Direct Care Research Articles

Caring for Transgender and Gender Diverse Prehospital Patients: a NAEMSP Position Statement and Resource Document

ABSTRACT Transgender and gender diverse (TGD) people have long faced significant barriers to safely accessing medical care–especially gender-affirming care, which has been shown to strikingly improve health outcomes like suicidality and depression. In the prehospital setting, gender-affirming care amounts to showing respect for the TGD patient’s identified gender and maintaining a safe environment that fosters a positive therapeutic relationship throughout the encounter. This represents a challenge for many Emergency Medical Services (EMS) systems due to the lack of TGD-specific training for EMS clinicians, a paucity of TGD-specific research to inform EMS education and clinical care, and in some cases the resistance of EMS clinicians to such training. Transgender and gender diverse people are facing a regression in legal access to essential medical care. With this position statement, NAEMSP joins other professional medical societies in providing recommendations to improve care for TGD patients, thereby affirming TGD individuals’ right to exist as their authentic selves, as well as their entitlement to the same high-quality prehospital medical care as their cisgender peers. NAEMSP Recommends: EMS clinicians should maintain basic cultural competency regarding TGD populations, including familiarity with TGD-related health and health care disparities, consideration of TGD populations as underserved, and understanding the centrality of stigma and transphobia in creating disparities and other challenges which complicate daily life for TGD people. EMS clinicians should demonstrate cultural humility towards the TGD community, which includes self-assessment of knowledge gaps, as well as openness to new or unfamiliar ideas, information, and advice from those with different lived experiences. EMS clinicians should understand basic TGD-specific terminology and use appropriate language–including patient-identified name and pronouns–during direct patient care, in handoffs, and in documentation. EMS clinicians should treat a patient’s TGD status as sensitive health information and take care not to inadvertently disclose this information without the patient’s express permission. EMS clinicians should have a basic understanding of social transitioning and of gender-affirming medical and surgical treatments. EMS clinicians should employ a trauma-informed approach when caring for TGD patients. EMS education and training should incorporate learning domains that address comprehensive care for TGD patients, with educational content providing the specific knowledge and skills required to promote equitable care. EMS workplaces should implement policies to improve recruitment and retention of TGD personnel, covering harassment protection, non-discrimination practices, inclusive working environments, equal advancement opportunity and tailored employee benefits. Future EMS research should focus on elucidating the disparities in and barriers to prehospital care of the TGD patient population with emphasis on patient experience and education of prehospital clinicians.

5066 Evolution And Evaluation Of A Longitudinal ECHO Program In Transgender Health

Abstract Disclosure: M.S. Rothman: None. A. Chippone: None. A. Clark: None. D. Saxon: None. D. Miller: None. K. Young: None. S.J. Iwamoto: None. Background: Providers often report a lack of training in the care of transgender and gender diverse(TGD) patients. Extension for Community Healthcare Outcomes(ECHO) programs have been developed around the world as a form of tele-mentoring. As gender-affirming care bans rise in the US, it is crucial for providers to have access to education in TGD patient health. ECHO Colorado(CO) launched “Comprehensive Care for Transgender Patients” in 2020 as an ongoing live monthly series for providers interested in improving care for TGD patients. Design/Methods: 40 sessions were held between 2/2020-9/2023. Topics spanned mental health, medical, and surgical care with didactic presentations followed by case discussions. Demographic data was collected at registration via Connect, an online portal, and evaluations were conducted quarterly using Qualtrics. Not all questions were required. Participants attending at least one session in the quarter were eligible to complete the survey. With multiple responses, the most recent survey was used in the analysis. Results: 257 individuals participated in at least one session. 164/255 (64.3%) respondents identified as clinical health care providers. The majority of the remainder identified as: behavior health professional(n=28), other(n=23) or health outreach/admin(n=17). Most participants (79.4%) practice in CO and the majority provide direct care for underserved populations. 110 attendees responded to at least one survey. 96% of all participants reported improved understanding of the subject matter. Of the prescribing providers, 80%(60/75) rated themselves as comfortable with continuing and 68%(51/75) were comfortable with initiating hormone therapy. In the most recent quarter, participants were asked to self-report levels of professional isolation before and after the series. 30%(8/27) reported feeling very or extremely isolated prior, while none(0/27) reported this since participating. Common barriers reported were obstacles to implementing care and scheduling conflicts preventing attendance. Conclusion: Participants with a variety of backgrounds are highly satisfied with this longitudinal program. ECHO learning may combat feelings of professional isolation. The majority of providers report comfort with initiating and providing hormone therapy, but future efforts should seek ways to improve comfort, competency and examine asynchronous educational opportunities. Interest from attendees outside of CO supports a need for a national collaborative of TGD focused ECHOs. Presentation: 6/1/2024

