Lymphatic Research and Biology

Background The integration of Artificial Intelligence (AI) in healthcare is revolutionizing patient care and clinical practice, enhancing efficiency, accuracy, and accessibility. However, it has also sparked concerns among nursing students about job displacement, reliance on technology, and the potential loss of human qualities like empathy and compassion, to this date, there is no established scale measuring the level of fear, especially among nursing students. Aim To develop and validate a scale to assess nursing students' fear of artificial intelligence. Methods The current study employed a cross-sectional design, involving a total of 225 Saudi nursing students enrolled in a nursing college. The scale's construct, convergent, and discriminant validity were evaluated using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Results A comprehensive review of the literature addressing fear of AI guided the development of the Fear Towards Artificial Intelligence Scale (FtAIS). An initial pool of items was subjected to a content validity assessment by an expert panel, which refined the scale to 10 items categorized into two dimensions: job issues and humanity. The two-factor structure was responsible for 73.52% of the total variance. The scale items' reliability was evaluated using Cronbach's alpha coefficient, yielding a value of 0.803. The reliability coefficients for the two subscales, job issues, and humanity, are 0.804 and 0.801, respectively. The confirmatory factor model demonstrated a good model fit. The scale's convergent and discriminant validity were both confirmed. Conclusion The FtAIS is a rigorously developed and validated tool for measuring nursing students' fears toward AI. These findings emphasize the need for targeted educational interventions and training programs that could mitigate AI-related fears and prepare nursing students for its integration into healthcare. The scale offers practical applications for educators and policymakers in addressing AI fear and fostering its confident adoption to enhance patient care and healthcare outcomes.

Introduction/Objectives In Japan, novice nurses are assigned to intensive care units immediately after graduation and are expected to become independent within about a year. Therefore, in addition to long-term, comprehensive educational programs, establishing an educational system that allows novice nurses to learn intensive care unit nursing while working is necessary. This study explored senior nurses’ expectations for novice nurses working independently in the intensive care unit after one year and identified the foundational skills needed for novice nurses to achieve this independence. Methods The research collaborators were eight senior nurses working in the intensive care unit of an acute care hospital. They were recruited from four facilities and had five or more years of clinical experience. The study used semi-structured interviews to generate data about the reports, contacts, and consultations they would expect from novice nurses to determine their readiness to become independent. Results This study clarified the circumstances under which novice nurses with no practical experience should voluntarily seek support to work as independent nurses one year after being assigned to an intensive care unit. It reflects the characteristics of patients who require intensive management, such as “assistance with central line insertion and removal” and “evaluation of vital signs,” as well as other advanced procedures. Conclusion This study clarified the basic skills required for novice nurses and identified the areas in which they should seek support. In the future, this method may be utilized in the early stages of novice nurse education.

Introduction Nursing is a demanding profession that calls for resilience and stress management. Nevertheless, many nurses do not receive adequate training in these areas. This study aimed to evaluate the impact of resilience training programs on work-related stress and resilience levels among nurses in Saudi Arabia. Methods A quasi-experiment intervention study employing pre- and post-test approaches was conducted from January to March, 2024, to assess a resilience training program for nurses in Hail, Saudi Arabia. Fifty nurses from sixteen hospitals were divided into two groups in the stratified random sample: the intervention group (n = 25) and the control group (n = 25). Data was collected using an online survey at baseline and three months post-training, with the Connor-Davidson Resilience Scale and the Expanded Nursing Stress Scale employed for measuring outcomes. The paired samples t-tests for statistical analysis were performed using the IBM SPSS Statistics 29.0. Results Significant improvements were noted in the intervention group, with resilience sores improving to 79.50 from 77.12 (p = 0.015) and stress levels decreasing to 63.54 from 65.08 (p = 0.020). No significant changes were noted in the control group. Conclusion Findings indicate that resilience training programs can significantly enhance resilience levels and reduce work-related stress. These results underscore the importance of implementing structured resilience training to better equip nurses for the challenges of their demanding profession.

