International Journal of Nursing Studies最新文献

{"title":"Vulnerability and core intervention targets in the symptom burden for personalized symptom management in hemodialysis care: A computational simulation modeling study","authors":"Xutong Zheng ,&nbsp;Aiping Wang","doi":"10.1016/j.ijnurstu.2025.105210","DOIUrl":"10.1016/j.ijnurstu.2025.105210","url":null,"abstract":"<div><h3>Background</h3><div>End-stage kidney disease (ESKD) patients on hemodialysis (HD) endure a high symptom burden. Despite the clinical importance of symptom management, traditional methods fail to predict intervention effects or identify optimal targets due to limited consideration of symptom interactions. Computational simulations with symptom network analysis to identify core intervention targets for personalized care is needed.</div></div><div><h3>Design</h3><div>Computational simulated modeling study using cross-sectional observational data.</div></div><div><h3>Setting</h3><div>Across five regions of China—northern, southern, western, eastern, and central.</div></div><div><h3>Participants</h3><div>A total of 1866 hemodialysis patients participated in the study.</div></div><div><h3>Methods</h3><div>A combination of variable-centered and person-centered approaches was used to simplify the symptoms measured by real patient-reported data, followed by latent profile analysis to classify patients into symptom burden profiles. In silico interventions were performed using the NodeIdentifyR algorithm to simulate the effects of alleviating and aggravating interventions on the symptom network.</div></div><div><h3>Results</h3><div>Four symptom clusters were identified: uremic toxin, water-electrolyte, psychological, and gastrointestinal. Latent profile analysis revealed two distinct patient profiles: severe and mild symptom groups. Network analysis highlighted key symptoms such as pruritus, fatigue, anxiety, and easy awakening as central nodes. The in silico interventions in overall groups showed that alleviating interventions targeting easy awakening, fatigue and pruritus as core targets. Treating these may reduce the symptom burden by 10.25 %, 10.00 % and 9.82 %. Aggravating interventions identified pruritus, dry skin and easy awakening as pivotal targets. Preventing the presence of these may separately reduce the symptom burden by 24.69 %, 23.05 % and 22.21 %.</div></div><div><h3>Conclusion</h3><div>This study provides critical insights into the symptom burden of hemodialysis patients, offering potential targets for personalized care plans for nurses. The results of computational simulations, if go through further longitudinal study for verification, the study has potential to advance the development of more tailored and effective symptom management care approaches, which could enhance patient care and quality of life.</div></div>","PeriodicalId":50299,"journal":{"name":"International Journal of Nursing Studies","volume":"172 ","pages":"Article 105210"},"PeriodicalIF":7.1,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145093489","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of the standardized communication system based on circadian rhythm regulation in psychological distress of adolescent and young adult cancer patients: A randomized controlled trial","authors":"Xiaofei Luo ,&nbsp;Yinglong Duan ,&nbsp;Yating Luo ,&nbsp;Ning Qin ,&nbsp;Xing Zhou ,&nbsp;Yuxuan Li ,&nbsp;Juan Luo ,&nbsp;Qinqin Cheng ,&nbsp;Huigao Duan ,&nbsp;Peter H.F. Ng ,&nbsp;Jianfei Xie ,&nbsp;Andy S.K. Cheng","doi":"10.1016/j.ijnurstu.2025.105215","DOIUrl":"10.1016/j.ijnurstu.2025.105215","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Multiple factors of psychological distress in adolescent and young cancer patients continue to be unearthed, suggesting the warranted exploration of interventions that meet individualized psychological needs and are integrated into daily lives to alleviate their psychological distress.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Objective&lt;/h3&gt;&lt;div&gt;To investigate the effects of the standardized communication system based on circadian rhythm regulation on psychological distress in adolescent and young adult cancer patients.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Design&lt;/h3&gt;&lt;div&gt;A three-arm randomized controlled trial.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting and participants&lt;/h3&gt;&lt;div&gt;A total of 129 adolescent and young adult cancer patients with psychological distress were recruited from the Third Xiangya Hospital of Central South University from January 2022 to May 2023.