Out of focus but still relevant? Influenza-related resource utilization and vaccination coverage gaps in adults below 60 years of age with underlying conditions: an analysis of 2016–2024 real-world data in Germany

Background In 2003, the WHO aimed for a 75% or higher influenza vaccination rate among at-risk populations. However, this target was achieved in a few groups during selected seasons in some European countries, and never in Germany. Adults with underlying conditions (UCs) are a critical negleted group for influenza vaccination. This study aimed to identify data gaps in influenza burden and vaccination coverage among adults under 60 with UCs in Germany and bridge these gaps using real-world data. Material and methods We conducted systematic research and analyses using German administrative and claims databases from June 2016 to April 2024. We report on epidemiology, direct care costs, indirect costs from work incapacity, vaccination coverage rates, and describe data gaps. Results Influenza data for high-risk populations are limited. Comprehensive data on influenza epidemiology and vaccination coverage rates (VCR) is available, though with a delay in data availability. Before and after the pandemic, individuals aged 50-59 had the highest rates of influenza-related hospitalization and ICU admission compared to younger age groups. Across all age groups and seasons, individuals with UC experienced higher rates of medically attended influenza cases, hospitalizations, and healthcare costs, with those aged 35–59 being particularly vulnerable. Vaccine coverage was higher in adults aged 35–59 compared to those aged 18–24, and in females compared to males. Limitations Discrepancies of vaccination status, limited data availability, and variations among the extent of UCs. Conclusion In Germany, recent policy measures have mainly targeted those aged 60 and above. While this elderly population experiences the highest disease-related impact, influenza can also lead to substantial healthcare resource utilization (HCRU) and costs in younger populations with chronic UCs; Facilitating vaccination access for this group, such as through pharmacies, is essential. Definition of quantifiable vaccination targets and measures to increase vaccination rates based on these targets are required.

Ethical dimensions of clinical data sharing by US healthcare organizations for purposes beyond direct patient care: Interviews with healthcare leaders.

Empirically investigate current practices and analyze ethical dimensions of clinical data sharing by healthcare organizations for uses other than treatment, payment, and operations. Make recommendations to inform research and policy for healthcare organizations to protect patients' privacy and autonomy when sharing data with unrelated third parties. Semi-structured interviews and surveys involving 24 informatics leaders from 22 US healthcare organizations, accompanied by thematic and ethical analyses. We found considerable heterogeneity across organizations in policies and practices. Respondents understood "data sharing" and "research" in very different ways. Their interpretations of these terms ranged from making data available for academic and public health uses, and to HIEs; to selling data for corporate research, to contracting with aggregators for future resale or use. The nine interview themes were that healthcare organizations: (1) share clinical data with many types of organizations, (2) have a variety of motivations for sharing data, (3) do not make data sharing policies readily available, (4) have widely varying data sharing approval processes, (5) most commonly rely on HIPAA de-identification to protect privacy, (6) were concerned about clinical data use by electronic health record vendors, (7) lacked data sharing transparency to the general public, (8) allowed individual patients little control over sharing of their data, and (9) had not yet changed data sharing practices within the year following the US Supreme Court 2022 decision denying rights to abortion. Our analysis identified gaps between ethical principles and healthcare organizations' data sharing policies and practices. To better align clinical data sharing practices with patient expectations and biomedical ethical principles, we recommend: updating HIPAA, including re-identification and upstream sharing restrictions in data sharing contracts, better coordination across data sharing approval processes, fuller transparency and opt-out options for patients, and accountability for data sharing and consequent harms.

