplay of factors influencing their decisions to enter clinical practice. Moreover, it underscores the dual challenges of role ambiguity and limited resources, while also illustrating the transformative potential of applying academic training to drive clinical innovation among nursing PhDs in hospital environments.
These findings offer critical insights for hospital administrators and educational policymakers. By elucidating the career development challenges and opportunities for nursing PhDs, the study underscores the need for tailored talent management frameworks and targeted educational reforms. The findings have important implications for hospital settings in China and offer guidance for global strategies in talent management and clinical education reform, ultimately contributing to improved patient care and healthcare outcomes.
Adhered to COREQ guidelines for qualitative research.
None.
Stroke incidence has increased recently, causing functional impairments in most patients. Augmented reality(AR) is frequently employed as an interactive and repetitive technology to facilitate functional rehabilitation. Therefore, this study aimed to examine the current evidence in the effect of AR for stroke rehabilitation.
Systematic review with meta-analysis.
Seven electronic databases including PubMed, Medline, CINAHL, Web of Science, Scopus, Embase and Cochrane were searched by MeSH terms and keywords such as ‘Stroke’ ‘Augmented reality’ up to December 1, 2024.
The Cochrane Risk of Bias tool was used to evaluate potential bias. Meta-analysis and Trial Sequence Analysis were used to analyse by the datastata15.0 software and TSA v0.9 software.
We searched 11 studies in a systematic review and 8 in a meta-analysis. The AR training group exhibited a significantly superior Berg Balance Scale scores(BBS) to those of the traditional training group. The Z-value curve of the sixth study crossed the traditional and TSA boundary values. Subgroup analysis revealed that BBS was significantly influenced in the hospital compared to the home intervention. The Timed Up and Go Test scores(TUG) and the 10-Meter Walk Test scores(10MWT) were similar in the AR and traditional training groups.
AR technology is beneficial for the lower limb balance functional rehabilitation of stroke patients. However, further exploration and verification are necessary due to an insufficient number of trials.
The findings provide clinical references for implementing AR in rehabilitation interventions for stroke patients.
This paper is helpful for nurses in the rehabilitation training process of stroke patients, to make personalised plans for their rehabilitation, implement rehabilitation, provide health education and address other aspects of efforts, to provide patients with comprehensive support and help, to promote the functional recovery of patients and improve the quality of life.
PRISMA guidelines.
PROSPERO number: CRD42024533761.
MJEditor (www.mjeditor.com) provided English editing services during the preparation of this manuscript.
To investigate the impacts of social support and psychological detachment on nurses' job burnout, as well as to validate psychological detachment's mediating effect.
The study was conducted using a questionnaire-based cross-sectional design.
From October 2023 to March 2024, convenience sampling was used to distribute electronic questionnaires (including a general information questionnaire, the Maslach Burnout Inventory, the Psychological Detachment Scale, and the Social Support Scale) to investigate the current state of job burnout, psychological detachment, and social support among nurses. A total of 325 nurses were included in the study. The statistical analysis was performed using SPSS 29.0 software and the SPSS Process 4.1 plug-in.
Results showed that both social support and psychological detachment were negatively correlated with job burnout. Excluding general demographic characteristics, social support was negatively associated with job burnout through psychological detachment, where psychological detachment mediated social support and emotionally exhausting job burnout with a mediating effect of 8.93%.
Nurses' job burnout can be mitigated by both social support and psychological detachment, with psychological detachment acting as a mediation of the effect of social support.
Nursing managers should take measures to enhance the social support of nurses appropriately. At the same time, it is necessary to arrange work reasonably and establish a solid communication mechanism to improve nurses' psychological detachment and reduce nurses' job burnout.
No patient or public involvement.
To explore the complete decision-making process and action logic of nurses making autonomous decisions that result in missed nursing care.
