Nursing Research最新文献

{"title":"Worse Nursing-Sensitive Indicators in Black-Serving Hospitals.","authors":"Eileen T Lake, Celsea C Tibbitt, John F Rizzo, Christin Iroegbu, Jessica G Smith, Douglas O Staiger, Jeannette A Rogowski","doi":"10.1097/NNR.0000000000000819","DOIUrl":"10.1097/NNR.0000000000000819","url":null,"abstract":"<p><strong>Background: </strong>In hospitals that serve disproportionately patients of Black race, here termed Black-serving hospitals (BSH), nurse staffing is worse, mortality rates are higher, and nursing-sensitive indicators may be worse than in other hospitals, but this evidence has not been compiled.</p><p><strong>Objective: </strong>The study objective was to examine whether nursing-sensitive indicators, which measure changes in patient health status directly affected by nursing care, differ in hospitals where Black patients predominantly access their care, as compared to other hospitals.</p><p><strong>Methods: </strong>To fulfill the objective, a cross-sectional design using publicly available 2019 to 2022 Hospital Compare, 2019 Medicare Provider Analysis and Review (MEDPAR), and case mix index (CMI) file databases were used. Four nursing-sensitive indicators were evaluated: pressure ulcer, postoperative sepsis, perioperative pulmonary embolus/deep vein thrombosis, and death rate among surgical inpatients with serious treatable complications (\"failure to rescue\") in hospitals classified into high, medium, and low BSHs according to the percentage of patients of Black race in the MEDPAR data. Mean outcome differences across BSH categories were assessed through analyses of variance and regression models, which controlled for hospital CMI.</p><p><strong>Results: </strong>The 3,101 hospitals were predominantly urban nonteaching hospitals in metropolitan areas. Although 12% of hospitals had Magnet designation, BSHs were disproportionately Magnet (14%). The outcome rates were 0.59 for pressure ulcers, 3.38 for perioperative pulmonary embolus/deep vein thrombosis, 143.58 for failure to rescue, and 4.12 for sepsis. Rates were significantly higher for pressure ulcers, perioperative pulmonary embolus/deep vein thrombosis, and sepsis in high BSHs. The mean failure to rescue rate was similar across low-to-high BSHs and did not show significant differences. These results were unchanged in models adjusting for CMI.</p><p><strong>Discussion: </strong>The evidence suggests that several nursing-sensitive indicators are worse in high BSHs. Research linking nursing-sensitive indicators to nursing resources such as staffing is needed to explicate the mechanism underlying these findings. Poorer nursing-sensitive indicators in combination with poorer nurse staffing in high BSHs presents a priority for policy and management intervention.</p>","PeriodicalId":49723,"journal":{"name":"Nursing Research","volume":" ","pages":"324-328"},"PeriodicalIF":2.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12197836/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143634871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Concurrent Validity of a Physical Activity Vital Sign Used in an Adult Preventive Cardiology Clinic.","authors":"Margaret McCarthy, Jason Fletcher, Gail Melkus, Allison Vorderstrasse, Mireille Chehade, Stuart Katz","doi":"10.1097/NNR.0000000000000818","DOIUrl":"10.1097/NNR.0000000000000818","url":null,"abstract":"<p><strong>Background: </strong>In clinical settings, counseling patients on physical activity starts by assessing patients' current physical activity levels. Self-report measures of PA are generally easy to administer; however, they may be too long to be convenient and are known to correlate poorly with objective measures of physical activity.</p><p><strong>Objective: </strong>To assess the concurrent validity of a self-report three-question physical activity vital sign with objective Fitbit step counts and the distance walked during a 6-min walk test.</p><p><strong>Methods: </strong>This pilot study tested a best practice advisory embedded in the Epic electronic health record, which was designed to prompt providers in a preventive cardiology clinic to counsel patients reporting low levels of physical activity. Patients were invited to participate in the remote patient monitoring phase to assess the change in their physical activity by wearing a Fitbit for 12 weeks and completing a 6-min walk test at baseline and 12 weeks. This analysis used the cross-sectional data collected in this phase. Pearson correlations were conducted between self-reported physical activity, Fitbit step counts, and the distance walked during the 6-min walk-a measure associated with current physical activity levels. Kappa coefficients were calculated to assess agreement between self-reported physical activity and step counts.