Background: Chronic Kidney Disease (CKD) and End-Stage Renal Disease (ESRD) rising cases poses a serious challenge for hemodialysis patients and healthcare teams, which can be addressed by an effective management through the implementation of Continuous Quality Improvement (CQI). Despite medical advancements, gaps in CQI persist, particularly in hemodialysis settings. This study that was conducted from August to November 2024, aims to develop a standardized CQI program for dialysis nursing care using the Delphi method, ensuring safe, effective, and patient-focused hemodialysis services in Ilocos Region, Philippines. Methods: The study employed a Delphi method, involving 15 hemodialysis nurses to understand their experiences. Fifteen (15) nursing experts participated in two rounds of Delphi consultations to refine the program. The methodology integrated findings from the first phase, used two Delphi rounds, and relied on online communication to achieve consensus. The insights gained from the study informed the initial enhancement training program. Results: During the first round of the Delphi approach, the participants identified four themes for the CQI: (1) the need for flexibility, resourcefulness, and commitment; (2) coping mechanisms; (3) aspirations for better CQI; and (4) personal realizations motivating their work. In the second round, a twenty-eight (28) module program was developed, which was further refined to 19 modules after expert validation, achieving over 70% agreement and a Fleiss’ Kappa of 0.729, indicating strong consensus. The final program was categorized into three areas: patient-centered care, skills development, and leadership/management. High Content Validity Index (CVI) scores confirmed the program's relevance and applicability. Conclusion: Hemodialysis nurses play a critical role in patient care. The CQI enhancement program addresses care gaps through a structured, evidence-based framework, equipping nurses with tools to improve patient outcomes, enhance healthcare quality, and ensure safety for both nurses and patients.
Patients undergoing hemodialysis often face physical, emotional, and psychological challenges that can downgrade their quality of life. However, their spiritual needs are frequently overlooked. On the other hand, spiritual care can improve mental health in these patients, reduce distress, and enhance resilience. By integrating spiritual care into routine care, it is possible to improve treatment outcomes and overall well-being of patients, and support their comprehensive recovery. This article presents the authors’ views on the importance of spiritual care for patients undergoing hemodialysis, drawing on the available evidence.
Background: Pediatric nursing faces a range of ethical challenges that are markedly different from those encountered in adult care, particularly concerning informed consent, confidentiality, and the welfare of children. The complexity of decision-making in pediatric settings necessitates a reevaluation of existing ethical frameworks to ensure they adequately address the unique needs of children while balancing parental authority. This study aims to explore ethical dilemmas in pediatric nursing by critically analyzing frameworks that balance informed consent, confidentiality, and child welfare, identifying prevalent challenges, and evaluating their application in real-world practice. Methods: Conducted in 2024, this narrative review systematically examined quantitative and qualitative studies on ethical challenges in pediatric nursing via searches in MEDLINE, PubMed, Embase, Web of Science, CINAHL, Scholar Google, and Persian databases of Magiran and SID. Finally, 32 studies on pediatric nursing ethics were included. The articles were narratively synthesized, and their quality was assessed using the SANRA (scale for the assessment of narrative review articles) checklist. Results: The narrative synthesis identified key ethical dilemmas in pediatric nursing, including decision-making tensions (e.g. informed consent conflicts), end-of-life care challenges, confidentiality breaches, communication barriers, and ethical numbness resulting from workload pressures. Pediatric nurses often face the challenge of balancing their advocacy for a child’s best interests with respect for parental preferences, particularly in situations that require informed consent. Furthermore, the literature emphasizes the importance of effective communication and collaboration among healthcare teams in navigating these complex ethical landscapes. Conclusion: The study highlights the urgent need for tailored ethical guidelines in pediatric nursing that prioritize child welfare while respecting parental authority and address unresolved challenges, such as assessing a child’s capacity for assent. Continuous education and interdisciplinary collaboration are essential for enhancing the ethical decision-making capabilities of pediatric nurses. By fostering a culture of ethical awareness, the nursing profession can significantly improve the quality of care provided to children, ensuring their voices are heard and respected within the healthcare system. This commitment is vital for creating a more equitable and compassionate healthcare environment for vulnerable populations.
