The survival of infants and children with complex medical conditions continues to increase, underscoring the need to quantify technology dependence more effectively. Existing measures emphasize mortality risk and fail to capture the burden of ongoing technological support. To address this gap, the Technology Dependence Index (TDI) was developed and initially validated as a standardized measure capturing the technology-dependence component of neonatal and pediatric caregiving complexity. Technology dependence is defined as the complexity and intensity of the skilled, health-related caregiving an infant or child needs to sustain physiological functioning, beyond the presence of any single device. Pooled data from six studies yielded 818 TDI observations across 265 infants. Inter-rater reliability was moderate (κ = 0.61), with intraclass correlations from 0.90 to 0.99 and at least 90% agreement for 10 of 12 domains, noting the medication domain had the lowest inter-rater reliability (45%-48%). Principal components analysis supported a multidimensional internal structure, with the 12 domains loading onto three retained factors. Researchers and clinicians can use the TDI retrospectively through chart review, prospectively in real time, or via parent report, making it adaptable to both research and clinical settings.
This study aimed to diagnose priority areas within the nursing practice environment by applying importance-performance analysis to examine job satisfaction across clinical ladder levels. Using a cross-sectional secondary data analysis, 8009 valid survey responses from registered nurses at a tertiary medical center in Taiwan were analyzed across nine survey waves collected between 2020 and 2025. Sequential regression revealed that personal and job-related characteristics accounted for only 3.2% of the variance in job satisfaction. Satisfaction demonstrated a U-shaped distribution across career stages, with the lowest levels observed among competent (N2) nurses. Importance-performance analysis identified professional autonomy as the sole dimension located in the "concentrate here" quadrant, signifying a high-importance but low-performance area and highlighting a marked structural autonomy gap. In contrast, nursing workload, although rated lowest in performance, was not located in the immediate intervention quadrant because of its comparatively lower association with overall job satisfaction. Findings suggest that nurse retention challenges are primarily associated with structural conditions, particularly for intermediate-level nurses who face increasing clinical responsibility without commensurate decision-making authority. Healthcare organizations should shift retention strategies from individual-level selection toward environment-focused diagnosis, prioritizing structural empowerment initiatives that enhance professional autonomy and participation in decision-making.
Foot-ankle and walking exercises have been proposed as potential strategies for managing symptoms in people with diabetic peripheral neuropathy (DPN), yet evidence from primary care remains limited. This pilot study assessed the feasibility and acceptability of these interventions and explored preliminary outcome patterns in DPN, stress, and quality of life (QoL). A three-arm pilot randomized controlled trial was conducted in three public health centers in Yogyakarta, Indonesia (n = 108; 36 per group). The control group received usual care and health education. The foot-ankle group received education, leaflets, demonstrations, and guided practice, while the walking group received education and leaflets supporting a structured walking routine. Participants in the intervention groups then performed the exercises independently for 12 weeks. Outcomes were assessed at baseline, week 6, and week 12. Feasibility included recruitment, retention, data completeness, adherence, and adverse events. Adherence to the ≥ 150 min/week activity target was assessed using participant-reported exercise logs. Acceptability was explored through open-ended questions. Exploratory outcomes were analyzed using generalized estimating equations under an intention-to-treat approach. Feasibility indicators were favorable, with retention > 90%, minimal adverse events, and ≥ 80% adherence. Exploratory analyses suggested possible trends toward changes in DPN indicators, diabetes-related distress, QoL barriers, fasting blood glucose, blood pressure, and ankle-brachial index in the intervention groups compared with controls. These findings suggest that the interventions are feasible and acceptable in primary care and provide preliminary estimates to inform a future fully powered randomized trial.