</p><p><strong>Results: </strong>Participants who enrolled in the Fitbit monitoring were approximately 50% female, with the majority identified as White non-Hispanic adults. Their most common cardiovascular risk factor was hypertension. The self-reported physical activity vital signs were significantly associated with step counts at baseline and 12 weeks but were not associated with the distance during the 6-min walk test. However, the distance walked was significantly associated with step counts at baseline and 12 weeks. The Kappa results demonstrate a poor level of agreement between two categories (meeting or not meeting current physical activity guidelines) of self-report physical activity vitals and the objective Fitbit step counts.</p><p><strong>Discussion: </strong>There were moderate correlations between the self-reported physical activity vital signs and the Fitbit step counts, but there was lack of agreement when they were categorized. Further validation of this physical activity vital sign is warranted.</p>","PeriodicalId":49723,"journal":{"name":"Nursing Research","volume":" ","pages":"299-304"},"PeriodicalIF":2.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143634850","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Experiences of Females With Late Diagnosis of Autism: Descriptive Qualitative Study.","authors":"Maria Inmaculada Garcia-Simon, Eva Del Mar Navarro-Jimenez, Adrian Martinez-Ortigosa, Carmen Ropero-Padilla, Pablo Roman, Miguel Rodriguez-Arrastia","doi":"10.1097/NNR.0000000000000825","DOIUrl":"10.1097/NNR.0000000000000825","url":null,"abstract":"<p><strong>Background: </strong>Females with autism often receive late diagnoses-especially those with average or above-average intellectual abilities-highlighting the need to explore the unique experiences of this population for better health care support.</p><p><strong>Objective: </strong>To explore the experiences and perceptions of females who received a late diagnosis on the autism spectrum in terms of coping and managing their diagnosis.</p><p><strong>Methods: </strong>A descriptive qualitative study was conducted from December 2022 to March 2023 using semistructured interviews with 14 late-diagnosed autistic female subjects. Purposive and snowball sampling were employed, and thematic analysis of the interview data was performed using ATLAS.ti v.9 software. Findings were reported following standards for reporting qualitative research guidelines.</p><p><strong>Results: </strong>Two main themes emerged: (a) getting a diagnosis: fitting into the norm, and (b) navigating the distinct significance for autistic females. The findings indicated that masking strategies contribute to delayed diagnoses, and social and health care stigma surrounding autism in females was evident. Areas for improving access to resources and support programs were identified.</p><p><strong>Discussion: </strong>The results show that masking and camouflaging are predominant strategies among autistic females, contributing to delayed diagnoses and exposing them to additional risks. Enhancing resources and training for health care professionals is necessary to address the specific needs of this population.</p>","PeriodicalId":49723,"journal":{"name":"Nursing Research","volume":" ","pages":"288-293"},"PeriodicalIF":2.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144062402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Self-Care, Perceived Social Support, and Health-Related Quality of Life in Patients With Heart Failure.","authors":"Ashmita Thapa, JungHee Kang, Misook Lee Chung, Jia-Rong Wu, Martha J Biddle, Geunyeong Cha, Debra K Moser","doi":"10.1097/NNR.0000000000000820","DOIUrl":"10.1097/NNR.0000000000000820","url":null,"abstract":"<p><strong>Background: </strong>Depressive symptoms, anxiety, and inadequate social support are predictors of health-related quality of life (HRQoL) in persons with heart failure, but the prediction of HRQoL is multifaceted, and mechanisms underlying association are unknown. Self-care maintenance may moderate associations among these predictors, which is essential to better heart failure outcomes.</p><p><strong>Objectives: </strong>To determine whether self-care maintenance moderates the direct and indirect effects of social support on HRQoL through psychological status (i.e., depressive symptoms and anxiety) in persons with heart failure.