Category: Statistics

Appl Nurs Res. 2026 Apr;88:152061. doi: 10.1016/j.apnr.2026.152061. Epub 2026 Feb 10.

ABSTRACT

BACKGROUND: Information literacy and innovative behavior are key factors influencing evidence-based practice (EBP) competency in clinical nurses, yet the mechanisms underlying these associations remain unclear.

AIM: To examine the relationships among information literacy, innovative behavior, and EBP competency in clinical nurses, and to explore whether innovative behavior mediates the relationship between information literacy and EBP competency.

METHODS: A multicenter cross-sectional study was conducted from December 2023 to January 2024. Using convenience sampling, 1111 clinical nurses were recruited from three tertiary hospitals in Lishui City, Zhejiang Province, China. Data were collected using the Information Literacy Scale, Innovative Behavior Scale, and EBP Scale. Pearson correlation analysis assessed associations, and Mplus 8.3 tested the mediating effect.

RESULTS: A total of 1092 valid questionnaires were analyzed. Mean scores for information literacy, innovative behavior, and EBP competency were 76.86 ± 10.76, 33.70 ± 7.04, and 36.60 ± 5.29, respectively. EBP competency was positively correlated with both information literacy (r = 0.642, P < 0.01) and innovative behavior (r = 0.583, P < 0.01). Information literacy was also positively correlated with innovative behavior (r = 0.675, P < 0.01). Innovative behavior partially mediated the effect of information literacy on EBP competency (indirect effect = 0.159), accounting for 22.68% of the total effect.

CONCLUSION: Clinical nurses demonstrated above-average EBP competency. Strengthening information literacy and promoting innovative behavior may directly and indirectly enhance EBP competency.

PMID:41826038 | DOI:10.1016/j.apnr.2026.152061

Appl Nurs Res. 2026 Apr;88:152067. doi: 10.1016/j.apnr.2026.152067. Epub 2026 Feb 9.

ABSTRACT

BACKGROUND: Sleep quality is an important factor that can affect individuals’ work performance and productivity. This study was conducted to determine the relationship between sleep quality in nurses and their clinical decision-making, as well as the tendency to make medical errors.

METHODS: A descriptive and correlational survey design was used. A total of 366 nurses participated in the study. Data were collected using a Demographic Information Form for Nurses, the Pittsburgh Sleep Quality Index (PSQI), the Clinical Decision-Making in Nursing Scale (CDMNS), and the Medical Error Tendency Scale in Nursing (METSN).

RESULTS: The average total score of nurses on the PSQI was 7.2 ± 3.1, the average total score on the CDMNS was 97.7 ± 13.1, and the average total score on the METSN was 229.2 ± 18.7. The relationship between the total scores of the CDMNS and the METSN with the components of the PSQI was examined using path analysis. The path coefficients between the PSQI Subjective Sleep Quality and the total score for the CDMNS (β = 0.012; p < 0.001) and the total score for the METSN (β = 0.004; p = 0.045) were found to be statistically significant.

CONCLUSION: This study found a significant relationship between nurses’ sleep quality and their clinical decision-making and tendency to make medical errors. This study shows that the quality of sleep of nurses is a crucial factor influencing their clinical decision-making skills and their tendency to make medical errors.

PMID:41826037 | DOI:10.1016/j.apnr.2026.152067

Appl Nurs Res. 2026 Apr;88:152065. doi: 10.1016/j.apnr.2026.152065. Epub 2026 Feb 5.

ABSTRACT

BACKGROUND: Moral distress is increasingly recognized as a critical challenge in critical care settings, where nurses frequently encounter ethically complex situations that can undermine their moral integrity. With the growing adoption of artificial intelligence (AI) in clinical decision-making, there is a need to understand whether AI integration may help mitigate the ethical burden experienced by nurses.

AIM: This study aims to examine the relationship between moral distress and moral integrity and investigate the mediating role of AI integration in this association.

METHODS: A cross-sectional correlation design was employed among 250 ICU nurses recruited from three private hospitals. Data was collected using three structured questionnaires. Descriptive statistics, Pearson correlations, multiple regression, and structural equation modeling (SEM) were used to examine direct and indirect effects.