Background: The integration of generative artificial intelligence (AI) tools transforms educational practices, particularly in self-directed learning, academic engagement, and critical thinking. However, nursing education, where clinical reasoning and ethical practice are paramount, requires a theoretical understanding tailored to its unique pedagogical environment. While the trust-adaptation-intention (TAI) framework has been previously conceptualized in broader technology adoption contexts, its application to nursing students’ behavioral responses to generative AI has remained unexplored. This study aims to recontextualize the TAI framework to explain how nursing students build trust in generative AI tools, adapt their learning behaviors accordingly, and develop sustained intentions to integrate these technologies into their academic routines. Methods: A deductive axiomatic approach was employed to reinterpret the TAI framework within the nursing education context. Five foundational axioms were formulated from the literature on technology acceptance, behavioral psychology, and nursing pedagogy. These axioms informed three propositions that explain the behavioral progression of nursing students as they engage with generative AI. Results: The recontextualized TAI framework illustrates a sequential process: Unmet educational needs and perceived benefits of AI support trust formation, trust facilitates adaptive learning behaviors, so that trust and adaptation jointly influence students’ intention to continue AI use. This adapted framework provides a mid-range theoretical lens specifically tailored to the nursing education setting. Conclusion: This study gives a recontextualized interpretation of the TAI framework, offering practical insights for educators and policymakers in designing AI-integrated curricula that uphold the pedagogical and ethical standards of nursing education.
Background: Many nursing theorists have researched the relationship and interaction between nurses and patients for many decades in different general care settings. The interaction between nurses and patients during mechanical ventilation is unique and complex, but has been less studied. Nurses’ experiences will provide more insight into how they interact with these patients. This study explores nurses’ perspectives on the process of interaction with patients on mechanical ventilation. Methods: A qualitative study with the grounded theory approach (Strauss and Corbin, 1998) has been used for this study. A total of 25 nurses from the intensive care unit of the SRM Medical College and Hospital Research Center in India were included in the study, initially through purposive sampling and subsequently through theoretical sampling, until data saturation was achieved. Data were generated using individual, in-depth, face-to-face, semi-structured interviews. To ensure trustworthiness in this qualitative study, we applied Lincoln and Guba’s (1985) criteria. Results: We found three theoretical constructs: continuum of symptom dynamics, continuum of communication dynamics, and nurse-patient interaction, each consisting of 5–6 thematic categories and 2–5 text-based categories. The synergy between the communication continuum and the symptom continuum forms the basis of the interaction between nurses and patients. Conclusion: Effective nurse-patient interaction can improve patient outcomes. Thus, nurses working with patients receiving mechanical ventilation should understand how these constructs work together.
Background: Pre-eclampsia (PE), a prevalent cause of maternal and fetal mortality, is prompted by psychological, physical, and social risk factors. This study determined the association between intimate partner violence (IPV) and the likelihood of PE. Methods: A case-control study was carried out in Ayatollah Mousavi Hospital in Zanjan City, Iran. This study included 110 postpartum mothers who were randomly assigned to two groups: Case (with PE, n=55) and control (without PE, n=55). Study data were collected via the WHO domestic violence questionnaire. Statistical analyses included the independent t-test, the Fisher exact test, and logistic regression. All analyses were conducted in R (version 4.3.1) with a significance level set at 0.05. Results: The findings showed that in the PE group, 61.8% had experienced low violence and 38.2% moderate violence. There was no significant difference between the case and control groups regarding psychological (odd ratio [OR]: 1.05, P=0.303), economic (OR: 1.05, P=0.592), physical (OR: 1.11, P=0.309), sexual (OR: 1.02, P=0.917), and overall violence (OR: 1.02, P=0.329). On the other hand, maternal age (OR=1.07), husband’s age (OR=1.13), and age difference between partners (OR=1.15) were significantly associated with an increased risk of PE (P<0.05). Conclusion: Although IPV levels were slightly higher in the case group, no significant correlation was found between IPV and incidence of PE. Older parental age and greater age difference between partners were associated with an increased risk of PE. Further prospective studies are needed to explore the impact of IPV on pregnancy outcomes.
