Ilaria Marcomini, Marco Di Nitto, Francesco Zaghini, Valeria Caponnetto, Manuele Cesare, Paolo Iovino, Yari Longobucco, Rosaria Alvaro, Loreto Lancia, Duilio Fiorenzo Manara, Laura Rasero, Gennaro Rocco, Giancarlo Cicolini, Maurizio Zega, Beatrice Mazzoleni, Annamaria Bagnasco, Loredana Sasso
Introduction
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.
Design
Multicenter observational cross-sectional study.
Methods
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.
Results
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.
Conclusions
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.
Clinical Relevance
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.
{"title":"Predictors of Nurses' Job Satisfaction in Home Care Settings: Findings From the AIDOMUS-IT Study","authors":"Ilaria Marcomini, Marco Di Nitto, Francesco Zaghini, Valeria Caponnetto, Manuele Cesare, Paolo Iovino, Yari Longobucco, Rosaria Alvaro, Loreto Lancia, Duilio Fiorenzo Manara, Laura Rasero, Gennaro Rocco, Giancarlo Cicolini, Maurizio Zega, Beatrice Mazzoleni, Annamaria Bagnasco, Loredana Sasso","doi":"10.1111/jnu.13050","DOIUrl":"10.1111/jnu.13050","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Multicenter observational cross-sectional study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Only organizational variables had a predictive value for nurses' job satisfaction. Workload (OR = 1.01; <i>p</i> = 0.033), work–private life conflict (OR = 1.02; <i>p</i> < 0.001), burnout (OR = 1.02; <i>p</i> < 0.001), and staffing inadequacy (OR = 1.44; <i>p</i> = 0.003) predicted higher levels of nurse dissatisfaction. Instead, high-quality leadership (OR = 0.981; <i>p</i> < 0.001), possibility for development (OR = 0.973; <i>p</i> < 0.001), and good teamwork climate (OR = 0.994; <i>p</i> = 0.003) were predictors of better levels of satisfaction.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Clinical Relevance</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 </div>","PeriodicalId":51091,"journal":{"name":"Journal of Nursing Scholarship","volume":"57 3","pages":"536-545"},"PeriodicalIF":2.9,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143068849","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>Adverse childhood experiences (ACEs) are associated with an increased risk of developing chronic health conditions, including Alzheimer's disease and related dementias (ADRD) and subjective cognitive decline (SCD), self-reported confusion/memory loss, and an early clinical manifestation of ADRD. While ACEs and SCD have both been individually studied in transgender and nonbinary (TGN) adults, no study has examined the relationship between the two among this population. This study sought to establish the prevalence of ACEs and their association with SCD among TGN adults.</p> </section> <section> <h3> Design</h3> <p>Cross-sectional, secondary analysis of publicly available data.</p> </section> <section> <h3> Methods</h3> <p>2019–2021 Behavioral Risk Factor Surveillance System data, representing 16 US states that assessed ACEs, SCD, and self-reported gender identity were used to determine the association between ACEs and SCD among TGN adults aged 45+ (<i>N</i> = 206). Pearson's chi-squared/Fisher's exact tests assessed the association between ACEs (individual, categorical, sum score) and SCD. Crude and adjusted odds ratios (aORs) along with 95% confidence intervals (CIs) were calculated to investigate the associations between ACEs and SCD.</p> </section> <section> <h3> Results</h3> <p>18% (<i>n</i> = 38) of TGN adults in the sample endorsed SCD, 60% (<i>n</i> = 120) experienced any ACE, 20% (<i>n</i> = 41) 1 ACE, and 18% (<i>n</i> = 37) experienced > 4 ACEs. Nearly 50% experienced childhood abuse (<i>n</i> = 94) or household dysfunction (<i>n</i> = 92). Among those with SCD, 34% (<i>n</i> = 13) reported > 4 ACEs, and 73% (<i>n</i> = 26) reported childhood abuse or household dysfunction (<i>n</i> = 27). Most ACES were associated with and increased the risk of SCD, even after adjusting for BRFSS year, age, race, education, and employment. The odds of SCD increased 40% as the number of ACEs increased (aOR = 1.4, 95% CI: 1.2–1.6, <i>p</i> < 0.0001). The odds of SCD were higher with childhood abuse (aOR = 4.3, 95% CI: 1.88–10.02, <i>p</i> < 0.01) or household dysfunction (aOR = 4.7, 95% CI: 2.00–11.07, <i>p</i> < 0.01).</p> </section> <section> <h3> Conclusion</h3> <p>ACEs increase the risk of SCD among TGN adults. Gender-affirming and trauma-informed nursing care are important, and screening and interventions for ACEs and SCD are needed to help reduce the risk of SCD and ADRD.</p> </se
