Nursing Outlook最新文献

{"title":"Health promotion from the perspective of intersectionality: Derivation of a middle-range theory","authors":"Sâmia Monteiro Holanda ,&nbsp;Marcos Venícios de Oliveira Lopes ,&nbsp;Viviane Martins da Silva ,&nbsp;Tatyanne Maria Pereira de Oliveira ,&nbsp;Herla Maria Furtado Jorge ,&nbsp;Priscila de Souza Aquino","doi":"10.1016/j.outlook.2025.102516","DOIUrl":"10.1016/j.outlook.2025.102516","url":null,"abstract":"<div><h3>Background</h3><div>Health promotion remains a central goal in nursing practice and policy. However, conventional approaches often overlook how overlapping social identities and structural inequities influence health outcomes. Intersectionality provides a critical framework for understanding these complex dynamics.</div></div><div><h3>Purpose</h3><div>To derive a middle-range theory (MRT) that explains health promotion from an intersectional perspective, with the aim of informing nursing practice and advancing health equity.</div></div><div><h3>Methods</h3><div>This theoretical-reflective, qualitative study followed the derivation approach outlined by Walker and Avant (2019) to construct a MRT. Key concepts from intersectionality theory and health promotion literature were analyzed and synthesized to develop an explanatory model applicable to nursing.</div></div><div><h3>Discussion</h3><div>The theory is structured around two central constructs: (1) Intersectionality and Health Promotion: conceptual relations, which explores the interplay between social markers, such as race, gender, class, and territory, and health; and (2) Flowing towards Equity and Maximum Potential in Health, a metaphorical model that illustrates how structural forces affect individuals’ trajectories within the \"river\" of health promotion. This framework highlights sites for nursing intervention to disrupt inequities and enhance the flow toward optimal health.</div></div><div><h3>Conclusion</h3><div>Applying an intersectional lens to health promotion allows for the identification of hidden patterns, drivers, and opportunities for intervention. The proposed theory supports nursing practice by guiding the development of equity-focused strategies that address structural determinants and ensure that all individuals, particularly those historically marginalized, can achieve their maximum health potential.</div></div><div><h3>So What?</h3><div>The application of this theory contributes to more equitable health promotion policies and practices by considering the interactions between different social markers, such as race, gender, class, and territory. In this way, it enables the formulation of strategies that address structural inequalities and promote a more comprehensive positive impact, ensuring that historically marginalized groups have full access to their maximum health potential.</div></div>","PeriodicalId":54705,"journal":{"name":"Nursing Outlook","volume":"73 5","pages":"Article 102516"},"PeriodicalIF":3.7,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144780789","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":"Leveraging artificial intelligence to detect stigmatizing language in electronic health records to advance health equity","authors":"Teenu Xavier PhD, RN ,&nbsp;Qinglin Pei PhD ,&nbsp;Jane M. Carrington PhD, RN, FAAN","doi":"10.1016/j.outlook.2025.102493","DOIUrl":"10.1016/j.outlook.2025.102493","url":null,"abstract":"<div><h3>Background</h3><div>The use of stigmatizing language within electronic health records (EHRs) is a significant concern, as it can impact patient-provider relationships, exacerbate healthcare disparities, influence clinical decision-making, and effective communication, which in turn affects patient outcomes.</div></div><div><h3>Purpose</h3><div>To identify stigmatizing language in EHRs and its associations with patient outcomes.</div></div><div><h3>Methods</h3><div>A retrospective analysis was conducted on 75,654 clinical notes from 500 patients with hospital-acquired conditions at an academic medical center. Machine learning techniques were utilized to detect stigmatizing language within the EHRs.</div></div><div><h3>Discussion</h3><div>The model demonstrated high accuracy in identifying stigmatizing language (F1 score: 0.95), and stigmatizing language had a significant association with the length of stay. The study also revealed that older patients and those with government insurance are more likely to have stigmatizing language in their notes.</div></div><div><h3>Conclusion</h3><div>Using AI to model language is useful for identifying care patterns and patients at risk due to stigmatizing language.