Nursing Research最新文献

Background: Each year in the United States, approximately 42,211 women and men die from breast cancer. Individuals experiencing homelessness are disproportionately affected, facing a higher incidence of the disease. People experiencing homelessness (PEH) have a higher incidence of breast cancer and mortality than domiciled individuals. Across all 50 states, the Centers for Disease Control and Prevention provides free breast cancer screenings for eligible individuals with limited financial resources. However, PEH have screening rates that remain below the national average. Early detection is critical to identifying breast cancer. When detected in the earliest local stages, there is a 90% or better survival rate.

Objective: The objective of the study was to examine the perspective of PEH regarding perceived challenges of obtaining breast cancer screenings, education, and care.

Methods: We used a qualitative hermeneutic phenomenology design. Data were gathered using a focus group consisting of PEH in the state of New Jersey. This approach allowed the researchers to access multiple viewpoints of the phenomenon through robust discussions while prioritizing individual contributions and shared experiences. This qualitative hermeneutic phenomenology design used trustworthiness to establish rigor, using essential details in credibility, dependability, transferability, and confirmability.

Results: Eighteen individuals participated. Major considerations for this PEH focus group were finances, family, time, accessibility, emotions, and education.

Discussion: The results may be used to assist healthcare practitioners in becoming more informed about barriers to breast cancer education, screenings, and care. Identifying needs about finances, obligations, accessibility, and education may assist healthcare practitioners in discussing these key factors with patients, which may lead patients to become more open to breast cancer screenings. More dialogue about breast cancer screenings with PEH may lead to more screening participation.

Background: Communication is an important tool in combatting racial and economic healthcare disparities in cancer care. The ability to communicate treatment-related distress and troubling symptoms can allow proactive symptom mitigation and adherence to a prescribed cancer treatment. Few studies have explored how racial and economic differences in patient-clinician interactions in cancer care influence symptom distress and chemotherapy adherence.

Objectives: This study aimed to examine racial differences in interpersonal processes of care and their association with symptom distress and optimal chemotherapy dose among women diagnosed with early-stage breast cancer (ESBC).

Methods: Black and White women newly diagnosed with ESBC and prescribed chemotherapy for a diagnosis of invasive breast cancer were recruited. The Interpersonal Processes of Care Survey and Symptom Distress Scale were included in this analysis. Ratios of prescribed chemotherapy to received chemotherapy were recorded as total chemotherapy percentage.

Results: Persons who were Black perceived worse scores in communication, including "lack of clarity," "discrimination due to race/ethnicity," and "disrespectful office staff." Participants who lived in areas of greater deprivation perceived worse levels of "discrimination due to race/ethnicity" compared to those living in areas of less deprivation. Participants who perceived higher "discrimination due to race/ethnicity" were less likely to achieve optimal chemotherapy doses. Those who perceived worse scores for "lack of clarity," "discrimination due to race/ethnicity," "disrespectful office staff," and "compassion" had significantly higher levels of symptom distress.

Discussion: Symptom distress during ESBC chemotherapy must be communicated via patient-provider interaction. Patients' perceptions of discrimination and bias may inhibit this process. This interaction requires further interrogation to develop an inclusive symptom communication protocol.

Background: Computable phenotyping is a data science method that systematically synthesizes clinical attributes, such as a disease, condition, or patient cohort, enabling a database to be queried for entries matching these characteristics. Developing computable phenotypes will enhance current clinical and research efforts and is foundational for effective nurse scholar participation in future data science endeavors, such as artificial intelligence (AI) and machine learning (ML) research.

Objective: The aim of the study was to (a) present a foundational, disease-agnostic framework for systematic computable phenotype construction; (b) demonstrate the framework used by exploring the following question: "Does early pubertal timing increase the risk of developing type II diabetes in males?"; and (c) outline the methodological utility and limitations of computable phenotyping for nursing research.

Methods: A proof-of-concept pilot project explored computable phenotype research utility by querying the TriNetX de-identified health record database. Various computable phenotypes were constructed to retrieve complete case frequency counts of specific health records for children experiencing puberty. These retrieved records allowed for quantifying type 2 diabetes (T2D) risk by comparing children diagnosed with precocious puberty (medically diagnosed early puberty) to those without an abnormal puberty diagnosis. A translational science lens informed the extraction and synthesis of the underlying scientific and operational principles relevant to systematic computable phenotyping.

