Impact of Different Illness Perceptions and Emotions Associated with Chronic Back Pain on Anxiety and Depression in Patients Qualified for Surgery

BackgroundAnxiety and depression are known comorbidities of chronic back pain. Their psychological predictors are not well established in patients with chronic back pain qualified for neurosurgery.AimsThe purpose of this study was to determine the psychological predictors of depression and anxiety in patients with chronic back pain qualified for surgery.DesignThis was a cross-sectional study.SettingsA neurosurgical ward in Gdańsk, Poland.Participants/SubjectsAll patients who were admitted to the neurosurgical ward and met the inclusion criteria were recruited for the study. Finally, 83 patients with chronic back pain waiting for surgery were recruited.MethodsA battery of questionnaires, including Illness Perceptions Questionnaire–Revised, Multidimensional Health Locus of Control Scale, Hospital Anxiety and Depression Scale, and Brief Pain Inventory, was used in 83 spinal surgery candidates.ResultsHigher anxiety was predicted by stronger beliefs about negative consequences of illness (β = .205, p < .05), worse illness coherence (β = .204, p < .05), negative emotional representations of illness (β = .216, p < .05), and depression (β = .686, p < .001). Higher depression was predicted by anxiety (β = .601, p < .001), pain interference (β = .323, p < .01), lower personal control over pain (β = −.160, p < .05), and lower external control of health (β = −.161, p < .05) but, surprisingly, higher internal control of health (β = .208, p < .01).ConclusionsAnxiety and depression commonly coexist in chronic back pain sufferers qualified for spine surgery but are derived from dissimilar beliefs. The results highlight the usefulness of advising about the disease and treatment in comprehensive care for this group of patients.     

Tailored educational supportive care programme on sleep quality and psychological distress in patients with heart failure: A randomised controlled trial

BackgroundUp to 74% of patients with heart failure report poor sleep in Taiwan. Poor symptom management or sleep hygiene may affect patients’ sleep quality. An effective educational programme was important to improve patients’ sleep quality and psychological distress. However, research related to sleep disturbance in patients with heart failure is limited in Taiwan.ObjectivesTo examine the effects of a tailored educational supportive care programme on sleep disturbance and psychological distress in patients with heart failure.Designrandomised controlled trial.Participants and settingEighty-four patients with heart failure were recruited from an outpatient department of a medical centre in Taipei, Taiwan. Patients were randomly assigned to the intervention group (n = 43) or the control group (n = 41).MethodsPatients in the intervention group received a 12-week tailored educational supportive care programme including individualised education on sleep hygiene, self-care, emotional support through a monthly nursing visit at home, and telephone follow-up counselling every 2 weeks. The control group received routine nursing care. Data were collected at baseline, the 4th, 8th, and 12th weeks after patients’ enrollment. Outcome measures included sleep quality, daytime sleepiness, anxiety, and depression.ResultsThe intervention group exhibited significant improvement in the level of sleep quality and daytime sleepiness after 12 weeks of the supportive nursing care programme, whereas the control group exhibited no significant differences. Anxiety and depression scores were increased significantly in the control group at the 12th week (p < .001). However, anxiety and depression scores in the intervention group remained unchanged after 12 weeks of the supportive nursing care programme (p > .05). Compared with the control group, the intervention group had significantly greater improvement in sleep quality (β = −2.22, p < .001), daytime sleepiness (β = −4.23, p < .001), anxiety (β = −1.94, p < .001), and depression (β = −3.05, p < .001) after 12 weeks of the intervention.ConclusionThis study confirmed that a supportive nursing care programme could effectively improve sleep quality and psychological distress in patients with heart failure. We suggested that this supportive nursing care programme should be applied to clinical practice in cardiovascular nursing.     