{"title":"Adverse Childhood Experiences and Subjective Cognitive Decline Among Transgender Adults","authors":"Jobina Chiow, Ethan C. Cicero","doi":"10.1111/jnu.13047","DOIUrl":"10.1111/jnu.13047","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Adverse childhood experiences (ACEs) are associated with an increased risk of developing chronic health conditions, including Alzheimer's disease and related dementias (ADRD) and subjective cognitive decline (SCD), self-reported confusion/memory loss, and an early clinical manifestation of ADRD. While ACEs and SCD have both been individually studied in transgender and nonbinary (TGN) adults, no study has examined the relationship between the two among this population. This study sought to establish the prevalence of ACEs and their association with SCD among TGN adults.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Cross-sectional, secondary analysis of publicly available data.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>2019–2021 Behavioral Risk Factor Surveillance System data, representing 16 US states that assessed ACEs, SCD, and self-reported gender identity were used to determine the association between ACEs and SCD among TGN adults aged 45+ (<i>N</i> = 206). Pearson's chi-squared/Fisher's exact tests assessed the association between ACEs (individual, categorical, sum score) and SCD. Crude and adjusted odds ratios (aORs) along with 95% confidence intervals (CIs) were calculated to investigate the associations between ACEs and SCD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>18% (<i>n</i> = 38) of TGN adults in the sample endorsed SCD, 60% (<i>n</i> = 120) experienced any ACE, 20% (<i>n</i> = 41) 1 ACE, and 18% (<i>n</i> = 37) experienced > 4 ACEs. Nearly 50% experienced childhood abuse (<i>n</i> = 94) or household dysfunction (<i>n</i> = 92). Among those with SCD, 34% (<i>n</i> = 13) reported > 4 ACEs, and 73% (<i>n</i> = 26) reported childhood abuse or household dysfunction (<i>n</i> = 27). Most ACES were associated with and increased the risk of SCD, even after adjusting for BRFSS year, age, race, education, and employment. The odds of SCD increased 40% as the number of ACEs increased (aOR = 1.4, 95% CI: 1.2–1.6, <i>p</i> < 0.0001). The odds of SCD were higher with childhood abuse (aOR = 4.3, 95% CI: 1.88–10.02, <i>p</i> < 0.01) or household dysfunction (aOR = 4.7, 95% CI: 2.00–11.07, <i>p</i> < 0.01).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>ACEs increase the risk of SCD among TGN adults. Gender-affirming and trauma-informed nursing care are important, and screening and interventions for ACEs and SCD are needed to help reduce the risk of SCD and ADRD.</p>\u0000 </se","PeriodicalId":51091,"journal":{"name":"Journal of Nursing Scholarship","volume":"57 3","pages":"431-438"},"PeriodicalIF":2.9,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jnu.13047","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143061167","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}
R D Udeshika Priyadarshani Sugathapala, Aindralal Balasuriya, Brigid M. Gillespie, Wendy Chaboyer, Sharon Latimer
<div> <section> <h3> Aim</h3> <p>To describe the development and implementation of evidence-based teaching strategies for assessing and classifying pressure injuries in older nursing home individuals ≥ 60 years old with darker skin tones.</p> </section> <section> <h3> Design</h3> <p>Pressure injury assessment learning interventions based on pre- and post-test assessments.</p> </section> <section> <h3> Methods</h3> <p>The learning interventions were developed by experts in pressure injury education and were based on empirical evidence, international clinical practice guidelines, and underpinned by social constructivism theory and the integrated interactive teaching model. The teaching strategy was developed to educate research assistants in the assessment of pressure injuries in darker skin tone individuals. The content included requisite knowledge and skills for pressure injury assessment and classification in darker skinned individuals. Using evidence-based teaching strategies, the content was delivered through face-to-face lectures, small group discussions, and practical application sessions delivered using classroom and practical-based activities. Photographic images were used to assess their knowledge and skills in classifying pressure injuries. Four Bachelor of Nursing-qualified registered nurses in Sri Lanka were recruited as research assistants using the new education resource. Using scores from 1 to 20 points, mastery of the theory and practice components was assessed.