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BackgroundWe investigated the effect of influenza vaccination on disease severity in adults hospitalized with laboratory-confirmed influenza during 2013-14, a season in which vaccine viruses were antigenically similar to those circulating.MethodsWe analyzed data from the 2013-14 influenza season and used propensity score matching to account for the probability of vaccination within age strata (18-49, 50-64, and ≥65 years). Death, intensive care unit (ICU) admission, and hospital and ICU lengths of stay (LOS) were outcome measures for severity. Multivariable logistic regression and competing risk models were used to compare disease severity between vaccinated and unvaccinated patients, adjusting for timing of antiviral treatment and time from illness onset to hospitalization.ResultsInfluenza vaccination was associated with a reduction in the odds of in-hospital death among patients aged 18-49 years (adjusted odds ratios [aOR] = 0.21; 95% confidence interval [CI], 0.05 to 0.97), 50-64 years (aOR = 0.48; 95% CI, 0.24 to 0.97), and ≥65 years (aOR = 0.39; 95% CI, 0.17 to 0.66). Vaccination also reduced ICU admission among patients aged 18-49 years (aOR = 0.63; 95% CI, 0.42 to 0.93) and ≥65 years (aOR = 0.63; 95% CI, 0.48 to 0.81), and shortened ICU LOS among those 50-64 years (adjusted relative hazards [aRH] = 1.36; 95% CI, 1.06 to 1.74) and ≥65 years (aRH = 1.34; 95% CI, 1.06 to 1.73), and hospital LOS among 50-64 years (aRH = 1.13; 95% CI, 1.02 to 1.26) and ≥65 years (aRH = 1.24; 95% CI, 1.13 to 1.37).ConclusionsInfluenza vaccination during 2013-14 influenza season attenuated adverse outcome among adults that were hospitalized with laboratory-confirmed influenza.

Chronic pain resilience is a concept that is frequently used in research but lacks theoretical clarity. Understanding chronic pain resilience is germane to developing interventions to improve it and the overall quality of life among individuals with chronic pain. To uncover and clarify the unique characteristics of the concept of chronic pain resilience. A concept analysis using Rodgers' evolutionary method. Full-text articles published after 2000 in English were used to inform the concept analysis. Scopus, PubMed, PsychINFO, Embase, and CINAHL Plus with Full Text were utilized for literature searches. Rodgers' evolutionary approach was used to clarify the attributes, antecedents, and consequences. The search yielded 31 articles that were used in the analysis. The key attributes of chronic pain resilience included engagement in meaningful activities despite pain, maintaining positive psychological homeostasis, buffering against negative mental outcomes, seeking support, and self-empowerment. After considering surrogate terms, antecedents, attributes, and consequences, chronic pain resilience may be defined as the development of the capacity to successfully adapt to chronic pain. This adaptation results in a move toward optimal social, physical, mental, and behavioral functioning by balancing negative and positive psychosocial factors, despite the additional challenges brought about by living with chronic pain. [ABSTRACT FROM AUTHOR]

Adolescent sexual health education is a complex concept with multiple dimensions. Approximately 95% of adolescents report receiving sexual health education before graduating high school but the concept of adolescent sexual health has not been defined and consistently used in research. The dimensional analysis method of concept analysis was used to uncover the key dimensions that comprise adolescent sexual health education. The dimensions discussed in this analysis are (a) educational content, (b) length of intervention, (c) curriculum timing, (d) delivery of content, and (e) measurable outcomes. From the studies in this analysis, educational content was the most discussed dimension. Length of intervention and measurable outcomes were the most variable dimensions where standardization could have the greatest effect. Reporting sexual health education interventions using these five dimensions will reduce difficulty in comparing and evaluating studies. Using these dimensions to standardize reporting, will help researchers uncover the most effective sexual health education programs. Once the most effective programs are uncovered, they can be replicated nationwide to improve adolescent sexual health outcomes.