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;Participants were randomly divided into three groups. Both intervention groups received eight standardized communication system intervention topics, while the control group received only routine psychological care. The difference between the two intervention groups was that the duration of the intervention in the intervention group 2 was matched to the three types of circadian rhythm of the study participants. The primary outcomes of psychological distress, anxiety, and depression, as well as the secondary outcomes of sleep quality and quality of life, were measured four times at baseline, immediately after completing the intervention, and one month versus three months after completing the intervention. The generalized estimating equations were used to compare the effects of the intervention across the three groups.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;In one month after the intervention, the two intervention groups significantly reduced psychological distress, anxiety, and depression, and improved the quality of sleep and quality of life in adolescent and young adult cancer patients compared to the control group (&lt;em&gt;P&lt;/em&gt; &lt; 0.01). Meanwhile, the intervention group 2 was more effective than the intervention group 1 in reducing psychological distress (−&lt;!--&gt; &lt;!--&gt;1.20, &lt;em&gt;CI&lt;/em&gt;, −&lt;!--&gt; &lt;!--&gt;1.82 to −&lt;!--&gt; &lt;!--&gt;0.57, &lt;em&gt;P&lt;/em&gt; &lt; 0.001) and improving sleep quality (−&lt;!--&gt; &lt;!--&gt;1.72, &lt;em&gt;CI&lt;/em&gt;, −&lt;!--&gt; &lt;!--&gt;2.83 to −&lt;!--&gt; &lt;!--&gt;0.62, &lt;em&gt;P&lt;/em&gt; &lt; 0.001) of patients. Moreover, the effects persisted three months after completing the intervention (&lt;em&gt;P&lt;/em&gt; &lt; 0.05).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;The standardized communication system interventions can effectively alleviate psychological distress, anxiety, and depression, and improve sleep quality and quality of life in adolescent and young adult cancer patients. In addition, the standardized communication system based on circadian rhythm regulation is more advantageous in improving the psychological distress and sleep quality of adolescent and young adult cancer patients than the standardized commun","PeriodicalId":50299,"journal":{"name":"International Journal of Nursing Studies","volume":"172 ","pages":"Article 105215"},"PeriodicalIF":7.1,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145159733","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of three peripherally inserted central catheters insertion techniques on catheterization outcomes: A randomized controlled trial","authors":"Lan Li ,&nbsp;Xinlei Wu ,&nbsp;Lihui Lin ,&nbsp;Zhiyun Cai ,&nbsp;Xijun Ye ,&nbsp;Yufeng Lin ,&nbsp;Yajiao Wang ,&nbsp;Liu Yang","doi":"10.1016/j.ijnurstu.2025.105209","DOIUrl":"10.1016/j.ijnurstu.2025.105209","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Catheterization methods for peripherally inserted central catheters (PICC) mainly include the traditional method, one-needle subcutaneous tunnel catheterization, and two-needle subcutaneous tunnel catheterization, all of which are widely used in clinical practice. Researchers focus heavily on complications after these PICC catheterizations but ignore the effect of PICC catheterization process, such as one-time puncture success rate, patient experience, bleeding, and related issues.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;This was a three-arm, parallel, randomized controlled trial. Patients were recruited from Zhongshan Hospital of Xiamen University in China between January and April 2025. Patients who met the inclusion criteria were randomly categorized into three groups. Primary indicators were the one-time puncture success rate, pain intensity, and total bleeding volume during catheterization. Secondary indicators included the blood oozing rate within 24 h after catheterization and catheterization operating time.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;In total, 681 patients were recruited. 226 in the traditional non-tunnel catheterization group, 232 in the one-needle subcutaneous tunnel catheterization group, and 223 in the two-needle subcutaneous tunnel catheterization group. The one-needle and two-needle subcutaneous tunnel catheterization groups demonstrated significantly better outcomes compared to the traditional non-tunnel catheterization group in terms of one-time puncture success rate (RD = 6.3 %, 95 % CI: 1.6 % to 11.1 %, &lt;em&gt;P&lt;/em&gt; = 0.014; RD = 6.6 %, 95 % CI: 1.8 % to 11.3 %, &lt;em&gt;P&lt;/em&gt; = 0.011) and blood oozing rate within 24 h after catheterization (RD = −&lt;!