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Background: Pressure injuries (PIs) are costly to hospitals and have a negative impact on patient outcomes. Despite the use of validated tools that describe PI risk, such as the Braden Scale, the incidence of PIs remains high. Studies have shown that Braden Scale subscale scores should be considered when planning care; however, there is a discrepancy between understanding the importance of subscale-specific interventions and implementation. The goal of this study was to test the ability of an educational intervention tailored to specific interventions based on the subscales of the Braden Scale to improve knowledge among nurses. Method: This study was a prospective, quasi-experimental, single-group design where nurses (n = 35) from a neurosurgery stepdown unit in a large teaching hospital completed a preintervention survey (T1), attended an educational presentation, and then completed an immediate postintervention survey (T2) and a 2-month postintervention survey (T3). Results: Data analysis compared presurvey scores with postsurvey scores. Nursing comprehension improved from the preintervention survey (T1, M = 5.57) to the postintervention surveys (T2, M = 6.34; T3, M = 6.42) (p =.031). Conclusion: Nurses showed increased comprehension after the educational intervention from T1 to T3. [J Contin Educ Nurs. 2024;55(1):42–48.] [ABSTRACT FROM AUTHOR]

One in three nursing home (NH) residents experience adverse events. One strategy for safer NH care is health information technology (HIT). Two national NH surveys measuring HIT maturity were administered in 2020 (N = 719) and 2021 (N = 312). Quarterly NH survey deficiencies from the same years were linked to HIT maturity surveys. Descriptive statistics and logistic regression were used in analysis. NHs were of similar size and location, with more for-profit facilities. Most (67.5% and 61.9%, respectively) NH administrators reported having capabilities to share data internally within their facility, and not externally. Mean HIT maturity scores increased from Year 1 to Year 2. Over 2 years, 5,406 deficiencies were reported, mostly (31.3%) for nutrition and dietary deficiencies. There were negative associations between HIT maturity and deficiency scope. With a 1-unit increase in HIT maturity, relative risk of widespread scope decreased by 14%. Among covariates, bed size, staffing, and year were significant factors associated with deficiency scope. [Journal of Gerontological Nursing, 50(1), 8–14.] [ABSTRACT FROM AUTHOR]

Studies on HIV self-testing (HIV-ST) have been limited to adults (age 18+). The study assessed use of HIV-ST among a diverse group of young men who have sex with men (YMSM) in the United States (US) and assessed differences in uptake by demographic characteristics and requirements for parental consent. This study demonstrated feasibility of HIV-ST for YMSM as young as 14 years of age, which suggests potential for increasing HIV testing in this young age group and promoting health equity. [ABSTRACT FROM AUTHOR]

Background and Purpose: It is critical to accurately measure and understand the nurse practitioner (NP) work environment in which individual NP information is gathered but decisions or inferences are made at an aggregated, group level. However, there is little research on preconditions of aggregating individual-level data into group level in nursing research. This study was conducted to assess the multilevel reliability and group interrater agreement (IRA) of the Nurse Practitioner Primary Care Organizational Climate Questionnaire. Methods: Secondary data analysis from a cross-sectional survey with 247 NPs in 112 practices across 6 U.S. states in 2018–2019 was used. Results: The generalizability coefficients and values of IRA were acceptable (>.70), and values of ICC(1) were significant (.18–.38). Conclusions: Aggregating individual NP data to a higher group-level work environment construct is acceptable. [ABSTRACT FROM AUTHOR]

Background: Primary care structural capabilities (i.e., electronic health records, care coordination, community integration, and reminder systems) can address the multiple needs of persons living with dementia (PLWD). Objectives: This study describes structural capabilities in primary care practices where nurse practitioners (NPs) provide care to PLWD and compares the presence of structural capabilities in practices with a high and low volume of PLWD. Methods: We conducted a secondary analysis of cross‐sectional data from 293 NPs in 259 practices in California. Logistic regression models were used to determine the association between the volume of PLWD and the presence of structural capabilities. Results: NPs reported that 96% of practices had electronic health records, 61% had community integration, 55% had reminder systems and 35% had care coordination capabilities. Practices with a high volume of PLWD were less likely to have community integration compared to practices with a low volume of PLWD. Conclusion: Many PLWD‐serving practices do not have the essential infrastructure for providing optimal dementia care. Practice managers should focus on implementing the essential structural capabilities to address the complex needs of PLWD. Implications for practice: Clinicians and practice administrations can use the findings of this study to improve the delivery of care in practices that provide care to PLWD. [ABSTRACT FROM AUTHOR]