Results: A six-step, disease-agnostic, computable phenotyping framework is synthesized for nurse researchers and clinicians to leverage "big data" applications in their work. The puberty case example-illustrating foundational use of the framework-suggests that males with precocious puberty may be six times more likely to develop T2D when 14-18 years old than those without diagnosed early puberty. The framework provides a foundation for sophisticated statistical analyses, such as leveraging computable phenotypes in multivariate modeling and ML algorithms.

Discussion: The six-step, computable phenotype framework will introduce nurse scholars and clinicians to leverage data science principles in real-world interfaces. Applications using the framework can include generating and testing epidemiologic hypotheses, identifying participants for research with specific clinical attributes, deploying statistical models for healthcare monitoring and decision-making, and participating in future research on AI and ML algorithms. The puberty case example generates foundational evidence to justify future puberty research.

Background: Rapid and objective pressure injury (PI) assessment is crucial for preventing further wound deterioration.

Objectives: This study aimed to develop an image-based intelligent system for PI determination that does not rely on human sensory evaluation.

Methods: An image-based PI determination system was developed using a combination method of feature variable extraction and machine learning. Color and texture features were selected because they are closely related to human sensory evaluation methods. The digital data from these selected feature variables served as the original data set for model construction. Then, the contribution and relationships between the extracted feature variables and model performance were investigated using shapely additive explanations and Spearman algorithms to enhance the robustness of the PI determination model. Additionally, the influence of sample size and K values on model performance was determined for robust model construction.

Results: A k -nearest neighbor algorithm was used to build PI prediction models based on these selected variables and image samples. The classification rate for the best model is 97.22% and 97.08% on the training and test sets, respectively.

Discussion: All results demonstrate that image-based feature variables coupled with machine learning are efficient for PI determination and perhaps other medical diagnoses involving visual recognition.

Background: Despite the beneficial associations of nurse leaders' interpersonal communication competence with job satisfaction, engagement, and reduced burnout among nurses, there has been little research on the topic.

Objectives: To describe nurse leaders' perceptions of interpersonal communication competence.

Methods: A qualitative descriptive study was conducted in the three well-being services counties in Finland between February and April 2024. A total sample of 21 nurse leaders participated. Data were analyzed using abductive content analysis, starting with a deductive phase guided by a conceptual framework of nurse leaders' interpersonal communication competence categories, followed by inductive analysis. Furthermore, the outcome of the analysis was viewed through the theory of interpersonal communication competence.

Results: In addition to the three categories of nurse leaders' interpersonal communication competence-message competence, relational competence, and task competence-the study identified a fourth main category: ethical principles. Alongside these main categories, 27 subcategories were identified. An exploration of the results through the lens of interpersonal communication competence theory showed that the theory's cognitive, behavioral, and affective dimensions were identifiable in the description.

Discussion: Using a unique multidisciplinary methodological solution, the results highlight the complex and adaptive nature of nurse leaders' interpersonal communication competence. It provides a thorough description of nurse leaders' interpersonal communication competence, supported by interpersonal communication competence theory. The results promote an understanding of the interpersonal communication competence required in nursing leadership. To retain competent nurses and ensure quality care, a comprehensive understanding of communication competence in nursing leadership is essential, highlighting the need for further research on this topic.

Background: Adequately powered randomized controlled clinical trials (RCTs) provide the highest level of evidence to support nursing interventions that are thought to improve clinical outcomes. To ensure adequate power, recruitment at multiple study sites is often required. Complexity is exponentiated when RCTs are conducted in multiple settings, especially on an international level. Regardless of logistical challenges, funders typically expect subjects to be enrolled within the first year of funding.

Objective: To describe essential elements that must be considered when launching a multisite RCT.

Methods: Step-by-step review of essential multisite RCT start-up activities using PROSpect , a nurse-led 50+ site international pediatric critical care RCT, as an exemplar. Essential pre- and postaward activities and organizational structure are discussed. The PROSpect launch timeline, with comparisons between United States and international study site initiation, is presented.

