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The Munich Security Conference 2024 highlighted the complex connections between climate change and global security risks. Engaging students in fighting climate change is a stepping stone to achieving the Sustainable Development Goals.
To investigate the effect of a video-based climate change program on revitalising eco-cognizance, emotional response, and self-efficacy among nursing students in rural communities.
A randomised controlled trial research design was adopted.
A total of 140 nursing students completed a survey related to the Climate Change Perceptions, the Climate Change Anxiety Scale, and the Environmental Self-Efficacy Scale. The study group engaged in the video-based climate change program, while the comparison group received flyers related to climate change across the globe.
The intervention group significantly improved climate change perception and environmental self-efficacy compared to the control group, with large effect sizes. On the other hand, significantly lower levels of cognitive impairment due to climate change anxiety were recorded among the intervention group compared to the control group.
Our intervention improved nursing students' climate change literacy, pro-environmental attitudes, environmental self-efficacy, and anxiety. Future research may target a variety of university majors and use RCTs nested in a mixed-method design to capture the student experience with climate change before and after the RCT.
This study demonstrated that a comprehensive educational program significantly improved climate literacy, pro-environmental attitudes, and environmental self-efficacy among undergraduate nursing students while reducing climate anxiety. The findings of this study offer valuable insights for enhancing student nurses' ability to translate their scientific understanding into informed decision-making regarding issues like climate change.
Drastic natural disasters, including extreme temperatures, flooding, wildfires and snow and sandstorms, significantly affect populations, including nursing students. Early screening and management of climate change anxiety among university students is recommended as a buffer against upcoming mental health issues. Student counselling services are urged to consider the effect of climate change as a mental health parameter that significantly affects students' psychological and, consequently, academic life and progress. A video-based climate change program (VBCCP) is beneficial for equipping students with climate change literacy. The revitalization of the participant's overall eco-emotional response, pro-environmental behaviour and cognizance signalled the potential of VBCCP as a simulation teaching tool that might be integrated into nursing curriculums. Additionally, VBCCP is a cost-effective strategy that complies with International Nursing Association for Clinical Simulation and Learning (INACSL) requirements. The VBCCP can be delivered in the conventional classroom environment or through the digital platform without incurring additional costs and in alignment with the definition of simulation provided by the Agency for Healthcare Research and Quality.
No public or patient contributions.
RCT registration: NCT06223412, on 23rd January 2024
To develop the Preschool Children eHealth Cardiac Rehabilitation programme based on the Interaction Model of Client Health Behaviour, and to evaluate its effects on children after congenital heart surgery.
A parallel two-arm randomised controlled trial was conducted.
A total of 84 participants were recruited from July 2022 to June 2023 and randomly assigned to either the intervention group (n = 40) or control group (n = 44). The intervention group participated in a 3-month eHealth Cardiac Rehabilitation programme, while the control group received routine care. Outcomes were measured at baseline, 3 months post baseline (intervention endpoint), and 6 months post baseline. Eighty participants completed the study.
Compared to the intervention group, the control group demonstrated significantly worse outcomes at both 3 and 6 months, including a higher risk of heart failure, lower left ventricular ejection fraction scores, and shorter 6-min walk distance tests. The intervention group engaged in significantly more vigorous physical activity. Significant between group differences were also observed in parental knowledge, attitudes, behaviours and trust levels. Additionally, the proportion of parents experiencing anxiety decreased significantly more in the intervention group by 6 months post baseline.
This pioneering eHealth programme transforms home-based rehabilitation for preschool children with congenital heart disease, addressing a critical gap in accessible and long-term paediatric cardiac rehabilitation care.
The use of eHealth programmes is valuable for improving paediatric cardiac rehabilitation by empowering parents, enhancing care continuity, and reducing barriers to accessing specialised services in paediatric care, especially in areas with limited medical resources.
This study establishes the first validated eHealth framework for family-centred cardiac rehabilitation in preschool children following congenital heart surgery, addressing the critically low uptake of previously home-based rehabilitation. It also provides clinicians with a scalable solution for delivering care in underserved regions lacking access to specialised cardiac services.
This study adhered to the CONSORT checklist guidelines for reporting randomised controlled trials.
This study did not include patient or public involvement in its design, conduct, or reporting.
This study was a randomised controlled clinical trial. The research protocol was registered with the China Clinical Trial Registration Center (registration number: ChiCTR2200062022; https://www.chictr.org.cn/showproj.html?proj=174261).
To investigate the association between the New Early Warning Score (NEWS) and 28-day mortality in patients with severe fever with thrombocytopenia syndrome (SFTS).
