International Journal of Nursing Studies Advances最新文献

{"title":"Undergraduate nursing students’ experiences during international clinical placement: A scoping review","authors":"Lasse Andreassen ,&nbsp;Simen A. Steindal ,&nbsp;Jyoti Sarin ,&nbsp;Benedicte Sørensen Strøm","doi":"10.1016/j.ijnsa.2025.100378","DOIUrl":"10.1016/j.ijnsa.2025.100378","url":null,"abstract":"<div><h3>Background</h3><div>Immigration, combined with the growth of multicultural societies, has increased patient diversity, highlighting the need for cultural competence in healthcare to prepare nurses to understand the nature of global health. Nurses should have knowledge to understand and respect how culture influences patients’ health needs, access to healthcare services, and the health-related decision-making process. Offering international clinical placement to nursing students is one way to increase this cultural competence. No scoping review has mapped undergraduate nursing students’ experiences during international clinical placement.</div></div><div><h3>Objectives</h3><div>To provide an overview of published studies on undergraduate nursing students’ experiences during international clinical placement.</div></div><div><h3>Design</h3><div>A scoping review.</div></div><div><h3>Methods</h3><div>A systematic search was performed in three databases (CINAHL, Medline, PubMed). The inclusion criteria were: 1) studies with quantitative, qualitative or mixed methods design, 2) studies reporting undergraduate nursing students’ experiences of international clinical placement and 3) studies published in peer-reviewed journals in the English language between January 2008 and February 2023. Pairs of authors independently assessed eligibility and extracted data. Data were thematically grouped.</div></div><div><h3>Results</h3><div>42 papers were included, 39 studies employed a qualitive design, while 3 studies employed a quantitative design. All studies included students from Western countries with international clinical placement in non-Western countries. Most students had international clinical placement in hospitals, with a wide range of length of exchange. Four thematic groupings were identified: 1) developing cultural competence through culture shock, 2) a novel way of practicing nursing due to a different nursing role, 3) the essential role of the supervisor in learning outcomes and 4) the impact of language barriers on learning outcomes.</div></div><div><h3>Conclusions</h3><div>Students developed cultural competence by experiencing culture shock when exposed to an unfamiliar cultural environment. While they often reacted negatively to these differences, they often adjusted their prejudices and biases over time. Language skills were the greatest barrier to achieving learning outcomes, creating more frustration than cultural barriers. There is a need to investigate how non-Western students experience studying in a Western country.</div></div>","PeriodicalId":34476,"journal":{"name":"International Journal of Nursing Studies Advances","volume":"9 ","pages":"Article 100378"},"PeriodicalIF":3.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144723998","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Generational differences in nurse stress and coping strategies in relation to perceived patient safety: A cross-sectional study","authors":"Natalia Pawlak ,&nbsp;Lena Serafin ,&nbsp;Bożena Czarkowska-Pączek","doi":"10.1016/j.ijnsa.2025.100385","DOIUrl":"10.1016/j.ijnsa.2025.100385","url":null,"abstract":"<div><h3>Background</h3><div>Multigenerational nursing teams, composed of Generations X, Y, and Z, face distinctive challenges due to differing perceptions of stress and coping mechanisms. Recognizing these generational variances is crucial for enhancing collaboration and improving patient outcomes.</div></div><div><h3>Objectives</h3><div>We investigated intergenerational differences in stress levels and coping strategies and their impact on patient safety among nurses from different generations. The aim was to provide insights that could help optimize the dynamics of multigenerational teams.</div></div><div><h3>Participants</h3><div>The study involved 692 registered nurses in Poland who were born in Generation X (1965–1980), Generation Y (1981–1996), or Generation Z (1997 and later), all of whom were employed in diverse healthcare settings.</div></div><div><h3>Setting and methods</h3><div>Data were collected using the Multidimensional Nursing Generational Questionnaire, Perceived Stress Scale, and Brief Coping Orientation to Problems Experienced Inventory questionnaire. The analyses involved analysis of variance and path analysis to inspect the relationships among stress levels, coping strategies, and generational affiliation.