Results: In the first 2 years of PROSpect funding (June 15, 2018-June 14, 2020), 54 sites in 13 countries spanning five continents initiated study launch activities and subsequently went on to begin subject screening. Of these, 15 sites (28%) began screening within the first funding year and 29 (54%) within the second year. PROSpect enrolled its first subject prior to the end of the first year of funding. Sites completed launch activities within a median of 295 days of receiving an instructional e-mail delineating study launch steps (IQR: 202, 379; range = 151-1,046). International sites ( n = 19) required more time to launch than U.S. sites ( n = 35; 448 [360, 785] vs. 219 [201, 299] days; p < .001).

Discussion: Nurses must provide care that is supported by the best available evidence. Multisite RCTs are complex but provide high-quality evidence and can be managed with prospective systematic organization. In PROSpect, international sites took approximately twice as long to activate as U.S. sites. When developing a study start-up timeline, it is important to adjust milestones to accommodate the complexities of launching international sites and maintain momentum throughout the process, as start-up delays can increase the risk of trial failure. This paper contributes to recent efforts to demystify and streamline the multisite RCT start-up process for nurse investigators transitioning from conducting single-site to multisite trials.

Background: Falls constitute a public health crisis for older adults. Almost half of older adults have increased symptom burden that limits function and increases fall risk.

Objectives: The aims of this study were to determine if the relationship between symptom burden and outcomes are mediated by falls and whether symptoms further moderate the outcomes of falls.

Methods: Data came from the National Health and Aging Trends Study. Path models were used to test the mediation of the relationship between symptom burden in 2015 and outcomes in 2016 by falls in the past year, as well as the moderation of the effect of falls on outcomes by symptom burden. Models were stratified by age.

Results: There was a significant moderated mediation for participants aged ≥80 years in which higher symptom burden had a direct association with higher risk for hospitalization, an indirect link to higher risk for hospitalization through an increased risk for falls, but a dampening effect on the association between falls and hospitalization. For disability and well-being, falls partially mediated the association between symptom burden and outcomes for those <80 years. For ≥80 years, symptom burden was associated with falls and with the outcome, but there was no mediation. Falls consistently mediate the connection between symptoms and outcomes for those aged 65-79, but not for those aged 80 and older.

Discussion: The results suggest that symptom burden may be a potential assessment tool for identifying the risk for falls in older adults. Further research could explore tailored intervention development for targeting symptom management and fall prevention.

Background: Organizational turnover among nurses is associated with high levels of burnout, which may be exacerbated by workplace discrimination and exclusionary organizational policies. The theory of inclusive organizations suggests that fostering inclusive workplace environments can positively affect job retention.

Objectives: This study examined the role of inclusive hospital policies in shaping nurses' intentions to leave employment. We hypothesized that inclusive policies would reduce turnover intentions among all nurses, with a stronger effect among those experiencing high burnout.

Methods: This cross-sectional study analyzed three survey data sets from 2021: the RN4CAST-NY/IL data collected from registered nurses in New York and Illinois; the Healthcare Equality Index data, which assesses and scores hospitals' inclusion efforts for lesbian, gay, bisexual, transgender, queer or questioning, and other sexual and gender-diverse individuals; and the American Hospital Association Annual Survey. The dependent variable was nurses' intent to leave their employer within a year. The independent variable was the Healthcare Equality Index score, with nurses' high burnout serving as the moderating variable. Multilevel logistic regression with cross-level interaction was employed for the analysis.

Results: A total of 6,294 nurses from 111 hospitals were included in the study. An increase in the total Healthcare Equality Index score was associated with decreased odds of nurses intending to leave their employer. Nurses experiencing high burnout were more likely to intend to leave their employer compared to those without high burnout. Nurses' high-burnout status did not moderate the relationship between hospitals' Healthcare Equality Index scores and nurses' intent to leave.

Discussion: Inclusive hospital policies positively affect job retention regardless of nurses' burnout status. Healthcare organizations should foster inclusive and supportive environments as one strategy to improve nurse retention and organizational stability.