</div></div>","PeriodicalId":54705,"journal":{"name":"Nursing Outlook","volume":"73 5","pages":"Article 102493"},"PeriodicalIF":3.7,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144772551","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":"The Fortitude Framework: A psychological model for sustained leadership presence in nursing","authors":"Aisha K. Brooks DNP, MPH, FAAN","doi":"10.1016/j.outlook.2025.102518","DOIUrl":"10.1016/j.outlook.2025.102518","url":null,"abstract":"<div><h3>Background</h3><div>Despite growing recognition of the emotional strain and ethical complexity in nursing leadership, most leadership models continue to emphasize postcrisis recovery, role-based performance, or external outputs. This narrow framing leaves a gap in understanding how leaders can sustain their presence and judgment before, during, and after prolonged challenges.</div></div><div><h3>Purpose</h3><div>This conceptual article introduces the Fortitude Framework, a leadership model grounded in psychological appraisal theory and adapted from Pretorius’ theory of fortitude.</div></div><div><h3>Methods</h3><div>A concept analysis anchored in Pretorius’ theory of fortitude, combined with a theoretical synthesis of related constructs (resilience, grit, hardiness, and self-efficacy), was conducted to clarify fortitude’s conceptual boundaries. This process generated three interdependent internal capacities—Unapologetically Grounded (intrapersonal appraisal), Strategically Aligned (transpersonal appraisal), and Ethically Present (interpersonal appraisal)—that support sustained leadership presence under pressure.</div></div><div><h3>Discussion</h3><div>The Fortitude Framework translates these capacities into observable leadership patterns that can be actively developed through reflective practice, coaching, and context-sensitive leadership development. Public health nurses are offered as exemplars of this model in practice.</div></div><div><h3>Conclusion</h3><div>The Fortitude Framework is situated within existing literature on resilience, self-efficacy, and moral presence, distinguishing fortitude as a foundational capacity rather than a reactive trait. It offers a new lens for leadership development and mentoring while guiding system-level strategies to support psychological sustainability in nursing leadership.</div></div>","PeriodicalId":54705,"journal":{"name":"Nursing Outlook","volume":"73 5","pages":"Article 102518"},"PeriodicalIF":3.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144757569","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":"Professional citizenship in nursing","authors":"Carol Huston MSN, DPA, FAAN","doi":"10.1016/j.outlook.2025.102497","DOIUrl":"10.1016/j.outlook.2025.102497","url":null,"abstract":"<div><h3>Background</h3><div>Although guideposts for professional citizenship are sparse, numerous associations and documents guiding nursing education and practice (including <em>The Essentials</em>) acknowledge the critical role of professional citizenship.</div></div><div><h3>Purpose</h3><div>Nurses must understand why professional citizenship matters and educators must intgegrate strategies to promote professional citizenship across all levels of the curricula.</div></div><div><h3>Methods</h3><div>Six strategies to promote professional citizenship in nursing are identified.</div></div><div><h3>Discussion</h3><div>Professional citizenship, defined as actively engaging professionally in nursing as well as broader communities, to identify and seek out solutions to enduring social problems, is declining in nursing. This has occurred despite deep roots in nursing’s history supporting professional citizenship. Changing generational values with different patterns of participation, behaviors, and professional priorities contribute to the decline.</div></div><div><h3>Conclusion</h3><div>Professional citizenship should be an expectation, not a choice. Without it, nurses lose the power of a collective voice as well as opportunities to address social justice, health equity, upholding human rights, patient advocacy, and healthcare reform.</div></div>","PeriodicalId":54705,"journal":{"name":"Nursing Outlook","volume":"73 5","pages":"Article 102497"},"PeriodicalIF":3.7,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144724984","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":"Making nursing visible: AI-assisted standardization of electronic health record interventions using generative pre-trained transformer models and retrieval-augmented generation process","authors":"Tamara G.R. Macieira PhD, RN ,&nbsp;Ragnhildur I. Bjarnadottir PhD, MPH, RN ,&nbsp;Patricia de Oliveira Salgado PhD, MS, RN ,&nbsp;Aseem Baranwal MS ,&nbsp;Alexander Semenov PhD ,&nbsp;Karen B. Priola MSCIS ,&nbsp;Priscilla Pestana BSN ,&nbsp;Soluchukwu Okafor BSN ,&nbsp;Nathan Mena MSN, RN ,&nbsp;Noelle Montoya RN ,&nbsp;Laura Sargent RN ,&nbsp;Ashley Presley RN ,&nbsp;Yingwei Yao PhD ,&nbsp;Gail M. Keenan PhD, RN, FAAN","doi":"10.1016/j.outlook.2025.102494","DOIUrl":"10.1016/j.outlook.2025.102494","url":null,"abstract":"<div><h3>Background</h3><div>Nurses provide essential care that significantly impacts patient outcomes. However, nursing care is rarely examined due to a lack of standardized nurse-generated data suitable for large-scale analysis.</div></div><div><h3>Purpose</h3><div>To test the performance of retrieval-augmented generation (RAG) and generative pre-trained transformer (GPT) models in standardizing electronic health records nursing intervention terms.