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.
Design
Qualitative case study.
Methods
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).
Results
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.
Conclusion
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.
Clinical Relevance
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.
{"title":"From Task Shifting to Advanced Practice Nursing in Primary Care: A Contextualized Framework for LMICs Informed by Evidence From The Philippines","authors":"Reiner Lorenzo J. Tamayo, T. J. Robinson Moncatar","doi":"10.1111/jnu.70041","DOIUrl":"10.1111/jnu.70041","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Qualitative case study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>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).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Clinical Relevance</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 </div>","PeriodicalId":51091,"journal":{"name":"Journal of Nursing Scholarship","volume":"57 6","pages":"1012-1024"},"PeriodicalIF":2.9,"publicationDate":"2025-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144818090","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
With ambient listening systems increasingly adopted in healthcare, analyzing clinician-patient conversations has become essential. The Omaha System is a standardized terminology for documenting patient care, classifying health problems into four domains across 42 problems and 377 signs/symptoms. Manually identifying and mapping these problems is time-consuming and labor-intensive. This study aims to automate health problem identification from clinician-patient conversations using large language models (LLMs) with retrieval-augmented generation (RAG).
Methods
Using the Omaha System framework, we analyzed 5118 utterances from 22 clinician-patient encounters in home healthcare. RAG-enhanced LLMs detected health problems and mapped them to Omaha System terminology. We evaluated different model configurations, including embedding models, context window sizes, parameter settings (top k, top p), and prompting strategies (zero-shot, few-shot, and chain-of-thought). Three LLMs—Llama 3.1-8B-Instruct, GPT-4o-mini, and GPT-o3-mini—were compared using precision, recall, and F1-score against expert annotations.
Results
The optimal configuration used a 1-utterance context window, top k = 15, top p = 0.6, and few-shot learning with chain-of-thought prompting. GPT-4o-mini achieved the highest F1-score (0.90) for both problem and sign/symptom identification, followed by GPT-o3-mini (0.83/0.82), while Llama 3.1-8B-Instruct performed worst (0.73/0.72).
Conclusions
Using the Omaha System, LLMs with RAG effectively automate health problem identification in clinical conversations. This approach can enhance documentation completeness, reduce documentation burden, and potentially improve patient outcomes through more comprehensive problem identification, translating into tangible improvements in clinical efficiency and care delivery.
Clinical Relevance
Automating health problem identification from clinical conversations can improve documentation accuracy, reduce burden, and ensure alignment with standardized frameworks like the Omaha System, enhancing care quality and continuity in home healthcare.
背景：随着环境听力系统越来越多地应用于医疗保健，分析临床医生与患者的对话变得至关重要。奥马哈系统是用于记录患者护理的标准化术语，将健康问题分为四个领域，涉及42个问题和377个体征/症状。手动识别和映射这些问题既耗时又费力。本研究旨在使用检索增强生成（RAG）的大型语言模型（llm）从临床-患者对话中自动识别健康问题。方法：采用奥马哈系统框架，对22例家庭医疗中临床患者的5118次话语进行分析。rag增强的llm检测健康问题并将其映射到Omaha系统术语。我们评估了不同的模型配置，包括嵌入模型、上下文窗口大小、参数设置（top k、top p）和提示策略（零射击、少射击和思维链）。对三种llms——llama 3.1- 8b - instruction、gpt - 40 -mini和gpt - 03 -mini进行了精度、召回率和专家注释的f1分数的比较。结果：最优配置使用1个话语上下文窗口，top k = 15, top p = 0.6，以及使用思维链提示的少镜头学习。在问题和体征/症状识别方面，gpt - 40 -mini得分最高（0.90），其次是gpt - 03 -mini(0.83/0.82)，而Llama 3.1-8B-Instruct得分最差（0.73/0.72）。结论：使用Omaha系统，具有RAG的法学硕士在临床对话中有效地自动识别健康问题。这种方法可以提高文档的完整性，减少文档负担，并有可能通过更全面的问题识别来改善患者的结果，转化为临床效率和护理交付方面的切实改进。临床相关性：从临床对话中自动识别健康问题可以提高文档的准确性，减轻负担，并确保与奥马哈系统等标准化框架保持一致，从而提高家庭医疗保健的护理质量和连续性。
