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Autistic people with communication support needs can benefit from the use of augmentative and alternative communication. While research has considered the use of AAC to supplement communication and improve communication effectiveness, less is known about other potential outcomes across the lifespan such as wellbeing and social interaction. The aim of this systematic review was to synthesise current research regarding the use of AAC for autistic adults and children; exploring how AAC supports the individual's communication, adaptive functioning and quality of life. A systematic search was conducted across six databases; PsychINFO, Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus, Educational Resources Information Centre (ERIC), and Google Scholar. Eligibility criteria included experimental design, peer-reviewed publications and papers published in English after 2013. Relevant papers were exported to Covidence; screening, full text review and data extraction were conducted in duplicate and quality appraisal was completed for all papers using the Scientific Merit Rating Scales (SMRS). Included studies were grouped by age, intervention types, AAC types and reported outcomes, and described qualitatively. The 69 included papers focused on a range of AAC types. The majority investigated speech-generating devices and low-tech picture exchange. Most used behavioural intervention techniques. Most papers focused only on children, with only three papers investigating outcomes of AAC use with adults. The results were largely descriptions of proximal outcomes, such as simple requests, with few considering generalisation of skills or distal outcomes such as quality of life. The quality of the papers was generally low, with limitations in study design and diagnostic ascertainment noted. AAC has the potential to be an important support for autistic people, however, evidence regarding the impact on the broad range of communication functions and quality of life is very limited. A greater focus on the impact of AAC on these areas is needed in both research and practice along with a stronger focus on adults and a greater range of AAC types. PROSPERO number: CRD42023473247 WHAT THIS PAPER ADDS: What is already known on this subject The use of augmentative and alternative communication (AAC) with autistic adults and children is an established practice. Previous research has shown some effectiveness related to the specific goals being studied but it has centred mostly on children, and most research has focused on making requests, rather than broad communication or life outcomes. What this paper adds to existing knowledge This study explores the literature about autism and AAC and seeks to specifically examine the range of outcomes reported. We found that most of the research on this topic continues to focus on children, aided rather than unaided communication, and on outcomes related directly to the intervention, such as making requests. Very few studies included measures of generalisation or considered broader outcomes of AAC supports, such as quality of life, or enhanced social interactions. What are the potential or actual clinical implications of this work? Clinicians and researchers should consider the potential for broader impacts of AAC and ensure that goals focus on skills beyond immediate functions to areas such as quality of life, well-being, learning and employment, and the development of social relationships. Clinicians and researchers should also ensure that AAC interventions are offered to not only children, but also to autistic adults who may benefit from communication supports.

Research in nursing, occupational therapy and dental hygiene indicates that clinical practice engagement enhances academic faculty's credibility with students and skill retention. However, common barriers include limited time, institutional constraints and unclear policies. Despite ongoing clinical involvement among physical therapy faculty, little is known about how these activities influence teaching performance and workload management. This study examined the experiences of full-time faculty members with clinical practice, focusing on the perceived benefits, barriers and institutional factors that affect their ability to sustain patient care while fulfilling academic duties. This phenomenological pilot study examined the lived experiences of seven full-time physical therapy faculty at a public land-grant institution. Data were collected through semistructured interviews and analysed using Colaizzi's method with thematic coding. Research questions addressed experiences, perceived benefits and barriers and the influence of personal and institutional factors on clinical engagement. Four themes emerged: the experiences of engaging in physical therapist clinical practice, the perceived benefits of clinical practice, the perceived barriers to clinical practice and the impact of participant characteristics on experience. Clinical practice was viewed as essential for maintaining competence and enhancing teaching. Faculty valued it as a professional motivator, but institutional barriers often limited participation. Formalising clinical practice through policies, workload models and curricular integration may help sustain dual academic and clinical roles. These findings suggest that supporting faculty in maintaining clinical engagement benefits educators and students in physical therapy education.

Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD) is associated with high rates of hospital readmission and mortality. Traditional fragmented care often fails to address the complex needs of these patients. This study aimed to evaluate the impact of an Integrated Medical-Nursing Management (IMNM) model on readmission rates, mortality, and patient-centered outcomes in AECOPD patients. A retrospective cohort study was conducted at the First Hospital of Hebei Medical University involving AECOPD patients admitted between January 2022 and January 2025. Patients were divided into a Control Group (standard care, Jan 2022-Jun 2023) and an Intervention Group (IMNM model, Aug 2023-Jan 2025). The IMNM model featured interdisciplinary rounds, joint discharge planning, and structured follow-up. Propensity Score Matching (PSM) was used to balance baseline covariates (1:1 matching). The primary outcome was hospital readmission rates at 30, 90, 180, and 365 days. Secondary outcomes included all-cause mortality, CAT scores, and treatment adherence. A total of 120 patients (60 per group) were included after PSM. The Intervention Group showed significantly lower readmission rates at 30 days (15.0% vs. 28.3%, P=0.046) and 365 days (26.7% vs. 51.7%, P<0.001). The hazard ratio for readmission-free survival favored the intervention (HR 0.38, 95% CI 0.21-0.70). All-cause mortality at 1 year was significantly lower in the Intervention Group (5.0% vs. 13.3%, P=0.041). Patients in the IMNM group also demonstrated improved CAT scores (MD -5.4, P<0.001) and higher medication adherence (80.0% vs. 53.3%, P=0.004). In conclusion, the Integrated Medical-Nursing Management model is associated with reduced hospital readmissions and mortality, as well as improved patient quality of life and treatment adherence in AECOPD patients. These findings provide actionable evidence for healthcare systems to adopt collaborative clinical pathways, thereby standardizing routine clinical practice to mitigate the burden of AECOPD.

Pre-procedural anxiety in patients with intravitreal injections shows a significant negative association with vision-related quality of life. This study determines the effect of telenursing with self-care education podcasts on anxiety and quality of life in patients with diabetes undergoing intravitreal injections. A randomized clinical trial was conducted in 2022 in Mashhad, Iran on 68 patients assigned to two groups. After informed consent were obtained, patients completed a demographic questionnaire, the Spielberger State-Trait Anxiety Inventory, and the SF-36 quality of life questionnaire. Relevant podcasts were delivered individually via WhatsApp once a week over an 8-week period to the intervention group (n=34), while the control group (n=34) received routine education via pamphlets. Anxiety levels were measured before the commencement of the intervention and each injection; the quality-of-life questionnaire was administered before and after the completion of the intervention. Data were analyzed using SPSS version 26. The statistical tests included the t-test, Chi square, repeated measures ANOVA, ANCOVA, and Mann-Whitney U test. The intervention group demonstrated a significantly greater reduction in both state anxiety (P<0.001) and trait anxiety (P<0.001) over the eight-week study period compared to the control group. Furthermore, the intervention group comparison with the control group showed statistically significant improvement in the total score of quality-of-life (P<0.001). A telenursing program delivered via self-care podcasts, a feasible task for community nurses, significantly reduced anxiety and improved quality of life in patients with diabetic retinopathy undergoing intravitreal injections.Trial Registration Number: IRCT20220611055134N.

Background/Objectives: Providing an appropriate diet to older adults with dysphagia can prevent aspiration, choking, and nutritional deficiencies and help preserve their quality of life. Therefore, assessments for determining the appropriateness of food types are required. This multicenter study aimed to determine the reliability and validity of the Meal Rounds Observation Form (MROF), which was developed to identify food forms that can be safely consumed by older adults with dysphagia. Methods: We analyzed 532 food-texture observations obtained from 155 participants (114 men and 41 women). The reliability and validity of the MROF were compared with those of videofluoroscopic (VF) or videoendoscopic (VE) examinations of swallowing. Results: The food-form categories were water (108 pairs), 0j (54 pairs), 0t (118 pairs), 1j (20 pairs), 2-1 (28 pairs), 2-2 (37 pairs), 3 (68 pairs), 4 (67 pairs), and normal food (32 pairs) based on JDD 2021 codes. The AUC was lowest for the water (0.568) category and highest for food forms requiring chewing, such as those of the 4 and normal food (0.678) categories. The sensitivity and specificity of the Gugging Swallowing Screen were 60.1% and 69.1%, respectively (p < 0.001). The agreement between the Gugging Swallowing Screen and the MROF evaluation for food types requiring mastication was 73.2%. Logistic regression analysis revealed asymmetric movement of the corners of the mouth and coughing as important indicators when evaluating food types requiring mastication. Conclusions: The MROF is useful for determining food intake safety when VF or VE tests cannot be performed in medical and nursing care settings and can guide clinical decision-making. However, caution is required in applying it clinically because of its relatively low specificity.