Postoperative delirium, pain, and sleep disturbances prolong recovery after cardiac surgery. Evidence for multicomponent, nurse practitioner-led interventions is limited, especially in resource-constrained settings. This study evaluated their effect on delirium, pain, sleep quality, and hospital stay. In a single-blinded, post-test only RCT at a tertiary cardiac hospital in India, 100 adults undergoing elective coronary artery bypass graft, mitral valve replacement, or aortic valve replacement were randomized to nurse practitioner-led bundled care (n = 50) or routine care (n = 50). The intervention included preoperative orientation, early mobilization, cognitive reorientation, family engagement, relaxation, and sleep promotion. Outcomes-delirium (CAM-ICU), pain (VAS), and sleep quality (RCSQ) and length of stay were analyzed using chi-square/Fisher's exact tests, repeated-measures ANOVA, GLM, and Mann-Whitney U tests. All 100 participants completed the study (n = 50 per group) with comparable baseline demographics and clinical profiles. The intervention group showed significantly lower postoperative delirium (Day 2: 6% vs. 32%, p = 0.001; GLM group × time interaction p = 0.009), reduced pain scores across Days 1-3 (F1,98 = 72.18, p < 0.001), and improved sleep quality across Days 2-4 (F1,98 = 233.35, p < 0.001; group × time interaction p < 0.001) compared with controls. Recovery was faster, with shorter ICU stay (median 3 vs. 3-4 days, p = 0.006), ward stay (5 vs. 6 days, p = 0.002), and total hospital stay (8 vs. 10 days, p < 0.001). Nurse practitioner-led bundled care reduces delirium, improves pain and sleep, and shortens recovery, providing a feasible, low-cost approach for cardiac surgery patients. Trial Registration: CTRI/2023/06/054180 Dated 6/19/2023.
Workplace violence remains a pervasive occupational hazard in nursing, with new graduate nurses being particularly at risk during their transition to professional practice. Limited authority, inadequate coping resources, and low confidence in managing aggression contribute to their vulnerability. This scoping review maps interventions designed to prepare and support new graduate nurses in responding to Type II (patient/visitor-initiated) and Type III (colleague-initiated) workplace violence. Following the Arksey and O'Malley framework and guided by the Joanna Briggs Institute methodology, five electronic databases (PubMed, Embase, CINAHL, Scopus, and Web of Science) were searched. Thirteen studies met the inclusion criteria, comprising two focused exclusively on Type II violence, nine on Type III violence, and two addressing both types. The identified interventions primarily encompassed educational strategies (e.g., cognitive rehearsal training and transition programs) and organizational strategies (e.g., mentorship, reporting systems, and institutional safety policies). Quantitative measures showed limited reductions in violence incidence, while qualitative data consistently demonstrated improved confidence, recognition skills, and self-efficacy. Marked heterogeneity in outcome measurement precludes direct comparison across studies. Existing interventions effectively enhance new graduate nurses' self-efficacy and confidence in responding to workplace violence, yet have shown limited impact on violence occurrence itself. This suggests that while educational interventions can strengthen individual preparedness, meaningful reductions in workplace violence require broader organizational and perpetrator-focused strategies, alongside standardized measurement approaches capable of capturing change across different outcome domains.
Work-related musculoskeletal disorders among nurses arise from a complex interaction of physical, organizational, and psychosocial factors. Existing assessment tools often focus on isolated risk domains, limiting their applicability in comprehensive ergonomic risk evaluation. This study aimed to develop and evaluate the psychometric properties of the Behavioral Risk Assessment Scale for Work-Related Musculoskeletal Risk in Nurses (BRASM-N). Instrument development followed a multistage process including item generation, expert content validation, pilot testing, and field testing. The scale was administered to 382 hospital nurses, with exploratory and confirmatory factor analyses conducted on independent subsamples. Reliability was examined using internal consistency and test-retest methods, and construct validity was assessed through convergent and discriminant validity. Content validation produced a 22-item scale with acceptable to excellent item relevance (I-CVI = 0.78-1.0). In 382 nurses, exploratory and confirmatory factor analyses supported a stable four-factor structure with good model fit (CFI = 0.94, TLI = 0.93, RMSEA = 0.049). Internal consistency was acceptable to excellent across subscales (Cronbach's α = 0.72-0.85; total α = 0.90). Test-retest reliability was strong (ICC = 0.76-0.91). Floor and ceiling effects were minimal. Convergent and discriminant validity were supported through correlations with work ability, job control, stress, and coping measures. The BRASM-N is a psychometrically robust, multidimensional instrument for assessing behavioral risk factors associated with work-related musculoskeletal risk in nurses and may support ergonomic screening and preventive interventions in occupational health settings.