</div></div><div><h3>Methods</h3><div>The process involved: (a) manually mapping a subset of local terms to standardized terms to create a “gold standard” for comparison, (b) implementing and assessing the RAG pipeline with GPT models for standardization, and (c) incorporating the output into an AI-assisted manual mapping workflow.</div></div><div><h3>Discussion</h3><div>GPT models were comparable to human mappers but lacked sufficient accuracy for fully automated mapping.</div></div><div><h3>Conclusion</h3><div>Although GPT models are not yet reliable for full automation, they can reduce human workload and streamline the standardization process. This advancement represents an important step toward making nursing contributions visible through data-driven evaluation of nursing practices.</div></div>","PeriodicalId":54705,"journal":{"name":"Nursing Outlook","volume":"73 5","pages":"Article 102494"},"PeriodicalIF":4.1,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144695469","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":"Impact of minority stress and resilience on post-traumatic stress disorder symptom severity among a sample of transgender, nonbinary, and gender-expansive individuals","authors":"Starr Tomlinson PhD, MSN, ACNP-BC ,&nbsp;Mark Parshall PhD, RN ,&nbsp;Stephen Hernandez PhD, RN, FAAN ,&nbsp;Erick K. Hung MD ,&nbsp;Madeline B. Deutsch MD, MPH ,&nbsp;Kristopher Jackson PhD, MPH, MSN, AGACNP-BC ,&nbsp;Sharon Ruyak PhD, CNM, FACNM","doi":"10.1016/j.outlook.2025.102498","DOIUrl":"10.1016/j.outlook.2025.102498","url":null,"abstract":"<div><h3>Background</h3><div>Transgender, nonbinary, and gender-expansive (TNGE) individuals experience disproportionately high levels of discrimination and violence. These chronic stressors can disrupt stress responses and increase vulnerability to negative mental health outcomes.</div></div><div><h3>Purpose</h3><div>The purpose of this research was to explore the impact of gender minority stress and resilience on post-traumatic stress disorder (PTSD) symptom severity among TNGE individuals receiving outpatient medical or psychiatric care.</div></div><div><h3>Methods</h3><div>Individuals (<em>N</em> = 103) receiving gender-affirming healthcare services at one of two university-affiliated practice settings completed an anonymous survey measuring PTSD symptom severity and gender minority stress and resilience.</div></div><div><h3>Results</h3><div>One-third of participants met provisional criteria for PTSD. No significant differences in PTSD symptoms were found based on assigned sex at birth, current gender identity, marital status, sexual orientation, or race/ethnicity. Distal stressor subscales accounted for approximately 40% of variance in PTSD symptom severity in a hierarchical regression model. Proximal stressors and resilience subscales accounted for an additional 7% and 3% of variance, respectively.</div></div><div><h3>Discussion</h3><div>TNGE individuals’ experiences of gender minority stress, especially distal stressors, may constitute risk factors for PTSD. Interventions to foster community engagement may offer valuable mental health benefits for TNGE persons.</div></div>","PeriodicalId":54705,"journal":{"name":"Nursing Outlook","volume":"73 5","pages":"Article 102498"},"PeriodicalIF":4.1,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144695468","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":"Reproductive health disparities among women with disability and the role of ableism in nursing","authors":"Suzanne C. Smeltzer EdD, RN, FAAN,&nbsp;Linda Carman Copel PhD, RN, ANEF,&nbsp;Margaret Brace PhD,&nbsp;Amy McKeever PhD, CRNP, WHNP-BC","doi":"10.1016/j.outlook.2025.102487","DOIUrl":"10.1016/j.outlook.2025.102487","url":null,"abstract":"<div><h3>Background</h3><div>Health disparities affecting women with disability are largely due to ableism, which commands little attention in health care.</div></div><div><h3>Purpose</h3><div>This paper examines ableism related to reproductive health, health care disparities experienced by women with disability, and the role of nursing in addressing these disparities.</div></div><div><h3>Methods</h3><div>The authors used relevant research and documents to identify health disparities experienced by women with disability. Identified disparities relate to 1) pregnancy or maternal-child health, 2) sexual health, and 3) breast and cervical cancer screening and care. Historical perspectives on disparities affecting persons with disability and women with disability are presented.</div></div><div><h3>Conclusion</h3><div>Lack of education of healthcare professionals about care of women with disability is a major factor in the ableism largely responsible for health disparities. Conclusion: Healthcare professionals must assume a greater role in addressing ableism, ensuring that clinicians are prepared to recognize ableism and reduce reproducetive health disparities affecting women with disability.