The peripherally inserted central catheter (PICC) has been widely used in clinical practice, but there are also high risks in the use process. With the development of intravenous therapy technology, it is possible to reduce PICC related adverse events. This study aims to explore the effect of specialized nursing intervention of intravenous therapy in patients with PICC and the feasibility of preventing/reducing complications. Subjects 23 to 75 years treated with PICC catheterization concluded. A total of 96 subjects were assigned to a control group (n&#x2005;=&#x2005;48), which performed routine care, a study group (n&#x2005;=&#x2005;48), which received 2-week intravenous therapy specialist nursing therapy based on routine care. After 2 weeks for PICC nursing therapy, Chi square test analyses showed significant differences between routine care (75.00%) and intravenous therapy specialist nursing therapy (93.75%) in treatment compliance rate, as well as the scores of Cancer Patients PICC Sell management and the core scale of quality of life of cancer patients. Significantly lower incidence of complications for study group (8.33%) versus control group (27.08%). Intravenous therapy specialist nursing intervention has a significant effect on patients with PICC catheterization, which can improve patients' treatment compliance, improve their quality of life, and effectively reduce the occurrence of related complications.

Nursing students face various stressors during clinical practice that can negatively impact mental health and academic performance. This study aims to validity and reliability of the Indonesian version of the perceptions of clinical stressors scale (NSPCSS). The study used a cross-sectional design with clinical nursing students in Indonesia. Construct validity was assessed using confirmatory factor analysis (CFA), and reliability was analysed using Cronbach's alpha. The CFA results showed that the three-factor model had a good model fit (X=588.053, df=222, p=0.001, CMIN/DF=2.649, NFI=0.90, RFI=0.90, IFI=0.93, TLI=0.92, CFI=0.93, RMSEA=0.08). Cronbach's alpha value was 0.945. The NSPCSS is proven to be valid and reliable. It can be used to identify the main sources of stress experienced by nursing students during clinical practice in Indonesia.

Providing effective nursing interventions alongside pharmacological treatment is essential for enhancing children's cooperation, alleviating clinical symptoms, and promoting recovery. This study aims to investigate the effects of therapeutic play combined with emotional soothing care on clinical outcomes, nutritional status, and sleep quality in children with acute diarrhea, and to inform a comprehensive nursing strategy for clinical management. This retrospective study included 148 children with acute diarrhea admitted to the Women and Children's Hospital of Ningbo University between June 2023 and May 2025. Participants were grouped according to the nursing intervention received: children receiving emotional soothing care were assigned to the control group (n = 78), whereas those receiving therapeutic play combined with emotional soothing care were assigned to the observation group (n = 70). Baseline characteristics and clinical data were extracted from the medical record system and comparatively analyzed between groups. The observation group demonstrated significantly shorter diarrhea cessation time, abdominal pain cessation time, and length of hospital stay compared with the control group (p < 0.05). No statistically significant difference in fever resolution time was observed between the groups (p > 0.05). In the viral etiology subgroup, the observation group showed significantly shorter diarrhea cessation time, shorter abdominal pain cessation time, and a shorter length of hospital stay compared to the control group (p < 0.05). In the bacterial etiology subgroup, diarrhea cessation time and abdominal pain cessation time were also significantly shorter in the observation group (p < 0.05), whereas the difference in length of hospital stay between groups was not statistically significant (p > 0.05). Following the intervention, serum albumin (Alb), prealbumin (PA), and hemoglobin (Hb) levels in the observation group were significantly higher than those in the control group (p < 0.05). Post-intervention scores for sleep quality, sleep latency, sleep duration, sleep efficiency, sleep disturbances, daytime dysfunction, and the total Chinese version of the Pittsburgh Sleep Quality Index (PSQI) score were significantly lower in the observation group than those in the control group (p < 0.05). Although the incidence rates of dehydration, electrolyte imbalance, diaper rash, perianal breakdown, and dyspnea were lower in the observation group than those in the control group, these differences did not reach statistical significance (p > 0.05). The proportion of children experiencing at least one adverse clinical outcome was compared between the observation group and the control group (p < 0.05). Therapeutic play combined with emotional soothing care is associated with improved clinical outcomes, enhanced nutritional status, and better sleep quality in children with acute diarrhea, thereby facilitating overall recovery.

