Factors influencing self-care management in adult hemodialysis patients: An integrative review.

Background: End-stage renal disease (ESRD) poses a significant health challenge, with hemodialysis (HD) being the most prevalent therapy. Patients undergoing HD must comply with a strict therapeutic regimen, including dietary control, fluid restriction, and medication adherence. Successful disease management and improved outcomes rely on patients' involvement and participation in their care. Aim: To identify the factors that hinder or facilitate self-care management (SCM) in HD patients. Methodology: This review followed Whittemore and Knafl's integrative review framework. A comprehensive literature search of articles published between 2017 and 2022 was conducted in CINAHL, Medline, and PubMed using the keywords end-stage renal disease, hemodialysis, self-care management, self-care, and self-management. This search yielded 21 suitable articles for review. Results: SCM is influenced by three main factors: facilitators, barriers, and outcomes. Facilitators of SCM include self-care management interventions, patient knowledge, socio-demographic factors, family support, healthcare professionals, peer support, and psychological factors. Barriers encompass psychological and physical conditions. Outcomes include both physiological and psychological aspects. Conclusion: Understanding the factors influencing SCM in HD patients is vital for developing reliable and effective self-care strategies and interventions to enhance both physical and psychological outcomes.

Job satisfaction among expatriate nurses during the COVID-19 pandemic: A cross-sectional study.

AIM: To investigate the association between job resources, job satisfaction, and moderating effect of COVID-19 anxiety and practice setting among expatriate acute care nurses in Qatar. BACKGROUND: Expatriate nurses are more vulnerable to reduced job satisfaction. Increased COVID-19 anxiety and reduced perceived job resources among acute care nurses impact their job satisfaction more than that of general ward nurses. METHOD: An online survey was used to recruit 293 expatriate acute care nurses from four public hospitals in Qatar. Data were collected between June and October of 2021. Structural equation modeling was used for data analysis. We ensured to follow STROBE guidelines when doing this research. RESULTS: Job resources were a significant predictor of job satisfaction among expatriate acute care nurses (ß = 0.80, 95% CI: 0.73-0.85, p < 0.001). There was no significant moderating effect of COVID-19 anxiety (ß = 0.055, 95% CI: -0.61 to 0.151, p = 0.329) or workplace setting on this relationship (χ2  = 0.077, df = 1, p = 0.781). DISCUSSION: Our study found that the relationship between job resources and acute care nurses' job satisfaction is consistent across different workplace settings regardless of the level of COVID-19 anxiety. This is in line with previous studies that have highlighted the importance of job resources in determining nurses' job satisfaction. CONCLUSION: The study emphasizes the need for sufficient job resources for improved job satisfaction among expatriate acute care nurses in Qatar, especially during the COVID-19 pandemic. IMPLICATIONS FOR NURSING POLICY: Nursing leaders must prioritize adequate resources such as staffing, proper training, and policies that increase nurse autonomy to improve job satisfaction and reduce the negative effects of dissatisfaction.

Fear and stress related to COVID-19 and associated factors among undergraduate nursing students in Qatar.

BACKGROUND: The emergence of the coronavirus disease (COVID-19) has had an impact on nearly every human being with millions of related infections and deaths. The negative impact of the pandemic on individuals' mental health such as fear and stress, particularly among university students, have been reported. While the switch to online teaching and learning played an important mitigating role, it also had presented additional challenges to students' mental health. AIM: To examine the prevalence of fear and stress among undergraduate nursing students in Qatar and the factors associated with fear of COVID-19. METHOD: A cross-sectional design. An online survey was sent to students at the University of Calgary in Qatar. RESULTS: 135 participants completed the survey. The findings showed differences in fear of COVID-19 and stress and satisfaction with the measures proposed by the academic institution based on participants' demographic and COVID-19 profiles. Furthermore, fear of COVID-19 was associated with the age group (26-35), academic year level, and satisfaction with the measures proposed by the academic institution. CONCLUSION: The study found that switching teaching and learning online had a negative impact on participants' fear and stress. Several strategies were suggested to alleviate students' fear and stress and support them during future pandemics.

Psychometric evaluation of the acute care nurses' job satisfaction scale-revised.