</p><p><strong>Methods: </strong>We conducted a secondary analysis using cross-sectional data collected from 167 participants. Participants completed Patient Health Questionnaire-9, Brief Symptom Inventory, Multidimensional Scale of Perceived Social Support, Self-Care of Heart Failure Index version 6.2, and Minnesota Living with Heart Failure Questionnaire for depressive symptoms, anxiety, social support, self-care maintenance, and HRQoL, respectively. PROCESS macro was used for the analysis.</p><p><strong>Results: </strong>Self-care maintenance did not moderate the direct effect of social support on HRQoL. However, self-care maintenance moderated the indirect effect of social support on HRQoL through depressive symptoms and anxiety. The beneficial effect of social support on depressive symptoms and anxiety varied with self-care maintenance, suggesting a dose-response moderation effect.</p><p><strong>Discussion: </strong>Findings suggest that an increment in social support reduces depressive symptoms and anxiety, which further improves HRQoL. This relationship was more profound when the self-care maintenance was at a higher level. Our study emphasizes the need to focus on improving HRQoL by promoting positive social support that can decrease depressive symptoms and anxiety in persons with heart failure-particularly in those with low or moderate levels of self-care maintenance.</p>","PeriodicalId":49723,"journal":{"name":"Nursing Research","volume":" ","pages":"258-265"},"PeriodicalIF":2.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143701969","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hospital Performance, Nursing Resources, and Health Inequities During the COVID-19 Pandemic.","authors":"Ann Kutney-Lee, Daniela Golinelli, Shelli L Feder, Kelvin Eyram Amenyedor, Karen B Lasater, Matthew D McHugh, J Margo Brooks Carthon","doi":"10.1097/NNR.0000000000000821","DOIUrl":"10.1097/NNR.0000000000000821","url":null,"abstract":"<p><strong>Background: </strong>Few researchers have examined the organizational features of high-performing and low-performing hospitals for COVID-19 mortality during the pandemic, and how differences in hospital performance contributed to mortality disparities among socially vulnerable patients hospitalized with COVID-19.</p><p><strong>Objectives: </strong>Our objectives were (a) to identify high- and low-performing hospitals on COVID-19 inpatient mortality and describe their distinguishing organizational characteristics, including nursing resources, and (b) to assess whether patients admitted to high-performing hospitals differed by social vulnerability level.</p><p><strong>Methods: </strong>This analysis used linked nurse survey, hospital, and claims data for 73,792 hospitalized older adults diagnosed with COVID-19 across 96 New York and Illinois hospitals between January 1, 2020, and December 31, 2020. A robust benchmarking approach was used to identify high- and low-performing hospitals on 30-day inpatient mortality. We computed the cumulative proportion of admissions for patients in the highest and lowest social vulnerability index quartiles to the hospitals ranked by performance.</p><p><strong>Results: </strong>The average mortality rate in the high-performing hospitals was 16.2% compared to 31.5% in the low-performing hospitals. Compared to low-performing hospitals, high-performing hospitals had more favorable nurse work environments and lower patient-to-nurse ratios. About half the patients in the lowest social vulnerability quartile (least vulnerable) were admitted to hospitals in the top-performing tertile of hospitals compared to 38% of patients in the highest social vulnerability quartile (most vulnerable).</p><p><strong>Discussion: </strong>Nursing resources were a central feature of a high-performing hospital for COVID-19 mortality during the early stages of the pandemic. Patients diagnosed with COVID-19 who were admitted from the most socially vulnerable communities were less likely to be admitted to high-performing hospitals. Increasing nursing resources-particularly in hospitals that serve socially vulnerable communities-could be a key strategy for preparing for future public health emergencies and addressing health disparities.</p>","PeriodicalId":49723,"journal":{"name":"Nursing Research","volume":" ","pages":"280-287"},"PeriodicalIF":2.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12188792/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143701965","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Behavioral and Functional Adaptation to Chronic Stress in Older Adults.","authors":"Wan-Chin Kuo, Karl P Hummel, Roger L Brown, Katherine Mead, Daniel J Liebzeit","doi":"10.1097/NNR.0000000000000823","DOIUrl":"10.1097/NNR.0000000000000823","url":null,"abstract":"<p><strong>Background: </strong>The wear and tear from chronic stress exposure has been linked to premature aging through allostatic load; however, it is unclear how chronic stress exposure affects physical functioning and physical activity in older adults.