To explore how patients experience, interpret, and respond to missed nursing care during hospitalization in a Danish hospital context. A qualitative design was employed. Individual semi-structured interviews were conducted with fifteen patients who had been admitted to medical or surgical wards at a Danish university hospital. Data were analysed using reflexive thematic analysis. The overarching theme, 'Nursing care experienced through a filter of empathy and understanding', captured how patients perceived omissions and delays as understandable responses to systemic pressures rather than neglect. Although they experienced missed nursing care, patients rationalized these omissions as inevitable, adapting to organizational constraints with empathy toward nurses, awareness of workload pressures, and a wish not to be a burden. Three subthemes illustrated this process: 'Not wanting to be a burden: negotiating physical needs', 'Moderating expectations: the subtle importance of psychosocial care' and 'Waiting patiently: a sense of shared responsibility for timely care'. Patients' empathy and adaptation sometimes obscured unmet needs and contributed to the normalization of missed nursing care. Missed nursing care thus emerged as a relational, co-constructed phenomenon shaped by both system pressures and patients' efforts to avoid burdening nursing staff. Reducing missed nursing care requires action beyond staffing, addressing relational and cultural dimensions across clinical, organizational and policy levels through proactive, person-centered approaches. By foregrounding patients' perspectives, this study reframes missed nursing care as co-constructed by both system constraints and patient adaptations, offering new insight to guide policy, leadership, and practice efforts toward more responsive and person-centered nursing care. Reporting followed the consolidated criteria for reporting qualitative research. Patients contributed as interview participants but were not involved in the design, conduct, or reporting of the study.

Access to safe, high quality, acceptable and sustainable general practice (GP) and primary care services is essential to improved health outcomes and quality of life for people living in residential aged care homes (RACH). There are, however, critically low levels of service availability and a decline in GPs providing RACH services globally, suggesting there is an urgent need for safe and effective models of care. Telehealth, delivered as part of a holistic model of care, offers a solution to address this gap but comprehensive, person-centred research is needed to directly assess its effect on safety and quality of care in RACH settings. This collaborative 4-year project (General practice and Residential Aged CarE: GRACE video-telehealth) will (1) scope current telehealth models of care and their acceptability and person-centredness, including identifying the barriers and enablers experienced by RACH residents, carers, staff, GPs and practice managers; (2) co-design a best-practice model of care with an accompanying suite of digital resources and education materials to improve the uptake of video-telehealth; and (3) implement and evaluate this best-practice model of care. This is a mixed-methods study of residents, carers, RACH staff, GPs and their practice teams that will be conducted across New South Wales, Australia. This protocol describes a staged approach across three phases. In Phase 1, we will collect baseline measures of the frequency of telehealth use in GP practices and RACHs, clinical outcomes (eg, hospitalisations), questionnaires to measure person-centred care, satisfaction and usability of telehealth and qualitative observations and semi-structured interviews. In Phase 2, we will conduct workshops to co-design an intervention that will include developing a model of care to support person-centred video-telehealth, with an accompanying online hub of resources and educational materials to facilitate and support its utilisation. In Phase 3, we will implement and evaluate the intervention. Data will be analysed statistically and thematically and synthesised. Ethics approval has been obtained from the University of Sydney Human Research Ethics Committee (2025/000340) (human.ethics@sydney.edu.au). Prior informed written consent will be obtained from all research participants. Findings from each phase of the study will be submitted for peer-reviewed publication. Project outputs will be disseminated for implementation more widely across New South Wales and Australia.