--&gt; &lt;!--&gt;7.8 %, 95 % CI: −&lt;!--&gt; &lt;!--&gt;13.5 % to −&lt;!--&gt; &lt;!--&gt;2.0 %, &lt;em&gt;P&lt;/em&gt; = 0.012; RD = −&lt;!--&gt; &lt;!--&gt;8.3 %, 95 % CI: −&lt;!--&gt; &lt;!--&gt;14.1 % to −&lt;!--&gt; &lt;!--&gt;2.5 %, &lt;em&gt;P&lt;/em&gt; = 0.007). Both the traditional non-tunnel catheterization group and the one-needle subcutaneous tunnel catheterization group demonstrated significantly lower values compared to the two-needle subcutaneous tunnel catheterization group in terms of total bleeding volume (MD = −&lt;!--&gt; &lt;!--&gt;0.2, 95 % CI: −&lt;!--&gt; &lt;!--&gt;0.3 to 0.0, &lt;em&gt;P&lt;/em&gt; = 0.026; MD = −&lt;!--&gt; &lt;!--&gt;0.2, 95 % CI: −&lt;!--&gt; &lt;!--&gt;0.4 to −&lt;!--&gt; &lt;!--&gt;0.1, &lt;em&gt;P&lt;/em&gt; = 0.002), pain intensity (MD = −&lt;!--&gt; &lt;!--&gt;0.2, 95 % CI: −&lt;!--&gt; &lt;!--&gt;0.3 to −&lt;!--&gt; &lt;!--&gt;0.1, &lt;em&gt;P&lt;/em&gt; = 0.006; MD = −&lt;!--&gt; &lt;!--&gt;0.2, 95 % CI: −&lt;!--&gt; &lt;!--&gt;0.3 to −&lt;!--&gt; &lt;!--&gt;0.1, &lt;em&gt;P&lt;/em&gt; = 0.003), catheterization operating time (MD = −&lt;!--&gt; &lt;!--&gt;0.9, 95 % CI: −&lt;!--&gt; &lt;!--&gt;1.6 to −&lt;!--&gt; &lt;!--&gt;0.2, &lt;em&gt;P&lt;/em&gt; = 0.011; MD = −&lt;!--&gt; &lt;!--&gt;1.0, 95 % CI: −&lt;!--&gt; &lt;!--&gt;1.7 to −&lt;!--&gt; &lt;!--&gt;0.3, &lt;em&gt;P&lt;/em&gt; = 0.006).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;One-needle subcutaneous tunnel catheterization was superior to the other two methods and did not cause nerve or blood vessel damage. It is recommended for clinical use.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Registration&lt;/h3&gt;&lt;div&gt;Registered in the Chin","PeriodicalId":50299,"journal":{"name":"International Journal of Nursing Studies","volume":"172 ","pages":"Article 105209"},"PeriodicalIF":7.1,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145159704","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The reality of neonatal nursing work in Kenya and implications for quality and safety: Direct observation of tasks and time utilisation","authors":"Onesmus Onyango ,&nbsp;Vincent A. Kagonya ,&nbsp;Michuki Maina ,&nbsp;Kenneth Karumba ,&nbsp;Abdulazeez Imam ,&nbsp;Sebastian S. Fuller ,&nbsp;David Gathara ,&nbsp;Mike English ,&nbsp;the HIGH-Q Hospital Group","doi":"10.1016/j.ijnurstu.2025.105204","DOIUrl":"10.1016/j.ijnurstu.2025.105204","url":null,"abstract":"<div><h3>Background</h3><div>Little is known about how nurses working in care settings affected by remarkably high workloads and workforce constraints manage their work and time to deliver needed care.</div></div><div><h3>Objective</h3><div>This study aimed to characterise nursing workflows and examine time allocated to care in high mortality, intermediate care Kenyan neonatal units.</div></div><div><h3>Design and methods</h3><div>Using ‘shadowing’ as a time and motion technique, we directly observed 1–2 nurses per 12-hour shift in 8 Kenyan county hospitals. We used an Activity Log Sheet to document their activities during the shift and thematic content analysis of observation notes to classify and group tasks performed. In a second phase, we documented the time spent on specific critical tasks and instances of multi-tasking and care interruptions.</div></div><div><h3>Results</h3><div>We directly observed 499 person-hours over 36 day shifts and 15 night shifts. A typical day and night shift had a median of 38 (25–47) and 32 (18–44) babies respectively with a median nursing hours per-patient per-shift of 0.9 (0.5–1.2) hours. We recorded 1891 task episodes comprised of 36 different tasks that we grouped into eight workflow domains. Most tasks involved: direct patient care (37 %) or indirect patient care (23 %) with communications, documentation and reporting, staff or student supervision and mentorship, interruptions, personal breaks, and rest less frequently performed tasks. Nurses commonly devoted up to 20 minutes even to critical tasks while continuing to multi-task and managing more than 2 instances of interruptions during a newborn caring task.