Background: Fear and anxiety during labor are common among nulliparous women and may contribute to prolonged labor stages. Transcutaneous electrical nerve stimulation (TENS) is known for its anxiolytic effects, acting through the activation of inhibitory pathways in the central nervous system. This study aims to compare the effects of TENS at the Hugo and Sanyinjiao acupressure points on labor progression and duration in nulliparous women. Methods: This randomized clinical trial involved 123 nulliparous women referring to an educational-therapeutic center in Zanjan City, Iran. The participants were randomly assigned to three groups of 41 each: The Hugo group, the Sanyinjiao group, and the control group. The intervention began when cervical dilation reached 4 cm and labor pains started, and continued through the active phase of the first and second stages of labor. TENS was applied at acupressure points according to group allocation. Labor duration and clinical assessments were recorded using a standardized labor progress checklist. Statistical analyses were conducted using R software, version 4.2.2, employing analysis of variance (ANOVA) or the Kruskal-Wallis test, with Dunn correction applied for multiple comparisons. A P<0.05 was considered statistically significant. Results: The mean duration of the first stage of labor significantly differed among the groups (P=0.002), with the Hugo group showing an average of five hours (interquartile range [IQR]: 4.75–6) compared to 6 hours (IQR: 5–7) in the Sanyinjiao and control groups. The second stage of labor also showed a significant difference in duration (P<0.001), with a mean duration of 15 min (IQR: 10–16.25) in the Hugo group, 37.5 min (IQR: 30–60) in the Sanyinjiao group, and 30 min (IQR: 20–60) in the control group. Conclusion: The application of TENS at specific acupressure points, such as Hugo’s point, can effectively reduce labor duration. However, the findings revealed that the second stage of labor was longer in the Sanyinjiao group compared to the control group, which may be related to a different physiological response at this point or the method of intervention, warranting further studies in the future.
Background: Surrogacy is a complex reproductive option for women facing infertility, particularly in sociocultural contexts where biological motherhood is intricately linked with identity and status. This study explored the psychosocial, cultural, and contextual factors influencing surrogacy decision-making among Nigerian women with failed in vitro fertilization (IVF) experiences. The study investigated the factors influencing Nigerian women’s decisions to pursue surrogacy after experiencing one or more failed IVF cycles, focusing on the constructs of the health belief model (HBM). Methods: This study employed a qualitative content analysis approach (deductive and inductive), utilizing in-depth semi-structured interviews via WhatsApp with 20 infertile women recruited from 2 online fertility support groups (“voices of fertility and health” and “infertility, IVF and surrogacy”) in Nigeria through purposive and snowball sampling. HBM provides a theoretical framework guiding data collection and directed content analysis. Data that did not fit under the constructs of HBM were classified using conventional content analysis. Results: This study identified 6 emergent themes that complemented the constructs of the HBM (perceived susceptibility, severity, benefits, barriers, cues to action, and self-efficacy). The emergent themes were sociocultural identity pressures, family and marital dynamics, religious and spiritual tensions, medical and legal mistrust, financial class reality, and emotional distress and identity threat. These themes highlight the complex interplay between individual health beliefs and broader sociocultural, emotional, and contextual factors shaping surrogacy decision-making. The findings of this study have provided suggestions for modifying the HBM. Conclusion: The findings emphasize the need for holistic, culturally sensitive, and client-centered reproductive care. Fertility practitioners and health psychologists are suggested to acknowledge and respond to the sociocultural, emotional, and economic realities influencing surrogacy decisions.
Background: Non-suicidal self-injury (NSSI) has gained increasing recognition in recent years as a common mental health concern among adolescents, often co-occurring with symptoms of depression. So, depressed adolescents with NSSI are significantly more likely to report higher levels of suicidal ideation and attempts and to exhibit suicidal behavior over time. Although NSSI has multiple risk factors, depression may act as a mediator that exacerbates or prolongs NSSI behaviors. This review aims to find the risk factors for depression among adolescents with NSSI. Methods: This review followed the PRISMA (the preferred reporting items for systematic reviews and meta-analyses) guidelines. Searching was conducted across four databases: PubMed, CINAHL, ScienceDirect, and Scopus between 2014 and 2024. The risk of bias and methodological quality of the included studies were assessed using the Joanna Briggs Institute (JBI) critical appraisal checklist. Each study was evaluated independently by two reviewers, and disagreements were resolved through discussion or consultation with a third reviewer. All relevant studies were managed using EndNote software, 21. A narrative synthesis was conducted to identify risk factors of depression. The protocol was registered with PROSPERO (the international prospective register of systematic reviews) (Code: CRD42024555723). Results: Out of 2457 records yielded from the systematic search, 19 articles were selected to be included in the review, all of which were cross-sectional studies. The identified risk factors for depression were categorized into three main domains: 1) biological factors (including gender, alcohol use behavior, and exposure to negative life events), 2) psychological factors (including mental health conditions, self-directed behaviors, and cognitive functions), and 3) sociological factors (including education level of junior high school or below, parental relationships, experiences of abuse/trauma, and school bullying). Conclusion: Several risk factors for depression in adolescents with NSSI were identified. In future studies, data from this study can be used to identify risk factors and develop interventions that reduce risk factors leading to depression in NSSI.