RESULTS: Moral distress was negatively associated with both AI integration (r = -0.42, p < 0.01) and moral integrity (r = -0.56, p < 0.01), while AI integration demonstrated a positive association with moral integrity (r = 0.48, p < 0.01). The regression model explained 48% of the variance in moral integrity. SEM results indicated that AI integration partially mediated the association between moral distress and moral integrity (indirect β = -0.16, p < 0.001).

CONCLUSION: Moral distress significantly undermines nurses’ moral integrity, yet AI integration provides a partial protective effect by enhancing ethical clarity and decision support. While AI cannot fully offset the impact of chronic moral strain, it represents a promising tool to strengthen ethical practice in critical care environments.

PMID:41826035 | DOI:10.1016/j.apnr.2026.152065

Appl Nurs Res. 2026 Apr;88:152062. doi: 10.1016/j.apnr.2026.152062. Epub 2026 Feb 5.

ABSTRACT

BACKGROUND: Lifelong learning, counseling self-efficacy, and professional self-doubt are key determinants of nursing excellence, particularly in high-stress environments such as Emergency Departments (EDs) and Critical Care Units (CCUs). Understanding how these factors interact can inform strategies to enhance professional development and patient-centered care among nurses.

OBJECTIVE: This study aimed to examine the relationships between lifelong learning tendencies, counseling self-efficacy, professional self-doubt, and perceptions of nursing excellence among emergency and critical care nurses in Turkey.

METHODS: A descriptive cross-sectional design was employed with 744 registered nurses from 14 hospitals (8 governmental, 6 private). Participants were recruited via convenience sampling, and data were collected through a structured online questionnaire. Instruments included the Lifelong Learning Tendencies Scale (LLLTS), Counseling Self-Estimate Inventory (COSE), Professional Self-Doubt Scale (PSD), Good Nurse Questionnaire, and Better Nursing Questionnaire. Descriptive statistics summarized participant demographics and scores, while Pearson correlation coefficients examined relationships among the study variables.

RESULTS: Nurses reported moderately high lifelong learning tendencies (mean = 4.12, SD = 1.65), with motivation and persistence as the strongest sub-dimensions. Counseling self-efficacy was generally high (mean = 4.75, SD = 0.77), particularly in micro-skills and cultural competence. Professional self-doubt was moderate (mean = 2.82, SD = 1.07), with higher uncertainty reported when nurses felt unable to influence patient outcomes. Positive correlations were found between lifelong learning and professional competency (r = 0.41, p = 0.003), sense of achievement (r = 0.36, p = 0.009), expertise in nursing (r = 0.42, p = 0.002), and counseling self-efficacy subdomains, while professional self-doubt correlated negatively (r = -0.29, p = 0.049).

CONCLUSIONS: Nurses demonstrating stronger professional competence, confidence in counseling skills, and a sense of accomplishment were more inclined toward continuous learning and professional development. These findings underscore the importance of fostering lifelong learning and counseling self-efficacy while addressing professional self-doubt to enhance nursing excellence in critical care and emergency settings.

PMID:41826033 | DOI:10.1016/j.apnr.2026.152062

Appl Nurs Res. 2026 Apr;88:152060. doi: 10.1016/j.apnr.2026.152060. Epub 2026 Jan 30.

ABSTRACT

BACKGROUND: Pain is one of the most common and debilitating experiences for patients in the hospital setting, leading to significant adverse effects on patients’ physical, emotional, and psychological health. Although pain management has improved significantly worldwide, issues remain regarding assessment and treatment of pain. Nurses, as direct caregivers, play an important role in assessing and managing pain, and it is possible that their beliefs, knowledge, and barriers at the systems level can influence the effectiveness of pain management. The purpose of this study was to assess nurses’ knowledge, attitudes, and barriers related to pain management practices in hospitals located in the northern West Bank, Palestine.

METHODS: A descriptive cross-sectional study design was used to survey 199 registered nurses providing care in emergency, medical-surgical, and critical care settings. Nurses were surveyed using convenience sampling. A modified KASRP tool (33 items) was used to measure knowledge, attitudes, and barriers. Descriptive statistics, t-tests, and ANOVA were used to analyze the data.