To explore how receiving gerontological nurse telephone support assisted caregivers of older adults to provide care after hospital discharge. Informal caregivers are vital to the recovery of older patients after hospital discharge, but often feel under-prepared and unsupported. The need to strengthen caregiver support is becoming increasingly important due to the growing population of older adults and their needs for hospital services. This secondary analysis of a randomized controlled trial examined how nurse telephone support assisted caregivers in their caring role at the time of hospital discharge. A qualitative descriptive study. A purposive sample of informal caregivers (n&#x2009;=&#x2009;47) who had received nurse telephone support was recruited. In-depth semi-structured interviews were conducted with participants at six (March 21-January 23) and 12&#x2009;months (August 2021-June 2023) after the older adult's discharge. The nurses used a problem-solving approach to provide support. Transcripts were analysed inductively using content narrative analysis. Two themes emerged: (i) mastery and skills to care; (ii) empowerment to care. Caregiver mastery was developed through nurses providing tailored support that assisted caregivers to develop a structured approach to problem-solving, apply problem-solving to their personal circumstances, increase capacity and skills, and manage workload more effectively. Empowerment resulted from nurses creating a nurturing environment where caregivers developed a positive inner dialogue, increased confidence and capacity to foster a positive relationship with the care recipient and valued themselves. Synthesizing these themes via a concept map explained how nurse support assisted caregivers of older adults become more prepared to care and increase self-efficacy. Nurse telephone support can facilitate caregivers of older adults discharged from hospital to undertake problem-solving that is effective for their individual circumstances and empower them to care. Telephone calls enabled nurses to provide timely, tailored support for caregivers of older adults after hospital discharge. Nurses can provide expert, professional guidance via telephone to support caregivers be more prepared to care when older adults are discharged from hospital. This support should extend beyond instructions related to the care recipients' immediate needs and include the provision of knowledge and coaching to support a structured approach to problem-solving. Allocating dedicated time for hospital nurses to deliver caregiver support should be considered an integral component of person-centred care. This research strengthens the evidence for the valuable contribution that nurses can make to improving hospital discharge services. This study was reported using the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist. The research team includes consumer investigator (HL) who provided input throughout the research, including design, procedures, data analysis and manuscript authorship. Australian New Zealand Clinical Trials Registry Identifier: ACTRN12620000060943.

Mobile health (mHealth) apps are useful tools for research and disease management. However, implementation of mHealth apps is lacking in many areas. While mHealth apps offer various advantages to researchers and patients, their effectiveness depends on their actual use. Barriers to using mHealth apps are often due to human factors such as usability or technology acceptance. Although prior studies have examined the acceptance of mHealth apps in patient treatment, the key factors driving or hindering the use of mHealth apps in research remain unclear. This study explores user perceptions of 2 mHealth apps in the setting of an observational technology evaluation study using the unified theory of acceptance and use of technology. We aim to evaluate the technology acceptance of these specific apps and to investigate challenges in choosing suitable mHealth apps in research. The apps were intended for data collection; no effect on health was expected. Patients with chronic diseases as well as healthy participants used a symptom tracking app and a cognitive test app over the course of 4 weeks within the feasibility study of the project "Identifying Digital Endpoints to Assess Fatigue, Sleep and Activities of Daily Living in Neurodegenerative Disorders and Immune-Mediated Inflammatory Diseases." Thereafter, 61 qualitative interviews were conducted, recorded, and transcribed. A qualitative content analysis using the unified theory of acceptance and use of technology was performed. An important aspect of motivation for participants was feedback on their health data and performance in the cognitive tests. Effort played a significant role in app use. Patients rated the apps as easy to use and quick. Using the app multiple times per day at fixed times was perceived as disruptive. Participants preferred using their own phone. Social influence as well as facilitating conditions played a lesser role in intention to use the apps. Data security was no concern for most participants. They stressed the importance of good relations with the study team. In choosing suitable apps, one size will certainly not fit all. For medical research, pretesting of all materials with the potential users is of utmost importance. If the positive effects of the app on users' health are not immediately apparent, other factors may motivate use, for example, feedback, gamification, adjustable functions, applicability on all smartphone operating systems, and good relations to the study team.

Artificial intelligence (AI)-driven clinical decision support (CDS) tools offer promising solutions for health care delivery by optimizing resource allocation, detecting deterioration, and enabling early interventions. However, adoption remains limited due to insufficient validation and a lack of transparency and trust. Explainable AI (XAI) seeks to improve user understanding of AI outputs; however, how clinicians interpret and integrate these explanations into their decision-making remains underexplored. Furthermore, discrepancies in explanations, known as the "disagreement problem," can undermine trust and, at worst, lead to poor clinical decisions. This study examines clinicians' perspectives on the role and value of explainability in AI-driven CDS tools within Australian critical care settings and the impact of discrepancies in AI-generated explanations on clinical decision-making. Qualitative data were collected using semistructured interviews with 14 clinical experts, incorporating scenario-based exercises, and were analyzed using inductive thematic analysis. Clinicians valued explainability, particularly in complex or unfamiliar situations, when explanations were clear, plausible, and actionable. Trust and perceived usefulness extended beyond explanation quality, encompassing factors such as system accuracy, alignment with clinicians' reasoning, workflow integration, and perceived reliability. Discrepancies in explanations generated by different XAI methods were not a major concern, provided that the AI-generated predictive alerts were accurate. This study provides design recommendations for developing trustworthy, user-centric CDS tools that incorporate XAI. Findings highlight that explainability is critical for establishing initial trust in AI-driven tools by supporting perceived usefulness, but its importance diminishes over time and with user expertise and familiarity, as learned usefulness takes precedence. Recommendations highlight the importance of aligning the design and implementation of AI tools with clinicians' needs to enhance trust, mitigate risks, and promote successful adoption for improved patient outcomes.

