Conectar
Incarceration significantly impacts inmates health, particularly marginalized groups like transgender persons, due to systemic oppression and inadequate healthcare. This study aims to understand transgender prisoners' health management experiences.
An interpretative phenomenological approach was used. Data were collected through in-depth interviews with eight transgender inmates in Barcelona, Spain, and analyzed using the seven-step Colaizzi method.
Three primary themes emerged: (1) Navigating Vulnerability in Healthcare Dynamics, which highlighted experiences of stigma and inadequate care; (2) The Quest for Wellbeing Amidst Uncertainty, underscoring concerns regarding treatment continuity; and (3) Negotiating a Landscape of Violence, revealing experiences of harassment and discrimination.
This study highlights the need for culturally competent, person-centered healthcare policies in prisons, particularly for transgender individuals. Addressing the specific health needs of transgender inmates is crucial for enhancing their overall well-being. This emphasizes the importance of systemic reforms to improve care provision for transgender prisoners.
Prison nurses must prioritize person-centered approaches, ensure continuity of gender-affirming treatments, and provide empathetic mental health support to enhance trust and improve the overall well-being of transgender inmates.
Osteoporosis requires long-term self-care engagement, yet little is known about how individuals experience and manage self-care in everyday life. Understanding these experiences is essential to inform tailored nursing interventions. The objective of the study was to explore and describe the experience of self-care maintenance, monitoring, and management in people with osteoporosis.
A qualitative descriptive study.
We conducted semi-structured interviews. Data were analyzed using Mayring's qualitative content analysis with a deductive approach based on Riegel's theory of self-care. We reported data in accordance with the Consolidated Criteria for Reporting Qualitative Studies (COREQ) checklist.
Participants (1 Male, 19 Females; Aged 55–80) Identified Four Themes of self-care: maintenance (e.g., Medication Adherence, Physical Activity), monitoring (e.g., Symptom Recognition, Test Interpretation), management (e.g., Lifestyle Reflections, Prevention), and general self-care. Key factors included motivation, trust in healthcare professionals, and integration of health behaviors into daily life. Barriers were low self-efficacy, poor symptom recognition, and inconsistent adherence.
Self-care in osteoporosis is a multidimensional and dynamic process influenced by individual beliefs, contextual factors, and support from healthcare professionals. Recognizing the variability in patients' self-care behaviors is essential to develop personalized education and support. Strengthening general health behaviors may enhance disease-specific self-care. This understanding can guide healthcare professionals in designing more effective, tailored care strategies.
Smoking is the leading cause of preventable deaths. The training of professionals on brief tobacco interventions (BTIs) increases the effectiveness of these interventions.
To assess the effectiveness of an online training program on BTI based on the 5As and 5Rs model in acquiring anti-tobacco brief advice competencies among nurses.
Quasi-experimental study with a pre-test and post-test design, with a control group and without random assignment. In the experimental group (EG), online training was provided in three sections: BTI theoretical content and methodology, clinical scenario videos, and feedback. Each scenario assessed the 5As and 5Rs as a validated instrument (BTI-Prof(C)). The control group (CG) only assessed the three videos of clinical scenarios. In both groups, competence was measured at the following points in time: T0 (before the training), T1 (at the end of the training), and T2 (after 90 days). The efficacy of the intervention was measured through a two-way ANOVA, and the variation rate was calculated from T0 to T1 and from T0 to T2.
236 nurses participated (157 EG; 79 CG). The mean age was 42.9 years, and 76.7% were women. There was a significant group*time interaction in the three cases, indicating that the online BTI training increases the competence of these professionals in clinical scenario 1 (F = 10.210; p ≤ 0.001; η 2 = 0.081), clinical scenario 2 (F = 6.235; p = 0.002; η 2 = 0.051), and clinical scenario 3 (F = 11.271; p ≤ 0.001; η 2 = 0.090).
A brief, asynchronous, and online intervention using standardized video-based cases is effective in improving nurses' BTI competence. This type of training can be a useful option for the National Health System as part of a global and continuous strategy for nurses to perform BTI.
An asynchronous online training program provides nurses with standardized, evidence-based tools to implement brief tobacco interventions in routine care, offering a scalable and practical solution to strengthen preventive strategies in health systems.