Assessing the frontline competency gap: Emergency care perceptions among nurses in Yemen's conflict zone.

Nursing competencies in armed conflict situations are critical for effective response and recovery. This study explores nurses' perceptions regarding their competencies in armed conflict zones to identify areas of proficiency and those requiring further emphasis in training. This cross-sectional descriptive study adhered to the STROBE reporting guidelines. It used a validated questionnaire examining 47 different competencies for nursing in armed conflict zones, which were subsequently ranked to identify those that were valued most and least. In total, 102 questionnaires were returned (85% response rate). The highest-ranked competencies focused on immediate life-saving interventions and personal safety. In contrast, competencies involving broader disaster management, such as understanding organizational disaster plans, post-death care, and risk identification, ranked lower. This observation may indicate a tendency to prioritize direct clinical care over strategic planning and long-term recovery in disaster nursing education. This study highlights the critical need to strengthen emergency care competencies among nurses working in armed conflict zones in Yemen. Its findings underscore the importance of targeted training programs, particularly in complex trauma management and psychological first aid, to address nurses' self-identified competency gaps. Policy implications include prioritizing resource allocation for emergency care infrastructure, implementing competency-based deployment strategies, and ensuring access to mental health support for nurses in working conflict zones. These actions are essential for building a resilient nursing workforce capable of providing quality care amidst the unique challenges of armed conflict.

Educational needs of direct care workers in long-term care facilities providing mealtime assistance to older adults with dementia

BackgroundOlder adults with dementia in long-term care facilities often encounter challenges in self-feeding owing to cognitive and physical impairments. Although direct care workers play a crucial role in facilitating mealtime activities, they lack adequate and specific training. To develop an effective educational training program for this purpose, it is essential to understand the educational needs of direct care workers providing meal assistance. Therefore, this study aimed to identify the educational needs prioritized by direct care workers in long-term care facilities, regarding providing eating assistance to older adults with dementia.MethodsAdopting a mixed-methods approach, this study combined quantitative analysis using Borich’s needs assessment and locus for focus models with qualitative insights from focus group interviews. Participants comprised 174 direct care workers and five nursing managers from various long-term care facilities in South Korea.ResultsThis study identified four main educational priorities: enhancing knowledge regarding swallowing function, understanding institutional support mechanisms, applying multisensory stimulation techniques, and addressing food forgetfulness in older adults with dementia. These findings were aligned with the qualitative data that emphasized the necessity of training in these specific areas to improve the quality of meal assistance provided to this vulnerable population.ConclusionThe findings underscore the critical need for focused educational programs that equip direct care workers with the skills and knowledge necessary to effectively assist older adults with dementia during mealtime. This study advocates the implementation of continuous education and training initiatives led by nursing management to improve the meal assistance environment for older adults with dementia, thereby enhancing their overall care and quality of life.

Intensity of nursing work in a primary healthcare center: An observational study

ObjectivesIn the sphere of occupational intensity, nursing stands recognized for its inherently demanding nature, marked by a rapid succession of tasks. Our primary aim was to assess the level of job intensity within nursing by analyzing the frequency and duration of activities performed by nurses, instances of task overlap, and the distribution of break times within a primary healthcare center. MethodsThis study was conducted using a descriptive working method. Nursing activities were recorded with the observation of six nurses, each monitored for 37.5 h. We used the Maribor System for measuring Quantity in Nursing Care in Primary Health Care Settings to measure the nursing care activities about direct patient care, indirect patient care, and other unproductive aspects through direct non-participant observations. ResultsAbout 41.5% (n = 1,640) of all nursing activities involving direct contact with patients, about 38.2% (n = 1,508) was indirect patient care, where a large amount worked with paper files (n = 666, 16.9%). In addition, about 15.0% were other nursing activities (mostly computer work), and just 5.3% (n = 210) of tasks were unproductive. The observational findings indicate a pronounced level of work intensity experienced by nurses in primary health clinics. Significantly, nurses were predominantly engaged in direct patient care tasks, often managing multiple activities simultaneously. Their transitions between tasks occurred approximately every 3 min, frequently without adequate intervals for breaks. ConclusionsThis study highlights the need to shift nurses’ focus from a task-centric approach to one centered on patient care. The prevailing emphasis on tasks may contribute to enduring fatigue and professional dissatisfaction. Consequently, there is an urgent need to redefine the scope of a nurse’s role and implement a comprehensive computer information system as an integral part of this redefined approach.

