Nursing Research最新文献

{"title":"LASSO Regression-Derived Nomogram of Cognitive Frailty Following Ischemic Stroke Based on Self-Perceptions of Aging.","authors":"Xiaoqing Tao, Li He, Yu Liu, Yu Ren, Weihong Zhang","doi":"10.1097/NNR.0000000000000910","DOIUrl":"10.1097/NNR.0000000000000910","url":null,"abstract":"<p><strong>Background: </strong>Cognitive frailty (CF) is a high-risk state associated with poor long-term outcomes in elderly ischemic stroke (IS) patients.</p><p><strong>Objectives: </strong>The purpose of this study was to develop and validate a nomogram incorporating self-perceptions of aging (SPA) and clinical variables to predict individualized risk of CF in elderly IS survivors.</p><p><strong>Methods: </strong>This study included 940 elderly IS patients (≥60 years) who were randomly split into a training set (70%, n = 658) and a validation set (30%, n = 282). The optimal predictors were identified by taking the intersection of variables selected through Least Absolute Shrinkage and Selection Operator (LASSO) regression, univariable logistic regression, and multivariable logistic regression, and a nomogram was subsequently developed to visualize the model. Model performance was evaluated using area under the curve (AUC), calibration plots, and decision curve analysis (DCA), with validation by a gradient boosting machine (GBM) model.</p><p><strong>Results: </strong>Eight predictors (age, living with family members, family history of cognitive decline, physical activity, previous stroke ≥2 times, SPA, cancer, chronic kidney disease) were retained. The nomogram achieved AUCs of 0.913 in the training set and 0.899 in the validation set, with excellent calibration. Calibration curve and DCA demonstrated clinical utility across threshold probabilities. GBM confirmed SPA as the most influential predictor.</p><p><strong>Discussion: </strong>This nomogram, integrating SPA and clinical factors, provides a robust tool for predicting CF in elderly IS patients, supporting early intervention and personalized care strategies.</p>","PeriodicalId":49723,"journal":{"name":"Nursing Research","volume":" ","pages":"378-386"},"PeriodicalIF":2.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147787294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mixed Method Study of Drivers and Obstacles to Exposure-reducing Behaviors to Endocrine-disrupting Chemicals During Pregnancy.","authors":"Nalae Moon, Ju Hee Kim","doi":"10.1097/NNR.0000000000000911","DOIUrl":"10.1097/NNR.0000000000000911","url":null,"abstract":"<p><strong>Background: </strong>Pregnant women are particularly vulnerable to endocrine-disrupting chemicals (EDCs). However, there is limited evidence on the behavioral determinants of exposure-reducing practices during pregnancy. This gap underscores the need for mixed-methods inquiry.</p><p><strong>Objectives: </strong>The aims of this study were to identify drivers and obstacles influencing EDC exposure-reducing behaviors (EDC-RB) among pregnant Korean women, guided by an extended theory of planned behavior.</p><p><strong>Methods: </strong>A convergent mixed-methods design was used. Quantitative data were collected from 200 pregnant women through structured surveys assessing psychosocial and behavioral factors, while qualitative data were obtained from 17 participants through in-depth interviews and focus groups. Quantitative analyses examined predictors of EDC-RB, and qualitative thematic analysis explored contextual determinants. Integration of findings was conducted using methodological triangulation to enhance interpretive validity.</p><p><strong>Results: </strong>Quantitative analysis showed that perceived behavioral control, intention, risk perception, knowledge, education level, and prepregnancy drinking experience significantly predicted EDC-RB. Qualitative analysis identified five interrelated themes reflecting complex behavioral determinants. Integration revealed that knowledge and social influences functioned both as drivers and obstacles, providing explanatory depth to significant predictors and clarifying nonsignificant findings. Triangulation further highlighted interconnected factor relationships that were not evident through a single method.</p><p><strong>Discussion: </strong>EDC-RB during pregnancy is influenced by multiple individual and social factors. Mixed-methods integration clarified behavioral mechanisms and highlighted the importance of interventions targeting both personal and contextual barriers.</p>","PeriodicalId":49723,"journal":{"name":"Nursing Research","volume":" ","pages":"355-368"},"PeriodicalIF":2.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147787339","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Meta-Analysis and Meta-Regression of Perioperative Thirst Management Interventions.","authors":"Seçil Taylan, İlknur Özkan","doi":"10.1097/NNR.0000000000000919","DOIUrl":"10.1097/NNR.0000000000000919","url":null,"abstract":"<p><strong>Background: </strong>Perioperative thirst is a frequently reported and discomforting symptom in surgical patients, yet it remains underprioritized in clinical care, highlighting the need for evidence-based nursing interventions.</p><p><strong>Objectives: </strong>The aims of this study were to evaluate and compare the effectiveness of various nonpharmacological nursing interventions in reducing perioperative thirst severity.