As healthcare systems confront rising demands and workforce shortages, advanced practice nursing (APN) has emerged globally as a vital strategy to improve care delivery and address systemic gaps, particularly in primary care facilities in low- and middle-income countries like the Philippines.
Qualitative case study.
This study was conducted in a rural setting in the Philippines and draws on a preceding mixed-methods case study that explored task shifting and advanced nursing practice in primary care facilities. Using purposeful sampling, 41 nurses, physicians, academics, policymakers, and recipients of care participated in interviews and focus group discussions. Qualitative data were thematically analyzed in ATLAS.ti, and quantitative data were descriptively analyzed in JASP. Findings were integrated into the APN framework tailored to primary care in low- and middle-income countries (LMICs).
Although the Philippines lacks a formal APN policy, nurses informally fulfill many advanced practice roles aligned with Hamric's model, particularly in direct patient care, leadership, collaboration, and evidence-based practice. Key enabling competencies include health promotion, systems thinking, and policy implementation—environmental barriers such as a lack of regulatory frameworks, educational pathways, and financing limit APN institutionalization.
This study proposes a contextualized advanced practice nursing (APN) model, which is relevant for LMICs, particularly in primary care facilities facing workforce shortages and rising NCD burdens. To institutionalize APN roles, key reforms should include investments in education, certification, financing, and regulation. Settings implementing initiatives to attain universal health coverage can serve as entry points for recognizing APN functions through competency-based systems.
The study proposes a contextualized APN framework for low-resource settings, showing that formalizing expanded nursing roles through education and certification can enhance access to quality care and advance UHC in underserved areas.
Dementia resulting from type 2 diabetes mellitus (T2DM) complications significantly impacts older adults' quality of life, increasing suffering for both patients and their families. Numerous studies have identified self-management as a key factor in adopting appropriate health behaviors to prevent diabetes-related complications. However, internationally, there is insufficient empirical evidence for individual and family process factors predicting dementia prevention behaviors in older adults with T2DM. Therefore, we aimed to explore how dementia-preventive self-management behaviors (outcome dimension) are related to contextual and process dimensions based on the Individual and Family Self-Management Theory (IFSMT).
A cross-sectional observational study.
The 444 older adults with T2DM from six community hospitals in Chiang Mai completed valid and reliable self-reported measures, including a Socio-demographic Questionnaire, the Dementia Prevention of Individual and Family Self-Management Process Questionnaire (DP-IFSM-PQ), and the Dementia Preventive Self-Management Behavior Questionnaire (DPSMBQ). Data were analyzed using bivariate correlations, partial correlations, and multivariate linear regression with the stepwise method.
Most participants exhibited high levels of individual and family self-management processes and dementia-preventive self-management behaviors. Bivariate and partial correlation analyses revealed a significant association between DP-IFSM-PQ and DPSMBQ scores. Stepwise multiple linear regression identified self-efficacy, a subdomain of DP-IFSM-PQ, as the strongest predictor of DPSMBQ scores. Other significant predictors included awareness of dementia prevention among family members, neighbors, and the community; family income sufficiency; history of comorbidities; distance to the hospital; and knowledge and beliefs (a subdomain of the DP-IFSM-PQ). The regression model was statistically significant (F [1, 437] = 46.662, p = 0.000, Adjusted R 2 = 0.382).
Self-efficacy and knowledge and beliefs, based on IFSMT, are key predictors of dementia-preventive behaviors among older adults with T2DM. These predictors could be used as potential intervention components in a subsequent co-design study for promoting dementia preventive self-management behaviors in older adults with T2DM. The results also reinforce the importance of family members and healthcare providers in supporting older adults with T2DM to enhance their dementia prevention behaviors.
Older adults may experience a wish to die in the context of deteriorating health, a loss of autonomy, loneliness, or depression. Home care workers may likewise experience burden or symptoms of depression as a result of prolonged contact with this physical and emotional suffering. Training initiatives that can support the well-being of home care workers are therefore important.
To describe the typical profile of older adults who express a wish to die to their home care worker, and to examine whether a psycho-educational intervention for care workers exploring the end-of-life process and self-care strategies had an impact on the older adult's wish to die and on the care worker's perceived burden and depressive symptoms.
Quasi-experimental, longitudinal study involving non-randomized experimental and control groups and follow-up at 3–6 months post-intervention.