</div></div><div><h3>Conclusions</h3><div>Kenyan neonatal nurses perform direct and indirect patient caring tasks while grappling with demanding housekeeping, administrative, and clinical teaching and mentorship roles under extremely limited time availability. Time allocated even to complex tasks is minimal and rarely given full focus, threatening patient safety. Our findings highlight opportunities to redistribute basic non-clinical roles for enhanced patient and caregiver experience. Even so, nurse staffing must be substantially improved.</div></div>","PeriodicalId":50299,"journal":{"name":"International Journal of Nursing Studies","volume":"172 ","pages":"Article 105204"},"PeriodicalIF":7.1,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145098446","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Family caregivers at the crossroads - considerations, values and the decision to involve volunteers in end-of-life home care: A qualitative study","authors":"Carolien van Leussen ,&nbsp;Thessa Thölking ,&nbsp;Els van Wijngaarden","doi":"10.1016/j.ijnurstu.2025.105206","DOIUrl":"10.1016/j.ijnurstu.2025.105206","url":null,"abstract":"<div><h3>Background</h3><div>Family caregiving is often essential in fulfilling a patient's wish to die at home. While relatives may sometimes experience this role as an obligation, they frequently also find it rewarding. However, caregiving can be burdensome, particularly in the final stages of life, when care demands intensify and sometimes lead to unplanned hospital admissions. Volunteers can provide crucial support to help family caregivers sustain their caregiving efforts.</div></div><div><h3>Objective</h3><div>This Dutch study examines the considerations and underlying values that shape caregivers' decisions to accept volunteer assistance.</div></div><div><h3>Method</h3><div>A phenomenological research approach was conducted involving 22 interviews with family caregivers (partners and children) of deceased individuals who had received volunteer-supported end-of-life care at home. Purposive sampling was used for recruitment (June – September 2023) to ensure diversity. Inclusion criteria were close involvement during the final phase of life of a loved one who had passed away at home within the past year. The interviews were thematically analyzed in Atlas.ti. Subsequently the data were synthesized into composite narratives to contextualize caregivers' voices. This enhances the accessibility of findings for healthcare professionals, particularly community nurses and general practitioners, who often introduce the option of volunteer involvement.</div></div><div><h3>Results</h3><div>Family caregivers' considerations regarding volunteer support are complex and multifaceted. Their commitment to care is strong, and accepting support from volunteers was regularly experienced as failing. This perception is compounded by uncertainty about the duration of care and the increasingly confined living space, which deepens the bond between family caregiver and relative. The emotional and physical burden grows, while caregivers often hesitate to act without the patient's approval and struggle to acknowledge their own limits. The desire to spend as much time as possible with a relative, combined with the wish to be present at the moment of their passing, makes the decision-making process regarding the acceptance of a volunteer more complex. Healthcare professionals play a pivotal role in facilitating discussions about volunteer support.</div></div><div><h3>Conclusions</h3><div>This study highlights the complex considerations individuals face in the process of deciding to accept volunteer support during a relative's final stages of life. Driven by an intense sense of duty and the value of shared time, caregivers often prioritize caregiving over their own needs, which leads to fatigue and reluctance to seek external help. Introducing volunteer support, while beneficial, can evoke feelings of inadequacy, underscoring the need for healthcare professionals to approach these situations with sensitivity to emotional and familial dynamics.</div></div>","PeriodicalId":50299,"journal":{"name":"International Journal of Nursing Studies","volume":"172 ","pages":"Article 105206"},"PeriodicalIF":7.1,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145083345","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of group-based multicomponent psychoeducational intervention on anxiety, depressive symptoms, quality of life, and coping among caregivers of children with cancer: A randomised controlled trial","authors":"Lophina Phiri ,&nbsp;Ho William Cheung Li ,&nbsp;Patrick G.M.C. Phiri ,&nbsp;Kai Chow Choi ,&nbsp;Watipaso Wanda-Kalizang'oma ,&nbsp;Grace Nkhandwe","doi":"10.1016/j.ijnurstu.2025.105205","DOIUrl":"10.1016/j.ijnurstu.2025.105205","url":null,"abstract":"<div><h3>Background</h3><div>Caring for a child with cancer is a stressful experience for caregivers because of the nature of cancer and the complexity of treatment, which predisposes them to negative psychological outcomes. Common negative psychological outcomes include anxiety and depressive symptoms. Caregivers also commonly report poor health-related quality of life and dysfunctional coping.