The complex characteristics of patients in Intensive Care Units place higher demands on the allocation of nursing resources, as well as on the professional skills, resilience and ethics of nursing staff. Preventing missed nursing care is particularly crucial in Intensive Care Units.
A theory construction qualitative study using grounded theory.
Semistructured face-to-face interviews were conducted with 20 nurses, including three head nurses and 17 bedside nurses. Head nurses provided insights into counselling and management practices.
The theoretical model of nurses' decision-making processes comprise four strategies: setting priorities, seeking help, delaying nursing care and omitting nursing care. The latter two constitute missed nursing care. Inadequate staffing, task urgency and negative emotions can lead to omitting nursing care.
This study proposes an original concept: grassroots arrangement of nursing care (GANC). Grassroots arrangement of nursing care includes the autonomous and adaptive decision-making process used by bedside nurses to optimise workflow in busy environments. It includes specific strategies and quality implications, enabling a nuanced balance between limited nursing resources, increasing patient needs and maintaining the best possible quality of care.
Nursing managers should consider the dual aspects of grassroots arrangement of nursing care, support nurses' grassroots autonomy and streamline decision-making processes.
This study follows the Consolidated Criteria for Reporting Qualitative Studies (COREQ).
No patient or public contribution.
The diagnosis of pediatric cancer is a major shock to family caregivers, and posttraumatic stress symptoms (PTSSs) emerge as the most prevalent adverse psychological outcomes. However, not all family caregivers have sufficient resilience to cope with these challenges; thus, supportive care interventions are necessary. These interventions, which include psychosocial support, education, and other forms of assistance, are designed to enhance the well-being of those affected by disease. In the past few years, more research has been delving into supportive care interventions for family caregivers of cancer-affected children, yet there is still a variance in the results.
To investigate the impacts of supportive care interventions on PTSSs and resilience in family caregivers of cancer-affected children, also focusing on the impacts of prerecruitment time to diagnosis, duration, type of intervention, and recruitment area on the outcomes.
Nine databases (Cochrane Library, Ovid MEDLINE, CINAHL Plus with Full Text, Embase, CNKI, Sinomed, WANFANG, VIP, and Web of Science) were searched from their inception to February 21, 2024. The revised Cochrane Risk of Bias tool and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) method were used to evaluate the quality of evidence. To gauge the effectiveness of the interventions, we computed the standard mean difference (SMD) and the 95% confidence interval (CI) utilizing StataCorp (version 16.0). Sensitivity analysis and Egger's test were also conducted.
Supportive care interventions significantly improved the PTSSs (SMD = −0.86, 95% CI [−1.39, −0.33], p < 0.01, I 2 = 94.95%) and resilience (SMD = 0.85, 95% CI [0.26, 1.44], p < 0.01, I 2 = 88.3%) among family caregivers of cancer-affected children. Subgroup analyses revealed that early interventions for family caregivers after the diagnosis of children and the short-term interventions were associated with improvements in their PTSS and resilience. Moreover, cognitive behavioral interventions were the most common type of interventions and were effective in supporting family caregivers. Additionally, supportive care interventions did not improve PTSSs among family caregivers in middle-income countries.
Supportive care interventions have demonstrated efficacy in improving PTSSs and resilience among family caregivers of cancer-affected children. This research proved the imperative of providing prompt supportive care to family caregivers early after the pediatric cancer diagnosis. Additionally, it is also necessary to further study and explore the optimal way to combine different intervention components based on caregivers' need and to develop regionally adapted and culturally sensitive supportive care interventions to better improve health outcomes for family caregivers.
Delirium is one of the most common and serious complications after cardiac surgery with cardiopulmonary bypass (CPB). A comprehensive assessment of independent risk factors for postoperative delirium (POD) is essential for early detection and prevention.
To investigate the incidence and independent associated factors of POD in adults undergoing cardiac surgery with CPB.
Prospective cohort design.