Quality of care in Hunan Province nursing homes: relationship to staffing and organizational climate

Our objective was to examine the quality of care perceived by nursing staff and its relationship with the staffing and organizational climate in nursing homes. The participants in this cross-sectional study included 358 nursing staff from 26 nursing homes in Hunan Province, China. This study found that the interaction effect between nursing staff to resident ratio and physician to resident ratio exerted a significant effect on quality of care (p < 0.05). Higher scores on the relationships and communication scale (OR = 4.771, p = 0.002) and lower scores on the work stress scale (OR = 0.980, p = 0.050) were also associated with better quality of care. More work experience was related to lower quality of care (OR = 0.944, p = 0.048), and work experience was associated with relationships and communication (Beta = 0.172, p = 0.002) and work stress (Beta= = 0.259, p = 0.000). Staffing level, work experience, work stress, relationships and communication are key factors in providing higher quality of care in nursing homes.     

The impact of professional identity on role stress in nursing students: A cross-sectional study

BackgroundAs newcomers to the clinical workplace, nursing students will encounter a high degree of role stress, which is an important predictor of burnout and engagement. Professional identity is theorised to be a key factor in providing high-quality care to improve patient outcomes and is thought to mediate the negative effects of a high-stress workplace and improve clinical performance and job retention.ObjectivesTo investigate the level of nursing students' professional identity and role stress at the end of the first sub-internship, and to explore the impact of the nursing students' professional identity and other characteristics on role stress.DesignA cross-sectional study.SettingsThree nursing schools in China.ParticipantsNursing students after a 6-month sub-internship in a general hospital (n = 474).MethodsThe Role Stress Scale (score range: 12–60) and the Professional Identity Questionnaire for Nursing students (score range: 17–85) were used to investigate the levels of nursing students' role stress and professional identity. Higher scores indicated higher levels of role stress and professional identity. Basic demographic information about the nursing students was collected. The Pearson correlation, point-biserial correlation and multiple linear regression analysis were used to analyse the data.ResultsThe mean total scores of the Role Stress Scale and Professional Identity Questionnaire for Nursing Students were 34.04 (SD = 6.57) and 57.63 (SD = 9.63), respectively. In the bivariate analyses, the following independent variables were found to be significantly associated with the total score of the Role Stress Scale: the total score of the Professional Identity Questionnaire for Nursing Students (r = −0.295, p < 0.01), age (r = 0.145, p < 0.01), whether student was an only child or not (r = −0.114, p < 0.05), education level (r = 0.295, p < 0.01) and whether student had experience in community organisations or not (r = 0.151, p < 0.01). In the multiple linear regression analysis, the total score of the Professional Identity Questionnaire for Nursing Students (standardised coefficient Beta: −0.260, p < 0.001), education level (standardised coefficient Beta: 0.212, p < 0.001) and whether or not student had experience in community organisations (standardised coefficient Beta: 0.107, p < 0.016) were the factors significantly associated with the total score of the Role Stress Scale. The multiple linear regression model explained 18.2% (adjusted R² scores 16.5%) of the Role Stress Scale scores variance.ConclusionsThe nursing students’ level of role stress at the end of the first sub-internship was high. The students with higher professional identity values had lower role stress levels. Compared with other personal characteristics, professional identity and education level had the strongest impact on the nursing students’ level of role stress. This is a new perspective that shows that developing and improving professional identity may prove helpful for nursing students in managing role stress.     

Association between COVID-19-related stress and self-directed learning ability among Korean nursing students

PurposeTraditional face-to-face classes for nursing students due to the COVID (Coronavirus Disease)-19 pandemic around the world made it inevitable to operate education delivery method using remote/hybrid fashion. This study was aimed to validate the Korean version of the Student Stress Inventory-Stress Manifestations (SSI-SM) and assess the association between COVID-19 pandemic related stress level and self-directed learning ability competence in nursing students.DesignThis research was a cross-sectional study design.MethodsThe study was conducted from December 2020 to January 2021, with a convenience sample of 172 nursing students in the 3rd and 4th grades in South Korea. The Korean version of SSI-SM(K-SSI-SM) was translated and adapted according to standard guideline, and tested construct validity and reliability. In addition, a multiple linear regression analysis was used to examine the associations between the COVID-19 related stress level and the self-directed learning ability.ResultsAn exploratory analysis showed that K-SSI-SM composed of 13-item in three factors (uncertainty, non-sociability, and somatization) accounted for 68.73% of the total variance after it was modified. The internal consistency was good with 0.91. Multiple linear regression analysis revealed that higher self-directed learning ability was associated with lower stress levels (β = −0.19, p = 0.008), positive toward online learning (β = 0.41, p = 0.003) and scored higher in theory (β = 0.30, p < 0.001) in nursing students.ConclusionThe K-SSI-SM is an acceptable instrument for assessing stress levels in Korean nursing students. And nursing faculties need to pay attention to related factors of self-directed learning ability, in order to achieve the course's self-directed learning goal in students attending online classes.     