Background: It has long been understood and acknowledged that the Neonatal Intensive Care Unit (NICU) environment and the transport environments are extremely loud, with both long- and short-term sequelae to the neonate, being well over the recommended amount of noise by the American Academy of Pediatrics (AAP). This problem has yet to be properly addressed. The purpose of this manuscript is to define and explain the concept of acoustic neuroprotection. While we cannot change the internal structures of the neonates' auditory system, we could change the acoustics of the environment to be support neuroprotection of these sensitive patients. Evidence acquisition: Walker and Avant's concept analysis steps were followed to create and define the idea of acoustic neuroprotection, as it has not had a definition before. A total of 45 articles from multiple search engines were chosen. A combination of 2 concepts were used: acoustic protection and neurodevelopmental protection/support. The search was expanded past 20 years for lack of research and importance of seminal works. Results: To achieve acoustic neuroprotection, a neonate should not be exposed to sound greater than 45 decibels (dBa) for longer than 10 s, and exposure to sound above 80 dBa should never occur. Appropriate interventions need to include supporting the neurodevelopment of the neonate through therapeutic sound, while decreasing the amount of toxic noise exposure to safe levels. Implications for Practice and research: By further understanding and having a quantifiable goal of acoustic neuroprotection for neonates, neonatal clinicians can work together to create new interventions for how to better protect and support the care of our tiniest patients. [ABSTRACT FROM AUTHOR]

Chronic health conditions impact nearly 40% of children in the United States, necessitating parents/caregivers to entrust healthcare responsibilities to youth aging into adulthood. Understanding the parental entrustment process may lead to tailored transition support; however, the concept lacks conceptual clarity, limiting its research and practical applications. Rodgers' evolutionary concept analysis method was used to clarify the parental entrustment of healthcare responsibilities to youth with chronic health conditions. PubMed, CINAHL, and PsycINFO databases were searched without date restrictions, including full-text, English-language, primary source articles related to parent-child healthcare transition preparation. Following title, abstract, and full-text screenings, data were analyzed using a hybrid thematic approach to identify antecedents, attributes, and consequences. Forty-three studies from August 1996 to September 2023 were identified. Antecedents encompass social cues and readiness factors, while attributes involve a) responsibility transfer, support, and facilitation, b) a dynamic process, c) balancing trust and fear, d) navigating conflict, and e) parental letting go. Consequences entail shifts in parental and adolescent roles. Parental entrustment is an iterative process wherein parents guide their maturing child through responsibility transfer via facilitation, support, conflict navigation, and trust building. The clarified concept underscores the role of parents/caregivers in empowering youth to manage their health. Introducing a working definition and conceptual model contributes to understanding the processes families navigate in the larger landscape of healthcare transition. This clarification holds implications for clinicians and policymakers, offering insights to enhance support and guidance for families navigating healthcare transition. • Pediatric healthcare transition necessitates child and family-centered care. • Parents/carers must entrust health responsibilities and outcomes to youth. • Parents enable transition through support, conflict navigation, and trust building. • Entrustment is an iterative process with complex parent-youth interactions. • Clinicians can foster family-centered transitional care by engaging parents. [ABSTRACT FROM AUTHOR]

Background: Although the concepts of uncertainty and anticipated loss have been explored in a variety of contexts, advances in genetic testing and life-sustaining technology rendered changes in the care of medically complex infants. The separate concepts no longer have the descriptive power to clarify new phenomena endured by parents in the changing neonatal landscape. A current concept analysis examining uncertainty in anticipated loss is necessary to generate knowledge concurrently with deviations observed in the neonatal intensive care unit. Purpose: To explore the concept of uncertainty in anticipated loss among parents of infants with genetic disorders. Methods: Following Rodgers' method of concept analysis, the concept was named, surrogate terms, antecedents, attributes, and consequences were identified from the literature, and a model case was constructed. The databases CINAHL, PubMed, and PsycINFO were used to conduct the literature search. Results: Fifteen articles provided the data for this analysis. Uncertainty in anticipated loss is a complex, nonlinear, and multifaceted experience anteceded by an ultimately terminal diagnosis, an ambiguous prognosis, and a lack of clear knowledge to guide treatment. Its attributes include a loss of control, assumptive world remodeling, role/identity confusion, and prolonged emotional complexity that consequently leads to a cyclical pattern of positive and negative outcomes. Implications: This newly defined concept empowers neonatal nurses to provide care that includes a holistic understanding of the experience of uncertainty in anticipated loss. Nurses are ideally positioned and have the responsibility to utilize this concept to become better advocates for infants and facilitators of parental wellness. [ABSTRACT FROM AUTHOR]