</div></div><div><h3>Results</h3><div>Significant generational differences surfaced, with Generation Z displaying the highest stress levels and a propensity for active coping, notably seeking support. This was positively correlated with their view of patient safety. Conversely, Generation X nurses exhibited a greater reliance on avoidance behaviors, correlating with poorer views of patient safety. The differences among generations moderated the stress-coping dynamics, suggesting that targeted interventions might improve team unity and patient care.</div></div><div><h3>Conclusions</h3><div>We have underlined the possible need for generationally-sensitive approaches in Polish nursing teams. We suggest that generational affiliation may shape how nurses experience stress, select coping strategies, and form views of patient safety. These differences highlight the potential importance of considering generational dynamics in efforts to support nurse well-being and team collaboration.</div></div>","PeriodicalId":34476,"journal":{"name":"International Journal of Nursing Studies Advances","volume":"9 ","pages":"Article 100385"},"PeriodicalIF":3.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144723996","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health educational interventions for adolescents living with HIV: A scoping review","authors":"Ndinohokwe Foibe Mukerenge ,&nbsp;Shelley Schmollgruber ,&nbsp;Ntombifikile Klaas","doi":"10.1016/j.ijnsa.2025.100359","DOIUrl":"10.1016/j.ijnsa.2025.100359","url":null,"abstract":"<div><h3>Background</h3><div>Adolescents living with HIV face unique challenges as they gain greater independence while transitioning into adulthood. They must adjust their self-management activities and take primary responsibility for their health, including adhering to medication regimens and attending clinic visits. These young individuals need to acquire knowledge about HIV and Antiretroviral treatment to manage their condition and improve their health outcomes effectively. This study aims to map existing interventions for adolescents with HIV, focusing on the types, content, and best practices that enhance their understanding of both HIV and Antiretroviral treatment.</div></div><div><h3>Methods</h3><div>The scoping review utilised a Joanna Briggs Institute (JBI) framework to map the relevant literature. We searched the CINAHL Complete, MEDLINE (via PubMed), ProQuest, Science Direct, and Scopus databases for studies published between January 1, 2000, and January 31, 2023. We selected studies using the inclusion criteria. Studies included health education programs as the intervention, which developed or implemented strategies to improve knowledge and skills related to HIV and self-management of antiretroviral treatment adherence among this population.</div></div><div><h3>Results</h3><div>Only five (5) studies met the eligibility criteria and were included in this review. Three (3) broad categories emerged from the analysis of the scoping review: the nature of interventions available for Adolescents living with HIV, the content of existing interventions, and best practices. The findings revealed limited evidence of programs aimed at adolescents in various settings. Most notable was the paucity of evidence on programs targeting Adolescents living with HIV, especially those that are designed to help them learn about their condition and associated treatment.</div></div><div><h3>Conclusion</h3><div>The review highlights the existence of limited evidence-based, context-specific, and consumer-tailored educational interventions for Adolescents living with HIV. More comprehensive, age-appropriate and personalised interventions are needed for adolescent self-management of HIV as a chronic health condition.</div></div>","PeriodicalId":34476,"journal":{"name":"International Journal of Nursing Studies Advances","volume":"9 ","pages":"Article 100359"},"PeriodicalIF":3.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144338732","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Psychometric properties and content of instruments for assessing penile cancer patients’ quality of life: A systematic review","authors":"Anu Soikkeli-Jalonen ,&nbsp;Suvi Vierelä ,&nbsp;Antti Kaipia ,&nbsp;Eeva Harju ,&nbsp;Elina Haavisto","doi":"10.1016/j.ijnsa.2025.100412","DOIUrl":"10.1016/j.ijnsa.2025.100412","url":null,"abstract":"<div><h3>Aim</h3><div>To describe the psychometric properties and content of the instruments used for assessing penile cancer patients’ quality of life</div></div><div><h3>Design</h3><div>A systematic review</div></div><div><h3>Method</h3><div>A systematic literature search was conducted in October 2024 across four electronic databases: PubMed, CINAHL, PsycINFO, and the Cochrane Library. The systematic approach was adhered to when conducting the review, and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed to ensure explicit reporting. The search across the four databases generated 135 articles, out of which 16 were included in the review.