{"title":"From Conversation to Standardized Terminology: An LLM-RAG Approach for Automated Health Problem Identification in Home Healthcare","authors":"Zhihong Zhang, Pallavi Gupta, Jiyoun Song, Maryam Zolnoori, Maxim Topaz","doi":"10.1111/jnu.70039","DOIUrl":"10.1111/jnu.70039","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>With ambient listening systems increasingly adopted in healthcare, analyzing clinician-patient conversations has become essential. The Omaha System is a standardized terminology for documenting patient care, classifying health problems into four domains across 42 problems and 377 signs/symptoms. Manually identifying and mapping these problems is time-consuming and labor-intensive. This study aims to automate health problem identification from clinician-patient conversations using large language models (LLMs) with retrieval-augmented generation (RAG).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Using the Omaha System framework, we analyzed 5118 utterances from 22 clinician-patient encounters in home healthcare. RAG-enhanced LLMs detected health problems and mapped them to Omaha System terminology. We evaluated different model configurations, including embedding models, context window sizes, parameter settings (<i>top k, top p</i>), and prompting strategies (zero-shot, few-shot, and chain-of-thought). Three LLMs—Llama 3.1-8B-Instruct, GPT-4o-mini, and GPT-o3-mini—were compared using precision, recall, and F1-score against expert annotations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The optimal configuration used a 1-utterance context window, <i>top k</i> = 15, <i>top p</i> = 0.6, and few-shot learning with chain-of-thought prompting. GPT-4o-mini achieved the highest F1-score (0.90) for both problem and sign/symptom identification, followed by GPT-o3-mini (0.83/0.82), while Llama 3.1-8B-Instruct performed worst (0.73/0.72).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Using the Omaha System, LLMs with RAG effectively automate health problem identification in clinical conversations. This approach can enhance documentation completeness, reduce documentation burden, and potentially improve patient outcomes through more comprehensive problem identification, translating into tangible improvements in clinical efficiency and care delivery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Clinical Relevance</h3>\u0000 \u0000 <p>Automating health problem identification from clinical conversations can improve documentation accuracy, reduce burden, and ensure alignment with standardized frameworks like the Omaha System, enhancing care quality and continuity in home healthcare.</p>\u0000 </section>\u0000 </div>","PeriodicalId":51091,"journal":{"name":"Journal of Nursing Scholarship","volume":"57 6","pages":"1003-1011"},"PeriodicalIF":2.9,"publicationDate":"2025-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144818089","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<div> <section> <h3> Background</h3> <p>Patients with advanced cancer can suffer from serious distress like death anxiety and depression, in addition to facing a reduced quality of life. Death education interventions have been shown to improve these outcomes, but their effectiveness remains unclear, especially in the advanced stages.</p> </section> <section> <h3> Objective</h3> <p>This meta-analysis aimed to examine the efficacy of death education interventions on death anxiety, depression, and quality of life in advanced cancer sufferers, and to explore the influence of the intervention site, duration, the age of participants, and dyadic relationships with caregivers on the effectiveness of these interventions.</p> </section> <section> <h3> Design</h3> <p>A meta-analysis of randomized controlled trials was performed.</p> </section> <section> <h3> Methods</h3> <p>A systematic search of 10 electronic databases identified 19 eligible RCTs with 1531 participants. Data were extracted and analyzed via Review Manager 5.4. Subgroup analyses were performed on the basis of the intervention site, duration, age of participants, and presence of caregivers.</p> </section> <section> <h3> Results</h3> <p>In comparison to the control intervention, the death education intervention notably alleviated death anxiety (SMD = −2.11, 95% CI: −5.91 to −0.89, <i>p</i> = 0.008) and depression (SMD = −0.45, 95% CI: −0.72 to −0.18, <i>p</i> = 0.001). Quality of life (SMD = 0.86, 95% CI: 0.39–1.33, <i>p</i> = 0.0003) was also significantly improved. Subgroup analyses revealed that interventions with longer durations, conducted in professional settings, and targeting younger patients were more likely to be effective in reducing depression and enhancing the quality of life. Interventions without family companionship were more effective in improving depression, while interventions with family companionship were more effective in improving quality of life.</p> </section> <section> <h3> Conclusion</h3> <p>Death education interventions are effective at improving death anxiety, depression, and quality of life in patients with advanced cancer. Tailoring interventions to individual features and cultural backgrounds is crucial to achieving the best effect.</p> </section> <section> <h3> Clinical Relevance</h3> <p>Death education is an effective and important intervention measure that can help patients with advanced cancer better cop