</p> </section> <section> <h3> Results</h3> <p>The mean pre-test score was 9 ± 1.6 (95% confidence interval 6.4–11.6), demonstrating that assessment and classification of pressure injury knowledge were lacking. The mean post-test score was 16 ± 0.8 (95% confidence interval 14.7–17.3) indicating an improvement in the participants' ability to assess and staging pressure injuries.</p> </section> <section> <h3> Conclusion</h3> <p>Early pressure injury detection among older individuals with darker skin tones is challenging. This evidence-based teaching approach can be used to educate clinical nurses and research assistants in assessing pressure injuries in individuals with darker skin tones.</p> </section> <section> <h3> Clinical Relevance</h3> <p>This study contributes to the body of knowledge by improving the early detection and accurate classification of pressure injuries in old
{"title":"Evidence-Based Teaching Strategies for Assessing Pressure Injuries in Older Nursing Home Residents With Darker Skin Tones","authors":"R D Udeshika Priyadarshani Sugathapala, Aindralal Balasuriya, Brigid M. Gillespie, Wendy Chaboyer, Sharon Latimer","doi":"10.1111/jnu.13044","DOIUrl":"10.1111/jnu.13044","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To describe the development and implementation of evidence-based teaching strategies for assessing and classifying pressure injuries in older nursing home individuals ≥ 60 years old with darker skin tones.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Pressure injury assessment learning interventions based on pre- and post-test assessments.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The learning interventions were developed by experts in pressure injury education and were based on empirical evidence, international clinical practice guidelines, and underpinned by social constructivism theory and the integrated interactive teaching model. The teaching strategy was developed to educate research assistants in the assessment of pressure injuries in darker skin tone individuals. The content included requisite knowledge and skills for pressure injury assessment and classification in darker skinned individuals. Using evidence-based teaching strategies, the content was delivered through face-to-face lectures, small group discussions, and practical application sessions delivered using classroom and practical-based activities. Photographic images were used to assess their knowledge and skills in classifying pressure injuries. Four Bachelor of Nursing-qualified registered nurses in Sri Lanka were recruited as research assistants using the new education resource. Using scores from 1 to 20 points, mastery of the theory and practice components was assessed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The mean pre-test score was 9 ± 1.6 (95% confidence interval 6.4–11.6), demonstrating that assessment and classification of pressure injury knowledge were lacking. The mean post-test score was 16 ± 0.8 (95% confidence interval 14.7–17.3) indicating an improvement in the participants' ability to assess and staging pressure injuries.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Early pressure injury detection among older individuals with darker skin tones is challenging. This evidence-based teaching approach can be used to educate clinical nurses and research assistants in assessing pressure injuries in individuals with darker skin tones.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Clinical Relevance</h3>\u0000 \u0000 <p>This study contributes to the body of knowledge by improving the early detection and accurate classification of pressure injuries in old","PeriodicalId":51091,"journal":{"name":"Journal of Nursing Scholarship","volume":"57 3","pages":"404-411"},"PeriodicalIF":2.9,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jnu.13044","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143015450","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}
Manuele Cesare, Fabio D'Agostino, Mario Cesare Nurchis, Erasmo Magliozzi, Gianfranco Damiani, the Nursing and Public Health Group, Antonello Cocchieri
Introduction
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.
Design
Observational, retrospective, monocentric study.
Methods
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.
Results
