Sequential Mediation Effects of Organizational Support and Collaboration on Missed Nursing Care.

BACKGROUND: It is necessary to find ways to mediate the relationship between role overload and missed nursing care in settings where nursing staffing is inadequate. This study aimed to identify the single and multiple sequential mediation effects of organizational support, nurse-physician collaboration, and nurse-nurse collaboration on the relationship between role overload and missed nursing care. METHODS: Data were collected from 237 registered Korean nurses working in general wards in October 2022. The measures used were the modified role overload scale, nurse-physician collaboration scale, nurse-nurse collaboration scale, a short version of the Perceived Organizational Support Scale, and the modified Missed Nursing Care Scale. Data were analyzed using PROCESS macro in SPSS. A hypothesis test was performed using Model 81, proposed by Hayes, which includes serial multiple mediators. RESULTS: Organizational support, nurse-physician collaboration, and nurse-nurse collaboration showed a mediation effect on missed nursing care. Organizational support, nurse-physician collaboration, and nurse-nurse collaboration showed significant multiple sequential mediation effects on the relationship between role overload and missed nursing care. When the indirect effect sizes of nurse-physician collaboration were compared with those of nurse-nurse collaboration in both single and multiple sequential mediation paths, the indirect effect of nurse-physician collaboration was greater than that of nurse-nurse collaboration on the relationship between role overload and missed nursing care. CONCLUSIONS: As an alternative strategy to reduce missed nursing care in situations with insufficient nursing staffing, organizational support should precede nurse-physician and nurse-nurse collaboration. In particular, improving nurse-physician collaboration shows promise in mitigating missed nursing care.

Development and Testing of the School Healthcare Partnership Scale for Parents.

BACKGROUND: Cooperation between parents and school nurses is essential for the successful completion of school courses and a healthy school life for children with long-term conditions. Therefore, this study aimed to develop and test a scale to measure parental perceptions of partnerships between school nurses and parents in the school health care (SHC) system for children with type 1 diabetes (T1D). METHODS: The content validity, factorial structure validity, convergent validity, discriminant validity, known-group validity, internal consistency reliability, and test-retest reliability of the School Healthcare Partnership Scale for Parents (SHCPS-P) were evaluated. Data were analyzed by performing exploratory factor analysis (EFA), Pearson's correlation, Cronbach's α, and independent t-tests. The total sample included 155 parents for the EFA and 49 parents for the stability test. Seventeen items, grouped into 3 dimensions, were extracted through principal axis factoring. RESULTS: The total variance explained by these factors was 53.57%. The scale demonstrated a high correlation with parental satisfaction regarding school nursing and a moderate correlation with diabetes-related safety, thereby showing convergent validity. A low correlation with empathy demonstrated discriminant validity. A significant difference existed in the partnership scores in known-group comparisons. Cronbach's α was 0.95, and the test-retest correlation coefficient was 0.95, which showed reliability. CONCLUSIONS: This study suggests that the SHCPS-P is a reliable and valid tool for measuring the perception of SHC partnership among parents of children with T1D and can be used as an indicator to measure parents' perspectives about SHC.

Effects of social support and self-efficacy on eHealth literacy in Korean women undergoing breast cancer treatment: A secondary analysis.

Objective: Patients with breast cancer need to seek out and understand relevant health information to make informed decisions about long-term and complicated illnesses. With the increased use of interventions using online health information, research on eHealth literacy should be expanded. However, existing studies on the factors affecting eHealth literacy in patients with breast cancer are currently lacking. This study, therefore, conducts a secondary analysis of a previous study that surveyed the quality of life of patients with breast cancer. The primary study found a significant correlation between eHealth literacy, social support, and self-efficacy. In this secondary analysis study, we specifically examine eHealth literacy among patients with breast cancer undergoing treatment, and how patient demographic characteristics, breast cancer-specific self-efficacy, and social support contribute to their eHealth literacy. Methods: A total of 143 women receiving outpatient treatment or were hospitalized for breast cancer at a cancer hospital in South Korea participated in the study from January to November 2022. The eHealth Literacy Scale (eHEALS), Multidimensional Social Support Scale, and Breast Cancer Survivors Scale were utilized in the analysis. The data were analyzed using a multiple regression analysis. Results: Full-time employment (ߠ​= â€‹0.19, P â€‹= â€‹0.006), a monthly family income of over 4 million won (3600 USD) (ߠ​= â€‹0.14, P â€‹= â€‹0.042), completing a high school education (ߠ​= â€‹0.52, P â€‹< â€‹0.001), completing college level or higher education (ߠ​= â€‹0.54, P â€‹< â€‹0.001), age (ߠ​= â€‹-0.23, P â€‹= â€‹0.003), and social support (ߠ​= â€‹0.21, P â€‹= â€‹0.002) were predictors of eHealth literacy, explaining 40.2% of the total variance (F â€‹= â€‹14.63, P â€‹< â€‹0.001). Conclusions: Social support was identified as a new factor influencing eHealth literacy among patients with breast cancer undergoing treatment. Therefore, nursing interventions to strengthen social support should be developed to improve eHealth literacy.

