Nursing Outlook最新文献

{"title":"A call to action for disrupting microaggressions, improving interprofessional collaboration, and optimizing outcomes: Nurse leaders have a role","authors":"Bimpe Z. Adenusi PhD, APRN, CRNA ,&nbsp;Laurel Daniels Abbruzzese PT, EdD, FNAP ,&nbsp;Olaide Oluwole-Sangoseni DPT, MSc, Ph.D., FNAP ,&nbsp;Kathy Lee Bishop PT, DPT, CCS, FNAP ,&nbsp;Lydia Ann Thurston PT, DSc. ATC, FNAP ,&nbsp;Barbara Maxwell Ph.D., DPT, MSc, Cert THE, FNAP ,&nbsp;Phyllis Simon OTD, OTR/L, FNAP ,&nbsp;Travis Threats Ph.D., CCC-SLP, FNAP ,&nbsp;Andrea L. Pfeifle EdD, PT, FNAP ,&nbsp;Rita K. Adeniran DrNP, RN, NEA-BC, FNAP, FAAN","doi":"10.1016/j.outlook.2025.102354","DOIUrl":"10.1016/j.outlook.2025.102354","url":null,"abstract":"<div><h3>Background</h3><div>Microaggressions are pervasive in clinical and academic environments, often unnoticed by those unaware of the privileges and power dynamics tied to socially constructed hierarchies. These subtle manifestations of bias and prejudice are typically directed toward historically marginalized individuals and groups (HMIGs), contributing to a toxic culture that undermines interprofessional communication, collaboration, and healthcare delivery.</div></div><div><h3>Purpose</h3><div>This article aims to explore the concept of microaggressions and their impact on healthcare environments. It provides strategies to address microaggressions through education, self-reflection, and interventions at both individual and organizational levels, emphasizing the role of nurse leaders in fostering inclusivity and optimizing outcomes.</div></div><div><h3>Methods</h3><div>A brief review of the literature was conducted to define microaggressions and their types—microassaults, insults, invalidations, and environmental microaggressions. Strategies and frameworks for addressing microaggressions were evaluated, focusing on the roles of victims, perpetrators, and bystanders in promoting inclusivity and dismantling hierarchies.</div></div><div><h3>Discussion</h3><div>Microaggressions negatively affect workplace culture, interprofessional collaboration, and healthcare outcomes, perpetuating inequities. Strategies to address these include fostering education and self-reflection, creating organizational policies for inclusivity, and empowering nurse leaders to take active roles in mitigating microaggressions. Frameworks encourage all stakeholders to act, supporting a culture of equity and effective communication.</div></div><div><h3>Conclusion</h3><div>Dismantling hierarchies and promoting inclusive communication are essential for reducing bias, improving healthcare outcomes, and ensuring equity. Nurse leaders play a pivotal role in addressing microaggressions and fostering collaboration, ultimately contributing to a more inclusive and equitable healthcare system.</div></div>","PeriodicalId":54705,"journal":{"name":"Nursing Outlook","volume":"73 2","pages":"Article 102354"},"PeriodicalIF":4.1,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143069651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A reproductive justice investigation of utilizing digital interventions among underserved populations with criminal legal system supervision: Policy brief","authors":"Allison D. Crawford PhD, RN ,&nbsp;Lindsey Linder Geramifar JD ,&nbsp;Kelly McGlothen-Bell PhD, RN, IBCLC ,&nbsp;Emily Salisbury PhD","doi":"10.1016/j.outlook.2025.102349","DOIUrl":"10.1016/j.outlook.2025.102349","url":null,"abstract":"<div><h3>Background</h3><div>Mobile health interventions that utilize artificial intelligence may provide way for underserved populations to engage with healthcare.</div></div><div><h3>Purpose</h3><div>Examine the policy considerations that must be deliberated when developing, regulating, implementing, and sustaining mHealth apps among historically underserved individuals.