Positive correlations between the number of medical diagnoses, NDs, NAs, and LOS were discovered (rs = 0.262, p = < 0.001; rs = 0.114, p = < 0.001; rs = 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, R2 = 0.361, adjusted R2 = 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,
导言：确保适当的住院时间（LOS）是医院的首要目标，因为延长的住院时间会带来临床风险和组织挑战。儿童和青少年由于经常住院和独特的脆弱性，包括可能需要额外护理和监测的发育性残疾，特别容易长期失去生命。本研究旨在描述儿童和青少年患者的LOS，并确定导致该人群LOS延长的社会人口学、组织、临床和护理因素。设计：观察性、回顾性、单中心研究。方法：采用顺序抽样方法，选取意大利某大学附属医院2022年收治的1538例儿童和青少年患者的临床资料。该研究包括所有住院至少2天的3-18岁儿童和青少年。排除门诊患者和LOS少于2天的患者。使用新生儿儿科专业评估工具（PAIped）和出院登记簿收集社会人口学、组织、临床和护理患者数据，包括护理诊断（NDs）和护理行动（NAs）。采用前向逐步回归方法在所选变量中识别LOS的预测因子。我们进行了一项中介分析，以探索在逐步回归中确定的护理预测因子在医疗诊断数量和LOS之间的中介作用。结果：医疗诊断次数、NDs、NAs与LOS呈正相关（rs = 0.262, p = s = 0.114, p = s = 0.384, p = 2 = 0.361，调整后R2 = 0.358）。中介分析显示，医学诊断次数正预测NAs数量(β = 2.774, p 2 = 0.295；结论：我们的研究强调了儿童和青少年患者LOS决定因素之间的重要相互作用，强调了有针对性的干预措施、资源规划和临床护理信息系统整合的必要性，以提高护理质量并支持循证实践。临床意义：优化资源分配和实施针对长期LOS风险患者的具体干预措施可以帮助减轻这种负面结果并提高护理质量。将护理数据纳入DRG系统可以提高报销准确性，有利于护理专业，这可能会带来更好的患者治疗效果和更低的医院费用。
{"title":"Determinants of Prolonged Hospitalization in Children and Adolescents: A Retrospective Observational Study","authors":"Manuele Cesare, Fabio D'Agostino, Mario Cesare Nurchis, Erasmo Magliozzi, Gianfranco Damiani, the Nursing and Public Health Group, Antonello Cocchieri","doi":"10.1111/jnu.13045","DOIUrl":"10.1111/jnu.13045","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Observational, retrospective, monocentric study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>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 (PAI<i>ped</i>) 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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Positive correlations between the number of medical diagnoses, NDs, NAs, and LOS were discovered (<i>r</i><sub>s</sub> = 0.262, <i>p</i> = < 0.001; <i>r</i><sub>s</sub> = 0.114, <i>p</i> = < 0.001; <i>r</i><sub>s</sub> = 0.384, <i>p</i> = < 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 (<i>β</i> = 0.516; <i>p</i> < 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 (<i>F</i> = 122.222, <i>p</i> < 0.001, <i>R</i><sup>2</sup> = 0.361, adjusted <i>R</i><sup>2</sup> = 0.358). The mediation analysis showed that the number of medical diagnoses positively predicted the number of NAs (<i>β</i> = 2.774, <i>p</i> < 0.001), which, in turn, ","PeriodicalId":51091,"journal":{"name":"Journal of Nursing Scholarship","volume":"57 3","pages":"412-430"},"PeriodicalIF":2.9,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142973172","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}
Sayonara de Fatima F. Barbosa, Maxim Topaz, Lisiane Pruinelli
{"title":"Artificial Intelligence in Nursing: Catalyzing Change Across Clinical, Educational, and Administrative Domains","authors":"Sayonara de Fatima F. Barbosa, Maxim Topaz, Lisiane Pruinelli","doi":"10.1111/jnu.13043","DOIUrl":"10.1111/jnu.13043","url":null,"abstract":"","PeriodicalId":51091,"journal":{"name":"Journal of Nursing Scholarship","volume":"57 1","pages":"3-4"},"PeriodicalIF":2.9,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142911109","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}
Hephzibah Sophie Edwin PhD, RN, NPD-BC, PCCN, Alison Trinkoff ScD, RN, FAAN, Sarah Holmes PhD, MSW, Shijun Zhu PhD, DrE, Mary Etta Mills ScD, RN, FAAN
Background
The healthcare work environment has numerous stressors that can contribute to distress and poor health outcomes among nurses. The impact of distress can be detrimental, resulting in nurses leaving the profession. Thus, it is critical to explore factors in the work environment that contribute to the distress symptoms and behaviors that promote nurses' health.
Objective
This study aimed to examine the constructs associated with the conceptual model of distress, such as the work environment, specifically workload and the practice environment (quality of care, salary, staffing, time, and satisfaction) and associations with psychological distress, sleep disturbance, and health promotion behaviors in nurses, using structural equation modeling.
Design
This study was a cross-sectional survey design collected as part of the Nurse Worklife and Wellness Study (NWWS) using balanced stratified sampling methods.
Methods
A confirmatory factor analysis tested the factorial structure of the latent constructs using weighted least squares estimation with missing data (WLSMV) for the sample (n = 1170). A structural equation modeling approach examined the direct and indirect associations between workload, practice environment, health promotion behaviors, psychological distress symptoms, sleep disturbance, and health.