School Health Teachers as Partners in Diabetes Caring: Maternal Perspectives.

BACKGROUND: The absence of primary care providers' participation in school health care may require close collaboration between school health teachers and parents. This study explores maternal perspectives on obstacles and improvements in partnerships with school health teachers of children with type 1 diabetes. METHODS: Participants were recruited using purposive sampling through an online type 1 diabetes self-help group in South Korea. Twenty-two mothers whose children were aged between 7 and 13 and had been diagnosed with type 1 diabetes at least 1 year ago were included. Individual interviews were conducted based on a semi-structured interview guide from February to June 2019. Qualitative data were analyzed using inductive content analysis comprising open coding, coding sheets, grouping, categorization, and abstraction. RESULTS: Mothers recognized obstacles in eight categories and improvements in nine categories under institutional, interpersonal, and intrapersonal aspects of the partnership with school health teachers. Respondents recognized insufficient legal coverage and guidelines, and also health teacher shortage and workload as obstacles in the institutional dimension. Mothers perceived building trust, compromising to balance responsibilities, and constant and open communication as improvements in the interpersonal dimension. They recognized practical competency and tailored care for ordinary school life as school health teacher-related improvements. CONCLUSIONS: The findings indicate that school health teachers should compromise to balance responsibilities to improve partnerships with parents in the school health care setting. Institutional improvements, such as establishing robust laws and clear guidelines and increasing the number of school health teachers, should be prioritized.

Development and validation of the school healthcare partnership scale for school nurses.

PURPOSE: This study was conducted to develop the School Healthcare Partnership Scale for School Nurses (SHCPS-S) for children with type 1 diabetes and to validate its psychometric properties. METHODS: This was a methodological study. A total 342 school nurses in South Korea participated in the study; 171 were randomly assigned to each group for exploratory factor analysis and confirmatory factor analysis. Data was collected from December 2021 to February 2022 via online survey. The Family Nursing Practice Scale was used to evaluate criterion validity, and the school nurse's professionalism scale and empathy were used to verify concurrent validity. Content validity review, response tests, and factor analysis were conducted. RESULTS: A 50-items pool was created based on a hybrid concept analysis. Forty items were selected following the content validity review, using content validity index. A 20-item scale with four factors (trusting relationships, balanced responsibility, providing tailored care, and transparent and open communication) was chosen following exploratory factor analysis. Confirmatory factor analysis for the four factors showed an adequate model fit. The correlation coefficient with the family nursing practice and school nurse's professionalism scale were 0.642, 0.630, and 0.376. The Cronbach's α was 0.919, and the correlation coefficient was 0.768 in test-retest. CONCLUSIONS: The SHCPS-S is a valid and reliable scale to measure school nurses' perceived collaborative relationships with parents for children with type 1 diabetes. PRACTICAL IMPLICATIONS: This scale can be used as a tool in interventional studies to enhance school healthcare partnerships.

School Nurse-Parent Partnership in School Health Care for Children with Type 1 Diabetes: A Hybrid Method Concept Analysis.