</div></div>","PeriodicalId":54705,"journal":{"name":"Nursing Outlook","volume":"73 5","pages":"Article 102487"},"PeriodicalIF":4.1,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144680072","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":"Innovative approaches to reducing variability in Doctor of Nursing Practice education, roles, and outcomes through collaborative healthcare partnerships","authors":"Karen Kesten DNP, APRN, FAAN ,&nbsp;Katherine Moran DNP, FADCES, FNAP ,&nbsp;Catherine Corrigan DNP, FNP, CNM ,&nbsp;Dianne Conrad DNP, FNP-BC, FNAP ,&nbsp;Sarah Beebe PhD, APRN, CHSE ,&nbsp;Amy Manderscheid DNP, APRN, AGPCNP-BC","doi":"10.1016/j.outlook.2025.102485","DOIUrl":"10.1016/j.outlook.2025.102485","url":null,"abstract":"","PeriodicalId":54705,"journal":{"name":"Nursing Outlook","volume":"73 5","pages":"Article 102485"},"PeriodicalIF":4.1,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144680073","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":"Shaping the nursing workforce through virtual reality: Pitfalls and possibilities of implementation in a nursing curriculum","authors":"Jason Thrift ,&nbsp;Kimberly Hill ,&nbsp;Jennifer Bagwell ,&nbsp;Lucia Gonzales ,&nbsp;Kimberly Stewart ,&nbsp;Raven Anderson ,&nbsp;Andrea O’dell ,&nbsp;Olivia Boice ,&nbsp;Ben Card","doi":"10.1016/j.outlook.2025.102486","DOIUrl":"10.1016/j.outlook.2025.102486","url":null,"abstract":"<div><h3>Background</h3><div>Nursing workforce concerns are shaping how colleges and schools of nursing effectively implement teaching strategies like simulation. With the growning nursing shortage, more chronic and complex conditions, and situations for patients arising, the education of student nurses must adapt to help this growning concern. Virtual reality simulation (VR-Sim) is a modality considered for nursing education, and it shows benefits in the literature. However, little is known about the implementation process within a nursing program.</div></div><div><h3>Purpose</h3><div>This paper aims to illustrate the process of implementing VR-Sim in an undergraduate nursing program.</div></div><div><h3>Methods for Curricular Enhancement</h3><div>A grant funded by the Health Resources and Services Administration (HRSA) provided the VR-Sim modality. Student nurses were provided with concurrent experiences in VR-Sim and traditional simulation modalities, such as high-fidelity human patient simulators and standardized patient encounters.</div></div><div><h3>Discussion</h3><div>The 184 student nurses engaged in the VR-Sim experience provided mixed evaluations for its use, with some stating the VR-Sim was beneficial, while others had concerns. The pitfalls and possibilities of implementing the VR-Sim experience are addressed, and insights on the implementation process and future considerations are offered.</div></div><div><h3>Conclusion</h3><div>Continued development of VR-Sim is needed to provide this modality for nursing education.</div></div>","PeriodicalId":54705,"journal":{"name":"Nursing Outlook","volume":"73 5","pages":"Article 102486"},"PeriodicalIF":4.1,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144654677","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":"Practice-based models for nurse scientists: A scoping review of core components, development, evaluations, and key success factors","authors":"Maria Samuelsson RN, RSCN, PhD ,&nbsp;Anna Ericsson RN, CRNA, PhD ,&nbsp;Elisabeth Carlson RN ,&nbsp;Lotta Sjögran RN ,&nbsp;Mia Hylén RN, CCN, PhD ,&nbsp;Rebecka Striberger RN, PhD","doi":"10.1016/j.outlook.2025.102488","DOIUrl":"10.1016/j.outlook.2025.102488","url":null,"abstract":"<div><h3>Background</h3><div>The need for improved organizational support for practice-based nurse scientists has been stressed. To provide a synopsis of the field, we mapped the existing literature.</div></div><div><h3>Purpose</h3><div>To map the existing literature on the development and evaluation, core components, and key success factors of practice-based models for nurse scientists.</div></div><div><h3>Methods</h3><div>A scoping review was conducted. CINAHL, Medline, PsycINFO, EBSCO, and ERIC were searched for original articles in June 2024.</div></div><div><h3>Findings</h3><div>In total, 14 papers were included. Five key success factors were identified. Thorough development processes were reported and, at large, the core components were uniform. Evaluations were diverse and nonrelated to patient care.</div></div><div><h3>Discussion</h3><div>Findings indicate key factors to consider when developing and implementing practice-based models for nurse scientists. Further, a possibility of progressing the research field from developing to evaluating the models. Consensus on outcomes may help to build an evidence basis on the significance of practice-based nurse scientists.</div></div>","PeriodicalId":54705,"journal":{"name":"Nursing Outlook","volume":"73 5","pages":"Article 102488"},"PeriodicalIF":4.1,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144654676","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}