At the start of the study, all care workers (n = 126) provided sociodemographic information (age, gender) for themselves and the care recipient, and completed the Karnofsky Performance Status scale and the Assessment of the Frequency and Extent of the Desire to Die (AFEDD) interview to provide a baseline measure of the care recipient's functional status and wish to die. They also completed the Beck Depression Inventory (BDI) and Zarit Burden Interview (ZBI) as a measure of their own perceived burden and depressive symptoms. The AFEDD, BDI, and ZBI were completed again by care workers at 3 and 6 months post-intervention.
The typical profile of care recipients was a woman aged 85.5 years who required considerable support and assistance and who had at least occasionally experienced a wish to die, although these thoughts were not always verbalized. Scores on the AFEDD remained relatively stable over the follow-up period in both the control and experimental groups. There was no significant association between the older adult's wish to die and depressive symptoms in the care worker across the study period. However, a positive and significant correlation between a wish to die in the older adult and perceived burden in the care worker was observed at 6 months post-intervention in both the total sample (p = 0.032) and among controls (p = 0.028). By contrast, this significant association was not found for care workers in the experimental group (p = 0.376), suggesting that the psycho-educational intervention may have had a protective effect.
Although further studies are needed to corroborate and extend these findings, the results suggest that psycho-educational interventions aimed at increasing home care workers' understanding of the end-of-life process and which introduce them to self-care strategies may help to reduce their perceived burden when the older person for whom they are caring expresses a wish to die.
Home care workers may find it challenging to care for an older adult who expresses a wish to die. Psycho-educational interventions that enhance care workers' understanding of the end-of-life process and teach them self-care strategies could help to support their well-being and their ability to provide adequate care.
The way communication is conducted directly influences the professional–patient relationship, how patients cope with their diagnosis, and their sense of hope throughout treatment. This study aims to map the literature on strategies that healthcare professionals can use to promote hope in communication with pediatric patients and their families in the context of chronic illness. Based on this objective, the study highlights an algorithm to assist healthcare professionals in instilling hope in this population through communication.
Scoping review.
This systematized review was conducted using the databases PubMed, LILACS, PsycInfo, Embase, CINAHL, and Scopus, employing the PCC framework and the Boolean operators AND and OR. The time frame was limited to the last 20 years (2004–2024). A total of 734 studies were identified across the databases, with an additional four retrieved through manual citation searches, resulting in 19 articles included in the final sample.
The findings highlight three key pillars for promoting hope in communication: (1) careful preparation for information delivery, which involves identifying the diverse needs of families and creating a physically comfortable and emotionally supportive environment; (2) providing information and emphasizing how it is presented—considering content, clarity, honesty, empathy, and adaptation to the recipient's specific needs; and (3) follow-up after information delivery, ensuring emotional support and active, skilled listening.
Interpersonal communication between the healthcare professional, the patient, and the family was mainly focused on the transmission of information about the disease and treatment in a clear and empathetic manner, considering who is receiving the information and how the information is interpreted.
This review provides guidance for healthcare professionals in implementing communication strategies that foster hope in the context of pediatric chronic illness. Additionally, this guide may serve as a model for training students and healthcare professionals. Further research is needed to implement and explore additional effective communication strategies for this population across diverse cultural settings.
The study aims to assess the extent of compulsory citizenship behaviors (CCBs) and their impact on the nurses' subjective vitality based on self-determination theory.
CCBs are harmful to both nurses and organizations. These behaviors mean employees are expected to perform additional tasks outside their job descriptions. Although CCBs are highlighted within the recent nursing literature, empirical evidence of their effects is lacking.
This is descriptive cross-sectional research. The study included 244 staff nurses using a convenience sampling method who worked in two hospitals in Istanbul. Data were collected via a survey consisting of a personal information form, the compulsory citizenship scale, and the subjective vitality scale. STROBE guidelines were followed when reporting the study. Descriptive statistical analyses, independent samples t-test, one-way ANOVA test, Pearson's correlation, and hierarchical simple linear regression analyses were used.
The participants' mean scores for compulsory citizenship and subjective vitality were 3.34 out of 5 (SD = 1.05) and 4.15 out of 7 (SD = 1.36), respectively. Nurses' compulsory citizenship scores significantly differed according to their education level, income, and sector. Their subjective vitality scores statistically differed according to their income levels. Regression analysis revealed that CCBs were significant negative predictors of subjective vitality (β = −0.22, p < 0.01).