</div></div><div><h3>Results</h3><div>Eight instruments assessing the quality of life (QoL) among penile cancer patients were identified: four generic, two cancer-specific, and two penile cancer-specific. The content of these instruments fell into three main categories: physical functioning, psychosocial resilience, and overall life functions. However, none of the instruments covered all these aspects comprehensively. Additionally, no instrument was reported to be thoroughly valid or reliable.</div></div><div><h3>Conclusions</h3><div>A psychometrically tested and validated QoL instrument that covers all aspects of penile cancer patients' well-being was not found. There is a need for holistic instruments tailored to evaluate and improve the QoL for these patients. Such instruments would enable the identification and comparison of individual care needs and factors influencing their QoL.</div></div>","PeriodicalId":34476,"journal":{"name":"International Journal of Nursing Studies Advances","volume":"9 ","pages":"Article 100412"},"PeriodicalIF":3.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145007601","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Challenges to nursing leadership in research and academia in the UK: A systematic narrative review","authors":"Arun Vamadevan ,&nbsp;Vijesh Vijayan ,&nbsp;KasiReddy Jayasudha ,&nbsp;Styja Varghese ,&nbsp;Oghale Eboh ,&nbsp;Ajeesh Karthikeyan ,&nbsp;Christine Cole ,&nbsp;Lauren Walker","doi":"10.1016/j.ijnsa.2025.100411","DOIUrl":"10.1016/j.ijnsa.2025.100411","url":null,"abstract":"<div><h3>Background</h3><div>Nurses form the largest professional group in the United Kingdom (UK) healthcare system, yet they remain significantly underrepresented in research and academic leadership. While the medical profession has benefited from well-defined academic pathways, structured support for nurses in research remains inconsistent, limiting their influence in shaping evidence-based care and healthcare innovation.</div></div><div><h3>Aim</h3><div>This narrative Review explores the current landscape of nursing representation and progression in research and academic leadership in the UK. It identifies enabling factors, systemic and cultural barriers, and the implications for workforce development and policy.</div></div><div><h3>Methods</h3><div>A systematic narrative Review was conducted using literature published between 2006 and April 2025, sourced from PubMed, Scopus, and the Cochrane Library. Eighteen eligible studies focusing on clinical academic roles for nurses were included. Data extraction and synthesis followed narrative methods, and study quality was appraised using the GRADE framework and ROBINS-I risk of bias tool.</div></div><div><h3>Results</h3><div>Included studies highlighted a range of initiatives, particularly the HEE/NIHR Integrated Clinical Academic (ICA) Programme, that have supported early clinical academic development and contributed to strengthening professional identity. However, progression to senior research leadership remains constrained by multiple structural and organisational barriers. These include poor visibility of nursing leadership, lack of integrated career frameworks, limited access to research mentors, insufficient protected time for academic activity, and poor alignment between NHS and academic institutions. Cultural expectations, undervaluing of nursing research, and gendered norms around leadership roles further hinder advancement. Key enablers included early exposure to research, access to structured development schemes, inclusive institutional culture, and visible role models. While the overall quality of evidence ranged from low to moderate, the ROBINS-I assessment identified frequent concerns around study design and reporting clarity. Equity issues affecting nurses from global majority backgrounds were underexplored and represent an important area for future research.</div></div><div><h3>Conclusion</h3><div>Advancing nursing leadership in research requires a nationally coordinated, long-term strategy with sustained investment, equitable access to career development, and cultural transformation. Mentorship, funding, structural support, and inclusive leadership are essential to enabling nurses to fully contribute to healthcare research and innovation. Addressing underrepresentation and inequality is critical for a diverse and sustainable clinical academic workforce.