Background Blood pressure measurement is a main clinical procedure used for the detection of Systemic Arterial Hypertension. Mercury sphygmomanometer, in combination with auscultation technique, is still recognized as the gold standard for non-invasive blood pressure measurement. Objective The objective of this study is to compare the diagnostic accuracy between automatic non-invasive blood pressure measurement devices versus mercury sphygmomanometers in hospitalized patients. Methods A prospective, analytical and cross-sectional diagnostic method study was designed to compare the concordance, positive and negative predictive value, the sensitivity and specificity of automatic non-invasive blood pressure measurement devices and the mercury sphygmomanometer. The devices were divided into two groups: the reference standard which was mercury sphygmomanometer (n=150), versus the index tests, that were wrist device (n=150), semi-automatic sphygmomanometer (n=150) and vital signs monitor (n=150). Results The monitor detected more cases (69%) of systemic arterial hypertension (p 0.0019, OR 5.3). The semiautomatic sphygmomanometer identified more true positives (n=22) and true negatives (n=113). It also showed a higher diagnostic accuracy: 67% sensitivity (p 0.0576, OR 0.5) and 97% specificity (p 0.088, OR 3.2). A mean arterial pressure variation <5mmHg of 65% was found with the semiautomatic sphygmomanometer (p <0.0001, OR 0.02) and 61% with the vital signs monitor (p <0.0001, OR 0.12). Best concordance of blood pressure between reference standard versus index test was obtained in the following order: Semi-automatic sphygmomanometer, Vital signs monitor, and Wrist device. Conclusion The use of vital signs monitor to measure blood pressure is recommended in all patients, although semiautomatic sphygmomanometer is more sensitive for the detection of systemic arterial hypertension.

Background Managing tuberculosis (TB) patients with comorbidities requires a holistic and patient-centered approach. This study evaluated patient-centered care (PCC) experiences among TB patients with multimorbidity under the Adaptive Diseases Control Expert Program in Tanzania (ADEPT), with a focus on the TB/diabetes mellitus (DM) co-epidemic targeted by the program. Methods A quantitative cross-sectional study was conducted involving TB patients with associated comorbidities receiving care from nurses trained in PCC through the ADEPT program. Patients were assessed for their interpretation of how they received PCC across eight dimensions of care. Results All 39 participants with TB had at least one comorbidity (100%). The most common multi-morbidities were TB/HIV (59.0%) and TB/DM (12.8%). Evaluation of needs, values, and preferences revealed that participants strongly felt healthcare workers considered these aspects (mean score = 4.53; scale 1 minimum- strongly disagree to 5 maximum- strongly agree). Subsequent analysis showed varying evaluations across dimensions. Patients reported robust endorsement for receiving care that involved family and friends, with mean scores of 4.04, and for access to care, with a mean score of 4.40. However, physical comfort, coordination, continuity of care, education and emotional support received comparatively lower rankings. Conclusion TB patients with multimorbidity under the ADEPT program experienced PCC. However, certain systemic issues such as physical spaces, coordination, transition of care, and information education did not meet patient’s needs in their own assessment, indicating opportunities for further quality improvement. Scaling up the ADEPT program within healthcare systems is likely to enhance care provision for TB patients with multimorbidity through a patient-centered approach.

Background Nursing managers are well-positioned to enhance holistic care for patients in psychiatric settings. Managers need to use evidence-based data available to them when making nurse staffing decisions. Patient classification systems can be an excellent source of patients’ priority care needs. Objective To understand the meaning of using patient classification systems as a management tool for psychiatric nursing managers. Methods Qualitative study with a content analysis methodological framework. Ten nursing managers from psychiatric institutions in the state of São Paulo participated. Data were collected between August 2016 and May 2017 using a semi-structured interview with recorded audio. Results The sample consisted of nine women and one man with an average of 14 years’ experience in mental health and seven years of management experience. The psychiatric care setting emerged as a general theme surrounded by four subthemes: current model of decision making, ideal model of decision making, nursing staff dimensioning/staffing, and professional and mental health legislation. Only half of the managers used a patient classification system as a management tool, and there were difficulties associated with their use of the tool. Conclusion A conceptual model was developed based on the themes, subthemes, categories, and sub-categories in this study. The model demonstrates major differences between psychiatric settings with biomedical models versus psychosocial models. Managers with knowledge of PCS data can better advocate for patients’ holistic needs and adequate nursing resource allocation. Managers may lack the knowledge and skills required for model transformation, and continuing management/leadership education is recommended.