By examining the CCBs and subjective vitality relationship, the current study extended the existing knowledge by drawing attention to the destructive and harmful effects of CCBs on positive psychological sources of nurses' subjective vitality. CCBs negatively predicted subjective vitality.
Organizational factors such as CCBs, which leads to a lack of autonomy, affect nurses' well-being, thus affecting care quality and patient safety. As the International Council of Nurses mentioned, “Nurses cope with many physical, mental, emotional, and ethical challenges. It is essential that we address these challenges in a way that supports their overall health”. In this regard, managers and policymakers in hospitals should develop preventive cautions for CCBs. However, in-service training activities should be carried out to increase awareness about the harmful effects of CCBs on nurses' psychological well-being.
Global organizations have pronounced about the importance of involving people in health care, however, this process is challenging. Given the availability of evidence that addresses people's experiences of involvement in nursing care, it is important to produce recommendations at this point by synthesizing the evidence. So, this review aims to synthesize the available qualitative evidence about people's experiences of their involvement in nursing care in a hospital setting.
Systematic review of qualitative evidence.
This systematic review was conducted according to the JBI methodology for systematic reviews of qualitative evidence. A comprehensive search strategy was conducted in nine databases/resources. The selection process, methodological quality assessment, and data extraction were conducted independently by two reviewers. The data were synthesized using the meta-aggregation approach, and the results were graded according to ConQual.
A total of 75 findings and 141 illustrations were extracted from the 15 included studies. These findings were aggregated into 12 categories and generated into three synthesized findings: (1) People who are hospitalized conceptualize and attribute importance to involvement in nursing care as an active process of participation and monitoring of care, decision-making, opinion, and partnership; (2) The establishment of a relationship between hospitalized people and nurses, trust, communication, and information are essential for participation in care; (3) People's participation in care is affected by the person's own constraints and preference for assuming a passive role, by barriers associated with a lack of information, the organization of care, the relationship established between nurses, and paternalistic attitudes.
People who were admitted to hospital conceptualized and attached importance to this phenomenon, perceived the conditions necessary to promote it, and the barriers they experienced.
This systematic review provides recommendations for nurses' clinical practice (with grade B). It recommends that nurses should establish a partnership relationship with hospitalized people, through trust, communication and information; give people the opportunity to monitor care, participate in decision-making and give their opinion; assess the person's preferences for involvement and other factors; and that the barriers to this process identified here should be assessed and addressed in each context. As such, this review provides very valuable information for nurses' clinical practice and should also be incorporated into health policy.
Protocol Registration: PROSPERO CRD42024506501.
Approximately 25% of the Brazilian population suffers from mental disorders, a prevalence exacerbated by systemic and cultural factors such as socioeconomic inequalities, underfunded mental health services, regional disparities, and persistent stigma. These conditions significantly impact hospital care. Nurses, due to their direct contact with these patients, face challenges ranging from managing physical conditions to handling verbal aggression and psychiatric crises. This study aimed to assess the scientific evidence regarding nursing care for hospitalized patients with psychiatric disorders.
A systematic review with a mixed-methods approach was conducted, registered in PROSPERO (#CRD42022359288) and guided by PRISMA standards. Databases, such as MEDLINE, LILACS, PubMed, Web of Science, Scopus, and BDEnf, were searched using keywords like “Mental disorder,” “Psychiatric health,” “Nursing care,” and “Hospital.” Methodological quality was assessed using JBI and SQUIRE tools. The integration of quantitative and qualitative components occurred through meta-aggregation of qualitative data and frequency-based coding of quantitative themes, allowing thematic convergence across study designs.
Six studies were included. Meta-aggregation revealed frequent terms, such as “Nurse,” “Emergency,” “Screening,” “Patient,” and “Care.” Similarity analysis linked “Nurse” with “perception” and “experience” and “Emergency” with “Screening” and “Mental health,” highlighting the importance of experience and training. Five categories emerged: (1) professional experience (19.05%, showing skill gaps despite experience); (2) caring process (19.05%, stressing efficient screening); (3) barriers and challenges (19.05%, revealing difficulty with comorbidities); (4) training process (19.05%, identifying training deficiencies); and (5) therapeutic interventions (23.81%, discussing restraint use). These percentages refer to the proportional frequency of themes identified across the total number of studies analyzed. For thematic classification, only statistically significant chi-square values (p < 0.05) were considered in the grouping of content.