{"title":"The Effectiveness of Death Education on Death Anxiety, Depression, and Quality of Life in Patients With Advanced Cancer: A Meta-Analysis of Randomised Controlled Trials","authors":"Yawen Su, Shu Zhang, Liyang Duan, Xiaolin Hu","doi":"10.1111/jnu.70037","DOIUrl":"10.1111/jnu.70037","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Patients with advanced cancer can suffer from serious distress like death anxiety and depression, in addition to facing a reduced quality of life. Death education interventions have been shown to improve these outcomes, but their effectiveness remains unclear, especially in the advanced stages.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This meta-analysis aimed to examine the efficacy of death education interventions on death anxiety, depression, and quality of life in advanced cancer sufferers, and to explore the influence of the intervention site, duration, the age of participants, and dyadic relationships with caregivers on the effectiveness of these interventions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>A meta-analysis of randomized controlled trials was performed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic search of 10 electronic databases identified 19 eligible RCTs with 1531 participants. Data were extracted and analyzed via Review Manager 5.4. Subgroup analyses were performed on the basis of the intervention site, duration, age of participants, and presence of caregivers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In comparison to the control intervention, the death education intervention notably alleviated death anxiety (SMD = −2.11, 95% CI: −5.91 to −0.89, <i>p</i> = 0.008) and depression (SMD = −0.45, 95% CI: −0.72 to −0.18, <i>p</i> = 0.001). Quality of life (SMD = 0.86, 95% CI: 0.39–1.33, <i>p</i> = 0.0003) was also significantly improved. Subgroup analyses revealed that interventions with longer durations, conducted in professional settings, and targeting younger patients were more likely to be effective in reducing depression and enhancing the quality of life. Interventions without family companionship were more effective in improving depression, while interventions with family companionship were more effective in improving quality of life.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Death education interventions are effective at improving death anxiety, depression, and quality of life in patients with advanced cancer. Tailoring interventions to individual features and cultural backgrounds is crucial to achieving the best effect.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Clinical Relevance</h3>\u0000 \u0000 <p>Death education is an effective and important intervention measure that can help patients with advanced cancer better cop","PeriodicalId":51091,"journal":{"name":"Journal of Nursing Scholarship","volume":"57 6","pages":"941-956"},"PeriodicalIF":2.9,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144765748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Siobhan O'Connor, Crina Grosan, Rebecca J. Oakey, Mengying Zhang, Xiaoyang Li, Emma Stanmore, David Woodcock, Jo Armes, Joanne Cull
<p>Clinical research networks (CRNs) are growing in popularity due to the complex and interdisciplinary nature of health research and the need to generate robust scientific evidence that improves patient outcomes and healthcare delivery (Brown et al. <span>2016</span>). These networks can include a range of nursing and other researchers, practicing clinicians from different specialties, Patient and Public Involvement and Engagement (PPIE) members, and administrative staff. Such networks can facilitate research collaboration in a topic area, strengthen education and training, and build researcher capacity alongside improving the research culture and environment (Robinson et al. <span>2015</span>). Several nursing-specific CRNs are active, such as a kidney care research network in the United Kingdom (Anderson <span>2020</span>), a global network on disability nursing (Fisher et al. <span>2024</span>), and a national clinical nurse leadership network in the United States (Bender et al. <span>2019</span>), all of which report positive outcomes as well as challenges with setting up, running, and evaluating the networks activities. Nurses are also involved in broader multidisciplinary research networks that focus on specific research methods such as clinical trials (Gurwitz et al. <span>2022</span>; Toups et al. <span>2023</span>) or health-related topics like COVID-19 (DeVoe et al. <span>2020</span>).