</div></div><div><h3>Methods</h3><div>Reproductive Justice was used to investigate policy considerations for those with criminal legal system supervision who engage with mHealth apps. Three policy considerations resulted: 1) improving the legislative and regulatory landscape of digital technology, 2) enhancing comprehensive data protection legislation, 3) heightening privacy protections.</div></div><div><h3>Discussion</h3><div>The need to bring awareness to policy protections on the local, institutional, state, federal, and global levels specific to mHealth apps among underserved groups with criminal legal supervision is required.</div></div><div><h3>Conclusion</h3><div>These emerging advances in technology serve as an avenue for direct healthcare services to collaborate with other professions and organizations to implement ethical interventions that respect human rights and improve reproductive health equity.</div></div>","PeriodicalId":54705,"journal":{"name":"Nursing Outlook","volume":"73 2","pages":"Article 102349"},"PeriodicalIF":4.1,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143069658","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relationship between nurse staffing during labor and cesarean birth rates in U.S. hospitals","authors":"Audrey Lyndon PhD, RN, FAAN ,&nbsp;Kathleen Rice Simpson PhD, RN, FAAN ,&nbsp;Gay L. Landstrom PhD, RN, FAAN ,&nbsp;Caryl L. Gay PhD ,&nbsp;Jason Fletcher PhD ,&nbsp;Joanne Spetz PhD","doi":"10.1016/j.outlook.2024.102346","DOIUrl":"10.1016/j.outlook.2024.102346","url":null,"abstract":"<div><h3>Background</h3><div>Cesarean birth increases risk of maternal morbidity and mortality.</div></div><div><h3>Purpose</h3><div>Examine the relationship between labor and delivery staffing and hospital cesarean and vaginal birth after cesarean (VBAC) rates.</div></div><div><h3>Methods</h3><div>Survey of U.S. labor nurses in 2018 and 2019 on adherence to AWHONN nurse staffing standards with data linked to American Hospital Association Survey data, patient discharge data, and cesarean birth and VBAC rates.</div></div><div><h3>Findings</h3><div>In total, 2,786 nurses from 193 hospitals in 23 states were included. Mean cesarean rate was 27.3% (SD 5.9, range 11.7%–47.2%); median VBAC rate 11.1% (IQR 1.78%–20.2%; range 0%–40.1%). There was relatively high adherence to staffing standards (mean, 3.12 of possible 1–4 score). After adjusting for hospital characteristics, nurse staffing was an independent predictor of hospital-level cesarean and VBAC rates (IRR 0.89, 95% CI 0.84–0.95 and IRR 1.58, 95% CI 1.25–1.99, respectively).</div></div><div><h3>Discussion</h3><div>Better nurse staffing predicted lower cesarean birth rates and higher VBAC rates.</div></div><div><h3>Conclusion</h3><div>Hospitals should be accountable for providing adequate nurse staffing during childbirth.</div></div>","PeriodicalId":54705,"journal":{"name":"Nursing Outlook","volume":"73 2","pages":"Article 102346"},"PeriodicalIF":4.1,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143069614","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An examination of factors contributing to different anesthesia models in underserved areas","authors":"Ashley Palmer PhD ,&nbsp;Jared Sawyer MPH ,&nbsp;Alexa Beeson MPP ,&nbsp;Samantha Rosner MPH ,&nbsp;Isha Padhye BA ,&nbsp;Holly A. Andrilla MS","doi":"10.1016/j.outlook.2025.102352","DOIUrl":"10.1016/j.outlook.2025.102352","url":null,"abstract":"<div><h3>Background</h3><div>Maternity care access is worsening across the United States, driven in part by difficulties staffing obstetric units in some hospitals. Certified registered nurse anesthetists (CRNAs) provide obstetric anesthesia services in underserved areas, including rural areas (<span><span>Cohen et al., 2021</span></span>, <span><span>Martsolf et al., 2019</span></span>), areas with low delivery volumes (<span><span>Kohzimannil et al., 2015</span></span>) and areas with more vulnerable populations (<span><span>Liao et al., 2015</span></span>).