Poor well-being and burnout among the nursing workforce were heightened by the COVID-19 pandemic. The purpose of this study was to deliver, spread, and sustain an evidence-based wellness program, Workforce Engagement for Compassionate Advocacy, Resilience, and Empowerment (WE CARE), for nurse leaders, staff registered nurses (RNs), and patient care technicians (PCTs) to ameliorate or prevent burnout, promote resilience, and improve the work environment. The program included Community Resiliency Model (CRM) training provided by a certified 6-member wellness team. A baseline and 6-month follow-up survey included measures of well-being, moral distress, burnout, resilience, perceived organizational support (POS), job satisfaction, intent to leave (ITL), and work environment. A total of 4900 inpatient RNs, PCTs, and leaders of a 1207-bed academic medical center in the southeastern United States were analyzed. From baseline (n = 1533) to 6-month follow-up (n = 1457), well-being, moral distress, burnout, job satisfaction, and work environment improved; however, resilience, POS, and ITL did not. Although we have seen some improvements in well-being and mental health indicators, it is still early in the intervention period to have reached a critical mass with the training and other interventions. The mental health and work environment issues among nurses are so complex, no one-size-fits-all intervention can resolve. [ABSTRACT FROM AUTHOR]

The purpose of this mini review is to (1) summarize the findings on the impact of night shift on nurses' health and wellness, patient and public safety, and implications on organizational costs and (2) provide strategies to promote night shift nurses' health and improve organizational costs. The night shift, compared with day shift, results in poorer physical and mental health through its adverse effects on sleep, circadian rhythms, and dietary and beverage consumption, along with impaired cognitive function that increases nurse errors. Nurse administrators and health care organizations have opportunities to improve nurse and patient safety on night shifts. Low-, moderate-, and higher-cost measures that promote night nurses' health and well-being can help mitigate these negative outcomes. The provided individual and organizational recommendations and innovations support night shift nurses' health, patient and public safety, and organizational success. [ABSTRACT FROM AUTHOR]

Justin L Miller, Patricia A Patrician, Allison R Jones School of Nursing, The University of Alabama at Birmingham, Birmingham, AL, USACorrespondence: Justin L Miller, Email jlmiller@uab.eduAim: To determine outcomes measured following blood transfusion for the resuscitation of adult patients who experienced trauma-related hemorrhage and compare them based on the timeframe in which they occurred: short-, intermediate-, and long-term.Design: Systematic Review.Review methods: We included articles that met the following criteria: published in English between January 1, 2014 and December 31, 2023; with full text available; peer-reviewed; and adult population (≥ 19 years). Two authors reviewed each title, abstract, and full text for inclusion using the online review tool, Covidence; a third author adjudicated conflicts. A similar method was used for data extraction. Outcomes were categorized as those that occurred in the short-term (day of injury to < 30 days post-injury), intermediate-term (30 days to six months post-injury), and long-term (> six months to one year post-injury). The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was used to rate the quality and strength of the reviewed evidence.Data Sources: PubMED, CINAHL, Scopus, and Embase.Results: The final analysis included 50 articles. Outcomes were categorized as those related to mortality, pathophysiologic outcomes, indices of coagulopathy, and duration of treatment. All four outcome categories were reported in at least one study during the short-term timeframe. Mortality was reported in 12 articles, the duration of treatment was reported in four articles, and pathophysiologic outcomes were reported in one article during the intermediate-term timeframe. Two articles reported mortality during the long-term timeframe.Conclusion: Short-term outcomes of patients resuscitated with blood products following a trauma-related hemorrhage have been well studied. Future studies are needed to assess the intermediate- and long-term outcomes of patients following a trauma-related hemorrhage.Impact: Understanding patient outcomes following trauma-related hemorrhage may help guide clinicians in the provision of care beyond the initial resuscitation period, and ultimately improve patient recovery and rehabilitation.Keywords: blood transfusion, wounds and injuries, trauma, hemorrhage, patient outcomes