</p><p>CRNs are often established to facilitate the generation of scientific evidence in a subject area and improve the flow of new knowledge, while supporting the professional development and career pipeline of clinical researchers. Ultimately, their goal is to improve healthcare delivery and quality of care by speeding up the translation of research evidence into professional practice, so new solutions to improve patient care and population health can be introduced into health systems nationally and internationally (Lopes et al. <span>2024</span>).</p><p>With the emergence of artificial intelligence (AI) and its rapidly evolving pace, AI models and AI tools are starting to be developed and introduced in healthcare. A recent systematic review found many applications of AI in nursing across a broad range of areas of clinical practice (O'Connor et al. <span>2023</span>). However, it highlighted that nurses lack of knowledge and skill in AI could hamper its development and integration in healthcare, as well as limit opportunities for nurses in their professional careers and their ability to support patients and families with AI-based health technologies. A recent special issue of the <i>Journal of Nursing Scholarship</i> also focused on the role of AI in nursing and included a range of primary research studies, some of which emphasised the same barriers in relation to introducing AI in nursing (Sigma Nursing <span>2025</span>).</p><p>With this in mind, a group of nursing scholars with support from colleagues in AI and data science established the world's fi
临床研究网络（crn）越来越受欢迎，这是由于健康研究的复杂性和跨学科性质，以及需要产生强有力的科学证据，以改善患者的治疗结果和医疗保健服务（Brown et al. 2016）。这些网络可以包括一系列护理和其他研究人员，来自不同专业的执业临床医生，患者和公众参与和参与（PPIE）成员以及行政人员。这样的网络可以促进一个主题领域的研究合作，加强教育和培训，并在改善研究文化和环境的同时建立研究人员的能力（Robinson et al. 2015）。一些护理特异性crn正在活跃，例如英国的肾脏护理研究网络（Anderson 2020），全球残疾护理网络（Fisher等人，2024）和美国的国家临床护士领导网络（Bender等人，2019），所有这些都报告了积极的结果以及建立，运行和评估网络活动的挑战。护士还参与了更广泛的多学科研究网络，这些研究网络侧重于特定的研究方法，如临床试验（Gurwitz等人，2022；Toups等人，2023）或与健康相关的主题，如COVID-19 （DeVoe等人，2020）。crn的建立通常是为了促进一个学科领域的科学证据的产生，改善新知识的流动，同时支持临床研究人员的专业发展和职业发展。最终，他们的目标是通过加速将研究证据转化为专业实践来改善医疗保健服务和护理质量，因此可以将改善患者护理和人口健康的新解决方案引入国家和国际卫生系统（Lopes et al. 2024）。随着人工智能（AI）的出现及其快速发展的步伐，人工智能模型和人工智能工具开始被开发和引入医疗保健领域。最近的一项系统综述发现，人工智能在广泛的临床实践领域的护理中有许多应用（O'Connor et al. 2023）。然而，它强调指出，护士缺乏人工智能方面的知识和技能，可能会阻碍人工智能在医疗保健领域的发展和整合，并限制护士在职业生涯中的机会，以及她们利用基于人工智能的卫生技术为患者和家庭提供支持的能力。《护理学术杂志》最近的一期特刊也关注了人工智能在护理中的作用，包括一系列初步研究，其中一些研究强调了在护理中引入人工智能的同样障碍（Sigma Nursing 2025）。为此，一群护理学者在人工智能和数据科学同事的支持下，建立了世界上第一个人工智能护理临床研究网络。在获得新CRN的资金后，我们于2024年12月在伦敦盖伊和圣托马斯NHS基金会信托基金的年度护士和助产士研究中心（ACORN）研究展示会上推出了人工智能护士网络（www.ai-nurses.com）。借鉴以往和现有护理crn的经验教训，我们设计了该网络，通过为护士提供一套免费访问和使用的资源、活动和机会，支持和推进护士在人工智能领域的作用。目前，该网络在全球拥有900多名会员，其中包括英国、加拿大和澳大利亚的护士。我们还建立了一个独立的咨询委员会，为新的网络提供持续的建议和支持。为了解决护理专业中人工智能素养的差距，我们正在利用由UKRI资助的现有在线培训计划“创新学者计划：通过技能培训实现大数据革命”，并在人工智能护士网络网站上分享免费电子学习课程套件的网页链接。这些课程涵盖了一系列人工智能和数据科学主题，是专门为医疗保健人员量身定制的，旨在帮助护士等专业人员学习这一新技术趋势的基础知识（表1）。这些课程提供的知识和技能与NHS英格兰人工智能和数字医疗技术能力框架（NHS英格兰2025）保持一致，使护士能够为其职业生涯建立一系列数字能力。对于那些没有数据经验的人来说，作为表1基础知识的先驱，一个基础入门课程也可以在Future Learn （https://www.futurelearn.com/courses/introduction-to-data-science-for-healthcare-professionals）上免费获得。此外，我们录制了一个介绍性网络研讨会，涵盖人工智能的关键概念及其在护理中的应用，该研讨会可在人工智能护士网络专用YouTube频道（https://www.youtube.com/channel/UCavb447TmIdCICmik0nC9yQ）上获得。 该频道还定期举办网络研讨会，我们记录了世界各地的护士在教育和临床实践中进行人工智能研究的情况，以帮助在专业人士中传播人工智能知识。我们还提供了一系列定制的在线培训研讨会，将于2025年夏季及以后举办，其中一些课程将被录制并在youtube频道上播出。其中包括教育护士如何访问和清理数字健康数据集，为预测建模做好准备，如何选择适当的机器学习算法或其他人工智能技术，以及如何开发和验证医疗保健人工智能模型（Charow et al. 2021）。此外，我们最近宣布了一项学生奖学金，以支持一名本科护理专业的学生参与人工智能护士网络。首届获奖者是一名大四本科儿童护理专业的学生，他正在参与我们正在进行的人工智能研究（Moldovan等人，2025；Rodger和O’connor, 2025）。我们希望现有的培训资源和奖学金将帮助全球护士掌握必要的人工智能专业知识，帮助他们为专业实践和患者护理提供证据。人工智能护士网络还提供种子资金，以支持创新和转化护士主导的人工智能临床研究的发展，这为患者护理和人口健康创造了积极的变化和价值（Morassaei et al. 2023）。特别是，我们寻求资助试点研究，这些研究可以从财政支持中受益，从而转化为竞争性应用，以获得更大的研究资助。我们的第一次种子融资于1月初开始，并于2025年2月底结束，提供从1万英镑到2万英镑的两级融资。我们收到了大量的申请，经过严格的评估，产生了三个资助的研究项目。由英格兰和苏格兰的大学和NHS信托基金的护士领导的研究涵盖了从心血管健康到术后恢复、护理工作流程和操作效率的一系列主题。我们期待着在未来几个月看到这些护士主导的人工智能研究项目的成果和影响，并希望能够每年为英国各地及其他地区的护士提供种子资金。最后，我们向护士推广各种人工智能活动和资源，以确保他们能够与人工智能研究人员、行业和其他利益相关者见面，提出他们对人工智能研究的想法，并了解最新的前沿人工智能研究、政策和法规，以及用于人工智能研究的其他培训和资金。我们建立并运营了一个专门针对人工智能护士网络（https://www.linkedin.com/groups/13072130/）的LinkedIn小组，并每月发送电子通讯，与网络成员分享与人工智能相关的内容。这些时事通讯也被存档在网站上，并在LinkedIn的网络群组中共享。该通讯总结了与护理相关的人工智能培训、资助和已发表的研究，并重点介绍了即将举行的人工智能会议和护士可以参加或在线访问的其他活动。我们也在计划自己的一系列活动，首先是将于2025年9月在伦敦举行的关于护理领域人工智能的黑客马拉松。护理领域的黑客马拉松有可能产生新的想法，以及创业项目和商业企业（Kagan等人，2023），我们希望这将使参加的护士受益。尽管人工智能护士网络仍处于起步阶段，但有早期迹象表明，它将有助于在专业人士之间分享人工智能知识，提高护士在人工智能方面的技能，并促进护士主导的人工智能研究，从而改善患者护理。从人工智能的角度来看，开发一个专注于护理中的人工智能的CRN是支持医疗保健创新的及时而重要的一步，