This study aims to assess palliative care service utilization among adult patients with cancer and examine how sociodemographic and clinical characteristics and patients' perceptions of palliative care influence this behaviour. A facility-based cross-sectional study design using the multivariate logistic regression model was employed to identify sociodemographic characteristics, clinical characteristics and perceptions of patients determining palliative care service utilization among adult patients with cancer. Jimma University Medical Center, Jimma, Southwestern, Ethiopia. A total of 409 participants were able to complete the interviewer-administered questionnaires from 20 February to 25 December 2024. The primary outcome of the study was utilisation of palliative care services, defined by the proportion of patients who actually used the service. The independent variables included sociodemographic and clinical characteristics and patients' perceptions of palliative care utilisation, measured by Perception of Palliative Care Instrument constructs. 39.4% of the participants used palliative care services. Female gender (adjusted OR (AOR)=0.5, 95%&#x2009;CI 0.3 to 0.8), diploma and above educational level (AOR=1.5, 95%&#x2009;CI 1.2 to 3.6), employed occupational status (AOR=2.2, 95%&#x2009;CI 1.1 to 4.3), having five or more family members (AOR=3.4, 95%&#x2009;CI 2.0 to 5.7), being diagnosed at Stage IV (AOR=0.6, 95%&#x2009;CI 0.3 to 0.8) and having a good perception of palliative care needs (AOR=1.3, 95%&#x2009;CI 1.0 to 1.5) were identified as being significantly associated with the utilization of palliative care services at p<0.05. The utilization of palliative care services was suboptimal among our participants. Being female and receiving a cancer diagnosis at an advanced stage contributed to the underutilisation of palliative care services. Conversely, higher educational level, being employed, increased family size and positive perception increased utilisation. Therefore, a family-centred approach to palliative care services, early integration into the care process and addressing gender inequities are highly recommended.

The new Universal Health Insurance (UHI) reforms aim to improve equity and quality of healthcare delivery; however, their sustainability depends on engagement and retention of the nursing workforce. Psychological empowerment has been identified as a key factor influencing nurses' attitudes and work-related behaviors, yet the evidence on how it relates to job embeddedness among nurses working in the early phase of UHI implementation in Egypt remains underexplored. This study aimed to assess the association between psychological empowerment and job embeddedness among nurses under the umbrella of the new Universal Health Insurance in Egypt. A descriptive cross-sectional design was employed from August 2025 to November 2025. A total of 213 nurses working at Aswan Specialized Hospital, affiliated with the UHI system in Upper Egypt, were recruited. Data were collected using a demographic questionnaire, and psychological empowerment was measured using the Psychological Empowerment Scale, and job embeddedness was assessed using the Global Job Embeddedness Scale. Descriptive statistics, Pearson correlation analysis, and hierarchical linear regression were used for data analysis. Among 213 nurses, the mean score of psychological empowerment was reported at high overall levels of 5.75 (SD&#x2009;=&#x2009;0.77), particularly in the dimensions of competence and meaning, alongside moderately high levels of job embeddedness, with a mean score of 4.76 (SD&#x2009;=&#x2009;0.89). Psychological empowerment showed a significant positive correlation with job embeddedness (r&#x2009;=&#x2009;0.512, p&#x2009;<&#x2009;0.001). In hierarchical regression analysis adjusting for demographic and professional covariates, psychological empowerment emerged as a strong and independent predictor of job embeddedness (&#x3b2;&#x2009;=&#x2009;0.55, 95% CI: 0.398-0.701, p&#x2009;<&#x2009;0.001), explaining an additional 16.5% of the variance after controlling for covariates (&#x394;R2&#x2009;=&#x2009;0.165). In adjusted analyses, the covariates were not independently associated with job embeddedness. Psychological empowerment was positively associated with nurses' job embeddedness in the UHI implementation setting. Higher levels of empowerment-related factors were positively associated with greater embeddedness, suggesting their relevance to workforce engagement and retention during health system reform. Our study findings highlight that psychological empowerment plays a crucial role in fostering nurses' job embeddedness, which is critical for sustaining workforce retention and stability. Enhancing supportive leadership and nurses' involvement in decision-making is critical, especially during the early phase implementation of the universal health insurance system reform.