Results
Based on the confirmatory factor analysis, the measurement model reported adequate model fit (CFI = 0.96; TLI = 0.95; SRMR = 0.048 and RMSEA = 0.039). The structural model showed that the workload was related to significantly increased psychological distress (β = 1.47, p < 0.001), sleep disturbance (β = 1.22, p < 0.01), and decreased overall health (β = −1.36, p < 0.01). Similarly, a positive practice environment was associated with significantly higher psychological distress (β = 1.61, p < 0.001), sleep disturbance (β = 1.31, p < 0.01), and lower overall health (β = −1.51, p < 0.01). Workload and the practice environment were associated with significantly increased health promotion behaviors such as interpersonal relations, spiritual growth, stress management, physical activity, and nutrition. A statistically significant indirect relationship was found between workload and psychological distress, mediated by health promotion behaviors. Psychological and p
{"title":"Nurses' work environment and health promotion in relation to psychological distress symptoms, and sleep disturbance: A structural equation modeling approach","authors":"Hephzibah Sophie Edwin PhD, RN, NPD-BC, PCCN, Alison Trinkoff ScD, RN, FAAN, Sarah Holmes PhD, MSW, Shijun Zhu PhD, DrE, Mary Etta Mills ScD, RN, FAAN","doi":"10.1111/jnu.13040","DOIUrl":"10.1111/jnu.13040","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The healthcare work environment has numerous stressors that can contribute to distress and poor health outcomes among nurses. The impact of distress can be detrimental, resulting in nurses leaving the profession. Thus, it is critical to explore factors in the work environment that contribute to the distress symptoms and behaviors that promote nurses' health.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This study aimed to examine the constructs associated with the conceptual model of distress, such as the work environment, specifically workload and the practice environment (quality of care, salary, staffing, time, and satisfaction) and associations with psychological distress, sleep disturbance, and health promotion behaviors in nurses, using structural equation modeling.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>This study was a cross-sectional survey design collected as part of the Nurse Worklife and Wellness Study (NWWS) using balanced stratified sampling methods.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A confirmatory factor analysis tested the factorial structure of the latent constructs using weighted least squares estimation with missing data (WLSMV) for the sample (<i>n</i> = 1170). A structural equation modeling approach examined the direct and indirect associations between workload, practice environment, health promotion behaviors, psychological distress symptoms, sleep disturbance, and health.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Based on the confirmatory factor analysis, the measurement model reported adequate model fit (CFI = 0.96; TLI = 0.95; SRMR = 0.048 and RMSEA = 0.039). The structural model showed that the workload was related to significantly increased psychological distress (<i>β</i> = 1.47, <i>p</i> < 0.001), sleep disturbance (<i>β</i> = 1.22, <i>p</i> < 0.01), and decreased overall health (<i>β</i> = −1.36, <i>p</i> < 0.01). Similarly, a positive practice environment was associated with significantly higher psychological distress (<i>β</i> = 1.61, <i>p</i> < 0.001), sleep disturbance (<i>β</i> = 1.31, <i>p</i> < 0.01), and lower overall health (<i>β</i> = −1.51, <i>p</i> < 0.01). Workload and the practice environment were associated with significantly increased health promotion behaviors such as interpersonal relations, spiritual growth, stress management, physical activity, and nutrition. A statistically significant indirect relationship was found between workload and psychological distress, mediated by health promotion behaviors. Psychological and p","PeriodicalId":51091,"journal":{"name":"Journal of Nursing Scholarship","volume":"57 3","pages":"500-513"},"PeriodicalIF":2.9,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142847443","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}
Zyad T. Saleh PhD, RN, Aziz Aslanoğlu PhD, RN, Wesam T. Almagharbeh PhD, RN, Doaa El Sayed Fadila PhD, RN, Mathar Mohideen Nagoor Thangam PhD, RN, Riyad Al-Dgheim PhD, RN, Bayan Oleimat MSN, RN, Mudathir Mohamedahmed Eltayeb PhD, RN, Dena Eltabey Sobeh PhD, RN, Ahmad Rajeh Saifan PhD, RN, Rami A. Elshatarat PhD, RN, Inas A. Ebeid PhD, RN
<div> <section> <h3> Background</h3> <p>Depressive symptoms are common, worsening heart failure (HF) progression and reducing quality of life. While supervised structured exercise training is effective for managing depressive symptoms, it often demands a substantial time commitment or intensive activity that may discourage participation.</p> </section> <section> <h3> Objective</h3> <p>Evaluate the impacts of reducing sedentary time with short bouts of light physical activities or greater intensity levels on depressive symptoms after HF patients' enrollment in a home-based intervention.