Nursing care for psychiatric patients in hospitals faces challenges like insufficient training and difficulty managing psychiatric comorbidities. Recommendations include incorporating structured mental health content into nursing curricula and hospital-based continuing education programs. These strategies may guide future healthcare policies in Brazil by improving patient safety, reducing hospital readmissions, and promoting more humane, evidence-based therapeutic interventions.
The findings emphasize the urgent need for targeted education and training to improve nursing care for psychiatric patients in hospital settings.
Family caregivers of children receiving pediatric palliative care (PPC) play a crucial role in their care and wellbeing, especially during the early stages of life.
To explore the experience of family caregivers of children aged 1–23 months who are receiving pediatric palliative care (PPC).
A systematic review of qualitative studies was conducted using the databases PubMed, Scopus, Web of Science, CINAHL, PsycINFO, and Cuiden. The studies were appraised using the Critical Appraisal Skills Programme tool. The selected studies were synthesized using Noblit and Hare's meta-ethnographic method.
Eleven studies, 169 themes, 36 metaphors and four main themes were identified. Caregivers develop coping strategies related to meaning-making, faith, maintaining hope, and decision-making abilities. They perceive limited time with the child due to structural constraints and the child's deteriorating health, which sometimes prevents them from recognizing their child's identity. Caregivers strive to remain united and rebuild the daily family life they long for, but face challenges related to self-care, maintaining employment, and caring for siblings and their partner. In many cases, they are unsatisfied with the care they receive, attributed to a lack of technical training and understanding of the principles of pediatric palliative care (PPC) by healthcare staff, poor communication skills, and inadequate coordination. Caregivers highlight the role of nurses and the PPC team, advanced care planning, and post-mortem care as positive aspects.
Caregivers' experiences reveal coping strategies, active decision-making, constant challenges, healthcare interactions, and a need for improved comprehensive support.
This study underscores the importance of addressing the unique needs of family caregivers of children aged 1–23 months receiving pediatric palliative care (PPC), highlighting their struggles with social isolation, neglected self-care, and disrupted family life. Healthcare providers should prioritize age-specific approaches to PPC, focusing on improving communication, care coordination, and understanding of palliative care principles to better support these caregivers.
The diverse cultural landscape of Europe underscores the importance of culturally safe healthcare. There is a necessity to assess cultural competence among European nursing faculty to provide an international perspective on cultural competence.
A descriptive, cross-sectional study.
An assessment of cultural competencies was conducted using the Cultural Competence Assessment scale, either in its original language (English) or in its translated and validated versions in Spanish, Italian, Portuguese, and Turkish. An online questionnaire was used to collect data.
The study was conducted in 71 higher institutions, distributed across 17 countries through a consecutive sample of 1364 nursing faculty.
The ethical principles of biomedical research were respected during the study, and the confidentiality of the data was guaranteed.
The mean level of cultural competence of the European nursing faculty was at the level of ‘good’. They showed greater cultural awareness and sensitivity than cultural competence behaviors. Significant associations were found between cultural competence level and the language of the questionnaire, level of education, having a nursing degree, leisure stays abroad, having friends from other countries or cultures, and international experiences abroad and at home. The better levels of cultural competence were found in profiles with the categories of: women with a Nursing Degree, a higher level of education, and with an ERASMUS+ stay experience.
This study offers an international overview of the cultural competence of nursing faculty. While the overall level of cultural competence was good, there is a need to reinforce the behaviors and factors that influence it.
Delay in detecting acute deterioration in older adults in care homes is associated with avoidable hospitalizations and adverse outcomes, including premature death.
Underpinned by the Knowledge to Action Framework, this study aimed to understand the barriers and enablers to direct care staff detecting and responding to the early signs of acute deterioration in care home residents.
Online focus groups or interviews with regulated (registered and enrolled nurses) and unregulated (assistants in nursing and personal care workers) direct care staff from participating care homes were conducted. Homes were recruited using disproportionate stratified random sampling to include metropolitan, inner regional, and outer regional care homes. Interview and focus group recordings were transcribed verbatim and analyzed using inductive thematic analysis.