Objective This study aimed to identify a valid and cultural-based questionnaire for drug use prevention programs for adolescents. Methods The study used a three-round Delphi technique. A total of 21 participants with knowledge and experiences in community nursing (11 nurses) and education for junior high school students (11 teachers) in Aceh Province, Indonesia, were included. For the first round, focus group discussions were conducted. For the second round, participants were asked to indicate their levels of agreement and provide their comments on the proposed questionnaire. For the third round, participants were instructed to indicate their level of agreement with the final version of the developed questionnaire. The consensus was defined based on the percent agreement. Results Initially, 64 questions for four domains (knowledge = 14 items, attitude = 29 items, intention = 9 items, behaviors = 12 items) were developed based on the FGDs and literature review. Finally, the four domains and 43 questions (knowledge = 14 items, attitude = 12 items, intention = 9 items, behaviours = 8 items) were supported by the group panels as the final instrument for the evaluation of drug use prevention programs for adolescents in schools. Conclusion Expert panels validated the content of the questionnaire for the drug use prevention programs in Indonesia. Nonetheless, further analysis and implementation of the instrument are required to identify the accuracy of the instrument.

Background Assessing the perceived quality of care and safety culture by nurses is an important part of nursing practice and is vital for improving the quality of nursing care. Aim This study was conducted to investigate the relationship between perceived quality of care and patient safety culture. Methods A cross-sectional study was conducted using stratified and convenience sampling techniques from March 2023 to January 2024 among 412 nurses working in hospitals at Mashhad University of Medical Sciences, Iran. The data collection tools were standard care behavior questionnaires (CBI-42) and the Hospital Survey on Patient Safety Culture (HSOPSC). The data were analyzed using descriptive and inferential statistical tests at a significance level of 0.05. Results The perceived quality of care among nurses was high, with a score of 4.79 (1-6). The highest score was in “knowledge and professional skill” (5.03), while “communication and positive attitude” scored the lowest (4.59). Patient safety culture averaged 3.35 (1-5), with “overall perception of patient safety” at 4.82 and “non-punitive response to error” at 2.40. A significant direct relationship was found between perceived quality of care and patient safety culture (r=0.226, p<0.001), indicating that improvements in one may enhance the other. Conclusion Due to the existence of a direct relationship between perceived quality of care and patient safety culture, appropriate training and using the experiences of others, improving the relationship between nurses and patients, creating a sense of security in nurses, and solving the problems of nurses can enhance the quality of health care services.

Background The increasing use of ionizing radiation in clinical environments, particularly during surgeries such as orthopedics and neurosurgery, has heightened concerns about the potential health risks associated with this type of radiation. This issue is particularly relevant for nursing students undergoing training in operating room settings, where they are frequently exposed to various sources of radiation. To effectively implement radiation protection principles, it is crucial to evaluate the knowledge and attitudes of the students toward ionizing radiation. Understanding their level of awareness and beliefs about radiation safety will inform the development of targeted training programs aimed at minimizing exposure and enhancing safety in clinical environments. Objective This study aimed to investigate the level of knowledge, attitudes, and performance of 8th-semester undergraduate anesthesia and operating room nursing students toward radiation protection principles. Methods This cross-sectional study was conducted at the Hamadan University of Medical Sciences in 2024. In this study, students were selected via the census sampling method. The data related to the study were collected from valid questionnaires concerning the participants’ level of knowledge, attitudes, and performance toward ionizing radiation. The data analysis was also conducted at the descriptive and inferential statistics level via SPSS version 16 software. Results The knowledge, attitudes, and performance of the students in both fields were inadequate compared to the ideal standards. Additionally, the mean attitude score toward protective principles was significantly greater among operating room nursing students than anesthesia nursing students (p-value = 0.023). Furthermore, a positive and significant correlation was found between students' Grade Point Average (GPA) and their scores on knowledge and attitudes toward protective principles (r = 0.449, p-value = 0.000 and r = 0.648, p-value = 0.000, respectively). Conclusion This study revealed that the level of knowledge among students regarding ionizing radiation is lower than the desired standards for ensuring safety in clinical environments. As a result, it is essential to implement targeted training courses to enhance students' understanding of the risks associated with ionizing radiation.