A total of 203 patients were enrolled in this study from October 2022 to December 2023 in China. Richmond agitation and sedation scale (RASS) and confusion assessment method-intensive care unit (CAM-ICU) were used for assessing delirium symptom. This study analysed various factors for POD, including demographic, physical, psychological, social, spiritual and environmental aspects. Using logistic regression analysis to identify the independent associated factors.
A totla of 60.1% (n = 122) of patients had POD. Of these cases, 86 (70.5%) were hypoactive delirium, 4 (3.3%) were hyperactive delirium and 32 (26.2%) were mixed delirium. Advanced age (OR = 1.069, 95% confidence interval [CI]: 1.031–1.107; p < 0.001), preoperative depression (OR = 1.847, 95% CI: 1.246–2.736; p = 0.002), postoperative albumin level (OR = 0.921, 95% CI: 0.851–0.997; p = 0.042) and duration of mechanical ventilation (OR > 1.000, 95% CI: 1.000–1.001; p < 0.001) were independent predictors of POD.
The incidence of POD in patients undergoing cardiac surgery with CPB was high. This study identified advanced age, preoperative depression, postoperative albumin level and duration of mechanical ventilation as significant and independent predictors of POD.
The study's findings highlight the urgent necessity for improved clinical vigilance and proactive management strategies.
No patient or public contribution.
To synthesise stakeholders' experiences and perceptions of animal-assisted intervention (AAI) for people with dementia in community care settings.
Qualitative evidence synthesis.
We systematically searched Medline, CINAHL, Embase, Scopus, Web of Science, PsycINFO and AgeLine for potentially eligible studies. Thematic synthesis was used to analyse the data from included studies. We assessed the methodological limitations of included studies using an adaptation of the Critical Appraisal Skills Programme checklist and used Confidence in the Evidence from Reviews of Qualitative Research (GRADE-CERQual) tool to assess confidence in review findings. This review is reported using the ENTREQ checklist.
We included 14 reports from 11 studies and developed three analytical themes incorporating a gardening analogy: planting–connecting with animals, growing–engaging in AAI and nurturing–making AAI work; and six subthemes: willingness to connect, building relationships, a rich experience, the benefits of AAI, individualised and holistic approach and training and support, with 15 key findings.
This review describes people's experiences and perceptions of AAI for people with dementia, and provides recommendations on the development and implementation of AAI, with moderate to high confidence. Nurses need to consider the factors that influence the implementation of AAI identified in this review, to facilitate engagement and long-term impacts while adopting AAI in community care settings.
This review may enhance healthcare professionals' understanding of AAI for people with dementia in community care settings. AAI is a complex intervention that can be delivered in varied manner. A multicomponent, flexible and individualised AAI is important. Additional training and education for staff are needed.
A man with dementia and his wife who share a love of dogs, advised at each step of the review, providing insights and perspectives and contributing as co-authors.
To investigate symptom clusters and sentinel symptoms in breast cancer survivors based on self-reported outcomes, explore the impact of sentinel symptoms on patients' quality of life and psychological distress, provide a basis for implementing accurate symptom management.
A cross-sectional survey.
The study was conducted from September 2021 to December 2022. We recruited 281 patients who were re-examined in an outpatient department of a tertiary hospital in Hebei Province. The European Organization for the Research and Treatment of Cancer (EORTC) Quality-of-Life Questionnaire - Core30 (QLQ-C30), the EORTC Quality-of-Life Questionnaire Breast Cancer - 23 (QLQ-BR23), the Hospital Anxiety and Depression Scale (HADS) were used to conduct the survey. Symptom clusters were explored using principal component analysis, sentinel symptoms were explored using the Apriori algorithm. Correlation analysis was used to explore the relationship between sentinel symptoms and quality of life, correlation with psychological distress. This paper adhered to the STROBE guidelines.