Eighty direct care staff (n = 48 regulated; n = 32 unregulated) from eight care homes participated. Fifteen focus groups (n = 7 unregulated staff, n = 8 regulated staff) and two interviews (n = 1 regulated staff, n = 1 unregulated staff) were conducted between July 2021 and October 2022. Four themes related to the barriers and enablers of detecting and responding to acute deterioration were generated: decision-making within the scope of practice; resource availability; streamlined communication; and teamwork.
Findings highlight the challenges direct care staff encounter in being able to detect early signs of acute deterioration and implement appropriate care pathways. Perceived barriers and enablers highlighted in this study need to be considered when developing and implementing programs to optimize the timely detection of, and response to, acute deterioration in care homes.
Workforce knowledge, experience, and confidence deficits are significant barriers to detecting acute deterioration, while the unique workforce mix in care homes poses additional challenges for the accurate detection of early signs of acute deterioration. Knowing the resident, working as a team, and valuing the contribution of aged care staff and families in managing acute deterioration are enablers to achieving better outcomes for residents experiencing acute deterioration.
Nurses' job satisfaction in hospitals is fundamental for the quality of care and the safety of patients. However, sociodemographic trends require moving care to patients' homes, and the predictors of job satisfaction for nurses working in the home care settings remain largely unknown. Therefore, the aim of this study was to investigate job satisfaction of nurses working in Italian home care settings and its determinants.
Multicenter observational cross-sectional study.
This study was conducted in the districts of 70 local health authorities in Italy. Data on the characteristics of the organization and nurses were collected. Nursing job satisfaction was evaluated on a four-point scale ranging from “very satisfied” to “very dissatisfied.” Additionally, the following variables were assessed: workload, quality of leadership, work–private life conflict, burnout symptoms, possibility for development, staffing and resource adequacy, nurse manager ability, safety climate, and teamwork climate. A logistic regression analysis was conducted to identify factors influencing job satisfaction.
Only organizational variables had a predictive value for nurses' job satisfaction. Workload (OR = 1.01; p = 0.033), work–private life conflict (OR = 1.02; p < 0.001), burnout (OR = 1.02; p < 0.001), and staffing inadequacy (OR = 1.44; p = 0.003) predicted higher levels of nurse dissatisfaction. Instead, high-quality leadership (OR = 0.981; p < 0.001), possibility for development (OR = 0.973; p < 0.001), and good teamwork climate (OR = 0.994; p = 0.003) were predictors of better levels of satisfaction.
This study suggested that home care nurses are generally satisfied with their jobs. To enhance job satisfaction, it is essential to improve nurses' work environment, the leadership quality and ensure professional development.
Our results are globally relevant as they contribute to the limited evidence available on this topic in home care settings. This study emphasizes the need of measuring nurses' job satisfaction and implementing interventions to promote healthy work environments.
Ensuring an appropriate length of stay (LOS) is a primary goal for hospitals, as prolonged LOS poses clinical risks and organizational challenges. Children and adolescents are particularly susceptible to prolonged LOS due to frequent hospitalizations and unique vulnerabilities, including developmental disabilities that may necessitate additional care and monitoring. This study aims to describe the LOS of children and adolescent patients and identify the sociodemographic, organizational, clinical, and nursing care factors contributing to prolonged LOS in this population.
Observational, retrospective, monocentric study.
A sequential sampling approach was used to select the clinical records of 1538 children and adolescent patients admitted to an Italian university hospital in 2022. The study included all children and adolescents aged 3–18 who were hospitalized for a minimum of 2 days. Patients from outpatient units and those with LOS shorter than 2 days were excluded. The Neonatal Pediatric Professional Assessment Instrument (PAIped) and the Hospital Discharge Register were used to collect sociodemographic, organizational, clinical, and nursing care patient data, including nursing diagnoses (NDs) and nursing actions (NAs). A forward stepwise regression approach was used to identify predictors of LOS among the selected variables. A mediation analysis was conducted to explore the role of nursing predictors, identified in the stepwise regression, as mediators between the number of medical diagnoses and LOS.