A cross-sectional derivation and validation study.
A total of 382 SFTS patients were included in retrospective and prospective studies. The primary outcome was short-term (28-day) mortality. Cox regression, receiver operating characteristic (ROC), and Kaplan–Meier analysis were utilised in the retrospective study to assess the association between NEWS and mortality. The prospective study assessed the applicability of the NEWS.
This study was reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines.
Among 219 SFTS patients in the retrospective study, 27 (12.3%) died within 28 days. NEWS was significantly higher in non-survivors than in survivors (4.00 [1.00, 5.00] vs. 1.00 [1.00, 2.00]). The ROC curve for MEWS predicting 28-day mortality showed an area under the curve (AUC) of 0.757 (95% confidence interval: 0.65–0.87), with a cut-off of 3.5 (sensitivity: 90.6%; specificity: 55.6%). SFTS patients were stratified into low (NEWS < 4), medium (NEWS 4–6), and high (NEWS > 6) risk groups. Kaplan–Meier analysis showed significantly lower survival rates in medium and high risk groups compared to the low risk group. The prospective study included 63 SFTS patients, of whom 11 (17.5%) died. 28-day mortality significantly increased across NEWS categories: [low risk (4/50, 8.0%), medium risk (4/8, 50.0%), high risk (3/5, 60.0%)].
NEWS was a quicker, simpler, and valuable parameter to identify SFTS patients at risk of 28-day mortality.
An elevated NEWS at admission is associated with a higher risk of poor short-term prognosis in SFTS patients. Incorporating NEWS into emergency nursing practice may aid in the early identification of SFTS patients at risk of adverse prognosis.
Emergency nurses performed the NEWS for the SFTS patients at admission.
The objective of this study was to investigate the risk factors for post-operative hypothermia in adult patients and to develop a prediction model.
Post-operative hypothermia is one of the most common complications and thus increases the degree of clinical and nursing risk. The previous studies mainly focused on intraoperative or post-operative hypothermia with limited data.
Cohort study.
A total of 99,644 records including anaesthesia and post-anesthesia care files were retrieved from October 1, 2021 to February 10, 2023, including 89,663 files in the training group and 9981 files in the validation group. The primary outcome was the incidence of post-operative hypothermia in the post-anesthesia care unit. Multivariate logistic regression was used to identify risk factors for post-operative hypothermia. A logistic regression nomogram was subsequently created to predict the probability of post-operative hypothermia during the post-anesthesia care unit stay.
The independent risk factors for post-operative hypothermia included male sex, age, low body mass index, anaesthesia duration, chest surgery and urological surgery. A nomogram was established to predict the probability of post-operative hypothermia during the post-anesthesia care unit stay. In the model, the areas under the receiver operating characteristic curve values in the training and validation groups were 0.86 and 0.87, respectively. The Brier scores in the training and validation groups were 3.46% and 3.34%, respectively.
In this study, the incidence of post-operative hypothermia was 3.6%. The following variables are independently associated with post-operative hypothermia: age, male sex, BMI, duration of anaesthesia, surgical type and anaesthesia type. A novel prediction model is feasible for predicting the probability of post-operative hypothermia during the post-anaesthesia care unit stay.
TRIPOD + AI checklist.
Nurses can utilise the predictive model to assess the risk of post-operative hypothermia, offering valuable guidance for implementing preventive measures.
No patient or public contribution.
To evaluate the quality of care from the patients' perspective after receiving either person-centred, nurse-led follow-up or standard care after surgical treatment of intermittent claudication.
Secondary analysis of a randomised controlled trial.
Patients at two centres for vascular surgery in Stockholm, Sweden were randomised to either a person-centred, nurse-led follow-up programme (intervention group) or a standard follow-up programme with surgeons. During their visits at 4 to 8 weeks and 1 year after surgery, they received the questionnaire Quality from patients' perspective with 28 items. The patients responded to each item from two aspects: (1) how they perceived the quality of received care and (2) subjective importance (how important the care was for them).
A total of 104 of 138 patients at 4–8 weeks and 159 of 193 patients at 1 year after surgery completed the questionnaire. At 4–8 weeks, the intervention group scored significantly higher perceived quality of care regarding five items: receiving useful information about “How I should take care of myself” and “Which nurse were responsible for my care”, “Nurses were respectful towards me”, “Nurses showed commitment/cared about me” and “Easy to get in contact with the clinic through telephone”. At 1 year, the intervention group scored higher regarding two items: “Which nurses were responsible for my care” and “Next of kin treated well”.