{"title":"AI Nurses Network: The Importance of Clinical Research Networks in Nursing","authors":"Siobhan O'Connor, Crina Grosan, Rebecca J. Oakey, Mengying Zhang, Xiaoyang Li, Emma Stanmore, David Woodcock, Jo Armes, Joanne Cull","doi":"10.1111/jnu.70042","DOIUrl":"10.1111/jnu.70042","url":null,"abstract":"<p>Clinical research networks (CRNs) are growing in popularity due to the complex and interdisciplinary nature of health research and the need to generate robust scientific evidence that improves patient outcomes and healthcare delivery (Brown et al. <span>2016</span>). These networks can include a range of nursing and other researchers, practicing clinicians from different specialties, Patient and Public Involvement and Engagement (PPIE) members, and administrative staff. Such networks can facilitate research collaboration in a topic area, strengthen education and training, and build researcher capacity alongside improving the research culture and environment (Robinson et al. <span>2015</span>). Several nursing-specific CRNs are active, such as a kidney care research network in the United Kingdom (Anderson <span>2020</span>), a global network on disability nursing (Fisher et al. <span>2024</span>), and a national clinical nurse leadership network in the United States (Bender et al. <span>2019</span>), all of which report positive outcomes as well as challenges with setting up, running, and evaluating the networks activities. Nurses are also involved in broader multidisciplinary research networks that focus on specific research methods such as clinical trials (Gurwitz et al. <span>2022</span>; Toups et al. <span>2023</span>) or health-related topics like COVID-19 (DeVoe et al. <span>2020</span>).</p><p>CRNs are often established to facilitate the generation of scientific evidence in a subject area and improve the flow of new knowledge, while supporting the professional development and career pipeline of clinical researchers. Ultimately, their goal is to improve healthcare delivery and quality of care by speeding up the translation of research evidence into professional practice, so new solutions to improve patient care and population health can be introduced into health systems nationally and internationally (Lopes et al. <span>2024</span>).</p><p>With the emergence of artificial intelligence (AI) and its rapidly evolving pace, AI models and AI tools are starting to be developed and introduced in healthcare. A recent systematic review found many applications of AI in nursing across a broad range of areas of clinical practice (O'Connor et al. <span>2023</span>). However, it highlighted that nurses lack of knowledge and skill in AI could hamper its development and integration in healthcare, as well as limit opportunities for nurses in their professional careers and their ability to support patients and families with AI-based health technologies. A recent special issue of the <i>Journal of Nursing Scholarship</i> also focused on the role of AI in nursing and included a range of primary research studies, some of which emphasised the same barriers in relation to introducing AI in nursing (Sigma Nursing <span>2025</span>).</p><p>With this in mind, a group of nursing scholars with support from colleagues in AI and data science established the world's fi","PeriodicalId":51091,"journal":{"name":"Journal of Nursing Scholarship","volume":"57 6","pages":"887-890"},"PeriodicalIF":2.9,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sigmapubs.onlinelibrary.wiley.com/doi/epdf/10.1111/jnu.70042","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144765784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Noppamas Pipatpiboon, Jirapas Sripetchwandee, Daniel Bressington
Introduction
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).
Design
A cross-sectional observational study.
Methods
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.
Results
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 R2 = 0.382).
Conclusions
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
2型糖尿病（T2DM）并发症引起的痴呆显著影响老年人的生活质量，增加了患者及其家人的痛苦。许多研究已经确定自我管理是采取适当的健康行为以预防糖尿病相关并发症的关键因素。然而，在国际上，个体和家庭过程因素预测老年2型糖尿病患者痴呆预防行为的经验证据不足。因此，我们旨在探讨基于个人和家庭自我管理理论（IFSMT）的痴呆症预防自我管理行为（结果维度）如何与情境和过程维度相关。设计：横断面观察性研究。方法：来自清迈6家社区医院的444名老年T2DM患者完成了有效可靠的自我报告测量，包括社会人口学问卷、痴呆预防个人和家庭自我管理过程问卷（DP-IFSM-PQ）和痴呆预防自我管理行为问卷（DPSMBQ）。数据分析采用双变量相关、偏相关和多元线性回归逐步方法。结果：大多数参与者表现出高水平的个人和家庭自我管理过程和痴呆预防自我管理行为。双变量和偏相关分析显示DP-IFSM-PQ和DPSMBQ得分之间存在显著相关性。逐步多元线性回归发现，自我效能感（DP-IFSM-PQ的一个子域）是DPSMBQ得分的最强预测因子。其他重要的预测因素包括家庭成员、邻居和社区对痴呆症预防的认识；家庭收入充足；共病史；到医院的距离；知识和信念（DP-IFSM-PQ的子领域）。回归模型差异有统计学意义（F [1,437] = 46.662, p = 0.000，调整后R2 = 0.382）。结论：基于IFSMT的自我效能感、知识和信念是老年T2DM患者痴呆预防行为的关键预测因素。这些预测因子可作为促进老年T2DM患者痴呆预防自我管理行为的后续共同设计研究的潜在干预成分。研究结果还强调了家庭成员和医疗保健提供者在支持老年2型糖尿病患者加强痴呆症预防行为方面的重要性。
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Jenifer Malumbres-Talavera, Alberto Gallart, Cristina Monforte-Royo
Introduction
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.
Aim
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.
Design
Quasi-experimental, longitudinal study involving non-randomized experimental and control groups and follow-up at 3–6 months post-intervention.
Methods
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.