Positive correlations between the number of medical diagnoses, NDs, NAs, and LOS were discovered (r s = 0.262, p = < 0.001; r s = 0.114, p = < 0.001; r s = 0.384, p = < 0.001, respectively). Longer hospital stays were associated with an increased number of medical diagnoses, NDs, and NAs. The number of NAs emerged as an independent predictor of LOS (β = 0.516; p < 0.001). Other significant determinants of LOS included a higher number of NAs and medical diagnoses, the presence of a medical DRG category, increased DRG weight, emergency admissions, residency in rural areas, and older age (F = 122.222, p < 0.001, R 2 = 0.361, adjusted R 2 = 0.358). The mediation analysis showed that the number of medical diagnoses positively predicted the number of NAs (β = 2.774, p < 0.001), which, in turn, positively affected LOS (β = 0.162, p < 0.001). A significant indirect effect of the number of medical diagnoses on LOS through NAs was observed (β = 0.448, 95% CI [0.34, 0.55]), along with a significant direct effect of medical diagnoses on LOS, even with the mediator in the model (β = 0.633, p < 0.001), indicating partial mediation (F = 321.6892; R 2 = 0.295; p < 0.001). These results highlight the influence of medical diagnoses on LOS through the mediating role of NAs.
Our study highlights the significant interplay between determinants of LOS in children and adolescent patients, emphasizing the need for targeted interventions, resource planning, and the integration of clinical nursing information systems to enhance care quality and support evidence-based practices.
Optimizing resource distribution and implementing specific interventions for patients at risk of prolonged LOS could help mitigate this negative outcome and enhance the quality of care. Incorporating nursing data into DRG systems could improve reimbursement accuracy and benefit the nursing profession, which may result in better patient outcomes and lower hospital expanses.
Cultural competence in nursing is crucial for providing effective health care. Social Identity is the degree to which they identify with their professional group. Identifying with the group of nursing professionals allows nurses to connect with norms and values that favor the development of cultural competence. The objective of this study is to analyze the relationship between social identity and the level of cultural competence of nursing professionals.
This was a cross-sectional correlational study (n = 211). Sociodemographic data were measured, and Cameron's social identity scales and a cultural competence measurement scale were used. The data were analyzed using correlations and a structural equation model.
The structural equation model demonstrated good fit (CFI = 0.94, TLI = 0.928 WRMR = 0.952, RMSEA = 0.058). The model indicated positive and significant relationships between social identity, cultural skills, and knowledge. However, it also revealed a negative and significant relationship between social identity and cultural awareness.
The findings suggest that greater identification with the nursing profession by nursing professionals is associated not only with higher levels of cultural knowledge and skills but also with lower levels of cultural awareness. This finding may be due to the fact that individuals seek to reinforce their professional identities when they feel that acknowledging their own personal biases represents a threat.
This study contributes to the understanding of how social identity can be related in a different way to the components of cultural competence. This work recognizes the challenges in developing cultural awareness in nursing and suggests that its findings can inform interventions to improve patient care and relationships.
The aim of this study was to evaluate and compare artificial intelligence (AI)-based large language models (LLMs) (ChatGPT-3.5, Bing, and Bard) with human-based formulations in generating relevant clinical queries, using comprehensive methodological evaluations.
To interact with the major LLMs ChatGPT-3.5, Bing Chat, and Google Bard, scripts and prompts were designed to formulate PICOT (population, intervention, comparison, outcome, time) clinical questions and search strategies. Quality of the LLMs responses was assessed using a descriptive approach and independent assessment by two researchers. To determine the number of hits, PubMed, Web of Science, Cochrane Library, and CINAHL Ultimate search results were imported separately, without search restrictions, with the search strings generated by the three LLMs and an additional one by the expert. Hits from one of the scenarios were also exported for relevance evaluation. The use of a single scenario was chosen to provide a focused analysis. Cronbach's alpha and intraclass correlation coefficient (ICC) were also calculated.
In five different scenarios, ChatGPT-3.5 generated 11,859 hits, Bing 1,376,854, Bard 16,583, and an expert 5919 hits. We then used the first scenario to assess the relevance of the obtained results. The human expert search approach resulted in 65.22% (56/105) relevant articles. Bing was the most accurate AI-based LLM with 70.79% (63/89), followed by ChatGPT-3.5 with 21.05% (12/45), and Bard with 13.29% (42/316) relevant hits. Based on the assessment of two evaluators, ChatGPT-3.5 received the highest score (M = 48.50; SD = 0.71). Results showed a high level of agreement between the two evaluators. Although ChatGPT-3.5 showed a lower percentage of relevant hits compared to Bing, this reflects the nuanced evaluation criteria, where the subjective evaluation prioritized contextual accuracy and quality over mere relevance.