Aim The purpose of this study was to determine the effects of emotional intelligence, caring efficacy, and social support on the clinical competency of Korean nursing students. Methods We conducted a descriptive correlational study from 5th March to 10th June 10, 2020, among 257 nursing students in 3rd and 4th years who participated in clinical practice at four universities in two cities. We collected the data using a self-structured questionnaire that included 129 items from the Wong and Law Emotional Intelligence Scale (WLEIS), the General Self-efficacy (GSE) scale, and scales on social support and clinical competency. We analyzed the data using frequency analysis, t-test, ANOVA, Scheffe test, Pearson correlation coefficient, and stepwise multiple regression analysis. Results The majority of the students, i.e., 80.2%, were female, 57.6% were in their 3rd year, and the students’ average age ranged from 22.91 to 4.75. The participants’ clinical competency was linked to their emotional intelligence (r =.457; p<.001), their ability to care for others (r =.516; p<.001), and their social support (r =.515; p^.001). There was a statistically significant difference in clinical competency based on the participants’ religion, academic performance, and satisfaction with their major and clinical practice. Factors, such as care efficacy, social support, emotional intelligence, religion, and significant satisfaction, influenced clinical competency. Conclusion Overall, 39.3% of the participants demonstrated clinical competency. The results have highlighted the need for the development of an effective educational program that can enhance emotional intelligence, care efficacy, social support, and major satisfaction, thereby promoting the clinical competency of nursing students.

Background Intubated conscious patients often experience communication difficulties. The present narrative review outlines the current evidence on communication methods adopted and the experience of conscious intubated patients in critical care areas. Objectives To our knowledge, studies have attempted to examine communication with conscious intubated patients. The present review had two objectives: (1) to identify the methods adopted by nurses and conscious intubated patients to ease the communication difficulties faced due to intubation and (2) to identify the experience of nurses and conscious intubated patients with the adopted communication methods. Methods The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) checklist was followed throughout this review. PubMed and ProQuest databases were searched with the terms “intubated conscious patients,” “communication,” and “nurse”, including original research articles published between January 2019 and May 2024 on conscious patients needing intubation. Dissertations, review papers, non-interventional research, and articles written in languages other than English were excluded. Only eight of the original 2,041 studies, which included 137 intubated patients and for 545 nurses, met the inclusion criteria. The authors used the Mixed Method Appraisal tool (MMAT) and the Critical Appraisal Skills Program (CASP) to collect data and assess quality. Results After the first search of generated 2041 papers, only eight articles—representing various studies—were able to meet the inclusion requirements. The included studies were six (6) quantitative, one (1) qualitative study and one (1) mixed-method study. Four communication intervention types were identified, namely: (1) Communication boards/charts (two studies), which improved communication and increased patient satisfaction. (2) Gestures and facial expressions (four studies) were reported to be frequently initiated for communication by the nurses with the patients. (3) Multiple methods (three studies) used were found to be insufficient to communicate with the patients. (4) Digital technology program, including Communicative Digital Technology Program was found to be effective means of communication in three such studies. Conclusion Results imply that communication techniques may be useful in enhancing patient–nursing professional communication with conscious intubated patients. However, in developing countries with fewer resources, a low-cost communication tool addressing both physical and emotional needs may be developed to aid in communication among patients and nurses.