</p><p><strong>Objectives: </strong>The study aims were to examine the behavioral and functional adaptation to chronic stress in older adults and its mediational pathways.</p><p><strong>Methods: </strong>Data from the Health and Retirement Study 2016 and 2020 ( N = 3075, mean age 66 years) were analyzed. Chronic and perceived stress exposure was quantified using Troxel's Chronic Stressors Scale and Cohen's Perceived Stress Scale. Physical activity was quantified using self-reported questionnaires, including light, moderate, and vigorous physical activity. Physical functioning was operated as a latent construct with four perceived physical limitations (i.e., difficulty in movement, hand strength, shortness of breath, and balance). The cross-sectional data were analyzed using latent regression analysis. The longitudinal data were analyzed using serial mediation based on MacKinnon's bias-corrected bootstrap confidence intervals.</p><p><strong>Results: </strong>Cross-sectionally, psychological stress, as a latent construct indicated by stress exposure and stress perception, explained more variances in perceived physical limitation than physical activity. Longitudinally, perceived stress and physical activity mediated the relationship between chronic stress exposure and perceived physical limitation with significant indirect effects. Furthermore, perceived physical limitation suppressed the effect of chronic stress exposure on physical activity levels. The effects of mediation and suppression remained significant after the adjustment for age, gender, years of education, race, number of comorbidities, working status, and marital status.</p><p><strong>Discussion: </strong>The promotion of physical activity and physical functioning in older adults might not achieve the optimal outcome if the program design overlooks the target population's chronic stress process and functional limitations.</p>","PeriodicalId":49723,"journal":{"name":"Nursing Research","volume":" ","pages":"250-257"},"PeriodicalIF":2.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12188819/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144058411","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Z-Coding for Social Contributors to Health in Colorado Federally Qualified Health Centers.","authors":"Sean M Reed, Colin Hensen, Sophia Centi, Tara Siebenaller, Laura D Rosenthal, Denise C Smith, Claudia R Amura, Teri L Hernandez, Amy J Barton","doi":"10.1097/NNR.0000000000000817","DOIUrl":"10.1097/NNR.0000000000000817","url":null,"abstract":"<p><strong>Background: </strong>Federally Qualified Health Centers (FQHC) provide services to individuals facing systemic barriers to health equity and are disproportionately affected by adverse social determinants of health. To better align healthcare services with the needs of those individuals experiencing health inequities, it is essential to screen for and document problematic social contributors to health in electronic health records, which health systems have been mandated to document by 2026.</p><p><strong>Objectives: </strong>The aims of this study were to 1) determine the prevalence of documented social contributors to health Z-codes among patients receiving care through Colorado nurse-led FQHCs across urban, rural, and frontier settings; and 2) estimate healthcare utilization and expenditures associated with the presence of documented social contributors to health Z-codes compared to a matched sample of patients without that Z-code documentation.</p><p><strong>Methods: </strong>We conducted a secondary analysis of the Colorado All Payers Claim Database. Social contributor of health ICD-10 Z-codes, reflecting problematic social structural circumstances as defined by Healthy People 2030, were extracted from patients receiving care in FQHCs. Social contributor of health-related charges were computed using propensity matching to compare individuals with and without documented social contributors of health.</p><p><strong>Results: </strong>Documentation of social contributors of health Z-codes was notably low. Housing instability was the most common Z-code documented. Chronic pulmonary disease, diabetes, and heart disease were the most prevalent comorbidities among those with identified social contributors of health. The majority of patients with social contributors of health Z-codes were insured through Medicaid and lived in rural areas. Persons with documented social contributors of health had significantly higher predicted annual medical expenditures compared to those without documentation.