PURPOSE: To define school nurse-parent partnerships in school health care for children with type 1 diabetes (T1D) and determine its attributes using a hybrid model. METHODS: This method involves a three-phase process: theoretical, fieldwork, and analytical. A literature review was conducted during the theoretical phase. A literature search of articles from January 1991 to February 2020 was conducted using relevant electronic databases. Eighty-three articles that met the inclusion criteria were completely read. Fieldwork data were collected through individual interviews from February to July 2019 in South Korea. In the fieldwork phase, interviews were conducted individually with 22 mothers of students with T1D and 20 school nurses recruited by purposeful sampling. Inductive content analysis was conducted. The findings from the theoretical phase were integrated with those from the fieldwork phase, and the final concept was derived. RESULTS: School nurse-parent partnership in school health care for children with T1D has been defined as an interactive process of maintaining a balanced responsibility and providing tailored care to meet needs by establishing trusting relationships and communicating transparently and openly. This analysis yielded four attributes: trusting relationships, transparent and open communication, balanced responsibility, and providing tailored care to meet needs-this entails providing nursing actions by advocating for students and performing a negotiated role together or individually for student and family. CONCLUSION: The findings of this study add to the importance of an attribute of balancing responsibility for partnership in school health care. The results show that this partnership could contribute to the development of a scale, theory, and nursing intervention in school health care for children with T1D.

Factorial Validity of the Pediatric Nurse Parent Partnership Scale-Pediatric Nurses (PNPPS-PN).

For the optimal growth and development of high-quality professional nursing care for hospitalized children, a partnership between pediatric nurses and parents within the context of the family is essential. The aim of the present study was to evaluate the factorial validity of the Pediatric Nurse Parent Partnership Scale for hospital pediatric nurses (PNPPS-PN) and to investigate the associations of its components with the Nursing Professional Value Scale and Compassion Competence Scale. This study used survey data from 236 pediatric nurses collected between March and June 2019. The seven-factor structure showed an acceptable to good fit in the confirmatory factor analysis, and the scale correlated as expected with measures of compassion competence and nursing professional values. The Cronbach's α for the scale was 0.89, indicating good internal consistency reliability. The PNPPS-PN is a psychometrically sound instrument for assessing pediatric nurse-reported partnerships between pediatric nurses and parents in hospital settings.

Impact of discriminant factors on the comfort-care of nurses caring for trans-arterial chemoembolisation patients.

PURPOSE: This study was conducted to identify the levels of comfort-care provided by trans-arterial chemoembolisation (TACE) nurses and examine the discriminant factors thereof. METHODS: Nurses (n = 146) with experience in caring for TACE patients, participated in this study. The data were collected using an online self-rated questionnaire and analysed with descriptive statistics and discriminant analysis. The discriminating factors included perception of post-embolisation syndrome and symptom interference, caring attitude, barriers to pain and nausea/vomiting management, and supportive care competence. RESULTS: The participants were classified into three groups, depending on the level of their comfort-care: "low" (n = 27), "moderate" (n = 88), and "high" (n = 31) comfort-care groups. One function significantly discriminated between the low and high comfort-care groups and correctly classified 79.3% of the participants in the cross-validation run. Supportive care competence (0.864), caring attitude (0.685), perception of symptom interference (0.395), perception of post-embolisation syndrome (0.321), and barriers to nausea/vomiting management (- 0.343) were significant discriminant factors of comfort-care. CONCLUSION: A low proportion of the participants provided high levels of comfort-care, which was determined by five discriminant factors. The study's findings imply that the development of supportive care competence, authentic human caring attitude, early detection of patients' symptoms and symptom interference, and the development of manuals and guidelines for removing barriers for nausea and vomiting are needed to improve the comfort-care of nurses caring for TACE patients.

Psychometric properties of the Korean version of ComOn coaching for oncology nurses.

Objective: The available tools to assess the communication skills of oncology nurses are limited, and the ComOn Coaching scale may be appropriate for this purpose. The aim of this study was to evaluate the psychometric properties of the Korean version of the ComOn Coaching scale from a patient-centered perspective. Methods: The participants were 296 oncology nurses and 42 nursing students. To assess construct, convergent, criterion, and known-group validities and the reliability of the ComOn Coaching scale, the Patient Care Communication Scale, the Korean version of the Watson Caritas Patient Score, and Cancer Survivor Integrated Supportive Care Competence were used. Exploratory and confirmatory factor analyses were conducted. Pearson correlation coefficients and Cronbach's alpha values were calculated. Differential item functions were analyzed. Results: Three factors were extracted from 12 items, and the cumulative variance was 58.8% of the total variance. The three extracted factors were based on the contents of the original scale: Factor 1, Structure of conversation; Factor 2, Building rapport; and Factor 3, Verbal communications skills. Confirmatory factor analysis verified the construct validity of the instrument [χ2/df â€‹= â€‹1.60, standardized root mean square residual (SRMR) â€‹= â€‹0.06, root mean square error of approximation (RMSEA) â€‹= â€‹0.06, goodness of fit index (GFI) â€‹= â€‹0.92, Turker Lewis Index (TLI) â€‹= â€‹0.93, and comparative fit index (CFI) â€‹= â€‹0.95]. Conclusions: The Korean ComOn Coaching scale may be a useful self-checking tool for the communication skills of oncology nurses. Repeated use of the Korean ComOn Coaching scale can provide practical information for developing a communication skills program for these professionals and testing its outcomes in the clinical setting.