Person-centred, nurse-led follow-up as implemented in this study has been shown to lead to a higher perception of quality of care regarding information about self-care, the experience of being respected, and knowing the care provider responsible for their care. Thus, it could contribute towards improved patient satisfaction without compromising the perception of quality of care regarding other factors such as receiving the best medical care or timeliness.
This study addresses how patients with intermittent claudication, who underwent revascularisation, perceive a follow-up care that is person-centred and nurse-led compared to standard care delivered by surgeons. The results indicate that patients find the person-centred and nurse-led follow-up programme satisfactory, with equal or higher quality of care and that follow-up can be delivered by nurses with retained patient safety. Thus, vascular units may consider transitioning follow-up care from surgeons to nurses while maintaining positive patient's perception of quality of care, patient satisfaction and safety.
Reporting of the work was made using the Consolidated Standards of Reporting Trials (CONSORT) statement.
No patient or public contribution.
Study Details | Person-centred Follow-up and Health Promotion Programme After Revascularization for Intermittent Claudication | ClinicalTrials.gov: NCT03283358
The study aims to determine the relationship between e-health literacy level and the care behaviour of neonatal nurses.
E-health literacy is becoming increasingly important, as health-related information can be obtained easily and quickly from electronic sources.
The study is a cross-sectional study.
The sample of the study consists of 384 neonatal nurses working in different hospitals in Türkiye. An introductory form, the E-Health Literacy Scale (eHEALS), and the Care Behaviours Inventory-24 (CBI-24) were used for data collection. The data collection forms were created using Google Forms.
eHEALS 4.32 ± 0.551, CBI-24 5.58 ± 0.567, CBS-24 sub-dimension: Assurance 5.58 ± 0.591, CBS-24 sub-dimension: Knowledge-Skills 5.64 ± 0.561, CBI-24 sub-dimension: Respect 5.56 ± 0.565, CBI-24 sub-dimension: Connectedness 5.52 ± 0.637 was found. It was determined that there was a very weak positive relationship between eHEALS, CBI-24 and sub-dimension scores (p < 0.001). A significant relationship was found between the eHEALS and the independent variables age, female, living in the Southeastern Anatolia region, working in a public hospital, using the internet for their profession, and CBI-24 sub-dimension: assurance (F = 6.111; p < 0.001).
The relationship between e-health literacy and care behaviours of neonatal nurses was examined. Neonatal nurses' was found eHEALS, CBI-24, and sub-dimension scores had a high and very weak positive relationship. A significant relationship was found between the eHEALS level and age, female, Southeastern Anatolia region, state hospital, using the internet for their profession, and assurance sub-dimension.
Study determines the eHEALS of neonatal nurses and provides information about this field. Interventions aimed at eHEALS should be developed and implemented at both the institutional and individual levels.
STROBE, No Patient or Public Contribution.
To investigate symptom clusters and sentinel symptoms in breast cancer survivors based on self-reported outcomes, explore the impact of sentinel symptoms on patients' quality of life and psychological distress, provide a basis for implementing accurate symptom management.
A cross-sectional survey.
The study was conducted from September 2021 to December 2022. We recruited 281 patients who were re-examined in an outpatient department of a tertiary hospital in Hebei Province. The European Organization for the Research and Treatment of Cancer (EORTC) Quality-of-Life Questionnaire - Core30 (QLQ-C30), the EORTC Quality-of-Life Questionnaire Breast Cancer - 23 (QLQ-BR23), the Hospital Anxiety and Depression Scale (HADS) were used to conduct the survey. Symptom clusters were explored using principal component analysis, sentinel symptoms were explored using the Apriori algorithm. Correlation analysis was used to explore the relationship between sentinel symptoms and quality of life, correlation with psychological distress. This paper adhered to the STROBE guidelines.
Breast cancer survivors have a wide range of self-reported symptoms in the form of four symptom clusters: a fatigue symptom cluster, a gastrointestinal symptom cluster, a sickness symptom cluster and a surgical trauma-related symptom cluster. Three sentinel symptoms were explored: pain, alopecia and limited function of the upper limbs. Except for sexual function, all of the sentinel symptoms were negatively correlated with patients' quality of life and positively correlated with psychological distress (p < .05).
Breast cancer survivors have a variety of symptoms in the form of four symptom clusters. Pain, alopecia and limited function of the upper limbs are the sentinel symptoms, which affect patients' quality of life and psychological distress.
To evaluate the effect of a novel, co-designed, digital AF educational program, ‘INFORM-AF’, to reduce re-hospitalisation of people with AF.