</div></div><div><h3>Registration</h3><div>Not registered, as this is a systematic narrative Review.</div></div>","PeriodicalId":34476,"journal":{"name":"International Journal of Nursing Studies Advances","volume":"9 ","pages":"Article 100411"},"PeriodicalIF":3.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145007602","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors related to well-being and psychological health in nursing students: A cross-sectional survey","authors":"Beatriz Calderón-Cruz ,&nbsp;Uxía García-Sánchez ,&nbsp;Jacinto Luis González-Oya ,&nbsp;Ángela Prieto-Campo","doi":"10.1016/j.ijnsa.2025.100421","DOIUrl":"10.1016/j.ijnsa.2025.100421","url":null,"abstract":"<div><h3>Background</h3><div>Psychological well-being is an important topic in mental health. It is known that university students have a high prevalence of stress and psychological distress, especially students in health sciences fields such as nursing. Despite the growing emergence of this public health issue, research on the factors affecting the mental health of nursing students is limited.</div></div><div><h3>Objective</h3><div>To estimate the global psychological health and well-being of Spanish nursing students and its associations with sociodemographic and lifestyle factors.</div></div><div><h3>Methods</h3><div>A cross-sectional study was conducted among nursing students. Descriptive analysis, bivariate analysis, and binary regression models were performed.</div></div><div><h3>Results</h3><div>A total of 235 students participated, of which 49.4 % had poor psychological well-being and 51.5 % reported high levels of detrimental emotional symptoms. The main factors related to these unfavorable outcomes were smoking (OR &gt; 5, 95 % C.I. 2–16.30), frequent consumption of fast food (OR &gt; 5, 95 % C.I. 2–16.30), sleeping &lt;7 h (OR &gt; 2.5, 95 % C.I. 1.46–5.09), and being in the third year of the University study program (OR 2.13, 95 % C.I. 1.051–4.331).</div></div><div><h3>Conclusions</h3><div>These results highlight healthy lifestyle habits as the main factors related to psychological well-being. Additionally, they underscore the need to create psychological support strategies for nursing students.</div></div>","PeriodicalId":34476,"journal":{"name":"International Journal of Nursing Studies Advances","volume":"9 ","pages":"Article 100421"},"PeriodicalIF":3.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145117967","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical-epidemiological predictors of phlebitis associated with peripheral intravenous catheters in Spanish hospitals: results of a national cohort study","authors":"José Antonio Cernuda-Martínez ,&nbsp;José Luis Cobo-Sánchez ,&nbsp;Eva María Alarcón-Duque ,&nbsp;Esther Moreno-Rubio ,&nbsp;María Belén Suárez-Mier ,&nbsp;María del Camino del Río-Pisabarro ,&nbsp;Marta Ferraz-Torres ,&nbsp;Flebitis Zero Group","doi":"10.1016/j.ijnsa.2025.100355","DOIUrl":"10.1016/j.ijnsa.2025.100355","url":null,"abstract":"<div><h3>Background</h3><div>Peripheral intravenous catheters (PIVC) are essential medical devices, yet they frequently lead to complications such as phlebitis, infiltration, and occlusion. Identifying risk factors is key to reducing these complications.</div></div><div><h3>Objectives</h3><div>To estimate the incidence of PIVC‑associated phlebitis in Spanish hospitals and identify clinical and epidemiological risk factors.</div></div><div><h3>Methods</h3><div>We performed a prospective cohort study in 80 Spanish hospitals from 1 to 28 February 2023. Adult inpatients (≥18 years) receiving PIVCs in non‑ICU, non‑emergency, non‑pediatric wards were eligible. A total of 13,812 PIVCs in 9387 patients were followed daily by trained nurses until catheter removal, phlebitis onset (Maddox grade ≥ 2), or 15 days. We calculated cumulative incidence and incidence density per 100 catheter‑days. Multivariable Cox proportional hazards models estimated hazard ratios (HRs) for predictors—sex, age group, number of infused medications, hospital size, and dwell time.</div></div><div><h3>Results</h3><div>Phlebitis occurred in 1302 PIVCs (cumulative incidence 9.43 %; incidence density 0.14 per 100 person‑hours). Independent risk factors were female sex (HR 1.32, 95 % CI 1.21–1.45), age 65–79 years (HR 1.25, 95 % CI 1.12–1.40), administration of ≥ 2 medications (HR 1.50, 95 % CI 1.35–1.67), and hospital size ≥ 1000 beds (HR 1.30, 95 % CI 1.12–1.52). Phlebitis risk peaked 48–96 h post‑insertion.