Trajectory of growth in Taiwanese nursing students' professional self-concept over two years and its association with critical thinking and class climate

BackgroundNursing is a practice-oriented profession, and the goal of education is to cultivate confidence and assertiveness for future clinical practice. Nurturing a professional self-concept at school is expecting to help students to approach their success in the nursing profession.PurposeUsing a hierarchical model associated with critical thinking, academic achievement, class climate, and work experience, this longitudinal correlational study explored the growth trajectory of professional self-concept over two years in students attending 2- or 4-year baccalaureate nursing programs.MethodThis was a longitudinal and correlational study with five repeated measurements. Questionnaire data were collected by using the Chinese version of the Nurses Self-Concept Instrument (NSCI-C) and the California Critical Thinking Disposition Inventory (CCTDI).ResultsScores for overall professional self-concept ranged from 84.51 (standard deviation [SD] 12.34) when the students began this study to 89.28 (SD 11.23) at graduation. Hierarchical linear modeling yielded the growth trajectory of professional self-concept was significantly associated with time (β = 0.93, p < .01), CCTIDI (β = 0.13, p < .001), and class climate (β = 5.20, p < .01). An intraclass correlation coefficient was 55.48%.ConclusionThis study confirmed the positive growth trajectory of the professional self-concept in the nursing students' two academic years. The continuous development of the professional self-concept of nursing students is encouraged. Development of critical thinking through their studies, feelings of belonging in their classes, and campus culture all contributed to this trend. To construct a comprehensive hierarchical model, future investigations should use large sample sizes from various classes and conduct multisite evaluations.     

An integrated model for the effects of self-reflection and clinical experiential learning on clinical nursing performance in nursing students: A longitudinal study

BackgroundThe use of clinical simulation in undergraduate nursing programs in Taiwan has gradually increased over the past 5 years. Previous research has shown that students' experience of anxiety during simulated laboratory sessions influences their self-reflection and learning effectiveness. Thus, further study that tracks what influences students' clinical performance in actual clinical sites is vital.ObjectiveThe aim of the study is to develop an integrated model that considers the associations among anxiety, self-reflection, and learning effectiveness and to understand how this model applies to student nurses' clinical performance while on clinical placement.DesignThis study used a correlational and longitudinal study design.MethodsThe 80 nursing students, who ranged in age from 19 to 21 (mean = 20.38, SD = 0.56), were recruited from a nursing school in southern Taiwan. Data were collected during three phases of implementation using four questionnaires. During the first phase, the State-Trait Anxiety Inventory (STAI), Simulation Learning Effectiveness Scale (SLES), and Self-Reflection and Insight Scale (SRIS) were used after students completed the simulation course in the school simulation laboratory. Nursing students also completed the Holistic Nursing Competence Scale at 2 months (Phase 2) and 4 months (Phase 3) after clinical practice experience. In Phase 3, students again completed the STAI and SRIS. Partial least squares (PLS), a structural equation modeling (SEM) procedure, was used to test the research model.ResultsThe findings showed that: (1) at the start of the simulation laboratory, anxiety had a significant negative effect on students' simulation learning effectiveness (SLE; β = − 0.14, p < 0.05) and on self-reflection with insight (SRI; β = − 0.52, p < 0.01). Self-reflection also had a significant positive effect on simulation learning effectiveness (β = 0.37, p < 0.01). Anxiety had a significant negative effect on students' nursing competence during the first 2 months of practice in a clinical nursing site (β = − 0.20, p < 0.01). Simulation learning effectiveness and self-reflection and insight also had a significant positive effect on nursing competence during the first 2 months of practice in a clinical site (β = 0.13; β = 0.16, p < 0.05), respectively; and (2) when students practice in a clinical setting, their previous experience of nursing competence during the first 2 months of clinical care and their self-reflection and insight have a significant positive effect on their 4-month nursing competence (β = 0.58; β = 0.27, p < 0.01). Anxiety, however, had a negative effect on 4-month nursing competence but not significantly. Overall, 41% of the variance in clinical nursing performance was accounted for by the variables in the integrated model.ConclusionThis study highlights that self-reflection with insight and clinical experience may help students to deflect anxiety that may influence the development of clinical competence. Of note is that real-life clinical experience has a stronger effect on enhancing clinical performance than does a simulation experience.     