</p><p><strong>Methods: </strong>A systematic review and meta-analysis were conducted following Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines and registered with PROSPERO (CRD420251065306). Databases including PubMed, MEDLINE, CINAHL, and three others were searched through May 2025. Seventeen randomized controlled trials involving 1,771 participants were included. Interventions were classified as iced menthol, ice, menthol, or water. The primary outcome was thirst severity, analyzed using mean difference with a 95% confidence interval. Subgroup and meta-regression analyses were performed using a mixed-effects model.</p><p><strong>Results: </strong>Thirst management interventions were found to significantly reduce thirst severity compared with control conditions. Subgroup analyses suggested that iced menthol, ice, menthol, and room-temperature water interventions were all effective in alleviating thirst. However, meta-regression analysis indicated no meaningful differences between intervention types, suggesting that the presence of an intervention rather than its specific type was the primary factor associated with thirst reduction.</p><p><strong>Discussion: </strong>These findings suggest that, in the management of perioperative thirst, the implementation of evidence-based, nonpharmacological nursing interventions is more critical than the specific type of intervention. The study supports integrating timely thirst management strategies into routine perioperative nursing care to improve patient comfort and care quality.</p>","PeriodicalId":49723,"journal":{"name":"Nursing Research","volume":" ","pages":"E238-E250"},"PeriodicalIF":2.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147943461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correlates of Glycemic Status Among American Indian Adults With Type 2 Diabetes in Rural Southeastern Oklahoma.","authors":"Tarah Nelson, Diana J Wilkie, Yingwei Yao, Richard Segal, Ashley DeVaughan Circles, William T Donahoo, R Turner Goins, Spero M Manson, Anatolia B Legaspi, Lisa Scarton","doi":"10.1097/NNR.0000000000000916","DOIUrl":"10.1097/NNR.0000000000000916","url":null,"abstract":"<p><strong>Background: </strong>Elevated glycosylated hemoglobin (HbA1c) levels have been associated with an increased risk for type 2 diabetes (T2D) complications.</p><p><strong>Objective: </strong>The aim of this study was to examine the electronic health record (EHR) correlates of HbA1c levels among adults with T2D using Tribal health services.</p><p><strong>Methods: </strong>EHR data from one Tribal health center were used for this study. Variables included driving distance to clinics, socioeconomic status, use of primary care and diabetes educators, age, sex, glycemic status, and HbA1c. Descriptive, bivariate, and linear regression analyses were performed.</p><p><strong>Results: </strong>Nearly 40% of the 5,205 patients in the sample had HbA1c levels <7% in 2021. HbA1c in 2020 was a strong predictor of HbA1c in 2021. Older age was weakly associated with lower HbA1c. A lack of primary care visits or diabetes educator visits was associated with lower HbA1c, likely due to patients with lower HbA1c levels having less need for T2D-related primary care or diabetes educator visits.</p><p><strong>Discussion: </strong>This study provided insight into factors associated with HbA1c levels that deserve further exploration, but it is important to note that factors included in social determinant of health frameworks specifically developed for Indigenous communities were not available in the EHR data set. Therefore, future studies are needed that examine Indigenous social determinants of health specific to the local community.</p>","PeriodicalId":49723,"journal":{"name":"Nursing Research","volume":" ","pages":"338-345"},"PeriodicalIF":2.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13390767/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148521344","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How Can Nursing Philosophy and Theory Be Strengthened? Courageous Individuals Acting Today to Build Tomorrow.","authors":"Juan P Cerón, Wendy J Gómez","doi":"10.1097/NNR.0000000000000918","DOIUrl":"10.1097/NNR.0000000000000918","url":null,"abstract":"","PeriodicalId":49723,"journal":{"name":"Nursing Research","volume":" ","pages":"337"},"PeriodicalIF":2.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148521413","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Leading Through Service: A Pathway to Growth and Transformation.","authors":"Ann-Margaret Navarra","doi":"10.1097/NNR.0000000000000933","DOIUrl":"10.1097/NNR.0000000000000933","url":null,"abstract":"","PeriodicalId":49723,"journal":{"name":"Nursing Research","volume":"75 5","pages":"387"},"PeriodicalIF":2.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148834408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Scoping Review of Barriers and Facilitators of Cervical Cancer Screening in Appalachia.","authors":"Jill E Sergison, Amy Alspaugh, Sarah Janek, Eleanor L Stevenson, Devon Noonan, Megan Huchko, Leila Ledbetter, Savannah Brinkley, Mitchell R Knisely","doi":"10.1097/NNR.0000000000000923","DOIUrl":"10.1097/NNR.0000000000000923","url":null,"abstract":"<p><strong>Background: </strong>Cervical cancer incidence and mortality in Appalachia exceed national averages, reflecting long-standing inequities in preventive care. Although cervical cancer screening (CCS) effectively reduces morbidity and mortality, participation among Appalachian women remains low. Understanding the multilevel factors that influence screening behavior is critical to inform culturally responsive and sustainable interventions.