</p> </section> <section> <h3> Methods</h3> <p>A total of 127 HF patients participated in an experimental two-group design, randomly allocated to either delayed or immediate decreasing sedentary time intervention. The immediate group started the intervention immediately, while the delayed group began after the first group finished their intervention. The 8-week intervention, guided by the Theory of Planned Behavior, focused on interrupting 30 min of sedentary behavior with short bouts of light- or greater intensity physical activities. Demographic and clinical variables were collected at baseline. Depressive symptoms were assessed at baseline, pre-intervention, and post-intervention. Physical activity (daily steps) was monitored daily during the study period using the Samsung mobile health app.</p> </section> <section> <h3> Results</h3> <p>Both groups demonstrated reduced sedentary time during the intervention, with improvements in HF symptom burden. Repeated measures analysis of variance revealed a significant reduction in depressive symptoms in both groups post-intervention, with a greater reduction seen in the immediate group before the delayed group began the intervention.</p> </section> <section> <h3> Conclusion</h3> <p>The study highlights the effectiveness of interrupting sedentary behavior with light- or greater intensity activities in managing depressive symptoms among HF patients. The home-based intervention, facilitated by mobile technology, provides a feasible and accessible approach to improving mental well-being.</p> </section> <section> <h3> Clinical Relevance</h3> <p>The findings support the broader implementation of home-based interventions addressing sedentary time reduction as a valuable strategy for enhancing the mental health of HF patients, particularly those facing challenges with traditional rehabilitation programs or intense exercise.</p> </section>
{"title":"Reducing sedentary behavior improves depressive symptoms among patients with heart failure enrolled in a home-based mobile health app cardiac rehabilitation","authors":"Zyad T. Saleh PhD, RN, Aziz Aslanoğlu PhD, RN, Wesam T. Almagharbeh PhD, RN, Doaa El Sayed Fadila PhD, RN, Mathar Mohideen Nagoor Thangam PhD, RN, Riyad Al-Dgheim PhD, RN, Bayan Oleimat MSN, RN, Mudathir Mohamedahmed Eltayeb PhD, RN, Dena Eltabey Sobeh PhD, RN, Ahmad Rajeh Saifan PhD, RN, Rami A. Elshatarat PhD, RN, Inas A. Ebeid PhD, RN","doi":"10.1111/jnu.13039","DOIUrl":"10.1111/jnu.13039","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Depressive symptoms are common, worsening heart failure (HF) progression and reducing quality of life. While supervised structured exercise training is effective for managing depressive symptoms, it often demands a substantial time commitment or intensive activity that may discourage participation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Evaluate the impacts of reducing sedentary time with short bouts of light physical activities or greater intensity levels on depressive symptoms after HF patients' enrollment in a home-based intervention.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A total of 127 HF patients participated in an experimental two-group design, randomly allocated to either delayed or immediate decreasing sedentary time intervention. The immediate group started the intervention immediately, while the delayed group began after the first group finished their intervention. The 8-week intervention, guided by the Theory of Planned Behavior, focused on interrupting 30 min of sedentary behavior with short bouts of light- or greater intensity physical activities. Demographic and clinical variables were collected at baseline. Depressive symptoms were assessed at baseline, pre-intervention, and post-intervention. Physical activity (daily steps) was monitored daily during the study period using the Samsung mobile health app.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Both groups demonstrated reduced sedentary time during the intervention, with improvements in HF symptom burden. Repeated measures analysis of variance revealed a significant reduction in depressive symptoms in both groups post-intervention, with a greater reduction seen in the immediate group before the delayed group began the intervention.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The study highlights the effectiveness of interrupting sedentary behavior with light- or greater intensity activities in managing depressive symptoms among HF patients. The home-based intervention, facilitated by mobile technology, provides a feasible and accessible approach to improving mental well-being.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Clinical Relevance</h3>\u0000 \u0000 <p>The findings support the broader implementation of home-based interventions addressing sedentary time reduction as a valuable strategy for enhancing the mental health of HF patients, particularly those facing challenges with traditional rehabilitation programs or intense exercise.</p>\u0000 </section>\u0000 ","PeriodicalId":51091,"journal":{"name":"Journal of Nursing Scholarship","volume":"57 3","pages":"394-403"},"PeriodicalIF":2.9,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142814893","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}
Janeth Wendolyne Molina-Sánchez MSc, PhD, Victor Pedrero PhD, Milton Carlos Guevara-Valtier PhD, Margarita Bernales PhD
Introduction
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.
Methodology
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.
Results
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.
Conclusions
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.
Clinical Relevance
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.