AIM: The aim of this study was to validate a job satisfaction scale among acute care nurses in the context of Qatar. DESIGN: Cross-sectional correlational survey. METHODS: A convenience sampling technique was used to recruit 295 acute care nurses between June 2021-September 2021. Exploratory factor analysis followed by confirmatory factor analysis was used for item reduction and convergent and discriminant validity evaluation. Pearson's correlations were conducted to evaluate the concurrent and convergent validity of the revised scale. Reliability was tested using several internal consistency indicators. RESULTS: A revised scale was proposed, the Acute Care Nurses Job Satisfaction Scale-Revised (ACNJSS-R) scale; it is composed of 13 items loaded on five factors. The composite reliability and the maximal reliability were >.7 for all factors. The study provides empirical support for the validity and reliability of the ACNJSS-R scale.

Arabic translation, cultural adaptation, and pilot-testing of multimorbidity self-management self-efficacy scales.

OBJECTIVE: This study aimed to translate to Arabic language and culturally adapt the Self-Efficacy for Managing Chronic Diseases Scale (SEMCD) and The Perceived Medical Condition Self-Management Scale (PMCSMS). DESIGN: The translation of the two scales was conducted according to the framework by Beaton et al. Then, these scales were tested in a cross-sectional correlational study with 85 Arabic-speaking participants with multimorbidities in Qatar. Psychometric tests to assess the reliability and validity of the translated scales were done. RESULTS: The internal consistency reliability (α) for the Arabic version of both PMCSMS and SEMCD scales was 0.953 and 0.949, respectively. Correlation coefficient (r) used to assess convergent validity between the PMCSMS and the SEMCD was 0.76 (p < 0.5). Number of morbidities negatively correlated with scores of self-management self- efficacy scores of the PMCSMS and the SEMCD (r = -0.50 and -0.51, respectively). DISCUSSION: The translated PMCSMS and SEMCD are valid and reliable scales that can be used by researchers and healthcare providers to assess levels of self-efficacy among individuals with multimorbidities. The translated scales can be employed in research or interventional programmes that aim to improve self-management or self-efficacy among individuals with multimorbidities.

The association between hope and quality of life in haemodialysis patients.

BACKGROUND: Hope is important for patients with end-stage renal disease receiving haemodialysis (HD) and hope is associated with quality of life (QoL). Studies examining hope among the HD population are limited and, as far as the authors know, have not been undertaken in Jordan. AIMS: To examine levels of hope and QoL and to examine the association between hope and QoL in HD patients in Jordan. METHODS: A cross-sectional design was used. A convenience sample of 202 patients from six different dialysis centres was recruited. The World Health Organization QOL-BREF and the Herth Hope Index were used. FINDINGS: Moderate levels of hope (M=32.3±4.1) were reported. Respondents reported low mean scores for the physical domain of QoL (M=48.3±21.1) but not for the psychological and social relationship domains. Higher hope scores were associated with better QoL. CONCLUSION: The findings suggest a positive relationship between the level of hope and QoL in people receiving HD. Encouraging hope while caring for HD patients in clinical settings may improve their QoL. Understanding the relationship between hope and QoL may help healthcare providers to improve the quality of care for patients and their families.

A Novel Non-Invasive Assessment of Cardiac Hemodynamics in Patients With Heart Failure and Atrial Fibrillation.

BACKGROUND: Heart failure (HF) and atrial fibrillation (AF) often coexist. The hemodynamic alterations induced by AF in patients with HF are well studied; however we lack reliable and non-invasive means to study these hemodynamic alterations in ambulatory patients. We sought to evaluate the clinical utility of impedance cardiography (ICG) as a novel and non-invasive tool to evaluate cardiac hemodynamics in ambulatory patients with HF and AF. METHODS: This was a single-center observational study. A convenient sample of ambulatory patients with chronic HF underwent non-invasive electrocardiogram (ECG) and hemodynamic monitoring using BioZ Dx impedance cardiographer. Hemodynamics were automatically computed and ECG data were interpreted by an independent reviewer. RESULTS: A total of 32 patients (62 ± 14 years of age; 66% male; ejection fraction 33±13%) were enrolled. There were no baseline demographic or clinical differences between those with AF (28%) and those without AF (72%). However, patients with AF exhibited lower stroke volume (60 ± 7 vs. 89 ± 29, P = 0.008), left ventricular work (33 ± 9 vs. 45 ± 13, P = 0.016), cardiac contractility (30 ± 8 vs. 40 ± 13, P = 0.037), and arterial elasticity (13 ± 5 vs. 21 ± 5, P = 0.012), as well as higher cardiac afterload (203 ± 57 vs. 151 ± 49, P = 0.015). CONCLUSIONS: Using non-invasive ICG, we have shown that it is feasible to characterize hemodynamics in ambulatory HF patients. We show that AF compromises left ventricular function in patients with HF and is associated with excess afterload and reduced arterial elasticity.