</p><p><strong>Objectives: </strong>To synthesize existing evidence on barriers to and facilitators of CCS among women residing in Appalachia using Levesque's Access to Care Framework.</p><p><strong>Methods: </strong>A scoping review was conducted in accordance with the JBI Manual for Evidence Synthesis and reported following PRISMA-ScR guidelines. PubMed, CINAHL, and Scopus were searched for studies published between January 2002 and August 2025. Eligible studies reported original empirical data on CCS among women aged 21-64 living in Appalachian counties. Editorials, reviews, gray literature, and studies lacking disaggregated Appalachian data were excluded. Extracted data were categorized into Levesque's five patient-level domains: the abilities to perceive, seek, reach, pay, and engage in care.</p><p><strong>Results: </strong>Of 3,457 records identified, 27 met the inclusion criteria. Studies employed qualitative, quantitative, and mixed methods designs. Barriers included cost, lack of insurance, transportation challenges, medical mistrust, fatalism, low health literacy, and negative prior health care experiences. Facilitators included trusted and consistent patient-provider relationships, clear provider communication, social support, female clinician availability, and access to free or subsidized screening through Title X and the National Breast and Cervical Cancer Control Program services.</p><p><strong>Discussion: </strong>Structural, interpersonal, and psychosocial factors intersect to shape screening behaviors in Appalachia. Findings highlight the importance of trust-building, trauma-informed, and culturally responsive communication, and system-level supports that address cost and access barriers. Expanding Medicaid, strengthening rural provider capacity, and increasing participation in Title X and national cervical cancer programs may reduce disparities and improve screening uptake. Future research should incorporate standardized measures of trust, health literacy, and psychosocial readiness to strengthen intervention design and cross-study comparability.</p>","PeriodicalId":49723,"journal":{"name":"Nursing Research","volume":" ","pages":"395-406"},"PeriodicalIF":2.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148206566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Genome-Wide Association of Cardiovascular Disease and Lifestyle in Korean Adults With Metabolic Syndrome.","authors":"Haejung Lee, DaeEun Lee, Sukhyun Jun","doi":"10.1097/NNR.0000000000000915","DOIUrl":"10.1097/NNR.0000000000000915","url":null,"abstract":"<p><strong>Background: </strong>Cardiovascular disease (CVD) is a major complication in patients with metabolic syndrome (MetS). The risk of CVD is influenced by genetic, sociodemographic, and lifestyle factors.</p><p><strong>Objectives: </strong>The aims of this study were to identify single-nucleotide polymorphisms (SNPs) associated with CVD risk in patients with MetS and examine the impact of sociodemographic, lifestyle, and genetic factors.</p><p><strong>Methods: </strong>We analyzed baseline data from the Korean Genome and Epidemiology Study-Urban Health Examinee cohort (KoGES-HEXA). MetS was defined as the presence of three or more of the MetS risk factors based on the National Cholesterol Education Program Adult Treatment Panel III. Participants who reported a diagnosis of angina, myocardial infarction, or stroke were classified into the CVD group. PLINK 1.9 was used to identify CVD-related SNPs, and logistic regression analyses to estimate odds ratios for CVD were performed using IBM SPSS Statistics (Version 27.0) and SAS (Version 9.4) software.</p><p><strong>Results: </strong>A genome-wide association study (GWAS) was conducted with 12,047 participants, comprising 839 participants in the CVD group and 11,208 in the non-CVD group. Three SNPs were associated with CVD. Sex, age, income level, drinking, smoking, sleep duration, nutrient intake, and specific SNPs were associated with CVD.</p><p><strong>Discussion: </strong>These findings highlight the identification of suggestive SNPs associated with CVD among individuals with MetS in a non-European population, addressing gaps in genomic research. Associations with alcohol consumption, smoking, and diet may reflect reverse causation or confounding rather than protective effects, and further longitudinal studies are needed to clarify causal relationships.</p>","PeriodicalId":49723,"journal":{"name":"Nursing Research","volume":" ","pages":"369-377"},"PeriodicalIF":2.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147822843","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mediation of Smoking and Cardiometabolic Factors on Diabetic Peripheral Neuropathy.","authors":"Siti Fadlilah, Untung Sujianto, Ratsiri Thato, Mei-Ling Yeh, Hsiu Ting Tsai","doi":"10.1097/NNR.0000000000000943","DOIUrl":"https://doi.org/10.1097/NNR.0000000000000943","url":null,"abstract":"<p><strong>Background: </strong>Diabetic peripheral neuropathy (DPN) is a common complication of type 2 diabetes, yet the combined roles of smoking behavior and cardiometabolic factors in shaping neuropathy risks remain insufficiently understood.