{"title":"Relationship between social identity and cultural competence among Mexican nursing professionals","authors":"Janeth Wendolyne Molina-Sánchez MSc, PhD, Victor Pedrero PhD, Milton Carlos Guevara-Valtier PhD, Margarita Bernales PhD","doi":"10.1111/jnu.13042","DOIUrl":"10.1111/jnu.13042","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methodology</h3>\u0000 \u0000 <p>This was a cross-sectional correlational study (<i>n</i> = 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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Clinical Relevance</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 </div>","PeriodicalId":51091,"journal":{"name":"Journal of Nursing Scholarship","volume":"57 3","pages":"527-535"},"PeriodicalIF":2.9,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142808480","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}
Seda Sarıköse RN, PhD, Sevilay Şenol Çelik RN, PhD
Purpose
To evaluate the effectiveness of the education program developed based on the structural empowerment (SE) and psychological empowerment (PE) theories and flipped classroom model for the empowerment of new graduate nurses (NGNs).
The study was conducted between June 2021 and September 2023 in two phases: developing the education program to empower NGNs and evaluating its effectiveness. An education program consisting of two parts, online and face-to-face, was developed. The online part consists of eight modules implemented for two weeks. The face-to-face part was implemented for two days and included the in-class activities. NGNs were randomly assigned to the intervention group (n: 32) and control group (n: 32). An education program was applied to the intervention group, whereas the control group continued their routine orientation program. A range of outcome measures of SE, PE, and education programs' effectiveness were evaluated. Data were analyzed using descriptive, chi-squared, and t-tests.
Results
The study determined that the intervention and control groups showed homogeneous distribution in the pretest. A statistically significant difference was identified between the intervention and control groups regarding the mean scores of PE and SE three months following the implementation of the education program, and the total mean score of the intervention group was higher.
Conclusion
The education program developed to empower NGNs was a highly effective intervention in increasing nurses' perceptions of SE and PE. There is a need to carry out studies and activities to disseminate this program.
Clinical Relevance
The findings of this study will guide educators, researchers, and administrators in future strategies and innovative programs for empowering NGNs.
{"title":"Evaluating the effectiveness of the education program developed for the empowerment of new graduate nurses: A randomized controlled trial","authors":"Seda Sarıköse RN, PhD, Sevilay Şenol Çelik RN, PhD","doi":"10.1111/jnu.13041","DOIUrl":"10.1111/jnu.13041","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>To evaluate the effectiveness of the education program developed based on the structural empowerment (SE) and psychological empowerment (PE) theories and flipped classroom model for the empowerment of new graduate nurses (NGNs).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Single-center, parallel-group, randomized controlled trial.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The study was conducted between June 2021 and September 2023 in two phases: developing the education program to empower NGNs and evaluating its effectiveness. An education program consisting of two parts, online and face-to-face, was developed. The online part consists of eight modules implemented for two weeks. The face-to-face part was implemented for two days and included the in-class activities. NGNs were randomly assigned to the intervention group (<i>n</i>: 32) and control group (<i>n</i>: 32). An education program was applied to the intervention group, whereas the control group continued their routine orientation program. A range of outcome measures of SE, PE, and education programs' effectiveness were evaluated. Data were analyzed using descriptive, chi-squared, and <i>t</i>-tests.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The study determined that the intervention and control groups showed homogeneous distribution in the pretest. A statistically significant difference was identified between the intervention and control groups regarding the mean scores of PE and SE three months following the implementation of the education program, and the total mean score of the intervention group was higher.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The education program developed to empower NGNs was a highly effective intervention in increasing nurses' perceptions of SE and PE. There is a need to carry out studies and activities to disseminate this program.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Clinical Relevance</h3>\u0000 \u0000 <p>The findings of this study will guide educators, researchers, and administrators in future strategies and innovative programs for empowering NGNs.</p>\u0000 </section>\u0000 </div>","PeriodicalId":51091,"journal":{"name":"Journal of Nursing Scholarship","volume":"57 3","pages":"514-526"},"PeriodicalIF":2.9,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jnu.13041","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142803283","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}
Danielle Scharp PhD, APRN, FNP-BC, Jiyoun Song PhD, APRN, AGACNP-BC, Mollie Hobensack PhD, RN, Mary Happel Palmer PhD, RN, FAAN, AGSF, Veronica Barcelona PhD, RN, PHNA-BC, Maxim Topaz PhD, RN, MA
