Frontiers in health services最新文献

[This corrects the article DOI: 10.3389/frhs.2025.1695320.].

Background: Specialist nurses represent an important pathway through which registered nurses transition toward advanced practice nurse roles, and their development and clinical practice are essential for addressing contemporary healthcare challenges. However, in countries such as China, substantial gaps remain in the training and practical implementation of specialist nurses. Despite more than two decades of specialist nurse training in China, systemic issues such as unclear role definitions, insufficient designated positions, and limited decision-making authority continue to constrain their clinical practice.

Objective: To investigate healthcare professionals' perceptions and experiences of specialist nurse practice in ICU to identify their roles, impacts, challenges, and suggestions for improvement.

Setting: A 25-bed ICU in a tertiary hospital in central China has been conducting under the specialist nurse practice model for six months.

Participants: A purposive sampling survey recruited 18 nurses (14 ICU registered nurses and 4 specialist nurses) and 3 ICU physicians, all with more than one year of ICU work experience.

Methods: A qualitative descriptive design using semi-structured interviews was adopted.

Findings: Three major themes emerged from the analysis: 1) being a versatile and core force; 2) leading nursing quality and professional transformation; and 3) facing challenges and pursing a path to growth.

Conclusion: Specialist nurses play a pivotal role in ICU nursing, driving quality improvement and professional development. However, systemic barriers such as resource constraints and role ambiguity limit their full potential. Addressing these challenges through workflow optimization, clear role definition, and policy reforms is crucial for advancing specialist nurse practice globally.

Background: Adverse drug reactions (ADRs) remain a major barrier to safe and effective cancer therapy. Existing pharmacovigilance systems predominantly rely on spontaneous reporting, which suffers from underreporting and delays. The Chinese Hospital Pharmacovigilance System (CHPS) provides an opportunity for active monitoring using multidimensional hospital data.

Methods: We conducted a retrospective cohort study, including 500 patients who received chemotherapy, targeted therapy, or immunotherapy. ADRs were identified through CHPS, classified by the Common Terminology Criteria for Adverse Events (CTCAE), and assessed using both active monitoring and spontaneous reporting. Signal detection employed disproportionality analyses (PRR, ROR, IC). Risk factors were analyzed with logistic regression, and predictive models for severe ADRs were evaluated with ROC curve analysis.

Results: The overall ADR incidence was 37.0% (185/500), with 28.1% classified as severe. Hematologic (29.7%), gastrointestinal (26.0%), and skin/mucosal (19.5%) events were most common. Severe ADRs led to hospitalization (34.6%), treatment discontinuation (23.1%), and death (9.6%). Independent risk factors included age ≥65 years, polypharmacy, hepatic/renal dysfunction, and prolonged drug exposure (≥14 days). Signal detection confirmed known associations and identified potential novel signals, including skin hyperpigmentation with PD-1/PD-L1 inhibitors and cardiotoxicity with tyrosine kinase inhibitors. Active monitoring detected more ADRs than spontaneous reporting (160 vs. 50, P < 0.001) and provided earlier detection (mean 4.2 vs. 10.7 days). Predictive modeling demonstrated strong performance of the multivariable model (AUC = 0.82), with active monitoring outperforming spontaneous reporting (AUC = 0.84 vs. 0.72).

Conclusion: CHPS-based active monitoring improves the detection, timeliness, and predictive assessment of ADRs compared with spontaneous reporting. These findings support the integration of active monitoring into hospital pharmacovigilance systems and highlight novel safety signals requiring further validation.

The fast-changing environment for healthcare in all countries calls for new approaches to achieving improvements. This article proposes that improve-mentation is one such approach. Improve-mentation synergistically combines elements of implementation and improvement sciences, as well as experience to carry out change in different settings. One feature is the iteration of the change so as to adapt the change to the evolving context for private and public healthcare in different countries. The article addresses challenges posed by increasing complexity and describes the methods used in four different improve-mentation frameworks, using case examples to illustrate different resolutions to generalisability and other issues.

Introduction: End-stage kidney disease (ESKD) affects many Americans, with higher risks in certain subgroups of the US population. Differential kidney health outcomes may stem from non-medical social drivers of health, cognitive difficulties, and functional limitations. Recommendations for individuals with ESKD are often standardized and may not account for unique challenges and access barriers that individuals face. These challenges lead to preventable differences in access to treatments such as home dialysis and kidney transplantation. This study examines the prevalence of unmet social, cognitive, and functional needs amongst patients receiving dialysis and evaluates the intersection of these barriers to inform strategies to improve kidney health outcomes for all patients.

Methods: In a cross-sectional study, a convenience sample of 962 patients from diverse backgrounds, currently undergoing dialysis from multiple dialysis centers across the United States (aged 21-95 years), were surveyed. Descriptive, Spearman's correlation, logistic regression, and Chi-Square Test analyses conducted.

Results: From our large sample, 45.1% reported memory challenges, 19.6% required assistance with activities of daily living (ADLs), and 51.0% experienced two or more mobility limitations. Additionally, 20.4% reported difficulty accessing healthcare, while 16.3% faced challenges obtaining medications. A subset (12.2%) of participants experienced overlapping social, cognitive, and functional barriers. Unmet needs were disproportionately higher amongst public insurance participants compared to those with private insurance, with 33.0% of Dual-eligible participants reporting three or more unmet needs.

