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Trajectories and Co‐Occurrence of Perceived Control in Patients With Heart Failure and Self‐Efficacy in Their Caregivers: A Three‐Month Longitudinal Study of Dual Trajectories

ABSTRACT

Aim

This study aims to explore the trajectories and co-occurrence of perceived control and caregiver self-efficacy among patients with heart failure (HF) and their caregivers within 3 months post-discharge and identify associated risk factors.

Design

A prospective cohort design.

Methods

A prospective cohort study was conducted from March to June 2024 in Tianjin, China. Information on perceived control and caregiver self-efficacy was collected 24 h before discharge, 2 weeks, 1 month, and 3 months after discharge. Group-Based Dual Trajectory Modelling (GBDTM) and logistic regression were used for analysis.

Results

The study included 203 dyads of patients with HF and their caregivers (HF dyads). Perceived control identified three trajectories: low curve (15.3%), middle curve (57.1%) and high curve (27.6%). Caregiver self-efficacy demonstrated three trajectories: low curve (17.2%), middle curve (56.7%) and high stable (26.1%). GBDTM revealed nine co-occurrence patterns, with the highest proportion (36.7%) being ‘middle-curve group for perceived control and middle-curve group for caregiver self-efficacy’, and 16.7% being ‘high-curve group for perceived control and high-stable group for caregiver self-efficacy’. Age, gender, household income, NYHA class, symptom burden and psychological resilience were identified as risk factors for perceived control trajectories; marital status, regular exercise and psychological resilience were identified as risk factors for caregiver self-efficacy trajectories.

Conclusion

We identified distinct trajectories, co-occurrence patterns and risk factors of perceived control and caregiver self-efficacy among HF dyads. These findings help clinical nurses to better design and implement interventions, strengthening the comprehensive management and care outcomes for HF dyads.

Impact

These findings highlighted the interactive relationship between perceived control and caregiver self-efficacy trajectories, suggesting that interventions should boost both to improve personalised treatment plans and outcomes for HF dyads.

Reporting Method

This study adhered to the STROBE checklist.

Patient or Public Contribution

Patients and their caregivers contributed by participating in the study and completing the questionnaire.

Family Resilience and Quality of Life Among Chinese Patients With Acute Leukaemia: A Moderated Mediation Model of Cognitive Appraisal and Coping Style

ABSTRACT

Aims and Objectives

To identify whether cognitive appraisal and coping style have moderating and mediating effects on the relationship between family resilience and quality of life (QoL) in patients with acute leukaemia (AL).

Background

AL is a clonal and aggressive haematological malignancy that requires long-term and continuous therapy, which may negatively influence QoL. Family resilience can be used as a psychosocial resource that may enhance patients' coping processes and QoL.

Design

This cross-sectional descriptive study was conducted among hospitalised patients with AL from June 2022 to June 2023.

Methods

A cross-sectional study was performed following the STROBE Statement. Convenience sampling was used in the present study, and 286 patients were recruited from five tertiary Grade A hospitals in Xi'an, China. The questionnaires included the Functional Assessment of Cancer Therapy-Leukemia (FACT-Leu), the Cognitive Appraisal of Health Scale (CAHS), the Trait Coping Style Questionnaire (TCSQ) and the Family Hardiness Index (FHI). We used SPSS 26.0 and Hayes' PROCESS macro for data analyses and path coefficients.

Results

The QoL of patients with AL was significantly positively correlated with family resilience and positive coping, and negatively correlated with cognitive appraisal. Cognitive appraisal partially mediated the relationship between family resilience and QoL. Positive coping moderated the relationships between family resilience and cognitive appraisal, and between cognitive appraisal and QoL.

Conclusions

The results revealed that the association between family resilience and QoL was partially mediated by cognitive appraisal and that positive coping moderated this relationship. These findings are meaningful for early interventions that reduce the risk of psychosocial distress and improve QoL in this population.

Relevance to Clinical Practice

Nurses should focus on the cognitive appraisal and coping style of AL patients and provide family support and respect to improve their QoL.

Patient or Public Contribution

This cross-sectional descriptive study was conducted on patients with AL undergoing clinical chemotherapy in Chinese medical facilities.

Framework for Nursing Quality Assessment in Tracheotomy Dysphagia Following Craniocerebral Trauma Using the Structure‐Process‐Outcome Model

ABSTRACT

Aim

This study aimed to establish a comprehensive set of nursing-sensitive quality indicators (NSQIs) for patients with dysphagia following tracheotomy due to acquired brain injury (ABI), based on the ‘structure-process-outcome’ model.

Design

A Delphi survey.

Methods

The research utilised a mixed-methods approach, including systematic literature reviews, qualitative interviews and two rounds of Delphi expert consultations. A diverse team comprising specialists in dysphagia rehabilitation and nursing management conducted the research, which involved defining and refining NSQIs through extensive evaluations and consensus among recruited experts.

Results

The finalised NSQI includes 4 structural indicators, 13 process indicators and 4 outcome indicators, covering key aspects such as resource allocation, patient assessment and clinical outcomes. The expert consensus provides verification. Kendall's harmony coefficients are 0.304 and 0.138 (p < 0.001), respectively, and the mean importance assignments of indicators at all levels are 3.90–5.00. The final care of patients with tracheotomy and dysphagia after brain injury was constructed. The evaluation indicators include a total of 4 first-level indicators, 23 second-level indicators and 52 third-level indicators.

Conclusion

The established NSQIs offer a systematic framework to enhance the quality of nursing care for ABI patients with posttracheotomy dysphagia. This model facilitates precise monitoring and proactive management of nursing practices, promising better patient outcomes and streamlined care processes.

Implication for the Profession and Patient Care

This study develops targeted NSQIs to improve dysphagia management in ABI patients’ posttracheotomy, fostering better patient outcomes and advancing nursing education through essential specialised training.

Patient or Public Contribution

Expert-driven insights from experienced clinicians informed the NSQIs, ensuring their relevance and effectiveness in enhancing patient-centred care.

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