</p><p><strong>Discussion: </strong>The low prevalence of social contributors of health coding aligns with previous studies and represents a missed opportunity to provide targeted interventions for populations experiencing adverse social contributors. These findings underscore the need for strategizing and implementing plans to identify and code social contributors of health, especially in facilities serving those experiencing health inequities. Improved documentation of social contributors to health can facilitate data-driven resource allocation and tailored interventions to address adverse social determinants and promote health equity.</p>","PeriodicalId":49723,"journal":{"name":"Nursing Research","volume":"74 4","pages":"318-323"},"PeriodicalIF":2.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144498996","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Urine Metabolites as Indicators of Chronic Pain and Related Symptoms in Active-Duty Service Members: A Secondary Data Analysis of a Pragmatic Clinical Trial With SMART Design.","authors":"Dahee Wi, Hannah Choi, Nathan Tintle, Nicholas Ieronimakis, Diane M Flynn, Jeffrey C Ransom, Kira P Orr, Honor M McQuinn, Tyler J Snow, Ardith Z Doorenbos","doi":"10.1097/NNR.0000000000000827","DOIUrl":"10.1097/NNR.0000000000000827","url":null,"abstract":"<p><strong>Background: </strong>Chronic pain is a major cause of distress and disability, and biomarkers may aid in the assessment and treatment of it. Urine metabolites may be valuable bioindicators that can provide biological insight regarding chronic pain.</p><p><strong>Objectives: </strong>To investigate the relationship between a multimarker composite measure of metabolites and patient-reported outcomes scores in adults with chronic pain, using data from a pragmatic clinical trial with a sequential, multiple-assignment randomized trial design.</p><p><strong>Methods: </strong>Self-reported measures and urine samples from 169 active-duty service members with chronic pain were collected. Urine was analyzed using a preestablished panel of metabolites, including four previously identified biomarkers of pain: kynurenic acid, pyroglutamic acid, ethylmalonic acid, and methylmalonate. Multivariable linear regression models-adjusted for participant characteristics such as age and sex-were used to cross-sectionally examine the relationship between 11 patient-reported outcomes (fatigue, sleep-related impairment, anxiety, depression, anger, pain catastrophizing, physical function, pain interference, satisfaction with participation with social roles, pain intensity, and pain impact score) and the four urine metabolites both individually and as a composite (urine metabolite pain indicator, or UMPI). Given the study's small sample size and exploratory nature, a significance threshold of p ≤ .10 was used for all analyses.</p><p><strong>Results: </strong>The UMPI showed statistically significant associations with five self-reported measures (fatigue, anxiety, depression, physical functioning, and pain impact score); adjusted Pearson correlations ranged from .18 to .25. Individual metabolite analyses supported these findings, with all relationships between individual metabolites and self-reported measures showing positive associations. Kynurenic acid and ethylmalonic acid showed the strongest associations, each having statistically significant relationships with four individual self-reported measures, while pyroglutamic acid had statistically significant relationships with three self-reported measures and methylmalonate with none. The UMPI demonstrated feasible reliability.</p><p><strong>Discussion: </strong>Our finding of associations between the UMPI and components of the self-reported measures supports the development of the UMPI and these four urine metabolites as biomarkers for chronic pain outcomes. Further research is planned and will be essential for establishing mechanistic insight and guiding biomarker development within the context of pain management.</p>","PeriodicalId":49723,"journal":{"name":"Nursing Research","volume":" ","pages":"272-279"},"PeriodicalIF":2.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144028708","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intelligent Prediction of Pressure Injury by Image-Based Feature Variable With Machine Learning.","authors":"Xuehua Liu, Chengbin Tang, Lingxiang Guo, Jun Shao, Gang Wu, Yaru Qi","doi":"10.1097/NNR.0000000000000846","DOIUrl":"https://doi.org/10.1097/NNR.0000000000000846","url":null,"abstract":"<p><strong>Background: </strong>Rapid and objective pressure injury assessment is crucial for preventing further wound deterioration.