RESULTS: The overall mean score for knowledge and attitude was 44.75%, which reflects a low adherence to appropriate practice, or standards of practice regarding pain management. Postgraduate educational level of nurses in the study had a significant association with high scores compared to lower educational levels (p = 0.016). In addition, scores in knowledge and attention to income had a significant association (p = 0.043). There were notable areas of knowledge gap, including concerns about opioid addiction (29.1% correct), as well, as the lack of understanding about benzodiazepine efficacy (34.2% correct). The most frequently reported barriers included concerns about addiction (61.5%), lack of IV access (61.4%) and time (59.3%).

CONCLUSION: Nurses in the northern West Bank demonstrate considerable deficits in pain management knowledge and systems-related barriers. The need for educational initiatives, trauma informed and updated policies, and standard clinical guidelines for evidence-based pain management, is urgent. By improving nurses’ competency, pain suffering may decrease and clinical outcomes improve.

PMID:41826029 | DOI:10.1016/j.apnr.2026.152060

Appl Nurs Res. 2026 Apr;88:152059. doi: 10.1016/j.apnr.2026.152059. Epub 2026 Jan 30.

ABSTRACT

OBJECTIVES: Given the high levels of occupational stress and compassion fatigue in psychiatric wards, this study aimed to investigate the effectiveness of mindfulness meditation on the professional quality of life of nurses working in these settings in Tehran, Iran.

METHODS: The present study employed a two-group randomized clinical trial with a pretest-posttest design involving 52 nurses randomly assigned to intervention and control groups. The intervention group underwent an eight-session mindfulness meditation training program conducted over four weeks, while the control group received standard in-service education. Data were collected at baseline and post-intervention using validated Professional Quality of Life (ProQOL) instruments. All analyses were performed using SPSS software (version 19).

RESULTS: A total of 49 participants completed the study. At baseline, there were no statistically significant differences between the groups in demographic characteristics or outcome variables. After the intervention, the intervention group showed significant improvements in compassion satisfaction (t = -5.19, p < 0.001), and significant reductions in burnout (t = 2.61, p = 0.01) and secondary traumatic stress (t = 3.62, p = 0.021), compared to the control group.

CONCLUSION: Mindfulness meditation effectively enhanced the professional quality of life among nurses in psychiatric wards. Considering its ease of implementation, lack of side effects, and proven benefits, it is recommended that nursing managers and healthcare policymakers incorporate mindfulness-based programs into periodic training, especially in high-stress environments such as psychiatric care settings.

TRIAL REGISTRATION: IRCT20240506061683N1. Registration date: 2024-05-21.

PMID:41826028 | DOI:10.1016/j.apnr.2026.152059

Mult Scler Relat Disord. 2026 Apr;108:106866. doi: 10.1016/j.msard.2025.106866. Epub 2025 Nov 20.

ABSTRACT

BACKGROUND: Multiple sclerosis (MS) is the most prevalent neuroinflammatory disorder significantly impacting patients’ health outcomes and economic burden. The increasing incidence of MS in Tehran, Iran, underscores the urgent need for effective patient care and management. While disease-modifying drugs (DMDs) play a crucial role in enhancing patient quality of life and reducing disease progression, they also contribute substantially to healthcare expenditures. Understanding the factors influencing changes in DMDs is essential for optimizing treatment strategies and managing costs effectively.

OBJECTIVE: This study aims to elucidate the underlying reasons for DMD changes among patients with MS (PwMS) in Tehran, Iran and to identify associated demographic and clinical factors.

METHODS: A registry-based cross-sectional study was conducted involving 2,771 PwMS who altered their DMD regimen within five years prior to October 15, 2023. Data were sourced from the National Multiple Sclerosis Registry of Iran (NMSRI) and analyzed using descriptive and inferential statistics with a significance level set at P < 0.05. The primary outcome focused on the reasons for DMT changes, while secondary outcomes included disease severity metrics, initial symptoms, and treatment history.

RESULTS: Among the participants, 70.3% reported a change in their DMD regimen. The primary reasons for these alterations included inadequate disease control or relapse (62.3%), adverse drug reactions (30.7%), and non-adherence (11.3%). Notably, demographic factors such as gender and age did not significantly correlate with changes in DMDs. Patients with progressive forms of MS exhibited a higher frequency of DMT modifications compared to those with non-progressive forms. Additionally, initial symptoms such as motor dysfunction significantly influenced the likelihood of changing therapies.