Evaluation of the Symptoms and Clinical Characteristics of Crohn's Disease and Ulcerative Colitis That Affect Healthcare Providers' Treatment Choices.

Treatment of inflammatory bowel disease-Crohn's disease (CD) and ulcerative colitis (UC)-is dependent on healthcare providers' (HCPs') clinical assessment of patient symptoms. We therefore evaluated which CD and UC symptoms impact HCPs' treatment choices and assessed the impact of those symptoms on treatment decision-making. We also examined the role of complete control (mucosal/histologic healing, clinical remission, no bowel urgency) in treatment decision-making, considerations for dose escalation or switching treatments, and HCPs' willingness to use the Urgency Numeric Rating Scale (NRS) to assess bowel urgency severity. We conducted an observational, cross-sectional, self-administered survey among HCPs (N = 459, across types/specialties) who work in direct patient care and treat patients with CD and UC in the United States. Data were collected from eligible participants between November 21, 2022, and December 6, 2022, and responses were summarized through descriptive statistics. For CD and UC, the symptoms of greatest importance when deciding on the course of treatment included cramping or abdominal pain, rectal bleeding, diarrhea, anemia, weight loss, and bowel urgency. Furthermore, most HCPs ranked rectal bleeding, clinical remission, abdominal pain, and complete control as "very" to "extremely" important in decisions about the course of treatment, dose escalation, or switching treatments. In total, 22.9% of HCPs indicated that they use the Urgency NRS, while 89.3% were at least somewhat willing to use it in the future. Our study provides real-world insights into the symptoms and clinical characteristics that most impact HCPs' treatment choices for CD and UC in clinical practice.

Hospice Administrators' and Providers' Perspectives on Providing Upstream Palliative Care: Facilitators, Barriers, and Policy Prescriptions.

Background: Among patients with serious illness, palliative care before hospice enrollment is associated with improved quality of life, reduced symptom burden, and earlier transitions to hospice. However, fewer than half of eligible patients receive specialty palliative care referrals. As most hospice clinicians and administrators have experience in specialty palliative care, several emerging programs propose engaging hospice clinicians to provide early palliative care. Objective: We sought to identify barriers and facilitators to upstream palliative care. Design: We conducted a key informant qualitative study among hospice administrators and clinicians. Setting/Subjects: We conducted semi-structured interviews with 23 hospice administrators and clinicians in eight states from March to August 2022. We identified participants using snowball and purposive sampling using states that participate in Medicare Advantage's value-based insurance design Model. Results: Respondents indicated that barriers to early palliative care included inadequate staffing and reimbursement. Hospice clinicians providing community-based palliative care can address access barriers and improve transitions to hospice. Respondents expressed desire for payer guidance in identifying eligible patients but were cautious about payers acting as direct palliative care providers. However, payers could facilitate uptake by broadening and specifying coverage of services to include goals of care conversations and symptom management. Routine referrals initiated by objective measures could potentially increase access. Conclusions: Utilizing hospice providers to provide upstream palliative care can increase access, improve outcomes, and ease the transition to hospice.