Resilience has been identified as a key concept for dementia family caregiver mental health; however, the concept is not well defined. A concept analysis examining dementia caregiver resilience was conducted using Rodger's Evolutionary Method. The aim of this concept analysis was to describe the historical perspective, attributes, antecedents, and consequences of resilience as it relates to dementia caregiver mental health. Key attributes of dementia caregiver resilience were acceptance, coping strategies, social support, self-appraisal, and spirituality. The results from this concept analysis provide the foundation for the development of resilience-based interventions to support the well-being of dementia family caregivers. • Resilience has been identified as a key concept for dementia family caregiver mental health • A concept analysis using Rodger's Evolutionary Method analyzed historical context, antecedents, attributes, and consequences of dementia caregiver resilience • Key attributes of dementia caregiver resilience are acceptance, coping strategies, social support, self-appraisal, and spirituality • Results provide a foundation for resilience-based interventions for dementia caregiver mental health [ABSTRACT FROM AUTHOR]

Background/Purpose: Meeting recommendations that nurses should partner in leading health care change is hampered by the lack of ambulatory care nurse-sensitive indicators (ACNSIs). This scoping review was conducted to identify evidence regarding ACNSI identification, development, implementation, and benchmarking. Methods: Following the PRISMA-ScR reporting guide, we performed PubMed/MEDLINE, CINAHL, and Cochrane Library searches for the period January 2006 to March 2021. Results: Twelve of the 1984 articles from 6 countries met inclusion criteria. All focused on identifying, developing/pilot testing indicators, and included structure, process, and outcome indicators. Seven articles were level II and all were at least grade B quality. Leverage points involved leadership support, automated data extraction infrastructure, and validating links between nurses' roles/actions and patient outcomes. Conclusions: While high-quality work is ongoing to identify clinically meaningful and feasible ACNSIs, knowledge in this field remains underdeveloped. Prioritizing this work is imperative to address gaps and facilitate national strategic health care goals. [ABSTRACT FROM AUTHOR]

Nursing professional practice models (PPMs) are known to have beneficial effects on nurse and patient outcomes. Determining what components should be present in a PPM, how to implement a PPM, and evaluating the outcomes associated with a PPM is less certain. Therefore, as part of a larger project to develop a nursing PPM for use within the United States Military Health System, this study aimed to conduct a systematic literature review on nursing PPMs. Specifically, the review sought to investigate components, implementation, and outcomes of PPMs in current literature. A total of 37 articles were included in the review. The literature supported the development of 12 recommendations for creating, implementing, and evaluating a nursing PPM. As health care facilities develop their own PPMs or reassess their current PPMs, findings from this review may assist hospital leadership by providing the most recent evidence on the strategic value of nursing PPMs in contemporary health care. [ABSTRACT FROM AUTHOR]

Objectives: During apnea diving, a patent foramen ovale may function as a pressure relief valve under conditions of high pulmonary pressure, preserving left-ventricular output. Patent foramen ovale prevalence in apneic divers has not been previously reported. We aimed to determine the prevalence of patent foramen ovale in apneic divers compared to non-divers.Design: Cross sectional.Methods: Apnea divers were recruited from a training camp in Cavtat, Croatia and the diving community of Split, Croatia. Controls were recruited from the population of Split, Croatia and Eugene, Oregon, USA. Participants were instrumented with an intravenous catheter and underwent patent foramen ovale screening utilizing transthoracic saline contrast echocardiography. Appearance of microbubbles in the left heart within 3 cardiac cycles indicated the presence of patent foramen ovale. Lung function was measured with spirometry. Comparison of patent foramen ovale prevalence was conducted using chi-square analysis, p < .05.Results: Apnea divers had a significantly higher prevalence of patent foramen ovale (19 of 36, 53%) compared to controls (9 of 36, 25%) (X2 (1, N = 72) = 5.844, p = .0156).Conclusions: Why patent foramen ovale prevalence is greater in apnea divers remains unknown, though hyperbaria during an apnea dive results in a translocation of blood volume centrally with a concomitant reduction in lung volume and alveolar hypoxia during ascent results in hypoxic pulmonary vasoconstriction. These conditions increase pulmonary arterial pressure, increasing right-atrial pressure allowing for right-to-left blood flow through a patent foramen ovale which may be beneficial for preserving cardiac output and reducing capillary hydrostatic forces. [ABSTRACT FROM AUTHOR]