</div></div><div><h3>Objective</h3><div>To evaluate the effectiveness of a group-based multicomponent psychoeducational intervention on anxiety, depressive symptoms, health-related quality of life, and coping among caregivers of children undergoing cancer treatment.</div></div><div><h3>Design</h3><div>A single-blind parallel randomised controlled trial.</div></div><div><h3>Setting(s)</h3><div>Two major paediatric cancer centres in Malawi.</div></div><div><h3>Participants</h3><div>Caregivers of children undergoing cancer treatment.</div></div><div><h3>Methods</h3><div>The intervention group underwent six weekly sessions of psychoeducational intervention, while the control group received the usual care. The primary outcome was anxiety and depressive symptoms, while secondary outcomes were health-related quality of life and coping. Data collection was conducted at baseline, immediately after the intervention and 3 months afterwards. A generalised estimating equation was used to analyse data. An intention-to-treat analysis was performed to minimise attrition bias.</div></div><div><h3>Results</h3><div>Overall, 118 participants were randomised to either the intervention group (59) or the control group (59). The intervention group showed a statistically significant reduction in anxiety levels, depressive symptoms, and avoidant coping immediately after the intervention compared with the control group, and the effect was sustained at 3-month follow-up. Furthermore, the intervention group demonstrated greater improvement in problem-focused and emotion-focused coping immediately after the intervention and at 3-month follow-up compared with the control group. However, there was no statistically significant difference between the groups in terms of changes in health-related quality of life immediately after the intervention and at the 3-month follow-up.</div></div><div><h3>Conclusions</h3><div>The study provides evidence that group-based multi-component psychoeducational intervention is effective in reducing anxiety and depressive symptoms and improving coping among caregivers of children with cancer. Nurses should consider group-based multi-component psychoeducational intervention for enhancing the psychological well-being of caregivers of children with cancer.</div></div><div><h3>Registration</h3><div>The trial was registered with the United States Clinical Trial Registry (<span><span>NCT05783310</span><svg><path></path></svg></span>). Registered on 13/03/2023, the first recruitment 22/05/2023.</div></div>","PeriodicalId":50299,"journal":{"name":"International Journal of Nursing Studies","volume":"171 ","pages":"Article 105205"},"PeriodicalIF":7.1,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145043693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and validation of a backpropagation neural network model for predicting nursing unit staffing needs: A cross-sectional study","authors":"Xinyue Pang ,&nbsp;Jia Pan ,&nbsp;Zhi Chen ,&nbsp;Xinmei Cao ,&nbsp;Jiaqi Shi ,&nbsp;Lijie Mao","doi":"10.1016/j.ijnurstu.2025.105207","DOIUrl":"10.1016/j.ijnurstu.2025.105207","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Nurse staffing requires a strategic approach that aligns staffing levels with actual patient needs. There is a need to explore staffing frameworks that both enhance patient safety and maximize workforce efficiency.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Objective&lt;/h3&gt;&lt;div&gt;This study aimed to integrate efficiency evaluation with deep learning techniques to develop a prediction model for optimizing nurse staffing in clinical units.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Design&lt;/h3&gt;&lt;div&gt;A cross-sectional study.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting(s)&lt;/h3&gt;&lt;div&gt;The study was conducted in a large comprehensive tertiary public hospital in Zhejiang Province, China.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Participants&lt;/h3&gt;&lt;div&gt;Data from fifty-five nursing units were collected to develop and validate the demand prediction model. Thirteen units with optimal nurse staffing efficiency formed the construction group for training the model, and forty-two units with suboptimal efficiency were used as the prediction group to assess the model's effectiveness in improving staffing.