Western Journal of Nursing Research

Physical inactivity is a major stroke risk factor. In 2016, over one-third of adults in high-income countries did not fulfil the World Health Organization recommendations for physical activity. Evidence on pre-stroke physical activity is limited and inconsistent.

We sought to assess pre-stroke physical activity in patients with stroke and its associations with medical conditions and sociodemographic variables.

This project was a cross-sectional study of patients hospitalised with stroke. Pre-stroke physical activity was assessed using the Physical Activity Scale-2, to identify whether the World Health Organization recommendations were fulfilled. Patients were stratified into the following: none, 1 to 149 minutes, or ≥150 minutes of moderate- or vigorous-intensity physical activity per week. Crude and age-adjusted logistic regressions were performed to identify associations.

Among 122 patients (mean age 71 years (standard deviation = 11.8), 40% women, 70% with a mild stroke), 55% did not fulfil the World Health Organization recommendations. Nonfulfilment was associated with age >75 years (odds ratio [OR] = 0.36; 95% confidence interval [CI], 0.15-0.89), smoking (OR = 0.25; 95% CI, 0.08-0.77), and use of mobility aid (OR = 0.18; 95% CI, 0.05-0.68). Thirty-four per cent reported no moderate- or vigorous-intensity physical activity.

Fifty-five per cent of the patients did not fulfil the World Health Organization recommendations before stroke, and one-third did not engage in moderate- or vigorous-intensity activity. Fulfilling the recommendations was linked to older age, smoking, and use of mobility aids.

Breastfeeding benefits both mothers and infants, but maternal employment can shorten its duration. There are limited data on workplace support for breastfeeding and pumping among registered nurses (RNs), who are predominantly women of childbearing age.

This study examined the association between workplace support and breastfeeding duration among RNs currently or previously pregnant in the United States.

We conducted a cross-sectional analysis of survey data from 89 RNs. Linear regression assessed breastfeeding duration and workplace support levels (low, moderate, high) for operational, managerial, coworker, time, physical environment, and an overall composite score.

On a scale from 0 to 100, operational support scored highest (69.7), whereas coworker and managerial support scored lowest (34.6 and 15.4, respectively). High overall workplace support was significantly associated with 4.7 months longer breastfeeding compared with low support (coefficient: 4.73; 95% CI: 1.17-8.29). Among the workplace support domains, physical environment support, such as equipment, place to store expressed breastmilk, and designated space, had the largest significant difference (coefficient: 4.26; 95% CI: 0.53-7.99).

RNs play a key role in promoting breastfeeding among new mothers, yet often lack workplace support to meet their own breastfeeding goals, potentially affecting their roles as breastfeeding champions and the length of their own breastfeeding. Therefore, implementing more comprehensive workplace support, including policies, physical environments, and interpersonal support, is imperative.

Cross-cultural differences are often observed in traditional Chinese medicine practices. To examine the effectiveness of such interventions, a cross-country comparison was conducted using samples from Eastern and Western populations.

This study evaluated the effectiveness and efficacy of a chair-based acupunch exercise program, Vitality Acupunch, in improving functional fitness and activities of daily living (ADL) among long-term care residents in 2 countries.

This quasi-experimental pilot study included 80 participants from Taiwan (treatment n = 23; control n = 17) and the United States (treatment n = 24; control n = 16). Treatment groups received a standardized 40-minute chair-based exercise program 3 times per week for 6 months, delivered by trained instructors. Physical fitness indicators (handgrip strength, upper and lower body strength, upper and lower body flexibility, shoulder joint mobility, and lung function) and ADL were assessed at baseline and at 3rd and 6th month.

The Taiwanese treatment group showed significant improvements in nearly all outcomes (all P < .05), except lower body strength (Wald χ² = 5.96, P = .051). The US treatment group demonstrated significant improvement only in handgrip strength (Wald χ² = 25.65, P < .001). Compared with the US group, Taiwanese participants achieved significantly greater gains in lower body flexibility, shoulder mobility, and ADL performance (all P < .05).

The chair-based acupunch exercise program was effective for long-term care residents in both countries. However, cross-country differences suggest potential cultural influences on treatment response, with Taiwanese participants demonstrating greater overall benefit.

In nursing simulation education, learning outcomes are essential for maintaining educational quality. Assessing both clinical competencies and the processes by which these outcomes are achieved can strengthen the learning feedback loop and enhance instructional effectiveness.