</p><p><strong>Objectives: </strong>This study aimed to develop an image-based intelligent system for pressure injury (PI) determination that do not rely on human sensory evaluation.</p><p><strong>Methods: </strong>An image-based PI determination system was developed using a combination method of feature variable extraction and machine learning. Color and texture features were selected because they are closely related to human sensory evaluation methods. The digital data from these selected feature variables served as the original data set for model construction. Then, the contribution and relationships between the extracted feature variables and model performance were investigated using shapely additive explanations and Spearman algorithms to enhance the robustness of the PI determination model. Additionally, the influence of sample size and K values on model performance was determined for robust model construction.</p><p><strong>Results: </strong>A k-nearest neighbor algorithm was used to build pressure injury prediction models based on these selected variables and image samples. The classification rate for the best model is 97.22% and 97.08% on the training and test sets, respectively.</p><p><strong>Discussion: </strong>All results demonstrate that image-based feature variables coupled with machine learning are efficient for PI determination and perhaps other medical diagnoses involving visual recognition.</p>","PeriodicalId":49723,"journal":{"name":"Nursing Research","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144530726","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Racial Concordance of Black Nurses and Patients Across Hospitals.","authors":"Eileen T Lake, Christin Iroegbu, John F Rizzo, Celsea C Tibbitt, Kimi Li, Jessica G Smith, Douglas O Staiger, Nehemiah Weldeab, Jeanette A Rogowski","doi":"10.1097/NNR.0000000000000844","DOIUrl":"https://doi.org/10.1097/NNR.0000000000000844","url":null,"abstract":"<p><strong>Background: </strong>A structurally fluent workforce is essential to demonstrate structural competency-the ability to recognize and address how social, political, and economic structures affect health. Such a workforce understands the role of external factors and social determinants in health inequities. Evidence shows that minority patients receive better care from a diverse workforce. The racial composition of hospital nurses and its correlation to patients remains unreported.</p><p><strong>Objective: </strong>To evaluate patient-nurse racial concordance at the hospital level in a large geographically representative hospital sample.</p><p><strong>Methods: </strong>A cross-sectional descriptive study design was employed using the 2015 Annual Registered Nurse Survey of the National Database of Nursing Quality Indicators and 2019 Medicare patient data. Concordance was measured by subtracting the hospital nurse percentage from the patient percentage. We defined Black-serving hospital status by classifying hospitals into categories (25/50/25) by low, medium, and high representation of Black patients. Descriptive and correlation statistics were calculated on nurse and patient race and their concordance at the hospital and BSH levels.</p><p><strong>Results: </strong>Among 574 hospitals, the proportion of Black nurses was significantly lower than that of Black patients, with considerable variation across hospitals. The representation of Black nurses and patients was strongly associated with hospitals that served more Black patients and generally employed more Black nurses. When grouped into low, medium, and high BSHs, the percentage of Black nurses differed considerably across the categories. High BSH had the greatest discordance.</p><p><strong>Discussion: </strong>While Black nurses and Black patients are often clustered in the same hospitals, there are relatively few Black nurses in hospitals where Black patients primarily receive care. This study underscores the urgent need for health care institutions and policymakers to prioritize building structural competency and diversifying the nursing workforce, particularly in hospitals serving higher Black patient populations. Future research is warranted on whether patient-nurse racial concordance or a nursing workforce more reflective of the patient population it serves reduces disparities.</p>","PeriodicalId":49723,"journal":{"name":"Nursing Research","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144530727","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}