Factors influencing preventive behavior against Middle East Respiratory Syndrome-Coronavirus among nursing students in South Korea

BackgroundMiddle East Respiratory Syndrome Coronavirus (MERS-CoV), an emerging infectious disease introduced in South Korea in 2015, spreads quickly through hospitals, and Korea became one of the major areas affected by the disease after the Middle East region. To stop the spread of an emerging disease, it is important to practice prevention guidelines correctly.ObjectivesThe purpose of this study was to investigate factors influencing preventive behavior against MERS-CoV among Korean nursing students.MethodsThis is a cross-sectional study using a questionnaire survey. Data were collected from 429 nursing students from three colleges of nursing in Korea from June 25 to July 3 in 2015.ResultsPreventive behavior against MERS-CoV was affected mostly by attitude (β = .243, p < .001). Such behavior was also high in relation to the variables of perceived risk (β = .232, p < .001), older students (β = .202, p < .001), knowledge level (β = .153, p < .01), and female respondents (β = .115, p < .05).ConclusionPreventive behavior against emerging infectious diseases such as MERS-CoV was found to be affected most significantly by attitude and risk perception. It is crucial to provide nursing students with information or knowledge, but it is also important to help those in nursing education recognize that active preventive behavior can prevent this infectious disease and stop its spread.     

Does a Photo Diary Decrease Stress and Anxiety in Children Undergoing Magnetic Resonance Imaging? A Randomized,Controlled Study

Using a randomized trial methodology with two groups, we surveyed 52 school-aged children and their parents to determine if photo-diary education pre-magnetic resonance imaging (MRI) scan decreased prescan stress and anxiety in children. We also examined anxiety and satisfaction with pre-MRI scan education in parents. At baseline, there were no differences in stress and anxiety total or subscale scores by group; total score p = .84 and .46, respectively. Posteducation, there were no differences in total stress or anxiety scores by group (p = .88 and .16, respectively); however, education group children had higher general anxiety (p = .04), that was reflected in greater likelihood to “worry about things,” p = .01. In parents in the education group, there was a trend for perceptions of greater satisfaction with education, less anxiety in their child, and more questions asked by their child (all p = .18); however, parent anxiety was similar between groups. We discuss results, especially the increase in anxiety and provide implications for nursing related to future research and clinical practice.     

Impact of the coronavirus disease 2019 pandemic on critical care healthcare workers' depression,anxiety, and stress levels