This study aimed to examine the reliability and validity of the Korean version of the Clinical Competency Evaluation Instrument (C-CEI) for assessing nursing students’ clinical competency in simulation-based learning.

The Korean translation was conducted in the following order: forward translation, back-translation by an expert panel, pretesting and cognitive interviews, and finalization, following WHO guidelines. The reliability of the final translated Korean C-CEI was verified through a self-report survey of 230 nursing students who had completed simulation classes in the previous semester. Criterion validity was verified by examining correlations with evidence-based practice (EBP) competencies, and construct validity was verified using confirmatory factor analysis.

The Korean version of the C-CEI demonstrated high internal consistency, with a Cronbach’s alpha of 0.97. The correlation coefficient between the C-CEI and the EBP competencies was 0.75, supporting criterion validity. Notably, the clinical judgment subscale of the C-CEI showed the strongest correlation with EBP competencies. Confirmatory factor analysis indicated acceptable model fit indices.

The Korean C-CEI may be a useful tool for assessing nursing students’ evidence-based clinical competencies, even also as a self-report tool, in simulation-based learning. Incorporated assessments of clinical competencies in nursing simulation may enhance educational outcomes and strengthen the feedback process for learners.

Health disparities in autistic people are well-documented. Less is known, however, about how health determinants intersect, including what factors make a difference, for whom, and under what conditions. Coincidence analysis (CNA) is a cross-case, mathematical approach that pinpoints minimally sufficient and necessary conditions for an outcome to appear, making it particularly well-suited to identify intersecting determinants and multiple paths to the same outcome.

Guided by the National Institute on Minority Health and Health Disparities Research Framework, the study aimed to identify difference-makers for “excellent/very good” overall health among autistic children.

The 2022 National Survey of Children’s Health contains parent-reported data about 1231 autistic children with “excellent/very good” overall health. A literature review informed the selection of 62 potentially relevant factors for analysis. CNA was applied to develop a model for explaining parents’ reporting “excellent/very good” health for their autistic children.

Initial exploratory analyses identified 7 strongly related factors. The final model revealed a 2-pathway solution that accounted for 82% of the respondents with 80% consistency: (1) a combination of no intellectual disability, no difficulty with chronic pain, and high family resilience; or (2) a combination of no intellectual disability, no difficulty with chronic pain, and no history of being overweight.

Combinations of health determinants accounted for differences in the reported overall health of autistic children. This nuanced explanation for “excellent/very good” health among autistic children can guide future interventions and practices aimed at modifiable determinants of health.

Clinical decision-making anxiety impairs nursing students’ relationship-centered care (RCC) delivery, yet the underlying psychological mechanisms remain unclear.

This study examined the relationship between clinical decision-making anxiety and RCC and also explored the mediating roles of sense of coherence (SOC) and emotional intelligence among nursing students.

A cross-sectional study was conducted from March to May 2024 with 185 nursing students from a 4-year undergraduate program in South Korea. Data were collected using 4 validated instruments: the Korean version of the Nursing Anxiety and Self-Confidence with Clinical Decision-Making Scale, the RCC Scale, the 13-item SOC Scale, and the Wong and Law Emotional Intelligence Scale.

Clinical decision-making anxiety negatively affected RCC primarily through indirect pathways. Emotional intelligence significantly mediated this relationship (β = −0.067; 95% Confidence interval [CI], −0.122, −0.024), as did the sequential pathway through SOC to emotional intelligence (β = −0.037; 95% CI, −0.065, −0.014). SOC alone did not significantly mediate the relationship, and the direct effect of anxiety on RCC was nonsignificant (β = −0.027, P = .469). The total indirect effect was significant (β = −0.089; 95% CI, −0.147, −0.043).

Clinical decision-making anxiety undermines RCC indirectly through emotional intelligence and the sequential SOC → emotional intelligence pathway rather than through direct effects. Educational interventions that reduce anxiety while systematically developing SOC and emotional intelligence may enhance nursing students’ RCC competency and improve patient outcomes.

Childhood cancer survivors tend to live longer than their adult counterparts. Given their longer life expectancy, attention should shift from mere survival to overall well-being. Accordingly, it is crucial to explore how they can flourish across various domains of life after active treatment.

This study aimed to explore flourishing experiences of childhood cancer survivors.