<div> <section> <h3> Introduction</h3> <p>Little is known about the range and frequency of symptoms among older adult home healthcare patients with urinary incontinence, as this information is predominantly contained in clinical notes. Natural language processing can uncover symptom information among older adults with urinary incontinence to promote holistic, equitable care.</p> </section> <section> <h3> Design</h3> <p>We conducted a secondary analysis of cross-sectional data collected between January 1, 2015, and December 31, 2017, from the largest HHC agency in the Northeastern United States. We aimed to develop and test a natural language processing algorithm to extract symptom information from clinical notes for older adults with urinary incontinence and analyze differences in symptom documentation by race or ethnicity.</p> </section> <section> <h3> Methods</h3> <p>Symptoms were identified through expert clinician-driven Delphi survey rounds. We developed a natural language processing algorithm for symptom identification in clinical notes, examined symptom documentation frequencies, and analyzed differences in symptom documentation by race or ethnicity using chi-squared tests and logistic regression models.</p> </section> <section> <h3> Results</h3> <p>In total, 39,179 home healthcare episodes containing 1,098,419 clinical notes for 29,981 distinct patients were included. Nearly 40% of the sample represented racially or ethnically minoritized groups (i.e., 18% Black, 14% Hispanic, 7% Asian/Pacific Islander, 0.3% multi-racial, and 0.2% Native American). Based on expert clinician-driven Delphi survey rounds, the following symptoms were identified: anxiety, dizziness, constipation, syncope, tachycardia, urinary frequency/urgency, urinary hesitancy/retention, and vision impairment/blurred vision. The natural language processing algorithm achieved excellent performance (average precision of 0.92). Approximately 29% of home healthcare episodes had symptom information documented. Compared to home healthcare episodes for White patients, home healthcare episodes for Asian/Pacific Islander (odds ratio = 0.74, 95% confidence interval [0.67–0.80], <i>p</i> < 0.001), Black (odds ratio = 0.69, 95% confidence interval [0.64–0.73], <i>p</i> < 0.001), and Hispanic (odds ratio = 0.91, 95% confidence interval [0.85–0.97], <i>p</i> < 0.01) patients were less likely to have any symptoms documented in clinical notes.</p> </section> <section> <h3> Conclusion</h3> <p>We found multidimensional symptoms and differences in symptom documentation among a diverse coho
{"title":"Applying natural language processing to understand symptoms among older adult home healthcare patients with urinary incontinence","authors":"Danielle Scharp PhD, APRN, FNP-BC, Jiyoun Song PhD, APRN, AGACNP-BC, Mollie Hobensack PhD, RN, Mary Happel Palmer PhD, RN, FAAN, AGSF, Veronica Barcelona PhD, RN, PHNA-BC, Maxim Topaz PhD, RN, MA","doi":"10.1111/jnu.13038","DOIUrl":"10.1111/jnu.13038","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Little is known about the range and frequency of symptoms among older adult home healthcare patients with urinary incontinence, as this information is predominantly contained in clinical notes. Natural language processing can uncover symptom information among older adults with urinary incontinence to promote holistic, equitable care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>We conducted a secondary analysis of cross-sectional data collected between January 1, 2015, and December 31, 2017, from the largest HHC agency in the Northeastern United States. We aimed to develop and test a natural language processing algorithm to extract symptom information from clinical notes for older adults with urinary incontinence and analyze differences in symptom documentation by race or ethnicity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Symptoms were identified through expert clinician-driven Delphi survey rounds. We developed a natural language processing algorithm for symptom identification in clinical notes, examined symptom documentation frequencies, and analyzed differences in symptom documentation by race or ethnicity using chi-squared tests and logistic regression models.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In total, 39,179 home healthcare episodes containing 1,098,419 clinical notes for 29,981 distinct patients were included. Nearly 40% of the sample represented racially or ethnically minoritized groups (i.e., 18% Black, 14% Hispanic, 7% Asian/Pacific Islander, 0.3% multi-racial, and 0.2% Native American). Based on expert clinician-driven Delphi survey rounds, the following symptoms were identified: anxiety, dizziness, constipation, syncope, tachycardia, urinary frequency/urgency, urinary hesitancy/retention, and vision impairment/blurred vision. The natural language processing algorithm achieved excellent performance (average precision of 0.92). Approximately 29% of home healthcare episodes had symptom information documented. Compared to home healthcare episodes for White patients, home healthcare episodes for Asian/Pacific Islander (odds ratio = 0.74, 95% confidence interval [0.67–0.80], <i>p</i> < 0.001), Black (odds ratio = 0.69, 95% confidence interval [0.64–0.73], <i>p</i> < 0.001), and Hispanic (odds ratio = 0.91, 95% confidence interval [0.85–0.97], <i>p</i> < 0.01) patients were less likely to have any symptoms documented in clinical notes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>We found multidimensional symptoms and differences in symptom documentation among a diverse coho","PeriodicalId":51091,"journal":{"name":"Journal of Nursing Scholarship","volume":"57 1","pages":"152-164"},"PeriodicalIF":2.9,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142734408","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}
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