The COVID-19 pandemic created unprecedented ethical challenges for nurses, often culminating in moral distress. The aim of this study was to explore the experiences of Spanish nurses in relation to moral distress and ethical conflicts experienced during the COVID-19 pandemic. Qualitative phenomenological study. Nurses who had tended COVID-19 patients were given a semi-structured interview via the Zoom application. Thematic analysis was carried out, identifying units of meaning and assigning codes that were grouped into the different categories using Open Code software. Seventeen nurses participated and four categories emerged: (i) Difficulties in the general management of the pandemic on the institutional level, (ii) Limitation of patients' rights in a pandemic situation, (iii) Influence on the humanization of healthcare, (iv) Impact on professionals and on the profession. Restrictions on patients' and families' rights during the pandemic generated ethical conflicts for healthcare professionals. In addition, the scarcity of both human and material resources, together with limited access to information, intensified value conflicts in clinical practice. This project provides evidence on ethical conflicts experienced by nurses during the pandemic, both in the quality of care and professionals' well-being. Findings will contribute to and have an impact on future action protocols and public policies aimed at better managing ethical challenges in health emergency situations.

To examine sociodemographic, clinical, and healthcare-related factors associated with preoperative health-related quality of life (HRQoL) among patients undergoing surgery for degenerative lumbar spine conditions in a multi-ethnic Asian population. This cross-sectional study used baseline data from the Spine PROM Surgery Registry, including 1194 patients scheduled for surgery within a Singapore healthcare cluster between 2017 and 2022. HRQoL was measured using the EQ-5D-3L, with utility scores crosswalked to the EQ-5D-5L index using the van Hout crosswalk. Hierarchical linear regression assessed factors associated with HRQoL across three blocks: sociodemographic, clinical, and healthcare/lifestyle. Multivariable logistic regression identified factors associated with reporting problems within each EQ-5D dimension. Mean age was 58.1 years (SD 16.1); 51.5% were female. Mean EQ-5D-5L index was 0.43 (SD 0.38). Pain/discomfort (93.6%) and usual activities problems (84.3%) were most commonly reported. Lower EQ-5D scores were independently associated with non-outpatient presentation (&#x3b2; = -0.37), non-Chinese ethnicity (e.g., Malay: &#x3b2; = -0.10), secondary education (&#x3b2; = -0.15), and accident/trauma history (&#x3b2; = -0.11). Dimension-level analyses showed secondary education was associated with higher odds of problems in mobility (OR&#x2009;=&#x2009;2.72), self-care (OR&#x2009;=&#x2009;1.87), usual activities (OR&#x2009;=&#x2009;1.80), and anxiety/depression (OR&#x2009;=&#x2009;1.97). Non-outpatient presentation was associated with markedly higher odds of self-care problems (OR&#x2009;=&#x2009;2.98). Patients awaiting lumbar spine surgery appear to have impaired preoperative HRQoL. Although the modest explained variance limits robust risk prediction, preoperative profiles may still help inform clinical discussions and shared decision-making. Non-outpatient presentation may help identify patients who could benefit from enhanced preoperative support, although this requires prospective validation. Differences by ethnicity and education suggest opportunities for culturally tailored counselling. EQ-5D dimension profiles may indicate targets for prehabilitation and provide Singapore-based benchmark data for a lumbar spine surgery cohort for patient-centred care, service benchmarking, and health technology assessment. Low back pain is a common reason why people lose the ability to work, move, and take part in daily life. Many patients with long-lasting back problems eventually need surgery, but their quality of life before surgery can vary widely. Understanding how patients feel and function before surgery is important for planning care, setting expectations, and deciding who may need extra support. This study looked at how good or poor quality of life is in patients waiting for surgery for degenerative lumbar spine conditions, and which personal, social, and clinical factors are linked to worse quality of life. We studied over 1100 patients in Singapore using a standard health questionnaire that measures mobility, self-care, daily activities, pain, and mental wellbeing. This allowed us to examine both overall quality of life and specific problem areas. We found that patients had substantial problems before surgery, especially with pain and daily activities. Quality of life did not differ by diagnosis, but was worse in patients who entered care through emergency or inpatient routes, and in some ethnic and educational groups. These findings suggest that identifying patients with poorer preoperative quality of life may help clinicians tailor support and plan care before surgery.