AimThe aim of the study was to determine levels of depression, anxiety, and stress symptoms and factors associated with psychological burden amongst critical care healthcare workers in the early stages of the coronavirus disease 2019 pandemic.MethodsAn anonymous Web-based survey distributed in April 2020. All healthcare workers employed in a critical care setting were eligible to participate. Invitations to the survey were distributed through Australian and New Zealand critical care societies and social media platforms. The primary outcome was the proportion of healthcare workers who reported moderate to extremely severe scores on the Depression, Anxiety, and Stress Scale-21 (DASS-21).ResultsOf the 3770 complete responses, 3039 (80.6%) were from Australia. A total of 2871 respondents (76.2%) were women; the median age was 41 years. Nurses made up 2269 (60.2%) of respondents, with most (2029 [53.8%]) working in intensive care units. Overall, 813 (21.6%) respondents reported moderate to extremely severe depression, 1078 (28.6%) reported moderate to extremely severe anxiety, and 1057 (28.0%) reported moderate to extremely severe stress scores. Mean ± standard deviation values of DASS-21 depression, anxiety, and stress scores amongst woman vs men was as follows: 8.0 ± 8.2 vs 7.1 ± 8.2 (p = 0.003), 7.2 ± 7.5 vs 5.0 ± 6.7 (p < 0.001), and 14.4 ± 9.6 vs 12.5 ± 9.4 (p < 0.001), respectively. After adjusting for significant confounders, clinical concerns associated with higher DASS-21 scores included not being clinically prepared (β = 4.2, p < 0.001), an inadequate workforce (β = 2.4, p = 0.001), having to triage patients owing to lack of beds and/or equipment (β = 2.6, p = 0.001), virus transmission to friends and family (β = 2.1, p = 0.009), contracting coronavirus disease 2019 (β = 2.8, p = 0.011), being responsible for other staff members (β = 3.1, p < 0.001), and being asked to work in an area that was not in the respondents' expertise (β = 5.7, p < 0.001).ConclusionIn this survey of critical care healthcare workers, between 22 and 29% of respondents reported moderate to extremely severe depression, anxiety, and stress symptoms, with women reporting higher scores than men. Although female gender appears to play a role, modifiable factors also contribute to psychological burden and should be studied further.     

Mindfulness for stress and anxiety management in nursing students in a clinical simulation: A quasi-experimental study

AimTo determine the efficacy of an online mindfulness intervention in reducing anxiety and stress levels in nursing students during clinical simulations.BackgroundClinical simulation as a learning strategy has many benefits but the high levels of stress and anxiety it produces in participants can compromise learning, motivation or performance.DesignA quasi-experimental study with a non-equivalent control group design is presented. Forty-two undergraduate nursing students from a natural group were divided into: an experimental group (n = 21) and a control group (n = 21).MethodsBefore conducting a clinical simulation, the experimental group followed a 10-day intensive online mindfulness intervention. All students received the same information and training. Instruments used were: Self-administered Analogue Stress Scale, State-Trait Anxiety Inventory and Five Facet Mindfulness Questionnaire. In addition, physiological data (blood pressure and heart rate) were collected at baseline, pre-briefing and debriefing.ResultsPhysiological variables increased in the prebriefing phase but remained statistically significantly lower in the experimental group (diastolic blood pressure p = .032 and heart rate p = .048). Levels of stress (p = .029) and anxiety (p = .016) were also managed better. Both groups in the debriefing session showed a statistically significant decrease in the different physiological variables, stress and anxiety. No changes in mindfulness were observed.ConclusionsThe clinical simulation is indicated to generate stress and anxiety in nursing students. Therefore, measures must be adopted to control it. The intensive online mindfulness intervention proposed in this study reduced physiological parameters, stress and anxiety in the clinical simulation.     

The effect of laughter yoga applied before simulation training on state anxiety,perceived stress levels,self-confidence and satisfaction in undergraduate nursing students: A pragmatic randomized controlled trial

AimThis study aimed to examine the effect of laughter yoga applied before simulation training on state anxiety, perceived stress levels, self-confidence and satisfaction in undergraduate nursing students.BackgroundClinical simulation-based teaching implied a revolution in nursing education. Along with the many opportunities that simulation offers, some disadvantages, such as anxiety and stress experienced during simulation scenarios, could affect students’ satisfaction and self-confidence in learning. Therefore, laughter yoga could be an alternative method that reduces students' anxiety and stress levels and increases their self-confidence and satisfaction with simulation training.DesignThe study was designed as a pragmatic randomized controlled trial.SettingThis study was conducted at a university in Turkey.ParticipantsA total of 88 undergraduate nursing students were randomized to the intervention group (n = 44) or control group (n = 44).MethodsThe intervention group participated in the laughter yoga sessions just before the clinical simulation scenario, while the control group only performed the simulation training. The researchers examined the effect of laughter yoga on state anxiety, perceived stress levels, self-confidence and satisfaction in learning before and after the intervention. Data were collected between January - February 2022.ResultsThis study showed that the mean scores of state anxiety, perceived stress, mean pulse rate and arterial pressure of the intervention group were significantly lower than those of the control group (p < 0.05). In addition, there was also a significant group*time interaction between the groups on state anxiety, perceived stress, pulse, respiratory and mean arterial pressure scores (p < 0.05). Moreover, the mean scores of student satisfaction and self-confidence in the learning of the intervention group were significantly higher than those of the control group (p < 0.05).ConclusionThe findings showed that laughter yoga helped nursing students reduce their state anxiety and perceived stress levels related to simulation training and improved their self-confidence and satisfaction with learning. Additionally, it enhanced the students' vital signs (including mean pulse rate and mean arterial pressure). These positive results are promising for using LY as an easy, safe and effective method to reduce undergraduate nursing students’ stress and anxiety levels and to improve their learning satisfaction and self-confidence levels in clinical skills training such as simulation training.     