</div></div><div><h3>Purpose</h3><div>This study examines the characteristics of hospitals that rely on CRNAs to provide anesthesia services in their obstetric departments, including hospital-level characteristics and state-level policy decisions.</div></div><div><h3>Methods</h3><div>We use an exploratory and explanatory sequential mixed-method design that relies on two series of key informant interviews and a survey of CRNAs practicing obstetric anesthesia.</div></div><div><h3>Discussion</h3><div>We find that CRNAs practice without medical direction more frequently in areas where fewer maternity care services are available, indicating that CRNAs may be filling an important vacancy in access to care.</div></div><div><h3>Conclusion</h3><div>Findings support the idea that CRNAs are vital in areas which would otherwise lack anesthesia providers and obstetric services. Policies that support hospitals in allowing CRNAs to practice without medical direction may increase access to hospital obstetric anesthesia services in underserved areas.</div></div>","PeriodicalId":54705,"journal":{"name":"Nursing Outlook","volume":"73 2","pages":"Article 102352"},"PeriodicalIF":4.1,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143061328","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Racism and the well-being of nurses of color: A scoping review","authors":"Heather L. Abrahim PhD, RN ,&nbsp;Olivia Liuson ,&nbsp;Christina Kelley DNP, APRN, AGCNS-BC ,&nbsp;E. Alison Holman PhD, FNP","doi":"10.1016/j.outlook.2025.102351","DOIUrl":"10.1016/j.outlook.2025.102351","url":null,"abstract":"<div><h3>Background</h3><div>Structural disparities in the United States (U.S.) healthcare system negatively impact care access and quality for racial and ethnic minorities. The predominantly White nursing workforce does not reflect the nation's diverse population. Enhancing workforce diversity is crucial to addressing these issues.</div></div><div><h3>Purpose</h3><div>This scoping review investigates associations between experiences of racism and the well-being of racial/ethnic minority nurses in the U.S., identifying existing evidence and literature gaps.</div></div><div><h3>Methods</h3><div>Utilizing Joanna Briggs’ Scoping Review Methodology and PRISMA-ScR standards, we screened eight databases; 31 studies met our inclusion criteria.</div></div><div><h3>Discussion</h3><div>Racism is consistently associated with worse psychological and/or physical outcomes among nurses of color across methodologically inconsistent studies. Future research should expand upon the nascent, methodologically inconsistent research reviewed herein to identify and eliminate sources of racism in healthcare and support a diverse nursing workforce.</div></div><div><h3>Conclusion</h3><div>Racism can undermine the well-being of nursing professionals. Policy changes to address racism in healthcare are needed.</div></div>","PeriodicalId":54705,"journal":{"name":"Nursing Outlook","volume":"73 2","pages":"Article 102351"},"PeriodicalIF":4.1,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143061337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effect of registered nurse staffing and skill mix on length of stay and hospital costs","authors":"Yin Li PhD ,&nbsp;Linda H. Aiken PhD, FAAN, FRCN ,&nbsp;Edmund R. Becker PhD ,&nbsp;Omid Razmpour BSN, RN ,&nbsp;Patti Landerfelt DNP, MS, APRN ,&nbsp;Yu Jin Kang BSN, MPH, PhD ,&nbsp;Jeannie P. Cimiotti PhD, RN, FAAN","doi":"10.1016/j.outlook.2025.102356","DOIUrl":"10.1016/j.outlook.2025.102356","url":null,"abstract":"<div><h3>Background</h3><div>Sepsis is a common cause of hospitalization among Medicare beneficiaries, often leading to prolonged hospital stays and high costs.</div></div><div><h3>Purpose</h3><div>To estimate the impact of registered nurse (RN) staffing and skill mix on hospital lengths of stay and associated costs for Medicare beneficiaries with sepsis.</div></div><div><h3>Methods</h3><div>A retrospective, cross-sectional analysis was conducted using 2018 data from 2,107 acute care hospitals, including 653,496 patients with sepsis.