• Definition of nurse well-being is elusive • Rodger's Evolutionary Method of Concept Analysis is useful • Individual nurse Well-being requires basic human needs to self-actualization • Nurse-well being is dependent on organizational support • Standardized definitions of well-being should guide future research and policy development An understanding of nurse well-being remains elusive, particularly in the current toxic health care environment. Therefore, a conceptual definition of nurse well-being is needed. The purpose of this paper is to report results of a concept analysis of nurse well-being. Rodgers' Evolutionary Method of concept analysis was used to examine the attributes, antecedents, consequences, and related concepts of nurse well-being. Findings revealed varying levels of nurse well-being: individual, organizational and community. Individual attributes included happiness, satisfaction, optimism, compassion, gratitude, forgiveness, and sound body/spirit. Organizational/community attributes included teamwork, sense of mission, pride in work, and social integration. Antecedents reflected commonalities with Maslow's hierarchy of needs, ranging from basic human needs to self-actualization. Consequences included resilience, collegial relationships, continued growth and development, empowerment, purposeful work, and physical/mental health. Standardized definitions of individual and organizational/community nurse well-being should guide future research and policy development. Organizations must build capacity for nurses' well-being and explore its connection to patient safety and quality outcomes. [ABSTRACT FROM AUTHOR]

Background: As large numbers of coronavirus disease 2019 (COVID-19) patients were admitted to intensive care units (ICUs) in 2020 and 2021, the United States faced a shortage of critical care providers. Intensivists are physicians specializing in providing care in the ICU. Although studies have explored the clinical and financial benefits associated with the use of intensivists, little is known about the organizational and market factors associated with a hospital administrator's strategic decision to use intensivists. Purpose: The aim of this study was to use the resource dependence theory to better understand the organizational and market factors associated with a hospital administrator's decision to use intensivists. Methodology: The sample consisted of the national acute care hospitals (N = 4,986) for the period 2007–2017. The dependent variable was the number of full-time equivalent intensivists staffed in hospitals. The independent variables were organizational and market-level factors. A negative binomial regression model with state and year fixed effects, clustered at the hospital level, was used to examine the relationship between the use of intensivists and organizational and market factors. Results: The results from the analyses show that administrators of larger, not-for-profit hospitals that operate in competitive urban markets with relatively high levels of munificence are more likely to utilize intensivists. Practice Implications: When significant strains are placed on ICUs like what was experienced during the COVID-19 pandemic, it is imperative that hospital administrators understand how to best staff their ICUs. With a better understanding of the organizational and market factors associated with the use of intensivists, practitioners and policymakers alike can better understand how to strategically utilize intensivists in the ICU, especially in the face of a continuing pandemic. [ABSTRACT FROM AUTHOR]

Background: COVID-19 negatively impacts many organ systems including the skin. One of the most significant skin-associated adverse events related to hospitalization are pressure injuries. Purpose: The aim of this study was to determine 8 risk factors that would place hospitalized patients at a higher risk for hospital-acquired pressure injuries (HAPIs) during the COVID-19 pandemic. Methods: A retrospective, descriptive analysis was conducted in an urban academic health science center located in the southeastern United States. Results: There were 247 of 23 093 patients who had pressure injuries and 1053 patients who had a positive COVID-19 diagnosis. Based on the generalized estimating equation model, diagnosis of COVID-19, age, male gender, risk of mortality, severity of illness, and length of stay are statistically significant factors associated with the development of HAPIs. Conclusions: Further study should explore pathology of COVID-19 skin changes and what interventions are effective against HAPIs in the COVID-19 population taking into consideration current treatments. [ABSTRACT FROM AUTHOR]