Discussion: This study highlights the significant intersection of social, cognitive, and functional barriers faced by patients receiving dialysis with ESKD, particularly those from vulnerable populations. Addressing these multifaceted needs through person-centered interdisciplinary care models and policy interventions is critical to reducing disparities and improving outcomes in kidney health outcomes.

The persistence of the science to service gap is evidence that evidence is not enough when defining evidence-based programs. Innovations must be developed with attention to the internal and external validity of the innovations themselves so that innovations can be replicated and scaled. This paper outlines the requirements for establishing an innovation, recommends standards for a usable innovation, and describes the usability testing processes to meet those requirements. Usability testing is a systematic process to efficiently and effectively determine the essential components and to develop a fidelity measure for an innovation. Usability testing is the foundation for research to establish the internal validity ("the basic minimum without which any experiment is uninterpretable") and external validity ("asks the question of generalizability") of the innovation itself. Once the essential components of a usable innovation are defined, measured, and linked with outcomes, implementation and scaling of usable innovations with fidelity can narrow the science to service gap.

Introduction: Hospital discharge is a vulnerable transition for older adults who often leave with limited understanding of their health and care instructions. This study evaluated the implementation and outcomes the Patient-Oriented Discharge Summary (PODS), a one-page co-designed tool to support hospital-to-home transitions.

Methods: Using a hybrid type II design, we combined a quasi-experimental pre-post study with an implementation evaluation in a Swiss acute care unit. Patients aged ≥50 years discharged home were allocated to control (n = 55) or intervention (PODS; n = 56). The primary outcome was perceived quality of care transition measured using the Care Transition Measure (CTM-15). Implementation outcomes were assessed through surveys, focus groups and interviews with healthcare professionals.

Results: PODS participants reported higher CTM-15 scores than controls (74.4 vs. 62.3, p < 0.001). Implementation findings showed that the PODS structured discharge teaching and supported dialogue but its blank, collaboratively completed format led to variable completeness and limited usefulness at home. Persistent barriers included workload, workflow integration, and uneven interprofessional engagement.

Conclusions: PODS improved perceived quality of care transition, primarily through the relational and educational processes it structures rather than the written document alone. While valuable, PODS alone appears insufficient; combining structured tools with contextual and organizational supports may enhance effectiveness.Clinical Trial Registration: clinicaltrials.gov, identifier (NCT06123546).

Background: Leadership underpins nurses' interrelated satisfaction and retention, particularly in military healthcare settings marked by strict hierarchies and high operational demands. In Greece, Navy nurses are integral to military healthcare, yet evidence on their job satisfaction and turnover intentions remains limited. This study offers an initial examination of these factors to inform retention strategies and sustain clinical workforce stability.

Methods: A cross-sectional survey was conducted between January and March 2025 among active-duty Hellenic Navy nurse officers, primarily serving at the Athens Naval Hospital. Data were collected using an anonymous questionnaire incorporating the Job Satisfaction Survey (JSS) and turnover intention items. Analyses employed descriptive statistics and bivariate tests.

Results: Sixty nurse officers participated (response rate: 53.6%). While respondents reported satisfaction with supervision (68.3%) and coworker relationships (31.7%), there was widespread dissatisfaction with extrinsic factors: 90.0% with pay, 85.0% with promotion opportunities, and 83.3% with fringe benefits. Overall, 53.3% of nurses reported low job satisfaction. Turnover intentions were high: 46.7% considered transitioning to civilian nursing, and 31.7% intended to leave both the Navy and the profession. Job satisfaction related to the nature of work (r = 0.36, p < 0.05) and communication (r = -0.33, p < 0.05) significantly correlated with turnover intentions.

Conclusion: Leadership quality, as reflected in supportive supervision, is a key protective factor against job dissatisfaction and turnover intention among Hellenic Navy nurse officers. Strengthening supervisory practices and leadership development, alongside reforms addressing extrinsic rewards and communication, is essential to enhance retention and sustain a resilient military nursing workforce.

Dialysis therapy is a resource-intensive treatment for end-stage kidney disease that remains highly dependent on in-center hemodialysis in Japan. From both economic and environmental perspectives, it is necessary to reduce energy consumption and resource use, and minimize waste generation to achieve sustainable kidney healthcare. The clinic targeted in this study provides hemodialysis in a regional city and launched a resource-saving committee in 2008 to implement initiatives, appoint green champions, and monitor four environmental items (electricity, gas and water consumption, and waste generation) and financial effects. To retrospectively evaluate environmental impact, we calculated the carbon footprint. The median monthly consumption of electricity, gas, and water per hemodialysis patient was approximately 353 kWh, 17 m³, and 9 m³, respectively. These levels of resource consumption were nearly equivalent to those of an average Japanese household in 2022. Switching to a combination of city water and well water reduced both costs and environmental impact. However, the overall financial benefit and initial investment burden, such as for installation of light-emitting diode fixtures and developing the water supply system, were not fully investigated. The resource-saving committee appears to have mitigated both economic and environmental impacts to some extent; however, steady resource-saving efforts were accompanied by surging costs of electricity and medical waste disposal during the study period, indicative of recent general inflation in Japan. To achieve more sustainable dialysis therapy that balances environmental and health considerations, further proactive initiatives are needed to reduce resource use beyond the current scope, such as through individualized dialysate prescriptions.