Online social support and collective empowerment: Serial mediation effect on self-efficacy among mothers of children with type 1 diabetes.

AIM: To identify a serial multiple mediation effect of social support in online health communities and collective empowerment on the relationship between diabetes-related burden (DRB) and self-efficacy, among mothers using a continuous glucose monitoring device for children with type 1 diabetes (T1D). DESIGN: A secondary analysis, cross-sectional, descriptive study. METHODS: Data were obtained from 198 mothers of children with T1D via a web survey, from August to September 2020. Measures used were the Collective Empowerment in the Online Health Community Scale, a modified version of the Multidimensional Scale of Perceived Social Support, Problem Areas in Diabetes Survey-Parent Revised version and a modified version of the Maternal Self-efficacy for Diabetes Management Scale. Data were analysed using SPSS 25.0, and PROCESS MACRO for SPSS v3.5. RESULTS: A serial multiple mediation model was used. The indirect effects of both social support in online health communities and collective empowerment were identified in the relationship between DRB and diabetes self-efficacy (DSE). However, there was no indirect effect of social support in online health communities on these relationships. CONCLUSION: These findings suggest that online social support alone has a limited role in chronic disease management self-efficacy. Collective empowerment should be a strategic component in intervention development using online health communities to strengthen DSE in mothers of children with T1D. IMPACT: This study provides novel insights into the functional mechanism of online health communities for T1D. Peer mentor coaching by parents of children with T1D effectively helps other children's parents with its recent diagnosis. The findings recognize a need for strategies enhancing collective empowerment among parents of children with T1D. Along with peer coaching, these strategies should strengthen knowledge of resources and methods to impact social change as well as resource mobilization for collective actions.

Relationships between Nursing Students' Skill Mastery, Test Anxiety, Self-Efficacy, and Facial Expressions: A Preliminary Observational Study.

Test anxiety and self-efficacy significantly influence the mastery of nursing skills. Facial expression recognition tools are central components to recognising these elements. This study investigated the frequent facial expressions conveyed by nursing students and examined the relationships between nursing skill mastery, test anxiety, self-efficacy, and facial expressions in a test-taking situation. Thirty-three second-year nursing students who were attending a university in a Korean metropolitan city participated. Test anxiety, self-efficacy, and facial expressions were collected while the students inserted indwelling catheters. Using Microsoft Azure software, the researchers examined the students' facial expressions. Negative facial expressions, such as anger, disgust, sadness, and surprise, were more common during the test-taking situation than the practice trial. Fear was positively correlated with anxiety. None of the facial expressions had significant relationships with self-efficacy; however, disgust was positively associated with nursing skill mastery. The facial expressions during the practice and test-taking situations were similar; however, fear and disgust may have been indicators of test anxiety and skill mastery. To create a screening tool for detecting and caring for students' emotions, further studies should explore students' facial expressions that were not evaluated in this study.

Predicting Quality of Life among Mothers in an Online Health Community for Children with Type 1 Diabetes.

Quality of life of parents of children with chronic disease is important for disease self-management. This study aimed to identify predictors of quality of life among mothers of children with type 1 diabetes. A cross-sectional study was conducted. A total of 208 mothers of children with type 1 diabetes were recruited from an online health community. Online health community collective empowerment and social support, diabetes self-efficacy, diabetes-related burden, and quality of life were measured. A multiple regression analysis was conducted to determine predictive factors for quality of life. Multiple regression analysis showed that diabetes-related burden and the child's age were predictors of quality of life, and total variance explained by the model was 64.1% using two factors. In mothers of younger children, it is important to reduce the diabetes-related burden. Factors that increase the diabetes-related burden should be identified, and strategies to reduce the diabetes-related burden must be established.

Barriers to and Facilitators of School Health Care for Students with Chronic Disease as Perceived by Their Parents: A Mixed Systematic Review.