Background: Burnout impacts nurses' health as well as brain structures and functions including cognitive function, which could lead to work performance and patient safety issues. Yet, few organization-level factors related to patient safety have been identified. Purpose: This study examined nurse-reported patient safety grade and its relationship to both burnout and the nursing work environment. Methods: A cross-sectional electronic survey was conducted among nurses (N = 928) in acute care Alabama hospitals. Results: In multilevel ordinal mixed-effects models with nurses nested within hospitals, all burnout dimensions of the Copenhagen Burnout Inventory (OR for +1 SD ranging 0.63-0.78; P < .05) and work environment (OR for +1 SD ranging 4.35-4.89; P < .001) were related to the outcome of patient safety grade after controlling for nurse characteristics. Conclusions: Results indicate that health care organizations may reduce negative patient safety ratings by reducing nurse burnout and improving the work environment at the organization level. [ABSTRACT FROM AUTHOR]

Acute conditions are the leading cause of work restrictions and missed workdays, contributing to over $27 billion in lost productivity each year and negatively impacting workers' health and quality of life. Primary care services, specifically patient-centered medical homes (PCMHs), play an essential role in supporting timely acute illness or injury recovery for working adults. The purpose of this review is to synthesize the evidence on the relationship between PCMH implementation, care processes, and outcomes. In addition, we discuss the empirical connection between this evidence and return-to-work outcomes, as well as the need for further research. [ABSTRACT FROM AUTHOR]

Burnout, a condition characterized by emotional exhaustion, depersonalization, and decreased personal accomplishment, has been studied in many disciplines in health care, including nursing, medicine, and social work. The purpose of this study was to examine the relationship between perceived organizational support, coworker social support, the nursing practice environment, and nurse demographics (age, years of nursing experience, education level, marital status, and sex) on burnout in a national sample of palliative care nurses. The study aims were (1) to examine the relationship between perceived organizational support, coworker social support, and nursing practice environment on burnout in palliative care nurses; (2) to examine the relationship between age, years of nursing experience, education level, marital status, and sex on burnout in palliative care nurses; and (3) to examine potential moderators (perceived organizational support and coworker social support) on the relationship between demographic characteristics and palliative care nurse burnout. A convenience sample of 73 Hospice and Palliative Nurses Association registered nurses who were bedside caregivers was recruited from Hospice and Palliative Nurses Association's membership. Data were analyzed using Pearson correlation and regression modeling. Findings indicated palliative care nurses had moderate to high levels of burnout. There was a negative correlation between burnout and perceived organizational support, and between burnout and coworker social support. The nursing practice environment of palliative care nurses was favorable; perceived organizational support and coworker social support were not moderators for demographics of age and years of experience and their relationship to burnout. [ABSTRACT FROM AUTHOR]

The Veterans Health Administration (VHA) led implementation of the Clinical Nurse Leader (CNL) role nationally with the goal to meet system needs for strong clinical leadership across all settings. After a decade of CNL role implementation, the VHA supported this evaluation to determine the current state, the successes, the challenges, and the fidelity to the original intent of the role. The team used mixed methods to evaluate the state of the CNL initiative. Ten evaluation activities were undertaken including a facility survey directed toward chief nurse executives at all VHA facilities, and a second survey directed at registered nurses who completed a CNL graduate program, were certified as a CNL, or were currently enrolled in a CNL graduate program. The evaluation results suggest the CNL initiative had not yet accomplished the stated goals to improve cost and financial outcomes, increase patient satisfaction, increase staff satisfaction and retention, improve quality and internal processes, and facilitate practice model transformation including evidence-based practice and collaborative, interdisciplinary practice across the system. Observed CNL practices within the VHA could serve as exemplars for developing a care delivery model that could achieve these goals and offer potential paths to move this role forward. [ABSTRACT FROM AUTHOR]