CONCLUSION: The findings underscore that inadequate disease control and adverse drug reactions are significant determinants driving DMT modifications among MS patients in Tehran. The higher rates of changes observed in patients with progressive forms of MS reflect the need for more effective treatment strategies tailored to individual clinical presentations. Overall, this study highlights the importance of personalized care approaches that consider disease severity and symptomatology to optimize therapeutic outcomes for patients with MS.

PMID:41825974 | DOI:10.1016/j.msard.2025.106866

Obes Rev. 2026 Mar 13:e70128. doi: 10.1111/obr.70128. Online ahead of print.

ABSTRACT

The objective of this scoping review is to examine the nature, extent, and impact of AI-supported interventions that include an AI agent intended to influence obesity-related behavior change. Empirical studies published from 2020 to 2025 examining AI-supported interventions that provide personalized feedback, support natural language communication, or adapt content based on user progress will be included. A search of Scopus, Web of Science, and PubMed will be undertaken, limited to English-language publications, with backward and forward citation searching to improve coverage. Data will be extracted and synthesized narratively by AI agent characteristics, interaction design, targeted behaviors, and intervention outcomes using descriptive statistics and thematic analysis.

PMID:41825969 | DOI:10.1111/obr.70128

J Health Psychol. 2026 Mar 13:13591053261425474. doi: 10.1177/13591053261425474. Online ahead of print.

ABSTRACT

Cardiovascular Emotional Dampening (CED) refers to reduced recognition of facial and vocal emotions among individuals with elevated blood pressure (BP). While CED is well established, the contribution of attentional and working memory deficits has rarely been examined. This cross-sectional study tested whether BP-related differences in emotion recognition remain after statistically adjusting for attention and working memory, and whether cognitive performance itself differs across BP groups. Ninety-six participants aged 18-55 years were categorised as hypotensives, normotensives, prehypertensives, or hypertensives. They completed the Positive and Negative Affect Schedule and tasks assessing attention, working memory, and emotion recognition. High BP groups showed significantly poorer emotion recognition accuracy (but not response time), even after controlling for cognitive and demographic covariates. Hypertensives also exhibited greater attentional and working memory deficits than normotensives. These findings support CED as an emotion recognition impairment rather than a byproduct of cognitive deficits. Future studies should consider cognitive confounds to clarify mechanisms underlying CED.

PMID:41825966 | DOI:10.1177/13591053261425474

Laryngoscope. 2026 Mar 13. doi: 10.1002/lary.70482. Online ahead of print.

ABSTRACT

OBJECTIVES: To estimate the prevalence of balance disorders in young and middle-aged adults, examine associations with risk factors, and changes over the past 20 years.

METHODS: The National Health and Nutrition Examination Survey (NHANES) is a cross-sectional complex random sample of the civilian, non-institutionalized United States population. In 2001-2004 and 2021-2023, NHANES included questions about balance, dizziness, and falls in the past 12 months. The modified Romberg test (MRT) was used to examine vestibular balance function. Logistic regression models were used to assess risk factor associations with balance disorders.

RESULTS: Among 4525 middle-aged adults 40-69 years in 2001-2004, 21.5% (95% confidence interval [CI]: 19.1%, 23.9%) reported difficulty with balance and dizziness, and 29.7% (27.3%, 32.1%) failed to pass four MRT (MRT-4) conditions. Among 3986 middle-aged adults in 2021-2023, 36.2% (34.5%, 37.8%) reported specific balance and dizziness problems (BDP), and 25.9% (23.2%, 28.6%) failed the MRT-4. An enhanced MRT with a fifth condition (MRT-5) increased the discrimination of adults at risk of balance problems and falls. Risk factors for vestibular balance disorders, including age, education, income, cigarette smoking, physical activity, hypertension, diabetes, trouble hearing, and severe headaches/migraines, remained consistent. Reported functional disabilities (hearing, mobility, and vision) were significantly associated with BDP and MRT. In 2021-2023, comparisons of 2084 young adults 20-39 years with middle-aged adults showed increased age-specific prevalences of BDP and falls.

CONCLUSION: Middle-age-specific MRT-4 results in 2021-2023 improved. Balance disorders are associated with other health conditions, increased risk of falls, and need for medical services.

PMID:41825962 | DOI:10.1002/lary.70482