This study aimed to examine the impact of an Emotional Freedom Technique (EFT)-based supportive intervention applied prior to mammography screening on women's perceived pain, situational anxiety, and satisfaction levels. It was hypothesized that women receiving EFT would report lower pain and anxiety levels and higher satisfaction compared to the control group. This research was designed as a randomized controlled trial. Data were collected at the Cancer Early Diagnosis, Screening, and Education Center between November 2024 and May 2025. The sample consisted of 94 women, with 47 in the EFT-based supportive intervention group and 47 in the control group. Participants were randomly assigned to groups using a computer-generated randomization sequence. Data were collected using the Pre- and Post-Procedure Information Form, the State Anxiety Inventory (STAI-I), and the Visual Analog Scale (VAS). The intervention group received a standardized single EFT session before mammography, with all procedural steps applied consistently, while the control group received only routine care. Between-group comparisons were done using the t-test or Mann-Whitney U test, and within-group changes with the Wilcoxon test. The intervention group had significantly lower post-procedure STAI-I scores (d = 2.18), lower pain levels during (d = 1.61) and after the procedure (d = 0.84), and higher satisfaction scores (d = 2.08) compared to the control group (all p < 0.001). The findings suggest that an EFT-based intervention appears effective in reducing pain and anxiety and enhancing satisfaction in women undergoing mammography, supporting its complementary use despite the study's modest sample size and some variability in intervention duration. Trial Registration: NCT06296927 (https://clinicaltrials.gov/).
To describe nurses' experiences of workplace flourishing in healthcare. A qualitative descriptive design using content analysis. Semi-structured remote individual interviews were conducted with 16 nurses between January and April 2023 in a private occupational healthcare organization in Finland. The data were analyzed using a deductive-inductive content analysis approach informed by the Flourishing at Work framework, which addresses the emotional, psychological, and social dimensions of workplace flourishing. Emotional well-being included experiencing mixed work-related emotions and energizing work performance. Psychological well-being included fostering employee engagement, supporting professional growth, developing professional self-awareness, recognizing the broader significance of work, and enhancing personal well-being at work. Social well-being included building an inclusive workplace environment, guiding actions through core values, fostering communality in the workplace, promoting mutual respect in the workplace, and experiencing human-centered leadership. A positive work community was a central driver of all WF dimensions, highlighting its social aspect. Human-centered leadership, characterized by coaching, empowerment, and interpersonal support, was essential for fostering WF. Nurses' WF was further shaped by personal values, meaningful work, and growth opportunities. Influence over one's work and organizational support for work-life balance also contributed significantly, underscoring the need to embed these elements in organizational practices. Findings highlight the need for human-centered leadership and supportive work communities to enhance nurse retention and well-being. Nurse supervisors play a key role in recognizing individual needs and supporting holistic well-being of nurses. The reporting is based on the Consolidated Criteria for Reporting Qualitative Research (COREQ).
Strengthening self-care is critical to preventing older adults with declining intrinsic capacity (IC) from progressing to disability. However, self-care among older adults with IC decline demonstrates heterogeneity, and standardized interventions often fail to fully meet the needs of this heterogeneous group. This study aimed to examine the self-care characteristics and needs of older adults with IC decline and develop tailored personas. We conducted an explanatory sequential mixed-methods study. The quantitative phase collected numerical data from a sample of 350 community-dwelling older adults with IC decline to identify clusters of self-care. These findings informed the purposive sampling and interview guide for the subsequent qualitative phase, in which 36 participants were selected for in-depth, semi-structured interviews to explore the characteristics and needs within each cluster. This study identified four distinct self-care personas among older adults with IC decline: (I) The Proactive Collaborator; (II) The Symptom-Triggered Reactor; (III) The Social Mimic; and (IV) The Passively Compliant. Developing personalized intervention strategies tailored to these personas, such as enhancing health literacy, providing collaborative platforms, offering psychological support, and implementing positive incentives, is crucial for improving self-care of older adults with IC decline. These findings equip healthcare professionals with actionable insights to optimize support strategies for older adults with IC decline, thereby helping to prevent disability.
Previous research has shown the effect of healthcare workers' sleep on their safety and health outcomes. The association between healthcare workers' sleep and the quality of care (QOC) has not been systematically investigated. A large survey was collected from a prospective cohort of healthcare workers at five public-sector facilities in the northeastern U.S. in 2018 and again in 2021. Sleep characteristics assessed were short sleep duration (≤ 6 h/day), sleep disturbances, and sleep at two or more episodes. Among 1553 healthcare workers (mean age 46.4 years, 61.5% female) who completed the 2021 survey, sleep risk factors (range 0-3, sleep disturbances or short duration or at ≥ 2 episodes) were cross-sectionally associated with a linearly increasing prevalence of poor QOC on the unit and in the last shift, and deteriorated QOC over the past year. Two or more sleep risk factors were associated with all poor QOC outcomes after adjusting for covariates. Among 428 healthcare workers who completed both surveys, two or more sleep risk factors at baseline were associated with a 133%-196% increase in reported deterioration of QOC at follow-up, but not in poor QOC on the unit or in the last shift, after adjusting for covariates. Healthcare workers' sleep behaviors were significantly associated with QOC outcomes cross-sectionally and prospectively. Evidence-based interventions at individual and organizational levels to improve healthcare workers' sleep would likely benefit QOC.