Introduction Placenta accreta is a pathological condition of the placenta associated with multiple maternal and neonatal complications, but its diagnosis and treatment have been sparsely reported from the nursing viewpoint. This report describes a case of placenta accreta from the nursing perspective to develop a conceptual framework of care. Case Presentation Our case involved a 37-year-old pregnant woman with four previous caesarean sections and a previous in vitro fertilisation. She was diagnosed with placenta accreta only in the operating theatre during a scheduled caesarean section, and she had not performed thorough antenatal care as in her previous pregnancies despite having significant symptoms, such as severe urinary incontinence. The patient experienced many complications during the caesarean section, including bladder injury, massive haemorrhage, and hysterectomy. Conclusion We develop a theoretical framework illustrating the core factors that influence the management of placenta accreta and associated maternal morbidities. This model highlights the distinction between patient characteristics, nurse characteristics, organisational factors, and pregnancy outcomes and shows their relationship to the diagnosis and prevention of placenta accreta. The model has important implications for research and practice, and the case reminds nurses of their recommended interventions to diagnose, manage, and prevent placenta accreta. The quality of care for placenta accreta cases should be promoted through the assessment of patients, nurses, and organisational factors and the application of prevention measures.

Background The Akha hill tribe of older adults in Thailand, a culturally diverse minority, faces health disparities. Due to limited access to health information and services, those who are unable to read Thai are at a higher risk of developing hypertension. Consequently, hill tribe communities need community engagement to enhance healthcare access and communication between health workers and the community. Objective This study aimed to investigate the effect of a community participation program on hypertension knowledge and health prevention behaviors among Akha older adults in Thailand. Methods This program was developed based on evidence and insights from community scholars and stakeholders. The program included three activities: 1] training the volunteers, 2] home visits by trained adolescent and adult volunteers, and 3] providing hypertension knowledge through village broadcasts. Pre- and post-intervention surveys were conducted using an Akha-specific hypertension knowledge and prevention behaviors questionnaire. Results Among the thirty healthy Akha older adults who could not communicate in Thai, following the implementation of the community participation program, there was a significant increase in hypertension knowledge (P = 0.000) and HT prevention behaviors (P = 0.017). Conclusion The community participation program could improve hypertension knowledge and hypertension prevention behaviors of older adults in the Akha hill tribe by bridging the gap between the healthcare system and the community.

Background Until the date of the search, Euthanasia was legally accepted in 5 countries: the Netherlands, Belgium, Luxembourg, Canada and Colombia. Objective We aimed to identify the role of nurses in euthanasia based on articles published both nationally and internationally between 2014 and 2022. Methods Qualitative and quantitative studies, editorials, literature reviews and Colombian regulations were included. Publications that did not meet the criteria of the Strengthening the Reporting of Observational Studies in Epidemiology statement and the Spanish Critical Appraisal Skills Programme were excluded. In total, 57 articles were evaluated and 19 were selected. Appropriate copyright principles were followed in accordance with Colombian Law 23 of 1982. Results With the data obtained, 4 thematic categories were developed as follows: reception and management of euthanasia requests and regulations in Colombia; emotional accompaniment and effective communication with the patient and family; participation in euthanasia preparations and administration of medications; and management of requests and administration of medications. Conclusion Nursing plays an important role in the care of the patient requesting euthanasia, from the reception and management of the request to the administration of the lethal drugs.

Background Smartphones have evolved into a fusion of traditional personal digital assistants and cellular phones, integrating mobile communication capabilities with features parallel to those of a handheld computer. Objective This study aimed to assess the health risks associated with smartphone use and the prevalence and nature of observed health issues among health college students at Qassim University in Saudi Arabia. Methods Employing a descriptive cross-sectional research design, this study surveyed a convenience sample of 511 health college students at Qassim University. The data collection instrument comprised two sections: Section 1 assessed sociodemographic, academic, and health-related information, while Section 2 evaluated the health risks as perceived by students. Results The majority of the participants were women (71%) and were studying nursing (26%). A significant proportion (39.9%) reported blurred vision, while 38.6% indicated a lack of adequate sleep. Notably, no significant association was observed between the health complaints and sociodemographic information. The analysis also revealed no significant relationship between health complaints and smartphone usage patterns. Conclusion The findings highlight a critical need for further research to investigate the factors contributing to the effect of smartphone use on the physiological well-being of university students. Such research is essential for developing targeted interventions to mitigate the associated health risks.