Sexual minority adolescents are more likely to have obesity compared to their heterosexual peers, but little is known about potential contributors to this disparity that lie outside of individual-level health behaviors, such as diet and exercise. One possible contributor is school violence victimization, a factor associated with overweight/obesity in adolescence. Another possible contributor is school climate, which is associated with feelings of safety and connectedness that can lower the likelihood of school violence victimization. Moreover, even less is known about relationships among all these factors among sexual minority adolescents. This gap in the literature was addressed by analyzing CDC's district-level data from the Youth Risk Behavior Survey and School Health Profiles (N = 60,625; 50.9% female, Mage = 16 years, 84.7% heterosexual, 15.3% sexual minority). Using multilevel mixed effects logistic regression models and controlling for covariates, it was found that among females and males, those with 2+ counts of last 12-month school violence victimization had higher odds of obesity than those with no school violence victimization (AOR = 1.33; AOR = 1.24). Furthermore, females and males in more positive LGBTQ school climates had lower odds of obesity than those in less positive school climates (AOR = 0.84; AOR = 0.85). There were no sexual identity differences in these models. Findings support the careful consideration of school violence victimization and LGBTQ school climate in future obesity prevention initiatives. [ABSTRACT FROM AUTHOR]

Accurate in‐hospital mortality prediction can reflect the prognosis of patients, help guide allocation of clinical resources, and help clinicians make the right care decisions. There are limitations to using traditional logistic regression models when assessing the model performance of comorbidity measures to predict in‐hospital mortality. Meanwhile, the use of novel machine‐learning methods is growing rapidly. In 2021, the Agency for Healthcare Research and Quality published new guidelines for using the Present‐on‐Admission (POA) indicator from the International Classification of Diseases, Tenth Revision, for coding comorbidities to predict in‐hospital mortality from the Elixhauser's comorbidity measurement method. We compared the model performance of logistic regression, elastic net model, and artificial neural network (ANN) to predict in‐hospital mortality from Elixhauser's measures under the updated POA guidelines. In this retrospective analysis, 1,810,106 adult Medicare inpatient admissions from six US states admitted after September 23, 2017, and discharged before April 11, 2019 were extracted from the Centers for Medicare and Medicaid Services data warehouse. The POA indicator was used to distinguish pre‐existing comorbidities from complications that occurred during hospitalization. All models performed well (C‐statistics >0.77). Elastic net method generated a parsimonious model, in which there were five fewer comorbidities selected to predict in‐hospital mortality with similar predictive power compared to the logistic regression model. ANN had the highest C‐statistics compared to the other two models (0.800 vs. 0.791 and 0.791). Elastic net model and AAN can be applied successfully to predict in‐hospital mortality. [ABSTRACT FROM AUTHOR]

Background: Asthma and COVID-19 have overlapping symptoms. During the 2019–2022 pandemic, pediatric asthma control appears to have improved, with some researchers theorizing that that is due to changes in asthma self-management. This study examined adolescents' views regarding how the pandemic impacted their asthma severity and self-management. Differences by urbanicity, sex, and race/ethnicity were explored. Methods: We utilized baseline data from adolescents with poorly controlled asthma (n = 183) who were participating in 1 of 2 school-based clinical trials—1 in rural schools and 1 in urban schools—testing the impact of interventions to improve asthma control. Adolescents reported if they believed their asthma severity remained the same, improved, or worsened during the pandemic, and if it changed, how it changed. They also reported if and how they modified their asthma management since the pandemic. We used multinomial logistic regression and binary logistic regression to assess the relationship between demographic factors and changes in asthma severity during the pandemic, and if adolescents altered their asthma management. Results: Adolescents' mean age was 15.9 years; most lived in rural communities (65.6%) and identified as female (66.7%). About half (56.2%) self-identified as black, 13.1% as Hispanic, and 10.4% as another race/ethnicity. Most (68.4%) reported that their asthma severity remained unchanged; 26.0% reported it worsened. Nearly 30% reported they altered how they managed their asthma, with most (80%) reporting additional efforts. Compared with asthma remaining the same, females had a higher relative risk than males of reporting that their asthma worsened [adjusted relative risk ratio = 3.65, 95% confidence interval (CI) = 1.34–9.90, P < 0.05]. Urban youth had greater odds (adjusted odds ratio = 5.4, 95% CI = 2.0–14.5, P < 0.001) of reporting they changed their asthma self-management compared with rural peers. Conclusion: This study demonstrates that during the 2019–2022 pandemic, adolescents generally believed their asthma severity stayed consistent and many took additional self-management efforts. [ABSTRACT FROM AUTHOR]