Heart failure (HF) is a chronic condition associated with frequent hospitalizations and impaired quality of life. Malnutrition is common in HF and is linked to adverse clinical outcomes, while self-care is an important component of HF management. This study aimed to examine the associations between nutritional status, self-care behaviors, and clinical characteristics in patients with chronic HF. A cross-sectional study was conducted among 100 hospitalized HF patients (mean age 75.9 &#xb1; 9.8 years; 63% men). Nutritional status was assessed using the Mini Nutritional Assessment (MNA), and self-care using the nine-item European Heart Failure Self-care Behaviour Scale (9-EHFScBS). Clinical variables included NYHA class, LVEF, comorbidities, BMI, and laboratory parameters. Comparative analyses and multivariate linear regression were performed. Patients who were malnourished or at risk of malnutrition had significantly higher NT-proBNP levels (p = 0.004) and higher NYHA class (p = 0.002), whereas well-nourished individuals had significantly higher triglyceride levels (p = 0.032). Nutritional status was negatively associated with NYHA class and NT-proBNP, and positively associated with BMI. Among laboratory parameters, significant positive correlations were observed with hemoglobin, hematocrit, albumin, and triglyceride levels. In multivariate analysis, the following variables were independently associated with MNA score: self-care score (B = 0.083 per point), BMI (B = 0.368 per kg/m2), comorbidity burden (B = -0.401 per comorbidity), and NYHA class (NYHA III: B = -2.425; NYHA IV: B = -5.966, vs. NYHA II). In patients with chronic heart failure, nutritional status is associated with disease severity, metabolic parameters, comorbidity burden, BMI, and self-care behaviors. These findings support the importance of routine nutritional screening as part of comprehensive HF management.

Alzheimer's disease patients often experience cognitive decline during disease progression, impacting their quality of life. Photostimulation therapy, as a non-invasive neuromodulation method, has been increasingly used in the adjunctive management of Alzheimer's patients in recent years. Despite the increasing number of related studies, a systematic review and comprehensive evaluation are still lacking. This review systematically summarizes the current application of photostimulation therapy in Alzheimer's disease patients, outlines its implementation characteristics, outcome indicators, intervention effects and mechanisms of action in cognitive function intervention, and identifies evidence gaps in current research. Relevant studies were systematically retrieved from PubMed, Web of Science, Cochrane Library, Embase, CINAHL, CNKI, CBM, WanFang Database, and VIP Database from their inception to January 5, 2026. Data from the included literature were extracted and analyzed. A total of 21 studies were included. Photostimulation therapy primarily includes light stimulation, 40 Hz rhythm-related light stimulation, photobiological modulation and their combined therapies, as well as transcatheter intracranial laser therapy. This therapy has potential value in improving cognitive function or delaying cognitive decline and may affect sleep/rhythm and behavioral symptoms. Its potential mechanisms involve neural oscillation modulation, circadian rhythm reconstruction, and improvement of synaptic plasticity. However, existing evidence exhibits significant heterogeneity in study design, sample size, intervention parameters, and outcome indicators. Photostimulation therapy has shown promising potential in cognitive function intervention for Alzheimer's disease patients, but current evidence is still largely in the exploratory stage. Future research should focus on multi-center, large-sample, and standardized studies to determine the optimal parameter combinations for different stages and scenarios, and to optimize individualized intervention protocols to improve clinical efficacy. Investigates the effectiveness and limitations of photostimulation therapy in improving cognitive function in Alzheimer&#x2019;s disease patients and summarizes its mechanisms of action. The results show that photostimulation therapy shows promising potential in improving cognitive function in Alzheimer&#x2019;s patients, and its mechanism of action involves multiple aspects. However, existing evidence exhibits heterogeneity in terms of study design and sample size, necessitating future multi-center, large-sample, and standardized studies.