Outpatient Rehabilitation Utilization After Major Limb Loss in Adults Receiving Care in the Military Health System From 2001 to 2017

ObjectiveTo investigate exposures associated with outpatient rehabilitation encounters among Military Health System (MHS) beneficiaries with major limb loss. DesignRetrospective, cohort study. SettingAmerican military treatment facilities and civilian health care facilities that accept TRICARE benefits. ParticipantsAdult MHS beneficiaries with major limb amputation(s) acquired between January 2001 and September 2017 (N=5161). InterventionsNot applicable. Main Outcome MeasuresThis exploratory analysis investigated associations between outpatient rehabilitation care and demographic and amputation characteristics in MHS beneficiaries with major limb loss. ResultsMost beneficiaries were aged 55-64 (36%), male (73%) and retirees/dependents (60%) with enlisted sponsor rank (88%) and single limb loss (89%). The active/reserve beneficiaries were younger, majority male, and more likely to be diagnosed with incident behavioral health conditions. Unadjusted negative binomial regression models revealed increased rates of outpatient rehabilitation encounters in active-duty service members (ADSMs) than in retirees/dependents (rate ratio, 10.02; 95% confidence interval, 9.30-10.80). The rate ratios for sex, sponsor rank, limb(s) lost, incident behavioral health condition, incident traumatic brain injury, incident posttraumatic stress disorder, and outpatient care setting were attenuated after stratification by beneficiary category. Enlisted ADSMs had increased rates of outpatient rehabilitation encounter days compared with officers, whereas retirees/dependents with enlisted sponsors had decreased than those with officer sponsors. ADSMs who accessed outpatient care in direct and private care settings demonstrated high rates of outpatient rehabilitation encounters compared with those who only sought care from private care settings (rate ratio, 4.60; 95% confidence interval, 2.95-6.81). ConclusionsThis study suggests that MHS beneficiaries with major limb loss use outpatient rehabilitation services differently, based on active/reserve duty or retiree/dependent status. This study is the first of its kind to quantify outpatient rehabilitation utilization for military beneficiaries with all-cause major limb loss and may inform MHS policymakers on the rehabilitation needs for combat- and noncombat-related amputee populations.

The relationship between radiation oncology department NIH funding and institutional community inclusion/investment.

153 Background: Disparities in healthcare access and funding allocation persist among racial minorities and low-income populations. Radiation Oncology departments play a crucial role in cancer treatment, yet the extent to which these departments serve historically underrepresented communities following receipt of National Institutes of Health (NIH) funding remains unclear. This study accessed the relationship between radiation oncology departments that are awarded National Institute of Health (NIH) funding and Lown Institute Hospitals Index rankings for community benefit and inclusivity. Methods: Radiation oncology departments awarded funding from the NIH from 2019-2021 were retrospectively studied. The 2023 Lown Institute Hospital Index rankings for community benefit and inclusivity were examined. The community benefit metric measures financial assistance spending, community investment spending, and Medicaid as a portion of patient revenue. The inclusivity metric measures the similarities of income, race, and education level between the hospital patient population and the surrounding community. Kendall’s correlation coefficient (tau value) and linear regression were used to evaluate the relationship between measures of community benefit and inclusivity and NIH radiation oncology department research funding. Results: Twenty-two radiation oncology departments that received NIH funding (median = $ 419,555.00) were included. A statistically significant positive correlation was observed between the amount of radiation oncology NIH research funding received and institutional rankings for overall community benefit (tau = 0.378; P < 0.034), with a trend towards significance for institutional rankings for community investment spending (tau = 0.497; P < 0.053). No significant correlation was observed between the amount of radiation oncology department funding and institutional rankings for charity care spending (P = 0.430), Medicaid as a portion of patient revenue (P = 0.837), and service of patients from racial and or ethnic minorities (P = 0.505), with low income (P = 0.612), or with lower levels of education (P = 0.700). Conclusions: Our study highlights the relationship between recent NIH funding received by Radiation Oncology departments and their commitment to community health and inclusivity. Our findings indicate a significantly positive correlation between NIH funding received by radiation oncology departments and overall community benefit. This suggests that departments receiving NIH funding may be incentivized to allocate resources towards initiatives to improve community health outcomes beyond direct patient care. This study prompts further exploration into the mechanisms through which NIH-funded radiation oncology departments allocate resources and engage with their surrounding communities.