People with mental illness experience significant health disparities, including morbidity and premature mortality. Evidence suggests that stigma is a contributing factor to these observed inequities. The tripartite conceptualization of stigma proposes that three problems underlie stigma: problems of knowledge (ignorance), attitudes (prejudice) and behaviour (discrimination). There is limited prior research concerning stigma towards mental illness among nurses in the United States (US). The aims of this study were to assess stigma among US nurses towards patients with mental illness, compare the stigma expressed by nurses working in medical/surgical settings with mental health settings, and identify factors associated with stigma. Participants were recruited online from national professional nursing organizations in the US. We collected demographic data and administered measures of mental health stigma and stigma‐related mental health knowledge. Mental health nurses demonstrated comparatively lower levels of stigma and higher levels of knowledge than the medical/surgical nurses. Nursing speciality and personal contact with mental illness were the most significant predictors of stigma and knowledge. Knowledge was found to partially mediate the relationship between nursing speciality and stigma. We found support for the 'contact hypothesis', that is, having a personal experience of mental illness or a friend or family member who has a mental illness is associated with lower stigma towards mental illness. These findings support the development of contact‐based and educational anti‐stigma interventions for nurses in order to reduce stigma towards mental illness. [ABSTRACT FROM AUTHOR]

Background: The COVID‐19 pandemic has forced nursing homes to adapt new models of care in response to the evolving crisis including rapid implementation of telehealth services. The purpose of our study was to investigate implementation of telehealth in nursing homes amidst the COVID‐19 pandemic using a human factors model. Methods: Using a mixed methods design, we conducted a secondary analysis of data from a national survey of nursing home administrative leaders (n = 204). Using six survey questions, we calculated a total telehealth score (range 0–42). Descriptive statistics and paired sample t‐test were used to explore the change in telehealth in two consecutive years (2019–2021). Next, we conducted semi‐structured interviews with (n = 21) administrators and clinicians to assess differences in implementation according to extent of telehealth use. Results: The mean telehealth score in year 1 was 12.11 (SD = 9.85) and year 2 was 19.25 (SD = 11.25). There was a significant difference in telehealth scores from year 1 to year 2 (t = 6.83, p < 0.000). While 64% of nursing homes reported higher telehealth scores in year 2 compared to year 1, over 32% reported a decline. Qualitative analysis revealed facilitators of telehealth including training, use of integrated equipment, having staff present for the visit, and using telehealth for different types of visits. Barriers included using smart phones to conduct the visit, billing, interoperability and staffing. Conclusion: Training, adaptation of work processes to support communication, and restructuring teams and tasks are the result of interactions between system components that could improve usability and sustainability of telehealth in nursing homes. [ABSTRACT FROM AUTHOR]

Nurse practitioner (NP) scope of practice (SOP) policies are different across the United States. Little is known about their impact on NP work environment in healthcare organizations. We investigated the association between SOP policies and organizational‐level work environment of NPs. Through a cross‐sectional survey design, data were collected from 1244 NPs in six states with variable SOP regulations (Arizona, New Jersey, Washington, Pennsylvania, Texas, and California) in 2018–2019. Arizona and Washington had full SOP—NPs had full authority to deliver care. New Jersey and Pennsylvania had reduced SOP with physician collaboration requirement; California and Texas had restricted SOP with physician supervision requirement. NPs completed mail or online surveys containing the Nurse Practitioner Primary Care Organizational Climate Questionnaire, which has these subscales: NP‐Administration Relations (NP‐AR), NP‐Physician Relations (NP‐PR), Independent Practice and Support (IPS), and Professional Visibility (PV). Regression models assessed the relationship between state‐level SOP and practice‐level NP work environment. NP‐AR scores were higher in full SOP states compared to reduced (β = 0.22, p < 0.01) and restricted (β = 0.15, p < 0.01) SOP states. Similarly, IPS scores were higher in full SOP states. The PV scores were also higher in full SOP states compared to reduced (β = 0.16, p < 0.001) and restricted (β = 0.12, p < 0.05) SOP states. There was no relationship between SOP and NP‐PR score. State‐level policies affect NP work environment. In states with more favorable policies, NPs have better relationships with administration and report more role visibility and support. Efforts should be made to remove unnecessary SOP restrictions. [ABSTRACT FROM AUTHOR]