Arterial Stiffness Is Associated With QTc Interval Prolongation in Patients With Heart Failure.

BACKGROUND: A prolonged corrected QT (QTc) interval is a known risk factor for adverse cardiac events. Understanding the determinants and physiologic correlates of QTc is necessary for selecting proper strategies to reduce the risk of adverse events in high-risk patients. We sought to evaluate the role of arterial stiffness in heart failure as a determinant of QTc prolongation. METHOD: This was an observational study that recruited ambulatory heart failure patients (New York Heart Association Classes I-II) from an outpatient heart failure clinic. In the supine resting position, consented patients underwent noninvasive 12-lead electrocardiograph (ECG) and hemodynamic monitoring using BioZ Dx impedance cardiography. ECGs were evaluated by a reviewer blinded to clinical data, and QTc interval was automatically computed. Patients with pacing or bundle branch block (BBB) were analyzed separately. Strengths of associations were evaluated using Pearson's r coefficients and multivariate linear regression. RESULTS: The final sample ( N = 44) was 62 ± 13 years of age and 64% male with ejection fraction of 34% ± 12%. At univariate level, QTc interval moderately ( r > .50) correlated with cardiac output, left cardiac work index, systemic vascular resistance, and total arterial compliance in patients with intrinsically narrow QRS complexes. At the multivariate level, increasing systemic vascular resistance and decreasing total arterial compliance remained independent predictors of widening QTc interval in this group ( R2 = .54). No significant correlations were seen in patients with pacing or BBB. CONCLUSIONS: In the absence of conduction abnormalities, magnitude of arterial stiffness, an indirect measure of endothelial dysfunction, is associated with QTc interval prolongation.

Impedance Cardiography-Guided Treatment of Hypertension: A Review of the Literature.

BACKGROUND: Hypertension occurs when regulatory mechanisms fail, resulting in increased cardiac output (CO) and/or increased systemic vascular resistance (SVR). Impedance cardiography (ICG) is a non-invasive technology that measures CO and SVR. OBJECTIVE: To assess the literature related to the use of ICG in guiding the selection of anti-hypertensive medications in individuals with hypertension. DESIGN: PubMed and Cumulative Index to Nursing and Allied Health Literature databases were searched for pertinent literature. Only English language, primary research reports published between 1990 and 2014 were included. FINDINGS: The literature demonstrated significant reduction of blood pressure among participants who were treated with ICG-guided selection of anti-hypertensive medications when compared to standard treatment. CONCLUSION: Although the research reviewed is not without limitations (e.g., small sample sizes and small effect sizes), individualized pharmacologic treatment of uncontrolled hypertension based on ICG-obtained hemodynamics seems successful in reducing blood pressure. Further research within the Canadian context that addresses the limitations is warranted.

Patient-surrogate agreement of predictors of decision delay among patients with acute myocardial infarction: a questionnaire survey.

BACKGROUND: Studies that assessed predictors of patient delay to seek healthcare for acute myocardial infarction lack generalization to all patient population as it investigated patients who survived coronary events. OBJECTIVES: To evaluate utility of using surrogates to proxy patients who cannot be interviewed and to examine patients-surrogate agreement. DESIGN: A cross-sectional descriptive survey study. The cognitive and emotional domains of the modified Response to Symptoms Questionnaire were used to interview participants. PARTICIPANTS AND SETTINGS: A convenient sample of patient-surrogate pairs was collected (n=109). Hospitalized patients with acute myocardial infarction were eligible if they were at least 18 years old, hemodynamically stable, pain free or controlled pain during interview, and could identify a surrogate. Exclusions (n=45) were patients transferred from other hospitals or those who had acquired heart attack following their admission. A surrogate was defined as an individual who witnessed the onset of symptoms and whom the patient has articulated symptoms with prior to admission. METHODS: Patient and surrogate were interviewed independently. Decision delay time was assessed by assisting participants and surrogates to triangulate the time of symptom onset and time of decision to seek help by placing it in the context of events that they would remember. The intraclass correlation coefficient was used to assess agreement. RESULTS: Patients were mainly men (81%), married (79%) and ranged in age from 39 to 78 years while surrogates were mostly women (74%) and 55% of them were patients' spouses. Surrogates ranged in age from 18 to 75 years. Intraclass correlation coefficients levels varied across different variables ranging from lack of agreement (p>0.05) to almost perfect agreement with decision delay time having the highest correlation coefficient (86%, p<0.05). Cognitive variables had higher agreement than emotional variables. Significant emotional variables' agreement ranged form 28% to 39% and significant cognitive variables' agreement ranged form 64% to 68%. Female surrogates (n=81) had higher agreement levels with their respective patients than male surrogates (n=28). CONCLUSIONS: Utilizing surrogates to proxy patients' account of decision delay time and its cognitive predictors is practical and feasible.

