Nursing Outlook最新文献

Background: Health inequities in United States (U.S.) healthcare and academic systems are not incidental but reflect historically rooted and persistently maintained structural designs that exclude Black and Brown communities and normalize unequal access and outcomes.

Purpose: This paper aims to translate the moral and ethical imperative to dismantle inequitable systems into actionable, evidence-based leadership strategies that advance health equity.

Methods: Drawing on economic data and equity-focused leadership scholarship, the paper presents a structured framework organized across five domains addressing leadership responsibility, mindset transformation, systemic disruption, policy reform, and implementation guidance.

Discussion: Health inequities cost the U.S. an estimated $320 billion annually and are projected to reach $1 trillion by 2040. Despite this burden, inequities persist due to institutional inertia, power asymmetries, and entrenched norms. The framework emphasizes structural competency, needs-based resource allocation, community partnership, accountability, and policy alignment as mechanisms for change.

Conclusion: Advancing health equity requires intentional redesign of systems, accountable leadership, and sustained investment. This framework provides practical direction to move from rhetoric to measurable, systemic transformation.

Background: Relational agency has emerged across care disciplines to conceptualize agency as a process embedded in relationships. However, the concept remains underdeveloped in nursing and allied health literature-fields where relationship-building is central to care provision.

Purpose: We clarify the concept of relational agency and explore its relevance and application to nursing practice.

Methods: An evolutionary concept analysis was conducted using Rodgers' method.

Discussion: Relational agency has four attributes: individual growth, collaborative action, relational knowing, and as something that can be cultivated. Antecedents included recognition, respect, and the creation of relational and/or physical spaces of opportunity. Consequences resulted in the development of trust, resilience, empowerment, and the ability to imagine new possibilities.

Conclusion: Relational agency offers a framework for relationship-building in nursing and allied health practice. It holds particular promise for addressing health disparities and improving care for populations who experience systemic barriers and distrust in formal health systems.

Background: Complex Adaptive Systems (CAS) theory is well-suited to address the dynamic, nonlinear nature of nursing. However, its application across the nursing research landscape lacks synthesis.

Purpose: To map the application of CAS theory in nursing research.

Methods: A scoping review was conducted following the Arksey and O'Malley framework and PRISMA-ScR guidelines. Seven databases (PubMed, Web of Science, EMBASE, Cochrane Library, CNKI, WanFang, VIP) were systematically searched in June 2025 for English and Chinese publications.

Discussion: CAS theory provides a practical framework for understanding complexity in nursing. Analysis of 27 studies identified five application domains: nursing management and leadership, clinical practice and patient safety, interprofessional collaboration, education and competency development, and research methodology innovation. The field is evolving from theoretical discussion to empirical application, yet a significant gap remains in using computational simulations.

Conclusion: This review synthesizes the applied value of CAS theory while revealing key methodological gaps. Future work requires interdisciplinary collaboration to develop dynamic models and translate complexity principles into actionable strategies for leadership, policy, and education to foster more resilient healthcare systems.

Background: A conceptual framework that integrates symptom science and self-management science is necessary to drive evidence-based innovations in symptom self-management, thereby improving outcomes for individuals with complex health conditions.

Purpose: The purpose of this paper is to describe the Symptom Self-Management Framework for Individuals with Complex Health Conditions.

Methods: In this paper, we describe the development process and framework components of the Symptom Self-Management Framework for Individuals with Complex Health Conditions.

Findings: The framework encompasses contextual factors (individual, interpersonal, institutional, and environmental factors) that influence symptoms and symptom self-management, which in turn impact health-related outcomes.

Discussion: We provide examples of how the framework is being applied by nurse scientists and include recommendations for future research and integration into practice.

Conclusion: This framework can be used for the testing of symptom self-management interventions for individuals with complex conditions across various practice settings and patient populations.

Background: Racial discrimination in healthcare affects both patients and nurses.

Purpose: This study examined whether nurses' racial and ethnic minority status was associated with workplace discrimination and whether supportive work environments moderated these experiences.

Methods: We analyzed data from the 2024 Penn Nurses4All Study (12,679 registered nurses across 872 hospitals in 10 U.S. states) linked with the American Hospital Association Annual Survey using multilevel logistic regression.

Discussion: Racial and ethnic minority nurses were more likely to experience workplace discrimination compared with non-Hispanic White nurses (adjusted odds ratio [aOR] = 1.40; 95% confidence interval [CI] = 1.24-1.58). Nurses in hospitals with more supportive work environments were less likely to experience workplace discrimination (aOR = 0.48; 95% CI = 0.37-0.61). Subgroup analysis showed administrative responsiveness reduced the likelihood of discrimination by 63% for non-Hispanic Black nurses and by 30% for non-Hispanic White nurses.

Conclusion: Addressing racial discrimination through strategies tailored to the needs of nurses from underrepresented backgrounds is essential for fostering well-being among nurses.

Background: Although previous literature has centered on the needs of family caregivers for terminally ill patients, most review articles published in the last twenty years have focused on such caregivers in specific conditions or settings, lacking an updated, holistic overview of relevant research.

Purpose: To summarize the literature on the expressed needs of family caregivers of patients at the end-of-life stage over the last two decades and to lay a scientific foundation for formulating future policies, regulations, and action strategies.