Aims: To explore the relationship between nurse practitioner work environment and nurse practitioner outcomes (job satisfaction and intent to leave) in the United States. Design The study used a cross‐sectional survey design to collect survey data from primary care nurse practitioners in six states in the United States. Methods: We sent mail surveys to 5689 eligible nurse practitioners in Arizona, New Jersey, Washington, Pennsylvania, California and Texas. The mail also contained an online link. Participants could complete either the paper or online questionnaire. In total, 1244 participants completed the survey in 2018–2019. The work environment was measured using the Nurse Practitioner‐Primary Care Organizational Climate Questionnaire comprised of four subscales: Nurse Practitioner‐Administration Relations, Nurse Practitioner‐Physician Relations, Independent Practice and Support and Professional Visibility. Global items measured job satisfaction and intent to leave. We used mixed‐effect proportional‐odds cumulative logit models to assess the association between work environment and job satisfaction and intent to leave. Results: Overall, 90% of participants were either very satisfied or somewhat satisfied with their job and 22% reported intent to leave their job in 1 year. With a one‐unit increase in the organizational‐level Nurse Practitioner‐Administration Relations score, the odds of having a higher job satisfaction level increased by about four times and the odds of intent to leave job decreased by about 60%. A higher organizational‐level Nurse Practitioner‐Physician Relations score was significantly associated with higher job satisfaction and lower odds of intent to leave. Conclusion: Improvements in work environments may improve nurse practitioner job satisfaction and retention. Impact This study examined the relationship between work environment, job satisfaction and turnover intention of nurse practitioners. Better work environment is associated with higher job satisfaction and lower turnover intention. Findings have implications for clinical leadership who can take actions to create better work environments to increase the nurse practitioner workforce capacity. [ABSTRACT FROM AUTHOR]

The current research includes a psychometric test of a nursing home (NH) health information technology (HIT) maturity survey and staging model. NHs were assembled based on HIT survey scores from a prior study representing NHs with low (20%), medium (60%), and high (20%) HIT scores. Inclusion criteria were NHs that completed at least two annual surveys over 4 years. NH administrators were excluded who participated in the Delphi panel responsible for instrument recommendations. Recruitment occurred from January to May 2019. Administrators from 121 of 429 facilities completed surveys. NHs were characteristically for-profit, medium bed size, and metropolitan. A covariance matrix demonstrated that all dimensions and domains were significantly correlated, except HIT capabilities and integration in administrative activities. Cronbach's alpha was very good (0.86). Principal component analysis revealed all items loaded intuitively onto four components, explaining 80% variance. The HIT maturity survey and staging model can be used to assess nine dimensions and domains, total HIT maturity, and stage, leading to reliable assumptions about NH HIT. [Research in Gerontological Nursing, 15(2), 93–99.] [ABSTRACT FROM AUTHOR]

Background: New York State (NYS) has approximately 4.7 million Medicaid beneficiaries with 75% having at least one or more chronic conditions. An estimated 10% of Medicaid beneficiaries seek emergency department (ED) services for nonurgent matters. It is unclear if an increased supply of nurse practitioners (NPs) and physician assistants (PAs) impact utilization of ED and subsequent hospitalizations for chronic conditions. Purpose: To investigate the relationship between NYS workforce supply (physicians, NPs, and PAs) and 1) ED use and 2) in-patient hospitalizations for chronically ill Medicaid beneficiaries. Methods: A cross-sectional study design was employed by calculating total workforce supply per NYS county and the proportion of physicians, NPs, and PAs per total number of Medicaid beneficiaries. We extracted the frequencies of all NYS Medicaid beneficiary chronic condition–related ED visits and in-patient admissions. Medicaid beneficiaries were considered to have a chronic condition if there was a claim indicating that the beneficiary received a service or treatment for this specific condition. We calculated the proportion of ED visits/beneficiary for each chronic disease category and the proportion of category-specific in-patient hospitalizations per the number of beneficiaries with that diagnosis. Results: As the NP/beneficiary proportion increased, ED visits for dual and nondual eligible beneficiaries decreased (p =.007; β = −2.218; 95% confidence interval [CI]: −3.79 to −0.644 and p =.04; β = −2.698; 95% CI: −5.268 to −0.127, respectively). Implications for practice: Counties with a higher proportion of NPs and PAs had significantly lower numbers of ED visits and hospitalizations for Medicaid beneficiaries. [ABSTRACT FROM AUTHOR]