</div></div><div><h3>Findings</h3><div>A one-unit increase in RN hours per patient day and a 1% increase in RN skill mix reduced hospital stays by 2% and 1%, respectively. Enhancing staffing to nine RN hours per patient day and an 80% RN skill mix could save 63,580 inpatient days annually, reducing costs by $152.9 million. Further increases to 11 RN hours and an 85% skill mix could save $331.9 million.</div></div><div><h3>Discussion</h3><div>Better RN staffing and skill mix can improve patient outcomes and yield significant cost savings.</div></div>","PeriodicalId":54705,"journal":{"name":"Nursing Outlook","volume":"73 2","pages":"Article 102356"},"PeriodicalIF":4.1,"publicationDate":"2025-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143043390","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Racial microaggressions in nursing: “We have a long way to go”","authors":"Heather Walsh PhD, RN, PCNS-BC, CHSE-A ,&nbsp;Laurie A. Theeke PhD, FNP-BC, GCNS-BC, FAAN, FNAP ,&nbsp;Richard Ricciardi PhD, CRNP, FAANP, FAAN ,&nbsp;Kupiri Ackerman-Barger PhD, RN, CNE, ANEF, FAAN ,&nbsp;Adriane J. Inouye MSN, RN, CPN ,&nbsp;Catherine Wilson Cox PhD, RN, CEN, CNE, FAAN, ANEF ,&nbsp;Angela M. McNelis PhD, RN, FAAN, ANEF, CNE","doi":"10.1016/j.outlook.2024.102347","DOIUrl":"10.1016/j.outlook.2024.102347","url":null,"abstract":"<div><h3>Background</h3><div>Racism in nursing is a significant issue affecting patient safety, nurse well-being, and job performance.</div></div><div><h3>Purpose</h3><div>Explore racial microaggression experiences of registered nurses working in a children’s hospital.</div></div><div><h3>Methods</h3><div>An exploratory, qualitative research design with in-depth interviews was used to collect data.</div></div><div><h3>Discussion</h3><div>Three categories containing 12 themes resulted. Nurses experienced (1) Biased first impressions, (2) “Firing” the nurse, (3) Questioning experience or credentials, (4) Where do I belong? and (5) All jokes have a grain of truth. Nurses responded through (6) Not being silent, (7) Intentional nonconfrontation, and (8) Showing or seeking support. Nurses used strategies of (9) Empowering, (10) Bracketing, (11) Communicating thoughtfully to build trust, and (12) Doing more to be perceived the same.</div></div><div><h3>Conclusion</h3><div>Most nurses in the study experienced and committed racial microaggressions; therefore, must be equipped with tools to recognize and respond to them. Moreover, microaggressions negatively impact building a diverse nursing workforce.</div></div>","PeriodicalId":54705,"journal":{"name":"Nursing Outlook","volume":"73 2","pages":"Article 102347"},"PeriodicalIF":4.1,"publicationDate":"2025-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143048508","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Knowledge and attitudes of school nurses in caring for sexual and gender minority youth: A national survey","authors":"April J. Ancheta PhD, MSHP, RN ,&nbsp;Catherine C. McDonald PhD, RN, FAAN ,&nbsp;Dalmacio Dennis Flores PhD, ACRN, FAAN ,&nbsp;Kaja Darien BA ,&nbsp;Nadia L. Dowshen MD, MSHP","doi":"10.1016/j.outlook.2025.102350","DOIUrl":"10.1016/j.outlook.2025.102350","url":null,"abstract":"<div><h3>Background</h3><div>School nurses (SNs) can play important roles in the health of sexual and gender minority (SGM) youth, yet little is known about their knowledge and attitudes toward this population.</div></div><div><h3>Purpose</h3><div>To understand SNs' knowledge and attitudes in caring for SGM youth across the United States.</div></div><div><h3>Methods</h3><div>We designed and disseminated the School Nurses and LGBTQ Youth online survey in May 2023 to U.S. SNs. Eight items addressed knowledge of SGM youth health needs and disparities; 11 addressed attitudes toward SGM youth.</div></div><div><h3>Discussion</h3><div>Overall, 1,189 SNs completed the survey (response rate 59.5%). Regression models revealed that liberal political affiliation and more past-year professional development were most strongly associated with higher knowledge and attitudes scores.