Understanding parental perspectives through mixed systematic reviews is imperative for developing effective school health care for children and adolescents with chronic disease. A mixed systematic review was conducted to explore barriers to and facilitators of school health care for students with chronic disease as perceived by their parents. Four databases (2010-2020) were searched, following which critical appraisals were conducted to determine the validity of the selected studies using the Mixed Method Appraisal Tool, version 2018. Twenty articles were synthesized using the convergent integrated approach from the Joanna Briggs Institute's mixed method systematic review methodology. We examined 20 articles regarding parents' perceived barriers and facilitators and found views across four levels: intrapersonal, interpersonal, institutional, and public and policy. Parents perceived more barriers than facilitators. Barriers on the institutional level were the most frequently reported of all levels of barriers. These results suggest that multi-level school health interventions could be a valuable resource to facilitate effective school guidelines and public policies for students with chronic diseases.

School nurses' perceptions regarding barriers and facilitators in caring for children with chronic diseases in school settings: A mixed studies review.

This study aimed to understand school nurses' perceptions regarding barriers to and facilitators for health care services for children with chronic diseases in school settings. Using the PubMed, Cumulative Index to Nursing and Allied Health Literature, Embase, and Web of Science databases, a mixed studies review was conducted for literature published between January 2011 and June 2020. We performed a mixed-methods systematic review using a convergent integrated approach. A quality appraisal of the included studies was conducted using a mixed-methods appraisal tool. Twenty-seven articles (10 qualitative, 10 quantitative, and seven mixed-methods) that met the inclusion criteria were analyzed. Integrated findings that emerged from data synthesis were categorized into four levels (intrapersonal level, interpersonal level, institutional level, and community and public policy level) based on a socio-ecological model framework. This mixed systematic review provides a comprehensive understanding of school nurses' perceived barriers and facilitators when providing school health care for students with chronic diseases and how these barriers and facilitators interact across multiple systems. Further policies and strategies should be developed to provide effective school health services considering this study's findings.

Low Body Mass Index for Early Screening of Adolescent Idiopathic Scoliosis: A Comparison Based on Standardized Body Mass Index Classifications.

PURPOSE: Scoliosis is a common musculoskeletal problem in adolescents. This study aimed to identify the prevalence of adolescent idiopathic scoliosis (AIS) and its associated factors among Korean adolescents. The prevalence of thin individuals among students with AIS was compared based on body mass index (BMI) classifications. METHODS: This study was a secondary data analysis and used the 2016 Korean National Health Examination for School Students data. Data from 16,412 students were analyzed using descriptive statistics, Chi-square tests, and logistic regression analysis. RESULTS: The prevalence of AIS was higher in women (3.8%) than in men (1.6%), and a higher school year was a risk factor for AIS in both sexes. In woman adolescents, scoliosis was associated with thinness; however, the risk of AIS was inversely associated with overweight/obesity in both sexes. The prevalence of thin woman students with scoliosis differed based on the criteria used: 3.3% by the World Health Organization criteria and 14.3% by the International Obesity Task Force criteria. CONCLUSION: The prevalence of thin students with scoliosis could increase by up to four times depending on the BMI criteria. For early screening of thin people at risk of AIS among female students, the criterion of International Obesity Task Force should be used as it is more permissive of thinness. This is also because of the underestimation of AIS prevalence when using the BMI Z score of the World Health Organization cutoff.

[Perceptions of School Health Care among School-aged Children and Adolescents with Chronic Disease: An Integrative Review]. / 만성질환을 가진 í•™ë ¹ê¸° 아동 ․ ì²­ì†Œë „ì˜ 학교 건강관리에 대한 인식: í†µí•©ì  ë¬¸í—Œê³ ì°°.

PURPOSE: The purpose of this integrative review was to synthesize previous research on perceptions of school health care among school-aged children and adolescents with chronic diseases. METHODS: This study was performed in accordance with Whittemore and Knafl's stages of an integrative review (problem identification, literature search, data evaluation, data analysis, and presentation of the results). Four databases (PubMed, CINAHL, Embase, and Web of Science) were used to retrieve relevant articles. RESULTS: Eighteen articles were included in this review. We identified five thematic categories: peer-related issues, a safe school environment, self-perception of an existing disease, self-management, and a supportive school environment. CONCLUSION: It is necessary to establish a school health care system with a supportive environment for children and adolescents with chronic diseases.

Individual and Environmental Factors Associated with Proteinuria in Korean Children: A Multilevel Analysis.