Background: Prevalence of electronic health records (EHRs) has significantly increased, and EHRs are a known contributor to clinician burnout. However, it is unknown whether the use of multifunctional EHRs is associated with nurse practitioner (NP) burnout in primary care practices. This is a major gap in the literature because 69% of practicing NPs deliver primary care services to patients. Purpose: This study aimed to investigate whether the use of multifunctional EHRs is associated with primary care NP burnout. Method: This study is a secondary analysis of cross-sectional survey data collected from NPs in two states (Pennsylvania and New Jersey). Nurse practitioners completed surveys measuring burnout, use of multifunctional EHRs, demographics, and characteristics of their practice. Use of multifunctional EHRs was operationalized using two items—computerized capabilities and electronic reminder systems. Burnout was measured using a validated, single item asking NPs to self-report their feelings of burnout. A multilevel cox regression model was built to test for associations between the use of multifunctional EHRs and NP burnout. Results: Of 396 NPs included, 25.3% reported burnout. The use of multifunctional EHRs did not increase primary care NP burnout (risk ratio = 0.30, 95% confidence interval = 0.13–0.71, p =.01). Implications for practice: With 25.3% of NPs burned out, it is imperative to reduce NP burnout. However, computerized capabilities and electronic reminder systems did not contribute to feelings of NP burnout. Future research examining other EHR components is needed to understand which features of the EHR contribute to NP burnout. [ABSTRACT FROM AUTHOR]

Background: Burnout threatens patient care and clinicians are experiencing challenges within the practice environment. Little is known about nurse practitioner (NP) perceptions of burnout and its relationship to care quality and practice environment. We investigate the relationship between primary care NP burnout on perceptions of care quality and if the practice environment moderates the relationship between burnout and care quality. Methods: This is a secondary analysis of cross‐sectional survey data from 396 NPs. Burnout and care quality were measured using a single item, but the practice environment was measured using the Nurse Practitioner Primary Care Organizational Climate Questionnaire. Multi‐level proportional odds cumulative logit models were built to test for associations between burnout and care quality and for moderation. Results: Total, 25.3% of NPs reported burnout. Odds of perceiving higher quality of care was 85% less for NPs experiencing burnout compared to those not experiencing burnout. Practice environment did not moderate the relationship between burnout and care quality, but with a one unit increase in the practice environment subscales, the odds of NPs perceiving higher care quality increased anywhere from 3.83 to 7.57 times. Conclusion: Burnout is related to lower perceptions of care quality but favorable environments were related to higher perceptions of quality. [ABSTRACT FROM AUTHOR]

Adoption of health information technology (HIT) in nursing homes (NHs) improves quality of care. Although there is a robust body of research on HIT adoption, the closely related process of technology abandonment is not well understood. As NHs grow more reliant on HIT, problems of technology abandonment, defined as failure to scale up, spread, and sustain HIT need to be studied. Our objective is to describe HIT abandonment and its associations with organizational characteristics among a national sample of US NHs. Longitudinal, retrospective analysis of data from 2 sources: HIT Maturity Survey and Staging model and public data from the Care Compare database. Random sample of NHs (n = 299) representing each US state that completed the HIT maturity survey in 2 consecutive years: year 1 (Y1) was June 2019–August 2020 and year 2 (Y2) was June 2020–August 2021. The primary dependent variable was technology abandonment, operationalized by using total HIT maturity score, HIT maturity stage, and subscale scores within each dimension/domain. Independent variables were NH organizational characteristics including bed size, type of ownership, urbanicity, Centers for Medicare & Medicaid Services Five-Star Overall Rating and Staffing Rating. Over the 2-year period, HIT abandonment occurred in 28% (n = 85) of NHs compared with 44% (n = 133) that experienced growth in HIT systems. HIT capabilities in resident care were abandoned most frequently. Using multivariable multinomial logistic regression, we found that large NHs (bed size greater than 120) were more likely to experience technology abandonment in administrative activities. Technology abandonment can increase strain on scarce resources and may impact administrators' ability to oversee clinical operations, especially in large NHs. This study contributes to the limited understanding of technology abandonment and can serve as a building block for others working to ensure limited resources are used effectively to improve care for NH residents. [ABSTRACT FROM AUTHOR]