This study provides valuable insights into the ability of LLMs to formulate PICOT clinical questions and search strategies. AI-based LLMs, such as ChatGPT-3.5, demonstrate significant potential for augmenting clinical workflows, improving clinical query development, and supporting search strategies. However, the findings also highlight limitations that necessitate further refinement and continued human oversight.
AI could assist nurses in formulating PICOT clinical questions and search strategies. AI-based LLMs offer valuable support to healthcare professionals by improving the structure of clinical questions and enhancing search strategies, thereby significantly increasing the efficiency of information retrieval.
The healthcare industry increasingly values high-quality and personalized care. Patients with heart failure (HF) receiving home health care (HHC) often experience hospitalizations due to worsening symptoms and comorbidities. Therefore, close symptom monitoring and timely intervention based on risk prediction could help HHC clinicians prevent emergency department (ED) visits and hospitalizations. This study aims to (1) describe important variables associated with a higher risk of ED visits and hospitalizations in HF patients receiving HHC; (2) map data requirements of a clinical decision support (CDS) tool to the exchangeable data standard for integrating a CDS tool into the care of patients with HF; (3) outline a pipeline for developing a real-time artificial intelligence (AI)-based CDS tool.
We used patient data from a large HHC organization in the Northeastern US to determine the factors that can predict ED visits and hospitalizations among patients with HF in HHC (9362 patients in 12,223 care episodes). We examined vital signs, HHC visit details (e.g., the purpose of the visit), and clinical note–derived variables. The study identified critical factors that can predict ED visits and hospitalizations and used these findings to suggest a practical CDS tool for nurses. The tool's proposed design includes a system that can analyze data quickly to offer timely advice to healthcare clinicians.
Our research showed that the length of time since a patient was admitted to HHC and how recently they have shown symptoms of HF were significant factors predicting an adverse event. Additionally, we found this information from the last few HHC visits before the occurrence of an ED visit or hospitalization were particularly important in the prediction. One hundred percent of clinical demographic profiles from the Outcome and Assessment Information Set variables were mapped to the exchangeable data standard, while natural language processing–driven variables couldn't be mapped due to their nature, as they are generated from unstructured data. The suggested CDS tool alerts nurses about newly emerging or rising risks, helping them make informed decisions.
This study discusses the creation of a time-series risk prediction model and its potential CDS applications within HHC, aiming to enhance patient outcomes, streamline resource utilization, and improve the quality of care for individuals with HF.
This study provides a detailed plan for a CDS tool that uses the latest AI technology designed to aid nurses in their day-to-day HHC service. Our proposed CDS tool includes an alert system that serves as a guard rail to prevent ED visits and hospitalizations. This tool can potentially improve how nurses make decisions and improve patient outcomes by providing early warnings about ED visits and hospitalizations.
To identify the current presence of stereotypes about the nursing profession in Italy and to understand how gendered processes and modalities are regulated and expressed in the physician-nurse dyad, and the implications for professional identity and autonomy.
Qualitative multimethod design.
Forty-five interviews were conducted with nurses and physicians. The collected qualitative data underwent automatic textual data analysis using a multidimensional exploratory approach and a gender framework analysis.
In Italy, nurses' roles are still associated with gender stereotypes stemming from the predominant male culture, which affects sexual and gender identity, the division of labor, and access to career paths. This leads to disadvantages in the nursing profession, which is heavily dominated by women.
Biological differences between sexes generate an unconscious yet shared symbolic gender order composed of negative stereotypes that influence nurses' professional roles and activities. They follow behaviors that enter the work routine and institutionalize organizational processes. These effects are also seen in the asymmetric, limited, and reciprocal interprofessional relationships between male physicians and female nurses, where the former hinders the latter's professional autonomy and access to top positions.
This survey raises awareness of gender issues and stimulates reflection. It also enables health and nursing organizations to take action to raise gender awareness and education by countering the image of a non-autonomous profession. The analysis of gender processes allows us to identify interventions that can counteract forms of oppression in the work environment that lead to the emergence of nursing as a non-autonomous profession.
FreshRSS