Predictors of decision delay to seeking health care among Jordanians with acute myocardial infarction.

PURPOSE: To identify predictors of decision delay time for health care seeking among Jordanians with acute myocardial infarction (AMI). DESIGN: The study was a cross-sectional descriptive survey. A convenience sample of Jordanians with AMI were interviewed at the coronary care units of two teaching hospitals in Jordan. METHODS: The Arabic version of the modified Response to Symptom Questionnaire was used to assess predictors of decision delay and patterns of health care-seeking behaviors. Decision delay was evaluated by assisting patients to triangulate time of symptom onset and time of decision to seek professional health care by placing both times in context of daily activities that participants could easily remember. Regression analysis was conducted to elicit predictors of decision delay. FINDINGS: Decision delay time among Jordanian men (n=110) and women (n=24) with AMI was alarmingly long (medians 3.5 and 3.6 hours, respectively). Variables that correspondingly predicted decision delay among men and women were age, waiting for symptoms to go away, anxiety due to symptom presentation, and others' responses to patients' symptoms. While 16 other variables (cognitive, emotional, and clinical) independently predicted delay among men, equivalent evidence was not established among women due to the relatively small sample size. CONCLUSIONS: Similarities and differences existed between Jordanian men's and women's decision delay to seek health care for AMI. Decision delay time among Jordanians with AMI requires intervention that incorporates awareness of delay predictors. Future research needs to utilize adequate sample sizes of both sexes to obtain a better understanding of sex differences. CLINICAL RELEVANCE: To reduce decision delay among Jordanians, health educators should emphasize early symptom recognition and the value of prompt health care-seeking behaviors.

Predictors of pre-hospital delay among patients with acute myocardial infarction.

OBJECTIVE: To evaluate current literature on predictors of pre-hospital delay among patients with acute myocardial infarction (AMI). METHODS: Medline, CINHAL, and Psych Info databases were searched using keywords: attitude to illness/health, health beliefs, help/health seeking behavior, health behavior, psychosocial factors, treatment delay, socioeconomic factors, time factors, pre-hospital delay, and symptoms. These keywords were combined with AMI to identify literature published during 1995-2008. RESULTS: Twenty-six data-based research articles were identified. Delay varied across literature and median pre-hospital delay was often reported due to distribution skewness resulting from extremely prolonged values (1.5-15.2h). Six categories of predictors influenced pre-hospital delay; socio-demographic, symptom onset context, cognitive, affective/psychological, behavioral, and clinical factors. Pre-hospital delay was shortest when the decision to seek healthcare was facilitated by family members or coworkers and when symptoms suggestive of heart attack were continuous and severe. CONCLUSION AND PRACTICE IMPLICATIONS: Developing interventions programs to reduce pre-hospital delay for high-risk patients is warranted. Because decision delay is the only modifiable part by intervention, it is recommended that future investigations and interventions attend to decision time as the primary variable of interest instead of combining it with transportation time. Moreover, content of patient education need to emphasize on symptom awareness and recognition, and prompt and proper patient actions for optimum results. Also, in order to eliminate sampling bias resulting from investigating surviving AMI patients, it is recommended that future studies incorporate data from both surviving and surrogates of non-surviving AMI patients.

The wider scope of video-assisted thoracoscopic surgery.

In the past, rudimentary devices were used to look closely into the chest; currently, advanced video technology, computers, and high-tech electronics are being used to perform many surgical procedures that formerly required a large, open incision. The goal of video-assisted thoracoscopic surgery (VATS) is the same as for comparable open procedures, but it is accomplished with less pain, less patient morbidity, and a shorter hospital stay. In addition to evaluating and treating thoracic injuries, VATS has demonstrated effectiveness in detecting and managing many other conditions, such as pleural disease, interstitial lung disease, and thoracic malignancies.