International Burn Disaster Nursing: Care, Commitment, Compassion, and Cost.

Burn mass casualty incidents can overwhelm local resources, challenging effective communication, triage, and provision of care. International responders can help by providing education and direct patient care. On November 5, 2021, a fuel tanker truck exploded in Freetown, Sierra Leone, killing or injuring hundreds of people. The needs of the severely burned survivors overwhelmed local resources, requiring an international response. Burn specialist teams from several countries, including the United States, were deployed to provide assistance. Members of the US burn care team educated local health care practitioners about wound care, physical therapy, and fluid and pain management. Educational content was delivered through lecture and discussion, case studies, clinical application, and bedside teaching. Demonstration of cultural competence and humility, as well as attentiveness to nuances of local communication, helped avoid ethnocentrism and other barriers to collaboration. Public congratulations and formal completion certificates were used to provide meaningful recognition of successful class participation. Before the lecture and discussion intervention, 57 students participating in a pretest assessment had an average score of 53.9% (high, 80%; low, 27.5%). After the intervention, 38 students participating in a posttest assessment had an average score of 79.3% (high, 95%; low, 55%), and local health care providers delivered care with more attention to patient comfort and shared new knowledge with colleagues. Providing optimal burn care and education under austere conditions requires cultural humility and a spirit of inquiry. Attentiveness to communication and cultural nuances promotes collaboration, improves educational effectiveness, and builds local burn care capacity.

Who Uses Pathways Around Care Management?

Clinical pathways are developed by clinicians but used for various purposes in the US health care system. Pathways were designed to result in the best possible clinical and financial outcomes. Real-world care manage­ment involves multiple clinicians, administrators, and other organizations re­sponsible for benefits administration outside of direct clinical care. As a result, there are many different uses for clinical pathways. This pilot study provides a brief literature review on users, uses, and a recent electronic survey to de­termine how users use pathways along with their feedback around their value. Key findings from this limited sample indicate a variety of uses for pathways re­ported primarily by nurses, nursing staff, or practice administration. This prelim­inary effort aids in documenting the value and real-world use of care pathways in the diverse care provider marketplace that plans to be studied in a larger sur­vey with updated questions. This area of clinical pathways remains an important effort to better understand and provide a guide for those working in this grow­ing field of clinical-economic work in the health care system.

Comparing direct medical care costs of patients with bladder cancer who received an ileal conduit vs. neobladder in the year following cystectomy

PurposeBladder cancer is 1 of the most costly cancers, however there is limited research on medical care costs by type of urinary diversion. The objective of our study was to compare medical care costs of the 2 most common urinary diversions in the year following radical cystectomy. MethodsThe Bladder Cancer Quality of Life Study included patients diagnosed with bladder cancer who underwent radical cystectomy and received an ileal conduit (IC, n = 821) or neobladder (NB, n = 181) in 3 integrated health systems. Medical care costs per patient per quarter were estimated for the year following cystectomy. Multivariable generalized linear models with a gamma distribution and log link were used to estimate mean monthly medical care costs (2022 USD$), adjusted for patient demographic and clinical characteristics. ResultsIn multivariable analysis, mean monthly costs per quarter were not significantly different between IC and NB patients in the 12 months following cystectomy. Overall, mean monthly costs in IC and NB patients were highest during the first quarter and decreased thereafter. Factors associated with higher mean costs across all quarters included presence of any complications and advanced tumor stage at cystectomy (all P < 0.001). ConclusionOur study addresses an important knowledge gap by quantifying the medical costs of bladder cancer patients by urinary diversion type and comparing costs of different treatment approaches. Studies that assess patient-reported outcomes and out-of-pocket costs, by urinary diversion type, are warranted to inform treatment decision-making and cost conversations.