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;The number of nurses on duty served as the predicted outcome, while predictors included the number of actual open beds, costs of nursing staff, number of nursing hours, number of diagnosis-related groups, case-mix index, total number of actual occupied bed days, bed utilization rate, nursing quality assessment results, and nursing adverse events. This study retrospectively analyzed data from 55 nursing units between January and December 2023. A backpropagation neural network model was developed using data from 13 units with optimal nurse staffing efficiency to predict nurse staffing demands. Model accuracy was evaluated via mean squared error, Pearson correlation coefficient, and Bland–Altman analysis, while the coefficient of determination (R-square) assessed goodness-of-fit. The validated model was then applied to predict staffing needs for units with suboptimal efficiency. Data envelopment analysis simulated pre- and post-prediction staffing efficiency comparisons to verify the model's practical effectiveness.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;The demand prediction model for nursing units staffing achieved high predictive accuracy (R-square = 0.97, mean square error = 0.1674) with no systematic staffing bias (mean: +&lt;!--&gt; &lt;!--&gt;0.0736 nurses, 95 % Limits of Agreements: −&lt;!--&gt; &lt;!--&gt;0.7308 to +&lt;!--&gt; &lt;!--&gt;0.8779; &lt;em&gt;P&lt;/em&gt; = 0.3693). Bootstrap-validated normal errors (skewness = −&lt;!--&gt; &lt;!--&gt;0.04, kurtosis = 3.18) supported parametric reliability. When simulated to implemented, the model improved technical efficiency in 91.67 % of months and optimized nurse-to-demand ratios (100 % scale efficiency), demonstrating its capacity to balance staffing precision with operational flexibility using existing resources.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;This study proposes a hybrid model to predict nurse staffing by linking operational efficiency with staffing adjustments. Preliminary result","PeriodicalId":50299,"journal":{"name":"International Journal of Nursing Studies","volume":"172 ","pages":"Article 105207"},"PeriodicalIF":7.1,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145089867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nurses experiences with an intervention enhancing skill-mix in Kenyan neonatal units with severe workforce deficits: A qualitative study","authors":"Nancy Odinga ,&nbsp;Caroline Waithira ,&nbsp;Justinah Maluni ,&nbsp;Gloria Ngaiza ,&nbsp;Vincent Kagonya ,&nbsp;Onesmus Onyango ,&nbsp;Abdulazeez Imam ,&nbsp;David Gathara ,&nbsp;Michuki Maina ,&nbsp;Kenneth Karumba ,&nbsp;Fred Were ,&nbsp;Sebastian Fuller ,&nbsp;Mike English ,&nbsp;Edna Mutua ,&nbsp;Sassy Molyneux ,&nbsp;Caroline Jones ,&nbsp;Dorothy Oluoch ,&nbsp;HIGH-Q Hospital Group","doi":"10.1016/j.ijnurstu.2025.105202","DOIUrl":"10.1016/j.ijnurstu.2025.105202","url":null,"abstract":"<div><h3>Background</h3><div>Nurses remain critical in newborn care delivery in Kenya. However, persistent nurse shortages in newborn units limit their ability to provide optimal care. Staff shortages contribute to missed care and high workloads, negatively impacting the motivation and well-being of nurses. Evidence from Low and middle-income countries reveals strategies employed by nurses to manage high workloads. These include prioritisation of care and informal task shifting, where tasks are delegated to caregivers, student nurses, and support staff. While sharing and shifting non-technical tasks to less qualified personnel may be helpful, perceptions linked to the cadre of staff taking on extra roles and effects on the care performed and other critical relational aspects of care are often unclear or overlooked. To generate evidence on the impact of staffing interventions, we investigated the effects of workforce interventions on supporting neonatal care in hospitals in Kenya. In this paper, we report on the experiences of nurses with the intervention.</div></div><div><h3>Methods</h3><div>We adopted an ethnographic approach to explore nurses experiences with a staffing intervention in four Kenyan newborn units (neonatal units). Non-participant observations on neonatal units and in-depth interviews were conducted with healthcare providers. Data collection occurred in three phases: at baseline (Phase 1), after supplementing the units with additional nurses (Phase 2), and after supplementing the units with ward assistants (Phase 3). Over 1000 hours of observations and 112 in-depth interviews were conducted between January 2022 and July 2023. Drawing from the project's theory of change, we used a thematic approach in analysing and interpreting the data.