</div></div><div><h3>Conclusions</h3><div>Phlebitis incidence remains above recommended levels. Multivariable analysis identified female sex, a higher number of infused medications, older patient age, larger hospital size, and longer PIVC dwell time as the main independent predictors of phlebitis. <strong>Registration:</strong> Not registered.</div></div>","PeriodicalId":34476,"journal":{"name":"International Journal of Nursing Studies Advances","volume":"9 ","pages":"Article 100355"},"PeriodicalIF":3.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144212857","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Self-care practice and associated factors among hypertensive patients in Ethiopia: Umbrella review of systematic review and meta-analysis studies","authors":"Sefineh Fenta Feleke ,&nbsp;Anteneh Mengist Dessie ,&nbsp;Atitegeb Abera Kidie ,&nbsp;Muluemebet Kassa ,&nbsp;Tesfaye Engdaw Habtie ,&nbsp;Natnael Amare Tesfa ,&nbsp;Zenebe Daniel Getachew ,&nbsp;Tadele Emagneneh ,&nbsp;Wagaw Abebe","doi":"10.1016/j.ijnsa.2025.100433","DOIUrl":"10.1016/j.ijnsa.2025.100433","url":null,"abstract":"<div><h3>Background</h3><div>Self-care practices are vital for managing high blood pressure. Four systematic reviews and meta-analysis in Ethiopia have shown inconsistent prevalence rates and varying quality scores for hypertensive self-care. This umbrella review aims to unify these findings into a comprehensive document for better comparison. It is the first of its kind in Ethiopia and seeks to support clinicians and policymakers in preventing hypertension-related complications.</div></div><div><h3>Methods</h3><div>This umbrella review incorporated four systematic reviews and meta-analyses identified through a literature search across PubMed, ScienceDirect, Web of Science, the Cochrane Database of Systematic Reviews, and the Database of Abstracts of Reviews of Effects, specifically targeting systematic reveiw and meta-analysis) studies on hypertension self-care practices in Ethiopia<strong>.</strong> Data from the included systematic review and meta-analysis studies were extracted using a standardized data abstraction form created in an Excel spreadsheet. The quality of all relevant systematic reviews and meta-analyses was assessed using the AMSTAR-2 (Assessment of Multiple Systematic Reviews) tool. R software version 4.3.2 was used to perform overall data synthesis and statistical analysis. The overall pooled prevalence and effect sizes were analyzed using a random-effects model.</div></div><div><h3>Results</h3><div>Four studies with 21,479 hypertensive patients were included. The overall pooled prevalence of good self-care practice among hypertensive patients in Ethiopia is 41 % (95 % CI 38 %, 44 %, I² =96 %, <em>P</em> = 0.001). Attending formal education (OR=1.56, 95 % CI: 1.23, 2.74), good knowledge of hypertension (OR=1.98, 95 % CI: 1.45, 3.01) were significantly associated with self-care practice among hypertensive patients in Ethiopia.</div></div><div><h3>Conclusions</h3><div>This umbrella review revealed low self-care practices among hypertensive patients in Ethiopia, with the poorest adherence in physical activity and the highest in smoking cessation. Education and knowledge about hypertension were key influences on self-care. The review suggests promoting physical activity, targeted education, and integrating these strategies into public health policies, alongside conducting nationwide studies to improve interventions.</div></div>","PeriodicalId":34476,"journal":{"name":"International Journal of Nursing Studies Advances","volume":"9 ","pages":"Article 100433"},"PeriodicalIF":3.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145265286","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adapting program theory to guide the implementation and evaluation of interventions delivered by advanced practice nurses in Hospital at Home: A programmatic framework for implementation and assessment","authors":"Rachid Akrour ,&nbsp;Philip Larkin ,&nbsp;Henk Verloo","doi":"10.1016/j.ijnsa.2025.100444","DOIUrl":"10.1016/j.ijnsa.2025.100444","url":null,"abstract":"<div><div>This article presents an adaptation of Program Theory framework designed to support the implementation and evaluation of interventions delivered by advanced practice nurses within Hospital at Home models. In response to increasing healthcare demands associated with aging populations and multimorbidity, this framework integrates three interrelated theories; Program Organizational, Service Utilization, and Impact theories to conceptualize and assess advanced practice nurse led care delivery in Hospital at Home settings.