• The concept of sustainability in global nursing has not been fully conceptualized. • Nursing is an exceedingly diverse discipline, spanning geographical boundaries. • Nurses in LMIC are more likely to be disempowered and/or migrate. • Existing conceptual models lack clarity and full integration of sustainability. • Our model and definition serve as adjuncts to existing models of global nursing. The concept of sustainability has received growing attention since the adoption of the United Nations' (UN) Sustainable Development agenda. Yet, in the context of sweeping changes regarding the status and profile of global nursing, sustainability has not been fully conceptualized. To explore the concept of sustainability in global nursing in order to develop an operational definition and model. Concept analysis using Rodger's Evolutionary method to explicate the term "sustainability" in a global nursing context. Key features of sustainability were described. Existing models of global nursing focus on partnerships and lack a clear conceptualization and integration of sustainability. An operational definition and model of sustainability in global nursing were developed. Evolutionary review and analysis led to clarity in operationalizing sustainability in global nursing. The definition and model compliment existing models and provide a road map for global nursing to contribute toward the UN Sustainable Development agenda. [ABSTRACT FROM AUTHOR]

Background: Community orientation refers to hospitals' efforts to assess and meet the health needs of the local population. Variations in the number of community orientation-related activities offered by hospitals may be attributed to differences in organizational and environmental characteristics. Therefore, hospitals have to strategically respond to these internal and external constraints to improve community health. Understanding the facilitators and barriers of hospital community orientation is important to health care managers facing pressure from the external environment to meet the expectations of the community as well as Affordable Care Act guidelines. Purpose: The purpose of this study was to examine the organizational and environmental factors that promote or impede hospital community orientation. Methodology: A multivariate regression with random effects was conducted using data from the American Hospital Association Annual Survey from 2007 to 2010 and county level data from the Area Health Resource Files. Findings: Not-for-profit, system-affiliated, network-affiliated, and larger hospitals have a higher degree of community orientation. In addition, the percentage of the county residents under the age of 65 years with health insurance and hospitals in states with certificate-of-need laws were also positively related to the degree of community orientation. During the study period, it appears that organizational factors mattered more in determining the degree of community orientation. Practice Implications: Overall, a better understanding of the factors that influence community orientation can assist hospital administrators and policymakers in stimulating the hospital's role in improving population health and its responsiveness to community health needs. These efforts may occur by building interorganizational relationships or by incentivizing those hospitals that are least likely to be community oriented. [ABSTRACT FROM AUTHOR]

The sex trafficking of adolescents is known as commercial sexual exploitation of children (CSEC). CSEC is a complex phenomenon where identification requires understanding of developmental disruptions from toxic bonding experiences that increase in complexity over time. These toxic bonding experiences forced through coercive methods disrupt the holistic development of a self in the CSEC victim that interferes with daily functions, decision-making and social and emotional development. Lacking in the literature is a conceptual foundation for trauma coerced bonding. The purpose of the analysis is to define and clarify the future concept of trauma coerced bonding from trauma bonding as it relates to CSEC victimization. The concept analysis used Rodgers' evolutionary method to search four databases (PubMed, CINHAL, Scopus, and Google Scholar [for grey literature]), using terms associated with various descriptions of trauma bonding (for instance, Stockholm syndrome), resulting in twenty papers for review. Attributes, antecedents, and consequences of trauma bonding were delineated and explained. It became apparent through this analysis that the concept of trauma bonding of adolescents exposed to CSEC is very different from other forms of trauma bonding, leading this author to a more precise term, trauma-coercive bonding. Trauma coercive bonding is a long process that is a developmentally disruptive form of bonding that has ramifications throughout the life span. Trauma coercive bonding is influenced by more than just an emotional bond. The proposed definition of trauma coercive bonding brings an in-depth description of vulnerabilities and disruptions to childhood when CSEC, which persists long into adulthood. Future qualitative research should pursue a grounded theory of trauma coercive bonding to further explain and study this phenomenon. • The commercial sexual exploitation of children (CSEC) is a complex phenomenon. • There is a lack of a conceptual foundation explaining toxic bonding experiences. • Trauma coercive bonding provides a conceptual foundation of CSEC victimization. • Conceptual foundation provides an in-depth description of vulnerabilities. • Promote awareness and education of trauma coercive bonding in nursing literature. [ABSTRACT FROM AUTHOR]