</div></div><div><h3>Results</h3><div>Additional nurses and ward assistants were perceived as contributing to the overall motivation and well-being of existing nurses. Additional nurses meant that there were more hands per shift, which enhanced teamwork, task sharing, and task completion. The reported benefits of having more ward assistants included nurses being able to delegate non-technical tasks to ward assistants, which reduced nurses workload and freed up their time to concentrate on critical nursing tasks. This contributed to improved nurse motivation and well-being.</div></div><div><h3>Conclusions</h3><div>Adequate staffing is crucial for delivering optimal care quality and is central to nurses well-being. There is a need to increase nurse staffing in neonatal units. Further beneficial support for nurses may be gained by carefully designing and implementing non-technical task-sharing roles.</div></div>","PeriodicalId":50299,"journal":{"name":"International Journal of Nursing Studies","volume":"171 ","pages":"Article 105202"},"PeriodicalIF":7.1,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145009028","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring the associations of unfinished nursing care with individual, team climate, and organizational factors in nursing homes: An observational study","authors":"Pauliina Hackman ,&nbsp;Arja Häggman-Laitila ,&nbsp;Marja Hult","doi":"10.1016/j.ijnurstu.2025.105203","DOIUrl":"10.1016/j.ijnurstu.2025.105203","url":null,"abstract":"<div><h3>Background</h3><div>Care workers in nursing homes globally report failing to comprehensively provide essential nursing care. This phenomenon of unfinished nursing care has adverse impacts on residents. Inadequate staffing levels are associated with unfinished nursing care, but this alone does not explain its prevalence. Unfinished nursing care emerges in a complex reality, requiring knowledge of its associations with care workers' individual factors, team climate, and organizational factors. These associations have mainly been studied in acute care settings.</div></div><div><h3>Objective</h3><div>To explore associations between individual, team climate, and organizational factors and unfinished nursing care in nursing homes.</div></div><div><h3>Design</h3><div>An observational study utilizing two cross-sectional data sources.</div></div><div><h3>Setting(s)</h3><div>Eighteen publicly owned nursing homes with 122 units in Finland.</div></div><div><h3>Participants</h3><div>Care workers (n = 503) delivering nursing care in these nursing home units.</div></div><div><h3>Methods</h3><div>Data were obtained from two different datasets drawn from the same nursing home units. The first dataset consisted of results at the nursing home unit level from the national Finnish Public Sector (FPS) study. The second dataset consisted of questionnaire responses from care workers related to unfinished nursing care. Multiple linear regression analysis examined the associations.</div></div><div><h3>Results</h3><div>Non-nursing tasks were statistically significantly associated with increased unfinished nursing care in all four care types: activities of daily living (β = 0.186, 95 % CI 0.071–0.302), caring, rehabilitation and monitoring (β = 0.260, 95 % CI 0.155–0.366), documentation (β = 0.376, 95 % CI 0.221–0.530) and social care (β = 0.487, 95 % CI 0.301–0.673). Better work-related well-being (β = −<!--> <!-->0.123, 95 % CI −<!--> <!-->0.233 to −<!--> <!-->0.012) was associated with decreased unfinished nursing care in social care. Temporary employment contracts were associated with decreased unfinished nursing care in caring, rehabilitation and monitoring (β = −<!--> <!-->0.193, 95 % CI −<!--> <!-->0.366 to −<!--> <!-->0.020) and social care (β = −<!--> <!-->0.357, 95 % CI −<!--> <!-->0.720 to −<!--> <!-->0.042). No clinically significant associations were found between unfinished nursing care and team climate factors.</div></div><div><h3>Conclusions</h3><div>The identified associations with unfinished nursing care in nursing homes highlight this complex issue, but the exact mechanisms remain unknown and require further investigation. Future studies should focus on nursing leadership and decision-making processes to better understand the underlying mechanisms potentially explaining unfinished nursing care.