Results
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), sugges
{"title":"The Wish to Die in Older Adults and Its Relationship to Burden and Depressive Symptoms in Home Care Workers: A Quasi-Experimental Longitudinal Study","authors":"Jenifer Malumbres-Talavera, Alberto Gallart, Cristina Monforte-Royo","doi":"10.1111/jnu.70036","DOIUrl":"10.1111/jnu.70036","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Quasi-experimental, longitudinal study involving non-randomized experimental and control groups and follow-up at 3–6 months post-intervention.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>At the start of the study, all care workers (<i>n</i> = 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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>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 (<i>p</i> = 0.032) and among controls (<i>p</i> = 0.028). By contrast, this significant association was not found for care workers in the experimental group (<i>p</i> = 0.376), sugges","PeriodicalId":51091,"journal":{"name":"Journal of Nursing Scholarship","volume":"57 5","pages":"874-881"},"PeriodicalIF":2.9,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144651155","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<div> <section> <h3> Introduction</h3> <p>Socially assistive robots (SARs) have been used in group interventions for older adults; however, their effectiveness remains unclear. This systematic review aimed to synthesize evidence on the efficacy of group interventions with SARs on various outcomes (physical, cognitive, psychological, quality of life, therapeutic engagement, and sociality) for older adults, and the factors that influence their effectiveness.</p> </section> <section> <h3> Design and Method</h3> <p>A literature search was conducted using five databases (Web of Science, PubMed, Scopus, PsycINFO, and MEDLINE) in October 2024. The research team selected and analyzed the studies applying a narrative synthesis.</p> </section> <section> <h3> Results</h3> <p>In all, 25 articles were identified, 15 of which were deemed of good quality. We found that companion robots are commonly used in group interventions for older adults that consist of physical, cognitive, and combined physical and cognitive activities. Insufficient evidence was identified on the effectiveness of physical interventions and groups with physical and cognitive activities on health outcomes (i.e., physical, cognitive, psychological, and quality of life). Regarding the cognitive group interventions, positive physical outcomes (i.e., improved sleep quality, decreased pulse rate, and increased pulse oximetry), improved cognitive function, positive psychological outcomes (i.e., decreased agitation, depression, anxiety, and loneliness, and increased positive emotions) were found; however, the positive effects in terms of cognitive level and certain psychological outcomes were comparable to the control groups. Mixed results were reported for quality of life in older adults. Across the three types of interventions, robots facilitated engagement and increased the sociality of most older adults. The effectiveness depended on the cognitive function of the older adults, the presence of staff, the type of robot, and the schedule of the interventions.</p> </section> <section> <h3> Conclusion</h3> <p>Research gaps have been identified, and more rigorous studies investigating the effectiveness of different types of group interventions in older adults are needed before applying SARs in group interventions on a large scale.</p> </section> <section> <h3> Clinical Relevance</h3> <p>Given the importance of group interventions in nursing care of older adults, healthcare professionals can use social
社会辅助机器人（SARs）已被用于老年人的群体干预；然而，它们的有效性仍不清楚。本系统综述旨在综合SARs群体干预对老年人各种结局（身体、认知、心理、生活质量、治疗参与和社交）的有效性的证据，以及影响其有效性的因素。设计与方法：于2024年10月对Web of Science、PubMed、Scopus、PsycINFO、MEDLINE五个数据库进行文献检索。研究小组采用叙事综合的方法对研究进行了选择和分析。结果：共鉴定出25篇文献，其中15篇为优质文献。我们发现同伴机器人通常用于老年人的群体干预，包括身体、认知以及身体和认知相结合的活动。关于身体干预措施以及进行身体和认知活动的群体对健康结果（即身体、认知、心理和生活质量）的有效性，已确定的证据不足。在认知组干预中，发现了积极的身体结果（即改善睡眠质量，降低脉搏率，提高脉搏血氧饱和度），改善认知功能，积极的心理结果（即减少躁动，抑郁，焦虑和孤独，增加积极情绪）；然而，在认知水平和某些心理结果方面的积极影响与对照组相当。报道了老年人生活质量的不同结果。在这三种干预措施中，机器人促进了大多数老年人的参与，增加了他们的社交能力。其有效性取决于老年人的认知功能、工作人员的存在、机器人的类型和干预的时间表。结论：研究空白已经确定，在大规模应用SARs进行群体干预之前，需要更严格的研究来调查不同类型的老年人群体干预的有效性。临床相关性：考虑到群体干预在老年人护理中的重要性，医疗保健专业人员可以在这种干预中使用社交辅助机器人来帮助照顾老年人。
{"title":"Effectiveness of Group Interventions With Socially-Assistive Robots for Older Adults: A Systematic Review","authors":"Yong-Xin Ruan, Mei-Chun Cheung","doi":"10.1111/jnu.70035","DOIUrl":"10.1111/jnu.70035","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Socially assistive robots (SARs) have been used in group interventions for older adults; however, their effectiveness remains unclear. This systematic review aimed to synthesize evidence on the efficacy of group interventions with SARs on various outcomes (physical, cognitive, psychological, quality of life, therapeutic engagement, and sociality) for older adults, and the factors that influence their effectiveness.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design and Method</h3>\u0000 \u0000 <p>A literature search was conducted using five databases (Web of Science, PubMed, Scopus, PsycINFO, and MEDLINE) in October 2024. The research team selected and analyzed the studies applying a narrative synthesis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In all, 25 articles were identified, 15 of which were deemed of good quality. We found that companion robots are commonly used in group interventions for older adults that consist of physical, cognitive, and combined physical and cognitive activities. Insufficient evidence was identified on the effectiveness of physical interventions and groups with physical and cognitive activities on health outcomes (i.e., physical, cognitive, psychological, and quality of life). Regarding the cognitive group interventions, positive physical outcomes (i.e., improved sleep quality, decreased pulse rate, and increased pulse oximetry), improved cognitive function, positive psychological outcomes (i.e., decreased agitation, depression, anxiety, and loneliness, and increased positive emotions) were found; however, the positive effects in terms of cognitive level and certain psychological outcomes were comparable to the control groups. Mixed results were reported for quality of life in older adults. Across the three types of interventions, robots facilitated engagement and increased the sociality of most older adults. The effectiveness depended on the cognitive function of the older adults, the presence of staff, the type of robot, and the schedule of the interventions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Research gaps have been identified, and more rigorous studies investigating the effectiveness of different types of group interventions in older adults are needed before applying SARs in group interventions on a large scale.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Clinical Relevance</h3>\u0000 \u0000 <p>Given the importance of group interventions in nursing care of older adults, healthcare professionals can use social","PeriodicalId":51091,"journal":{"name":"Journal of Nursing Scholarship","volume":"57 6","pages":"919-940"},"PeriodicalIF":2.9,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sigmapubs.onlinelibrary.wiley.com/doi/epdf/10.1111/jnu.70035","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144651154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Yu Ding, Rong-Rong Han, Yong-fang Deng, Bernice O. C. Lam Nogueira, Ling-Ling Gao
Introduction
Pregnancy can cause stress for couples, potentially leading to anxiety. However, most studies on antepartum anxiety focus on expectant mothers, ignoring the expectant fathers and the stress transmission between couples. We aim to examine the mediation of dyadic coping between antepartum anxiety and stress in expectant mothers and fathers.