Proteinuria is a significant sign of childhood renal disorders. However, little is known about how sociodemographic and environmental factors are related to the presence of proteinuria among children and adolescents. This paper focuses on the prevalence of proteinuria and its risk factors among children and adolescents. This study conducted a secondary analysis of data from the 2016 Sample Schools Raw Data of Health Examination for School Students (SSRDHESS). Data collected from 27,081 students who had undergone a health screening were analyzed using Chi-square tests, independent t-tests, and multilevel logistic regression analysis. The prevalence of proteinuria was higher in the thin group than in the normal weight group (adjusted odds ratio (aOR) = 1.77; 95% confidence interval (CI) = 1.34-2.33) and lower in the overweight/obese group (aOR = 0.64; 95% CI = 0.51-0.80). Additionally, those in metropolitan and small-medium sized cities had a proteinuria prevalence about 1.5-fold higher than that of those in rural areas (95% CI = 1.08-2.02, 95% CI = 1.19-1.92, respectively). Proteinuria was associated with environmental pollution, including smoking rate, ambient particulate matter and heavy metals in drinking water (aOR = 1.10; 95% CI = 1.01-1.20; aOR = 1.06; 95% CI = 1.01-1.11, aOR = 1.001; 95% CI = 1.0001-1.0015). These results suggest that to improve health management effectiveness, kidney disease prevention efforts for children and adolescents should focus on geographical area and environmental pollution, as well as body weight as individual factors.

Implementation of an SBAR communication program based on experiential learning theory in a pediatric nursing practicum: A quasi-experimental study.

BACKGROUND: Effective communication by nurses is crucial to ensure patient safety. A structured communication program increases communication clarity, education satisfaction, and positivity during interprofessional collaboration among students. In an effort to facilitate effective communication between nurses and physicians, the well-known structured communication tool SBAR (Situation, Background, Assessment, and Recommendation) has been extensively used in clinical and educational settings. OBJECTIVES: The purpose of the study is to investigate the impact of an SBAR communication program on communication performance, perception, and practicum-related outcomes in senior-year nursing students. METHOD: The study employed a non-equivalent control group quasi-experimental design and implemented the tool in the pediatric nursing practicum of a nursing school. The experimental group participated in a SBAR program, where role playing using SBAR techniques for different scenarios was used to improve practical communication among nursing students. The SBAR program was developed based on Kolb's Experiential Learning Theory. Communication performance was assessed via the SBAR communication tool and the communication clarity scale. Communication perception was measured by handover confidence level. Practicum-related outcomes of clinical practice self-efficacy, perceived nurse-physician collaboration, and practicum satisfaction, were also evaluated. RESULTS: The experimental group demonstrated significantly higher SBAR communication (p < .001), communication clarity (p < .001), and handover confidence (p < .001) than the control group. Clinical practice self-efficacy, perceived nurse-physician collaboration, and practicum satisfaction did not differ. CONCLUSIONS: The SBAR program in a pediatric nursing practicum improves SBAR communication, communication clarity, and perceived handover confidence in senior-year nursing students.

Mothers' needs regarding partnerships with nurses during care of infants with congenital heart defects in a paediatric cardiac intensive care unit.

OBJECTIVES: We investigated mothers' needs in forming partnerships with nurses based on children's postoperative recovery in a paediatric cardiac intensive care unit. DESIGN: This was a descriptive study using prospective data. SETTING: Data were collected from 36 mothers enrolled in a mother-nurse partnership program. MAIN OUTCOME MEASURES: We investigated mothers' need for information and participation activities using a self-made survey tool, as well as the duration of mothers' care participation and physical engagement and psychological connectedness. RESULTS: The mothers desired information on their infants' postoperative stability in the early recovery phases and information on infants' transfer and care in the later phases. Mothers' mean duration of care participation increased as infants' recovery progressed (15.82 ±â€¯8.76 minutes in the second phase of recovery to 29.46 ±â€¯4.53 minutes in the fifth phase; F = 19.54, p < .001). Mothers' physical engagement and psychological connectedness also increased with infants' recovery (F = 200.95, p < .001; F = 93.27, p < .001, respectively). Mothers generally passively participated at first and gradually developed more positive and enthusiastic participation as infants recovered. CONCLUSION: Infants' condition heavily influenced mothers' needs regarding partnerships. Thus, nurses must individually provide mothers with information and encourage them to participate in care.