</div></div>","PeriodicalId":50299,"journal":{"name":"International Journal of Nursing Studies","volume":"172 ","pages":"Article 105203"},"PeriodicalIF":7.1,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145076494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of a nurse-led diabetes self-management programme for people with type 2 diabetes receiving insulin injection therapy: A randomised controlled trial with qualitative process evaluation","authors":"Wei Liang ,&nbsp;Ka Ming Chow ,&nbsp;Xiaoying Ni ,&nbsp;Yetunde Oluwafunmilayo Tola ,&nbsp;Suzanne Hoi Shan Lo","doi":"10.1016/j.ijnurstu.2025.105200","DOIUrl":"10.1016/j.ijnurstu.2025.105200","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Many people with type 2 diabetes eventually require and benefit from insulin injection therapy, but only a minority of people receiving such therapy meet their glycaemic targets. Thus, effective diabetes self-management programmes are needed to support this cohort.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Objective&lt;/h3&gt;&lt;div&gt;To examine the effects of a nurse-led diabetes self-management programme on self-efficacy, self-management behaviours, glycaemic control, and diabetes-related distress of Chinese people with type 2 diabetes receiving insulin injection therapy, and to collect their experiences and perceived benefits of and feedback on the programme.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Design&lt;/h3&gt;&lt;div&gt;A prospective, two-arm, assessor-blinded, randomised controlled trial with repeated measures and qualitative process evaluation.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting&lt;/h3&gt;&lt;div&gt;Participants were recruited from a public community health service centre.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Participants&lt;/h3&gt;&lt;div&gt;One hundred and two participants (mean age: 64.03 years, standard deviation = 9.77 years) were recruited and then randomly assigned to the intervention group or the attention control group.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;The intervention group (n = 51) received a 6-week nurse-led diabetes self-management programme. This intervention was underpinned by Bandura's theory of self-efficacy and consisted of one individual interview session, three group-based education sessions, and two telephone-based maintenance sessions. The attention control group (n = 51) received parallel 6-week attention control contact. Outcome variables were measured at baseline (T0), upon completion of the intervention (T1), and at 3 months post-intervention (T2).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;At T0, there were no significant between-group differences in characteristics, except for education level, and no significant between-group differences in any outcome variables. At T1, compared with the attention control group, the intervention group exhibited significantly enhanced self-efficacy (&lt;span&gt;&lt;math&gt;&lt;mi&gt;β&lt;/mi&gt;&lt;/math&gt;&lt;/span&gt; = 17.341, &lt;em&gt;p&lt;/em&gt; &lt;span&gt;&lt;math&gt;&lt;mo&gt;&lt;&lt;/mo&gt;&lt;/math&gt;&lt;/span&gt; 0.001), improved self-management behaviours (&lt;span&gt;&lt;math&gt;&lt;mi&gt;β&lt;/mi&gt;&lt;/math&gt;&lt;/span&gt; = 0.696, &lt;em&gt;p&lt;/em&gt; &lt;span&gt;&lt;math&gt;&lt;mo&gt;&lt;&lt;/mo&gt;&lt;/math&gt;&lt;/span&gt; 0.001), and reduced diabetes-related distress (&lt;span&gt;&lt;math&gt;&lt;mi&gt;β&lt;/mi&gt;&lt;/math&gt;&lt;/span&gt; = &lt;span&gt;&lt;math&gt;&lt;mo&gt;−&lt;/mo&gt;&lt;/math&gt;&lt;/span&gt;0.160, &lt;em&gt;p&lt;/em&gt; = 0.015). However, at T2, compared with the attention control group, the intervention group did not demonstrate significant improvement in any outcome variables (all &lt;em&gt;p&lt;/em&gt; &lt;span&gt;&lt;math&gt;&lt;mo&gt;&gt;&lt;/mo&gt;&lt;/math&gt;&lt;/span&gt; 0.05). No adverse effects were reported by the participants. Qualitative interviews of 21 participants of the intervention group generated responses that could be categorised under four themes, namely perspectives on receiving the intervention, benefits of the intervention, barriers to behavioural change, and areas for improveme","PeriodicalId":50299,"journal":{"name":"International Journal of Nursing Studies","volume":"171 ","pages":"Article 105200"},"PeriodicalIF":7.1,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144988417","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}