Design
We implemented a cross-sectional study in Guangzhou, China, from October 2023 to January 2024.
Methods
Three-hundred and twenty-nine Chinese pregnant couples completed the Perceived Stress Scale, the Dyadic Coping Inventory, and the State–Trait Anxiety Inventory. The actor-partner interdependence mediation model was used for data analysis.
Results
Expectant mothers experienced antepartum anxiety symptoms at a rate of 42.6%, while the rate for expectant fathers was 32.5%. Regarding the actor effects, stress was positively associated with antepartum anxiety in expectant mothers (β = 0.66, 95% confidence interval CI [0.56, 0.74]) and fathers (β = 0.58, 95% CI [0.42, 0.70]), with dyadic coping acting as a mediator (expectant mothers: β = 0.08, 95% CI [0.03, 0.14]; fathers: β = 0.11, 95% CI [0.04, 0.19]). Regarding the partner effects, maternal dyadic coping was positively associated with paternal stress (β = 0.10, 95% CI [0.01, 0.19]).
Conclusion
The study highlights the interplay of stress, dyadic coping, and antepartum anxiety in expectant mothers and fathers, emphasizing the need to assess their antepartum anxiety and implement couple-centered interventions to enhance their psychological well-being during the first trimester of pregnancy.
Clinical Relevance
This study highlights the importance of assessing antepartum anxiety in both expectant mothers and fathers, emphasizing the mediation of dyadic coping in reducing stress and anxiety. The findings support the integration of couple-centered mental health interventions into routine antepartum care to enhance psychological well-being during pregnancy.
{"title":"Antepartum Anxiety, Dyadic Coping, and Stress Among Chinese Pregnant Couples: The Actor-Partner Interdependence Mediation Model","authors":"Yu Ding, Rong-Rong Han, Yong-fang Deng, Bernice O. C. Lam Nogueira, Ling-Ling Gao","doi":"10.1111/jnu.70030","DOIUrl":"10.1111/jnu.70030","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Pregnancy can cause stress for couples, potentially leading to anxiety. However, most studies on antepartum anxiety focus on expectant mothers, ignoring the expectant fathers and the stress transmission between couples. We aim to examine the mediation of dyadic coping between antepartum anxiety and stress in expectant mothers and fathers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>We implemented a cross-sectional study in Guangzhou, China, from October 2023 to January 2024.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Three-hundred and twenty-nine Chinese pregnant couples completed the Perceived Stress Scale, the Dyadic Coping Inventory, and the State–Trait Anxiety Inventory. The actor-partner interdependence mediation model was used for data analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Expectant mothers experienced antepartum anxiety symptoms at a rate of 42.6%, while the rate for expectant fathers was 32.5%. Regarding the actor effects, stress was positively associated with antepartum anxiety in expectant mothers (<i>β</i> = 0.66, 95% confidence interval CI [0.56, 0.74]) and fathers (<i>β</i> = 0.58, 95% CI [0.42, 0.70]), with dyadic coping acting as a mediator (expectant mothers: <i>β</i> = 0.08, 95% CI [0.03, 0.14]; fathers: <i>β</i> = 0.11, 95% CI [0.04, 0.19]). Regarding the partner effects, maternal dyadic coping was positively associated with paternal stress (<i>β</i> = 0.10, 95% CI [0.01, 0.19]).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The study highlights the interplay of stress, dyadic coping, and antepartum anxiety in expectant mothers and fathers, emphasizing the need to assess their antepartum anxiety and implement couple-centered interventions to enhance their psychological well-being during the first trimester of pregnancy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Clinical Relevance</h3>\u0000 \u0000 <p>This study highlights the importance of assessing antepartum anxiety in both expectant mothers and fathers, emphasizing the mediation of dyadic coping in reducing stress and anxiety. The findings support the integration of couple-centered mental health interventions into routine antepartum care to enhance psychological well-being during pregnancy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":51091,"journal":{"name":"Journal of Nursing Scholarship","volume":"57 5","pages":"838-847"},"PeriodicalIF":2.9,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144638627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Willyane de Andrade Alvarenga, Ana Carolina Andrade Biaggi Leite, Thalicia Mendes de Carvalho, Barbara Victórya da Silva Gonzaga, Maria Francisca Soares de Morais, Larissa Pereira da Silva, Zaida Charepe, Lucila Castanheira Nascimento
<div> <section> <h3> Introduction</h3> <p>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.</p> </section> <section> <h3> Design</h3> <p>Scoping review.</p> </section> <section> <h3> Methods</h3> <p>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.</p> </section> <section> <h3> Results</h3> <p>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.</p> </section> <section> <h3> Conclusions</h3> <p>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.</p> </section> <section> <h3> Clinical Relevance</h3> <p>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.</p> <
{"title":"Hope-Promoting Communication With Pediatric Patients With Chronic Diseases and Their Families: A Scoping Review","authors":"Willyane de Andrade Alvarenga, Ana Carolina Andrade Biaggi Leite, Thalicia Mendes de Carvalho, Barbara Victórya da Silva Gonzaga, Maria Francisca Soares de Morais, Larissa Pereira da Silva, Zaida Charepe, Lucila Castanheira Nascimento","doi":"10.1111/jnu.70034","DOIUrl":"10.1111/jnu.70034","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Scoping review.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Clinical Relevance</h3>\u0000 \u0000 <p>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.</p>\u0000 <","PeriodicalId":51091,"journal":{"name":"Journal of Nursing Scholarship","volume":"57 5","pages":"776-788"},"PeriodicalIF":2.9,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144592808","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mistriage is important because of its potential for serious consequences, notwithstanding the beneficial effects of the emergency patient classification system employed to alleviate overcrowding in emergency departments (EDs). This study aimed to assess mistriage using the Korean Triage and Acuity Scale (KTAS) and identify factors influencing it.