Breast cancer survivors have a wide range of self-reported symptoms in the form of four symptom clusters: a fatigue symptom cluster, a gastrointestinal symptom cluster, a sickness symptom cluster and a surgical trauma-related symptom cluster. Three sentinel symptoms were explored: pain, alopecia and limited function of the upper limbs. Except for sexual function, all of the sentinel symptoms were negatively correlated with patients' quality of life and positively correlated with psychological distress (p < .05).
Breast cancer survivors have a variety of symptoms in the form of four symptom clusters. Pain, alopecia and limited function of the upper limbs are the sentinel symptoms, which affect patients' quality of life and psychological distress.
To assess the effectiveness of different nonpharmacological treatments for severe radiation-induced oral mucositis in patients with head and neck cancer.
Radiation-induced oral mucositis is highly prevalent in patients with head and neck cancer. Current medications for radiation-induced oral mucositis are limited in effectiveness and susceptible to side effects, and while there is an increasing adoption of nonpharmacological interventions, the optimal one remains unclear.
Systematic review and network meta-analysis based on the PRISMA-NMA guidelines.
Six databases were searched. Two authors independently performed the literature screening, data extraction and methodological quality assessment of the included studies. Traditional pairwise meta-analysis was performed by R Studio. A network meta-analysis was then conducted to assess the effects of nonpharmacological interventions for severe radiation-induced oral mucositis in patients with head and neck cancer.
Fifty-two studies involving seven types of nonpharmacological interventions were enrolled. The network meta-analysis indicated that natural plant-based therapies might be the most effective, health education interventions might be the second most effective, and honey might be the third most effective interventions for reducing the incidence of severe radiation-induced oral mucositis. For reducing the incidence of severe oral mucositis-related pain, the pairwise meta-analysis showed that only natural plant-based therapies and health education interventions were effective.
Nonpharmacological interventions are effective in the management of severe radiation-induced oral mucositis among patients with head and neck cancer.
Nonpharmacological interventions are a category of safe and effective adjunctive therapies that should be encouraged in clinical practice.
CRD42023400745.
A systematic review and meta-analysis was performed to identify the factors related to cancer death anxiety based on available evidence.
This systematic review and meta-analysis followed the PRISMA 2020 guidelines.
Seven databases were searched to identify studies on the relationships of cancer death anxiety with demographic characteristics, disease factors and psychosocial factors from inception to May 2023. The Agency for Medical Research and Quality (AHRQ) scale was used to evaluate the quality of the included studies. After two researchers independently completed the literature search, data extraction and quality evaluation, meta-analysis was conducted by using RevMan5.3 and Stata 17.0 software.
In total, 52 studies were included in this review. The results revealed that there were positive correlations of death anxiety with female sex, the symptom burden, anxiety levels, depression levels, fear of recurrence, attachment avoidance, psychological distress, resignation and confrontation coping. Death anxiety was negatively correlated with age, education level, ability to perform daily activities, self-esteem, spiritual well-being, sense of meaning in life, resilience, quality of life, social support and religious beliefs.
Our results can inform the design of interventions to address death anxiety and improve the overall quality of life of cancer patients. Healthcare professionals should promptly identify and focus on death anxiety in high-risk populations of cancer patients.
Cancer patients commonly experience death anxiety, and this anxiety has a nonnegligible impact on patients' mental health and overall quality of life. This study can inform the development of interventions by clinical healthcare professionals.
This was a meta-analysis based on data from previous studies.
The aim of this study is to evaluate the relative merits of various heart failure models of care with regard to a variety of outcomes.
Systematic review.
Five databases including PubMed, Web of Science, Medline, Embase and Science Direct were searched from the inception date of databases to August 20, 2022.
This review used the Cochrane Collaboration's ‘Risk of Bias’ tool to assess quality. Only randomised controlled trails were included in this review that assessed all care models in the management of adults with heart failure. A categorical summary of the pattern of the papers was found, followed by extraction of outcome indicators.