The secondary aims are to examine the effect of the intervention on: (a) reducing cardiovascular-related hospitalisation, (b) increasing medication adherence, AF-related knowledge, and Atrial fibrillation (AF)-related quality of life and (c) determining the cost-effectiveness of the intervention.
AF is an increasingly prevalent cardiac arrythmia that involves complex clinical management. Comprehensive education is essential for successful self-management of AF and is associated with positive health-related outcomes. There has been an increase in technology-based education for AF. However, its effects on hospitalisation, medication adherence and patient-reported outcomes are unclear.
A prospective, randomised (1:1), open-label, blinded-endpoint, multicentre clinical trial.
Eligible participants are aged 18 years or above, diagnosed with AF, and own a smartphone. The study will be conducted at two metropolitan hospitals. In the intervention group, participants will receive the AF educational program delivered via Qstream®. In the control group, participants will receive the Stroke Foundation ‘Living with AF’ booklet. The primary outcome is re-hospitalisation within 12 months from an indexed presentation or hospital admission.
This clinical trial is part of a developing program of work that will examine mHealth educational-behavioural interventions on cardiovascular outcomes. Findings from this pilot study will inform the development of a digital educational framework for patients living with AF.
There remain many gaps in providing high-quality patient education for patients with AF. This trial will test a new theory-driven, smartphone-based education program on important clinical outcomes, including rehospitalisation.
This study evaluates a novel, co-designed, digital AF educational program, ‘INFORM-AF’, to reduce the re-hospitalisation of people with AF. Study results are expected to be reported in 2025. Findings are expected to inform practice recommendations for AF patient education that may be included in future clinical practice guideline recommendations.
SPIRIT Checklist.
JL is a consumer co-researcher on the project and provided critical input into intervention design, and feedback and input across the study duration.
This study aims to propose a self-management clusters classification method to determine the self-management ability of elderly patients with mild cognitive impairment (MCI) associated with diabetes mellitus (DM).
MCI associated with DM is a common chronic disease in old adults. Self-management affects the disease progression of patients to a large extent. However, the comorbidity and patients' self-management ability are heterogeneous.
A cross-sectional study based on cluster analysis is designed in this paper.
The study included 235 participants. The diabetes self-management scale is used to evaluate the self-management ability of patients. SPSS 21.0 was used to analyse the data, including descriptive statistics, agglomerative hierarchical clustering with Ward's method before k-means clustering, k-means clustering analysis, analysis of variance and chi-square test.
Three clusters of self-management styles were classified as follows: Disease neglect type, life oriented type and medical dependence type. Among all participants, the percentages of the three clusters above are 9.78%, 32.77% and 57.45%, respectively. The difference between the six dimensions of each cluster is statistically significant.
This study classified three groups of self-management styles, and each group has its own self-management characteristics. The characteristics of the three clusters may help to provide personalized self-management strategies and delay the disease progression of MCI associated with DM patients.
Typological methods can be used to discover the characteristics of patient clusters and provide personalized care to improve the efficiency of patient self-management to delay the progress of the disease.
In our study, we invited patients and members of the public to participate in the research survey and conducted data collection.
The aim of this cross-sectional study was to determine the point prevalence and associated risk factors of medical device-related pressure injuries (MDRPI) in intensive care patients in Turkey.
MDRPI remain a clinical problem that has garnered the attention of healthcare professionals.
This study used a cross-sectional design and was conducted over a single day in all intensive care units.
Data were collected through face-to-face interviews, observation, skin examination and detailed diagnosis of MDRPI development and influencing factors. Presence of pressure injuries on the skin in the areas where the patient's medical device was placed was defined. The study was reported according to the STROBE declaration.
MDRPI developed in 65 out of 200 patients included in the study (32.5%). The most frequent locations were on the face (71%). The MDRPIs were commonly associated with nasogastric tube (29.2%), endotracheal tube (18.5%) and CPAP mask (15.4%). A significant proportion of these injuries were mucosal (53.8%, n = 35). The majority of the skin pressure injuries were classified as Stage II (18.5%, n = 12). The risk increased 14 times in patients who were hospitalised for 9–16 days and 13 times in those who received mechanical ventilator support.
The study findings suggest that MDRPI developed in approximately one of three patients hospitalised in the intensive care unit, and the length of hospital stay and mechanical ventilator support were important determining risk factors. The high prevalence of MDRPI may indicate inadequate nursing care quality. Therefore, it is recommended that nurses be aware of risk factors and evaluate the suitability and safety of medical devices.
No patient or public contribution was involved in this study.
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