</p><p><strong>Objectives: </strong>To examine the associations of smoking behavior and cardiometabolic factors with DPN risk and evaluate their independent, combined, and mediating effects.</p><p><strong>Methods: </strong>This cross-sectional study included 905 adults with type 2 diabetes attending primary care services in Indonesia. DPN risk was assessed using the Michigan Neuropathy Screening Instrument. Tobacco smoking behavior was assessed using a structured questionnaire, while cardiometabolic factors were obtained from clinical examinations and laboratory measurements. Associations were analyzed using multinomial logistic regression, and mediation pathways were examined using partial least squares-structural equation modeling.</p><p><strong>Results: </strong>Both active smoking and secondhand smoke exposure were associated with an increased DPN risk, particularly among active smokers also exposed to secondhand smoke. Cardiometabolic factors, including elevated glycated hemoglobin, high fasting blood glucose, and an abnormal ankle-brachial index, showed independent associations with neuropathy risks. Combined exposure analyses demonstrated a cumulative pattern, with increasing numbers of abnormal risk factors associated with progressively higher odds of neuropathy. A pathway analysis indicated that the association between smoking behaviors and DPN was primarily mediated through metabolic dysfunction and impaired peripheral perfusion, whereas the mediating role of blood pressure was limited.</p><p><strong>Discussion: </strong>These findings support the multifactorial nature of DPN and suggest that behavioral and cardiometabolic factors interact in shaping neuropathy risks. Integrating smoking exposure assessments with glycemic and vascular risk management may strengthen prevention strategies in primary care populations with type 2 diabetes.</p>","PeriodicalId":49723,"journal":{"name":"Nursing Research","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148809270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Statistical Considerations for Research Reproducibility: Strategies for Building Transparent Analytic Workflows.","authors":"Laura K Kaizer, Zahra Ali, Grace N Bosma, Dawn M Aycock, Matthew J Hayat, Sarah J Schmiege","doi":"10.1097/NNR.0000000000000940","DOIUrl":"https://doi.org/10.1097/NNR.0000000000000940","url":null,"abstract":"<p><strong>Background: </strong>Reproducibility, the ability for independent investigators to obtain consistent results using the same data and analytic procedures, is foundational to scientific integrity, yet remains a challenge across research settings. Common practices such as manual data cleaning, point-and-click analyses, and creating tables by manually copying and pasting values from output to table shells increase the likelihood of error, reduce transparency, and impede efficient collaboration. As data become more complex and expectations for reproducibility from journals, funders, and the scientific community grow, researchers need practical, accessible guidance on implementing reproducible workflows.</p><p><strong>Objectives: </strong>To provide actionable steps to improve the reproducibility of data management, statistical analyses, and reporting, and demonstrate reproducible workflows using both R and IBM SPSS Statistics.</p><p><strong>Methods: </strong>We outline five steps toward reproducibility: (1) project organization and file structure, (2) use of ReadME documentation, (3) clear traceability from raw to analytic data sets, (4) use of syntax for all data cleaning and management, and (5) reproducible generation of tables and reports. A synthetic data set is used to illustrate these principles in both R and SPSS, highlighting how fully syntax-based workflows in R and syntax-supported workflows in SPSS can move researchers toward greater transparency and efficiency.</p><p><strong>Results: </strong>Implementing reproducible workflows reduces error, saves time, and strengthens scientific rigor. Syntax-based approaches create a complete, defensible record of every analytic decision, supporting clearer team communication and easier project hand off. Even small changes, such as maintaining untouched raw data, standardizing folder structures, and documenting decisions in ReadMe files, substantially improve transparency. Across platforms, the guiding principle holds: anything that is done manually can be done with syntax, enabling faster, more accurate, and fully repeatable results.</p><p><strong>Discussion: </strong>Reproducibility is both an ethical and methodological imperative. Incremental improvements can reshape research culture, producing more trustworthy work. Integrating reproducibility into education, mentorship, and team science can help ensure that rigorous, transparent analytic practices become standard in research.</p>","PeriodicalId":49723,"journal":{"name":"Nursing Research","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148800873","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}