</div></div><div><h3>Conclusion</h3><div>This national sample of SNs reported moderate levels of knowledge and positive attitudes toward caring for SGM youth. The findings have important implications for developing SN-tailored interventions to improve care and health outcomes for SGM students.</div></div>","PeriodicalId":54705,"journal":{"name":"Nursing Outlook","volume":"73 2","pages":"Article 102350"},"PeriodicalIF":4.1,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143043388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Harmonizing excellence: Crafting the nexus of competencies, standards, and degree demands in nurse practitioner education","authors":"Lorna Finnegan PhD, FNP, FAAN ,&nbsp;Susan Kelly-Weeder PhD, FNP-BC, FAAN ,&nbsp;Bimbola F. Akintade PhD, ACNP-BC, FAAN ,&nbsp;J. Dwayne Hooks PhD, FAANP, FAAN ,&nbsp;Shannon Reedy Idzik DNP, ANP-BC, FAAN ,&nbsp;Marcy Ainslie EdD, APRN, FNP-BC","doi":"10.1016/j.outlook.2025.102348","DOIUrl":"10.1016/j.outlook.2025.102348","url":null,"abstract":"<div><div>Nurse practitioner (NP) programs have a long history of producing safe and competent NPs; however, bold, transformative leadership is needed to set a minimum standard for quality NP education to support a 21st-century healthcare system. This paper is a call to action for leaders in NP education to transition NP education to the DNP degree utilizing the 2022 <em>National Task Force Standards for Quality NP Education</em> and a competency-based approach as defined in the 2021 AACN <em>Essentials</em>. There is now an opportunity to redesign healthcare systems with quality and equity as a primary consideration and DNP-prepared NPs are positioned to lead this redesign. The 2022 NTF Standards include several critical changes in clinical hours, oversight of clinical sites, and preparation of NP students to enter clinical sites. By emphasizing competency attainment within NP programs, the 2021 AACN <em>Essentials</em> ensure that NP graduates are practice-ready.</div></div>","PeriodicalId":54705,"journal":{"name":"Nursing Outlook","volume":"73 2","pages":"Article 102348"},"PeriodicalIF":4.1,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143029983","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"“We need a toolkit”: A response to nursing students and educators’ viewpoints on promoting social justice nursing practice","authors":"Victor Kpandemoi Abu","doi":"10.1016/j.outlook.2024.102340","DOIUrl":"10.1016/j.outlook.2024.102340","url":null,"abstract":"<div><h3>Background</h3><div>Nursing education programs do not often prepare students for social justice responsibilities in their practice.</div></div><div><h3>Purpose</h3><div>To explore ways of promoting social justice nursing practice.</div></div><div><h3>Methods</h3><div>Constructivist grounded theory research design guided the purposive sampling of nursing students (<em>n</em> = 11) and nurse educators (<em>n</em> = 11), at a Nursing University, to participate in interviews and focus groups, and for coding data analysis.</div></div><div><h3>Discussion</h3><div>Research participants suggested the need for a toolkit to promote social justice nursing practice. A toolkit of Awareness for Social Justice Action proposed in this study has the potential to promote social justice nursing practices, informed by critical thinking, critical pedagogy, and servant leadership.</div></div><div><h3>Conclusion</h3><div>This study demonstrates the necessity of pursuing learning, teaching, and leadership for actualizing ever-present, albeit equivocal nursing interest in social justice.</div></div>","PeriodicalId":54705,"journal":{"name":"Nursing Outlook","volume":"73 1","pages":"Article 102340"},"PeriodicalIF":4.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142781799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}