Design
Retrospective cross-sectional study.
Methods
We examined the factors influencing mistriage in the KTAS and rates of under- and over-triage. Participants were obtained by combining electronic health records with registry data from the National Emergency Department Information System. We assessed the eligibility of patients aged ≥ 15 years who visited the ED between July 1, 2022, and June 30, 2023. Using the KTAS classification criterion, two experienced experts determined the final acuity level. We employed multivariate logistic regression analysis to evaluate the factors that predict under- and over-triage.
Results
Of 53,947 ED encounters, 1110 participants were enrolled in this study. Mistriage occurred in 207 (18.6%) patients: 88 (7.9%) had under-triage, and 119 (10.7%) had over-triage. In adjusted analyses, under-triage was associated with lower mean arterial pressure (odds ratio [OR], 5.42; 95% confidence interval [CI], 1.45–20.32) and presenting complaints of immunity or fever (OR, 3.41; 95% CI, 1.38–8.45), while over-triage was associated with advanced age (OR, 0.52; 95% CI, 0.28–0.98), pain (OR, 1.96; 95% CI, 1.18–3.25), lower KTAS experience (OR, 1.95; 95% CI, 1.08–3.51), and several specific present complaints.
Conclusions
By improving mistriage, the quality of emergency medical services may be enhanced through reduced costs, increased operational efficiency, and improved patient safety and satisfaction. Implementation of standardized criteria, validated triage tools, and enhanced provider training is crucial for achieving more accurate emergency triage. Additionally, establishing regulatory and financial incentives and developing realistic standards for mistriage management will optimize triage processes and ensure prompt, prioritized care.
{"title":"Factors Influencing Mistriage Based on the Korean Triage and Acuity Scale: A Retrospective Cross-Sectional Study","authors":"Nayeon Yi, Dain Baik","doi":"10.1111/jnu.70033","DOIUrl":"10.1111/jnu.70033","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Mistriage is important because of its potential for serious consequences, notwithstanding the beneficial effects of the emergency patient classification system employed to alleviate overcrowding in emergency departments (EDs). This study aimed to assess mistriage using the Korean Triage and Acuity Scale (KTAS) and identify factors influencing it.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Retrospective cross-sectional study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We examined the factors influencing mistriage in the KTAS and rates of under- and over-triage. Participants were obtained by combining electronic health records with registry data from the National Emergency Department Information System. We assessed the eligibility of patients aged ≥ 15 years who visited the ED between July 1, 2022, and June 30, 2023. Using the KTAS classification criterion, two experienced experts determined the final acuity level. We employed multivariate logistic regression analysis to evaluate the factors that predict under- and over-triage.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 53,947 ED encounters, 1110 participants were enrolled in this study. Mistriage occurred in 207 (18.6%) patients: 88 (7.9%) had under-triage, and 119 (10.7%) had over-triage. In adjusted analyses, under-triage was associated with lower mean arterial pressure (odds ratio [OR], 5.42; 95% confidence interval [CI], 1.45–20.32) and presenting complaints of immunity or fever (OR, 3.41; 95% CI, 1.38–8.45), while over-triage was associated with advanced age (OR, 0.52; 95% CI, 0.28–0.98), pain (OR, 1.96; 95% CI, 1.18–3.25), lower KTAS experience (OR, 1.95; 95% CI, 1.08–3.51), and several specific present complaints.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>By improving mistriage, the quality of emergency medical services may be enhanced through reduced costs, increased operational efficiency, and improved patient safety and satisfaction. Implementation of standardized criteria, validated triage tools, and enhanced provider training is crucial for achieving more accurate emergency triage. Additionally, establishing regulatory and financial incentives and developing realistic standards for mistriage management will optimize triage processes and ensure prompt, prioritized care.</p>\u0000 </section>\u0000 </div>","PeriodicalId":51091,"journal":{"name":"Journal of Nursing Scholarship","volume":"57 5","pages":"860-873"},"PeriodicalIF":2.9,"publicationDate":"2025-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sigmapubs.onlinelibrary.wiley.com/doi/epdf/10.1111/jnu.70033","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144576888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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