Twenty articles (19 studies) were included. Seven examined nurse-led care, two examined multidisciplinary specialist care, nine (10 articles) examined patient self-management, and one examined nurse and physiotherapist co-led care. Regarding outcomes, this review examined how well the four models performed with regard to quality of life, health services use, HF self-care, and anxiety and depression for heart failure patients. The model of patient self-management showed more beneficial results than nurse-led care, multidisciplinary specialist care, and nurse and physiotherapist co-led care in reducing hospital days, improving symptoms, promoting self-care behaviours of HF patients, enhancing the quality of life, and strengthening self-care ability.
This systematic review synthesises the different care models and their relative effectiveness. Four different models of care were summarised. Of these models, the self-management model demonstrated better outcomes.
The self-management model is more effective in increasing self-management behaviours and self-management abilities, lowering the risk of hospitalisation and death, improving quality of life, and relieving anxiety and depression than other models.
There was no funding to remunerate a patient/member of the public for this review.
First-degree relatives (FDRs) of colorectal cancer (CRC) patients have a higher risk of developing CRC than the general population. Ensuring that these at-risk populations receive colonoscopy screening is an effective strategy for reducing the increased risk, but the rates remain low. Colonoscopy screening behavior is influenced by factors at multiple levels. However, most previous reviews failed to review them and their interactions systematically.
To explore factors influencing FDRs' colonoscopy screening behavior according to the ecological model.
A mixed-method systematic review was performed in accordance with The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guideline. A comprehensive literature search was conducted using eight bibliographic databases (Medline, EMBASE, PubMed, the Cochrane Library, Scopus, China National Knowledge Infrastructure, Wan Fang Data, and China Biology Medicine) for the period from January 1995 to February 2023. The Joanna Briggs Institute critical appraisal checklists were applied to assess studies qualities. A convergent integrated approach was used for data synthesis and integration.
In total, 24 articles reporting on 23 studies were included. Only one study was rated low quality, and the other 22 studies were rated moderate to high quality. The findings revealed that certain factors and their interactions affected FDRs' colonoscopy screening behaviors according to the ecological model, including misconceptions about CRC and colonoscopy, concerns about the procedure, perceived susceptibility to developing CRC, health motivation, fear of CRC, fatalism, the recommendation from CRC patients, and recommendations from physicians, colonoscopy schedules, cancer taboo, health insurance and cost of colonoscopy.
Family communication-centered multilevel interventions are recommended to promote colonoscopy screening behavior among FDRs of CRC patients.
As pharmacotherapy often leads to adverse reactions, mind–body exercise (MBE) treatments have become a more popular option for treating depression in people living with breast cancer (BC). However, the most effective type of MBE treatment for this population remains unclear.
The aim of this systematic review and network meta-analysis (NMA) was to compare the efficacy of the different MBE modes for depression in people with BC.
A systematic search for randomized controlled trials (RCTs) from inception to March 25, 2023, was conducted in the following database: EMBASE, PubMed, Web of Science, Cochrane Library, China National Knowledge Infrastructure, Wanfang Data, China Biology Medicine, OpenGrey, and ClinicalTrials.gov. A traditional meta-analysis was conducted using the random-effects model to directly assess the effectiveness of various MBE interventions. Stata 16.0 software was used for performing the NMA.
The NMA was performed in 32 eligible RCTs including 2361 participants. The efficacy of MBE treatments on depression was ranked as the following: Liuzijue (surface under the cumulative ranking curve [SUCRA] = 95.4%) > Tai chi (SUCRA = 76.9%) > yoga (SUCRA = 55.0%) > Baduanjin (SUCRA = 53.9%) > Pilates (SUCRA = 38.6%) > dance (SUCRA = 30.2%) > Qigong (SUCRA = 28.1%) > control (SUCRA = 21.9%).
Our research showed that Liuzijue and Tai chi might be the most significantly effective MBE intervention for mitigating depression among BC survivors. Healthcare professionals could consider recommending Liuzijue and Tai Chi as a complementary therapy for BC survivors who experience depression.
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