</div><div>Organizational Theory outlines the structural and functional requirements for integrating advanced practice nurses into Hospital at Home, including role definition, interprofessional collaboration, governance structures, and resource allocation. It emphasizes ways to foster the autonomy of advanced practice nurses, supporting clinical decision-making, and ensuring infrastructure for coordinated care. Service Utilization Theory focuses on the determinants of access, acceptance, and appropriateness of care. It addresses mechanisms for patient referral, eligibility assessment, and care escalation, and highlights the importance of aligning patient needs with the expertise of advanced practice nurses.</div><div>The adapted Impact Theory identifies causal pathways linking interventions delivered by advanced practice nurses, such as early assessment, individualized care planning, home visits, therapeutic education, and care coordination to patient and caregiver, for system-level outcomes. These outcomes include reduced hospital admissions and readmissions, fewer emergency department visits, lower nursing home placement rates, and improved functional status, quality of life, and patient satisfaction. The Program Theory framework also supports the evaluation of caregiver burden and the effectiveness of self-management support including health literacy.</div><div>Applied in the context of a French-speaking canton in Switzerland, where Hospital at Home services remain underdeveloped and advanced practice nurses are not integrated into these services, this framework provides a structured and theory-driven approach to guide the operationalization and evaluation of their interventions. It establishes a basis for the measurement of outcomes across care processes, individual experiences, and health system impacts. By aligning intervention components with expected outcomes, this approach addresses the complexity of Hospital at Home and the multidimensional contribution of advanced practice nurses, offering a foundation for future implementation and research.</div></div>","PeriodicalId":34476,"journal":{"name":"International Journal of Nursing Studies Advances","volume":"9 ","pages":"Article 100444"},"PeriodicalIF":3.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145424330","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reconsidering the use of race, sex, and age in clinical algorithms to address bias in practice: A discussion paper","authors":"Reanna Panagides ,&nbsp;Jessica Keim-Malpass","doi":"10.1016/j.ijnsa.2025.100380","DOIUrl":"10.1016/j.ijnsa.2025.100380","url":null,"abstract":"<div><div>Clinical algorithms are commonly used as decision-support tools, incorporating patient-specific characteristics to predict health outcomes. Risk calculators are clinical algorithms particularly suited for resource allocation based on risk estimation. Although these calculators typically use physiologic data in estimation, they frequently include demographic variables such as race, sex, and age as well. In recent years, the inclusion of race as an input variable has been scrutinized for being reductive, serving as a poor proxy for biological differences, and contributing to the inequitable distribution of services. Little attention has been given to other demographic features, such as sex and age, and their potential to produce similar consequences. By applying a framework for understanding sources of harm throughout the machine learning life cycle and presenting case studies, this paper aims to examine sources of potential harms (i.e. representational and allocative harm) associated with including sex and age in clinical decision-making algorithms, particularly risk calculators. In doing so, this paper demonstrates how systematic discrimination, reductive measurement practices, and observed differences in risk estimation between demographic groups contribute to representational and allocative harm caused by including sex and age in clinical algorithms used for resource distribution. This paper ultimately, urges clinicians to scrutinize the practice of including reductive demographic features (i.e. race, binary-coded sex, and chronological age) as proxies for underlying biological mechanisms in their risk estimations as it violates the bioethical principles of justice and nonmaleficence. Practicing clinicians, including nurses, must have an underlying model literacy to address potential biases introduced in algorithm development, validation, and clinical practice.</div></div>","PeriodicalId":34476,"journal":{"name":"International Journal of Nursing Studies Advances","volume":"9 ","pages":"Article 100380"},"PeriodicalIF":3.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144604529","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}