Methods: A systematic search of relevant literature published between January 2004 and September 2024 in China National Knowledge Infrastructure, Wanfang Data Knowledge Service, VIP Data Knowledge Service, Web of Science, Scopus, PubMed, CINAHL, Ovid, and ProQuest databases. The literature was screened and included using the scoping review method. The contents of the included literature were extracted and summarized.

Discussion: A total of 57 articles were included. Of these, 30 were qualitative studies, 23 were quantitative studies, and four were mixed-method studies. The needs of family caregivers of the terminally ill extend to multiple domains. The needs of family caregivers are predominantly characterized by the enabling needs that caregivers must fulfill in order to care for the patient. These include information and communication needs, as well as healthcare and other services. Of the direct needs related to the caregivers themselves, psychological and social needs are the most common. The following factors have been identified as being associated with the needs of caregivers: caregiver, the patient, and the caregiving situation. However, the findings of the study were not consistently replicable.

Conclusion: The needs of family caregivers of the terminally ill are multidimensional, dynamic, and individualized. The national government should implement dedicated strategies and enact legislation to clarify their rights and protections, while integrating key support services into the medical insurance payment system. At the institutional level, healthcare providers must establish standardized needs assessment and referral mechanisms, and set up in-hospital support centers to provide caregivers with ongoing information, skills training, and resource navigation.

Collaboration between Doctor of Nursing Practice (DNP) and Doctor of Philosophy (PhD) nurses presents a strategic opportunity to advance health equity by integrating clinical expertise with research-driven innovation. Although these collaborations are well-described in academic and clinical settings, far less is known about how DNP-PhD partnerships function within community-engaged contexts, particularly those serving Black communities disproportionately affected by health inequities. This article examines facilitators and barriers to effective collaboration and extends existing literature by presenting an equity-centered framework that operationalizes DNP-PhD teamwork across the research continuum. Brief case vignettes from community-based human immunodeficiency virus prevention projects illustrate how shared leadership, role complementarity, and equity-informed processes strengthen intervention relevance, trustworthiness, and sustainability. Colleges of nursing and healthcare institutions should invest in structures that support these partnerships. When implemented intentionally, DNP-PhD collaborations can enhance community trust, improve health outcomes, and drive equitable policy and practice improvements for marginalized populations.

Background: Cardiovascular disease (CVD) remains the leading cause of mortality in the United States, with hypertension disproportionately affecting historically disadvantaged groups. Doctor of Nursing Practice (DNP)-prepared nurses can bridge the gap between research and practice, yet structured translational research training remains scarce.

Purpose: The Translational Research and Implementation Science for Nurses (TRAIN) program was developed to equip underrepresented minority DNP students with research skills, mentorship, and hands-on experience to advance CVD health equity.

Methods: TRAIN is a 12-week National Institutes of Health-funded fellowship combining hands-on research (70%) and classroom instruction (30%) under interdisciplinary faculty mentorship. The curriculum includes translational research methods, responsible conduct of research, and CVD health equity science.

Discussion: One-year evaluation showed improved research literacy, confidence, and professional networking. Challenges included recruitment, program buy-in, and short duration.

Conclusion: TRAIN is a scalable model for DNP training in cardiovascular translational science, with future expansion planned for other chronic illnesses and mentorship.

Background: The intersection of gender and empathy remains a pivotal focus in contemporary sociological discourse. Few studies have examined gender differences in aggressive behavior within healthcare settings.

Purpose: To explore the association between empathy, feelings, thoughts, gender, and aggressive behavior toward nurses, and the role of gender in the association between empathy and aggressive behavior.

Methods: A cross-sectional study utilized a self-report questionnaire (completed by 555 participants). A three-step hierarchical linear regression was conducted to assess the unique effect of the explanatory variables on aggressive behavior.

Discussion: Empathy, positive feelings, and negative thoughts were found to explain aggressive behavior. Gender was a moderating factor between empathy and aggressive behavior. The effect was more pronounced among men than women as empathy increased.

Conclusion: Empathy is a crucial buffer against aggressiveness, with a strong effect among men. Intervention programs may benefit from boosting empathic competencies that address gender-related differences in socialization and emotional expression.

Health inequities in the United States are not accidental but structural-deliberately created and systematically upheld. This first paper in a two-part series examines how American founding values, cultural norms, and historical practices established inequity as an enduring feature of healthcare and academic systems. Although the nation professed ideals of freedom and justice, Black and Brown communities were excluded through policies grounded in Anglo-Saxon supremacy and White solidarity. Wealth extracted from enslaved labor exceeded $3 billion by 1860, and later programs such as the GI Bill reinforced disparities through discriminatory implementation. These systems promoted narratives of individualism that obscured structural racism and normalized inequity. Academic and healthcare institutions actively built and legitimized these structures. Universities advanced pseudoscientific theories-such as phrenology and false claims about racial differences in pain tolerance-that validated racist practices. Physicians carried out nonconsensual experimentation on enslaved and marginalized people, from J. Marion Sims's surgeries on enslaved women to the Tuskegee Syphilis Study. The unauthorized use of Henrietta Lacks's cells shows how exploitation persisted into modern biomedical research and corporate profit. These histories shape present-day inequities, visible in biased medical algorithms, flawed diagnostic tools, inequitable resource allocation, and institutional mistrust. Health inequities cost the United States $320 billion annually, projected to reach $1 trillion by 2040. Understanding these roots is essential for the transformative strategies outlined in Part 2.