Semi-structured in-depth interviews were conducted with 16 survivors of childhood cancer aged 10 to 24 years between October and December 2023. Participants were recruited through purposeful sampling at a tertiary hospital in Korea. Interviews were transcribed verbatim and analyzed using a descriptive phenomenological method.

Among the participants, 75% identified as male (n = 12) and 25% as female (n = 4). The mean age was 14.88 years old. Four central themes emerged regarding flourishing experiences: (1) gratitude for the invaluable daily life, (2) respecting one’s value, (3) gravitating toward love, and (4) expectations for the future. Participants experienced flourishing through gratitude for small things in daily life; recognized and respected their renewed self-worth; experienced a shared sense of being loved and loving within their families, among health care professionals, and with friends; and had positive expectations for their future.

These findings can inform the roles of mental health nurses and health care providers in delivering optimized clinical mental health counseling and person-centered care to help survivors experience a flourishing life after returning to their families and communities.

Online surveys offer data collection benefits and pitfalls, especially when utilizing crowdsourcing platforms such as Research Match and Prolific for recruitment.

The purpose of this methodology report was to describe strategies used to fortify an online REDCap research survey in which fraudulent and suspicious responses were identified and mitigated.

A two-pronged approach was designed to identify initial design limitations and engage in evidence-based redesign, which included scam alert features, study design changes, survey structure improvements, and crowdsourcing platform considerations.

A proactive, eight-step data cleaning protocol was designed and implemented in collaboration with the institutional review board and REDCap data experts. The same fraudulent records were identified within multiple steps of data cleaning, suggesting fraudulent records demonstrate multiple suspicious indicators.

Exciting opportunities in online data collection come with the risks of compromised data quality, resource waste, and damage to population health. Evidence-based protocols must be proactively designed to deter and detect early fraudulent results.

The U.S. nursing workforce faces persistent challenges, worsened by a 3.3% decline of nurses and high rates of emotional exhaustion, job dissatisfaction, and moral injury. An aging population drives rising demand for acute and long-term care, requiring proactive pathways for a healthy, competent workforce. This demands precise national and local insights, yet federal and state data sources complicate addressing current and future issues.

We examined registered nurse (RN) workforce data from common federal and state sources, highlighting data set strengths, discrepancies, implications, and use cases.

Using Minnesota as an example and California as a contrast, we compared workforce data sources, quantified projected shortages or surpluses, and drew actionable conclusions for nurse leaders and policymakers.

Substantial differences exist in nursing workforce data sets’ completeness and utility. State licensure and survey data provide complete nurse lists and voluntary samples on elements like intent to leave, focusing on supply and characteristics but not growth, demand, or shortages. Bureau of Labor Statistics and similar national data sets support modeling growth and demand but offer little on supply, characteristics, or maldistribution. For example, one source projects 5.6% national RN job growth by 2032, while another forecasts 10% supply and 11% demand growth. These projections are difficult to model due to assumption limitations, capturing long-term trends well but often missing short-term ones.

Accurate, complete historical data sets form the foundation for workforce planning and analyzing future trends. We must urgently document and study nursing’s endemic challenges and pursue sustainable solutions, requiring reliable, locally relevant data.

Clinical practice plays a crucial role in nursing education. Numerous studies have highlighted the positive impact of peer support during clinical placements. However, to date, no study has provided a comprehensive overview of the specific role of peer support within the context of clinical learning.

We aimed to map literature describing the role of peer support among nursing students during hospital-based clinical placements.

A scoping review was conducted. Five databases (CINAHL, PsycINFO, PubMed, ERIC, and ScienceDirect) were searched, yielding 550 articles. Two authors assessed eligibility using predefined criteria, extracted data from the selected studies, and performed a thematic analysis. The review is reported in accordance with the PRISMA-ScR guidelines.

Thirty-six articles were included. Peer support during hospital-based clinical placements emerged through 6 key roles: (1) reduces anxiety, (2) contributes to the feeling of not being alone, (3) facilitates adaptation to challenges, (4) contributes to the development of a sense of belonging, (5) promotes knowledge sharing, and (6) enriches the learning experience.

The findings underscore the significant role of peer interactions in clinical learning, positioning peer support as a key component of nursing education. They highlight opportunities for educators to design and support collaborative learning environments, while also emphasizing the need for further research to inform the implementation and evaluation of structured peer support strategies in nursing education.