Cumulative Adverse Childhood Experiences (ACEs) and low household income are associated with adolescent depression and anxiety, but it is unclear whether distinct ACE subdomains - maltreatment (e.g., abuse) versus parent challenges (e.g., parental mental illness) - when experienced in distinct developmental periods exert a unique influence on adolescent mental health, or how ACEs and economic disadvantage operate together to influence outcomes. Thus, we aimed to (1) examine associations between baseline household income, early childhood ACEs (ages 0-5; sub-indexed as Maltreatment vs. Parent Challenges) and adolescent depression and anxiety symptoms (age 15), and (2) investigate whether household income moderates the associations between ACE sub-indices and each mental health outcome. We used serial linear regressions and data from the United States-based, longitudinal, racially/ethnically and socioeconomically diverse Future of Families and Child Wellbeing Study (n = 2523; 51% female; 51% non-Hispanic Black; 36% in poverty at birth). The Parent Challenges sub-index (but not the Maltreatment sub-index) was associated with depression and anxiety symptoms. Low household income was associated with depression symptoms. Income moderated the association between the Parent Challenges sub-index and anxiety symptoms; youth from the lowest and highest income strata were at greatest risk. Strategies are urgently needed for ACE prevention and to support parents of very young children (or expectant parents) who are experiencing behavioral health challenges, interpersonal violence, criminalized behavior, and/or poverty to promote healthy child development and adolescent mental health. Health professionals are well-positioned to advocate for supportive policies, promote trauma-informed environments, and identify/address significant parental challenges early in development.
This randomized controlled trial aimed to determine the effect of music played during intrauterine device (IUD) insertion on perceived pain, state anxiety, and satisfaction levels. The study was conducted with 70 women who applied to a maternal and child health and family planning center and were randomly assigned to the intervention and control groups using simple randomization. Data were collected using a Demographic Information Form, the State-Trait Anxiety Inventory (STAI-I), and the Visual Analog Scale (VAS), as well as Bluetooth speakers and the musical piece Evgeny Grinko-Valse. Participants in the intervention group listened to music before and during the IUD insertion procedure, whereas the control group received routine care only. Data were analyzed using SPSS version 26 with appropriate descriptive and inferential statistical methods. Women in the music group had significantly lower perceived pain (p < 0.001) and state anxiety levels during the procedure (p = 0.022), and significantly higher satisfaction levels compared with the control group (p < 0.001). In addition, post-procedure state anxiety levels were positively correlated with pain intensity experienced during and after the procedure (r = 0.542 and r = 0.496, respectively; p < 0.001), and negatively correlated with procedural satisfaction (r = -0.652; p < 0.001). These findings suggest that listening to music during IUD insertion may help reduce pain and anxiety while potentially enhancing patient satisfaction. Trial Registration: NCT06215183.
Caring for infants experiencing or at risk of substance withdrawal often increases nursing workload and may contribute to missed nursing care (MNC). This study examined the relationship between infants' substance withdrawal status and the occurrence of MNC in neonatal intensive care units (NICUs). We conducted a secondary analysis of data from a longitudinal observational study involving 249 nurses and 1477 infants across 10 U. S. NICUs between April 2021 and May 2023. Nurses completed shift-level surveys reporting infant conditions and MNC for assigned infants, including whether infants were actively experiencing or at risk of substance withdrawal. Missed nursing care was measured using a 16-item instrument, and a global indicator captured whether any care was missed. Nurse characteristics were collected at enrollment using a researcher-developed questionnaire, and infant demographic and clinical characteristics were obtained from the electronic health record. Cross-classified multilevel logistic regression models were used to account for the clustering of nurses and infants. Compared with infants not identified as at risk of or experiencing withdrawal, infants identified as at risk of or experiencing withdrawal had significantly higher odds of MNC in eight areas, including developmental care, hourly surveillance, airway tube position assessment, high-risk medication assessment, oxygen titration per protocol, communication during handoffs, pain assessment, and overall missed nursing care. These findings suggest that infants experiencing or at risk of substance withdrawal are particularly vulnerable to MNC, underscoring the importance of accounting for withdrawal risk in nursing workload and staffing decisions to support high-quality care in NICUs.