Effects of unfolding case-based learning on academic achievement,critical thinking,and self-confidence in undergraduate nursing students learning health assessment skills

AimTo determine whether using unfolding case-based learning for undergraduate nursing students learning health assessment skills enhanced academic achievement, critical thinking and self-confidence, in comparison to traditional learning methods.BackgroundUnfolding case-based learning is an effective strategy for nursing students to narrow the gap between classroom learning and clinical practice. Little is known about whether unfolding case-based learning can be applied effectively in learning health assessment skills for undergraduate nursing students in China.MethodsA quasi-experimental design was used in this study. One hundred and fifteen undergraduate nursing students were recruited using convenience sampling from a medical university in southern China. They were assigned to an intervention group (n = 54) receiving unfolding case-based learning of health assessment skills, or a control group (n = 61) using traditional learning methods based on students’ choices. Learning outcomes were evaluated by students’ academic achievement, critical thinking and self-confidence. Data for critical thinking and self-confidence were collected before and after using the teaching strategies.ResultsThe academic achievements of undergraduate nursing students in the intervention group were better than those in the control group. The total average scores of critical thinking (272.51 vs. 266.47) and self-confidence (24.92 vs. 21.04) for nursing students in the intervention group were also higher than those in the control group after implementing teaching strategies. There were statistical differences in the theory test (P = 0.041), skill test (P = 0.013), critical thinking (P = 0.008) and self-confidence (P = 0.036) between the two groups. Additionally, the statistical significance of the scores for critical thinking (264.36 vs. 272.51, P < 0.001) and self-confidence (18.76 vs. 24.92, P < 0.001) before and after teaching strategies were also observed among participants in the intervention group, but not in the control group (P = 0.143, P = 0.738).ConclusionsUnfolding case-based learning may be effective and suitable for undergraduate nursing students learning health assessment skills. The findings of this study provide useful information to nursing teachers for the development of unfolding case-based learning when teaching other nursing skills to undergraduate nursing students.     

Effects of Relaxation-Focused Nursing Program in Women with Ovarian Cancer: A Randomized Controlled Trial

BackgroundSurgical treatment is a major cause of hospitalization in ovarian cancer. In this process, physical problems, such as pain and changes in respiratory functions, and psychological problems, such as anxiety and stress, may develop.AimThis study aims to investigate the effects of the Relaxation-Focused Nursing Program on pain, anxiety, lung volume, level of knowledge, and nursing care satisfaction in ovarian cancer surgery.MethodA randomized controlled trial in which participants were randomly assigned to either the experimental (preoperative relaxation exercises and education; n = 24) or control (usual nursing care; n =22) groups. The intervention consisted of practicing four sessions of relaxation exercises and education in the hospital for two days before surgery. Data were collected using the Trait and State Anxiety Inventory, Surgical Information Form, and Perioperative Assessment Form. The results were analyzed using the Friedman and Wilcoxon tests.ResultsThe findings showed significant reductions in pain (p = .045) and anxiety scores (p < .001). The level of knowledge means scores were higher in the experimental group, but there was no significant difference between mean scores of spirometer volume and care satisfaction.ConclusionsThe program was more effective than usual nursing care in preoperative anxiety, pain, and level of knowledge. Although there was no difference between the care satisfaction scores of the patients, the reasons for care satisfaction were different in the program. Developing and implementing care that combines stress reduction interventions and preoperative education can improve the preoperative outcomes of patients.