Artificial Intelligence And Its Implications In Health Care: A Textual Analysis

This all-inclusive research paper plunges into the transformative nature of artificial intelligence (AI) in healthcare, emphasizing its ability to change patient care and administrative activities. The investigation examines systematically how AI technologies are creating major improvements towards patients’ outcomes and enhanced operational efficiency within the healthcare systems. From diagnostics to personalized treatment plans and administrative tasks, AI is being integrated using sophisticated algorithms in numerous aspects of healthcare delivery. One major focus is improving diagnostic accuracy. AI-backed diagnostic tools such as image recognition software as well as predictive models have outperformed traditional methods in medical condition identification and diagnosis. For instance, artificial intelligence algorithms show exceptional skills in analysing medical images resulting to earlier detection as well as accurate diagnoses of diseases like cancer, cardiovascular conditions among others neurological disorders. These enhancements not only allow for timely intervention but they significantly reduce instances where diagnosis goes wrong hence enhancing patient prognosis while reducing health costs drastically. The ability to customize personalized therapy is yet another essential aspect of AI in healthcare. With such information as genetic data, medical records and lifestyle factors, and other patient information, AI systems can develop individualized treatment plans. It is for this reason that personalization of treatments enhances their efficiency while reducing the risk of any adverse effects as well as ensuring patients’ adherence to prescribed therapies. Besides, it is important to note that AI-driven predictive models are helpful in identifying individuals with a higher probability of developing specific conditions thereby allowing interventions aimed at preventing diseases and bettering overall population health. AI has also transformed administrative tasks within hospitals besides its clinical applications. For example, AI driven automation is now used to streamline scheduling of appointments or billing processes or even storage of patient records which are normally considered routine administrative works. In addition, through these means there is reduced burden on administrative duties for healthcare workers who continue to perform them with increased precision and timeliness. The net effect is that time and resources can be redirected towards more direct patient care thus improving service quality across the board’s entire system

Nurse Well-Being Interventions: The Nurse’s Voice

BackgroundMoral injury negatively influences nurse well-being, which may increase nurse burnout. Nurse leaders are acutely aware of moral injury impact; however, few studies represent the direct care nurse’s recommendations for interventions. MethodsA cross-sectional study was conducted surveying direct care nurses from 7 hospitals exploring nurse moral injury and preferences for nurse well-being interventions including an open-text format. ResultsNurses selected pet therapy (58%) and mindfulness reflection (44.3%) as priority interventions. Two core interventional themes emerged: well-being and work environment. ConclusionManageable workloads and healthy unit cultures are desired, alongside well-being interventions to mitigate moral injury.

Nursing Practices for Dyspnea Management in Patients with Cancer Based on Monthly and Weekly Prognoses: A Multi-Site Cross-Sectional Study of Palliative Care Nurses in Japan.

Dyspnea in patients with terminal cancer worsens near death, necessitating effective nonpharmacological management. Despite guideline recommendations, detailed studies on nonpharmacological nursing practices are scarce. This study aimed to elucidate nursing practices for dyspnea in patients with cancer based on monthly and weekly prognoses. A multi-site cross-sectional study was conducted among nurses in 389 palliative care units in Japan. The study surveyed the frequency of direct care practices for dyspnea management (nurse-led intervention, multidisciplinary intervention, psychoeducational programs, breathing techniques, walking therapy, inspiratory muscle training, respiratory rehabilitation, yoga, acupressure, fan therapy, guided imagery, abdominal massage, aromatherapy, and a reduction in room temperature and humidity) in patients with cancer with monthly and weekly prognoses. Of the 389 invited units, 162 participated. From these, 2448 registered nurses were invited and 539 (22.3%) responded. Almost similar nursing practices were provided regardless of patient prognosis. Nurse-led intervention was the most frequently practiced, followed by room temperature and humidity reduction, multidisciplinary intervention, and fan therapy. Yoga, respiratory rehabilitation, and acupressure were rarely practiced. Nursing practices for dyspnea are similar, irrespective of prognosis. Nurse-led interventions, reducing room temperature and humidity, multidisciplinary intervention, and fan therapy are frequently used for dyspnea in patients with cancer. Future studies should evaluate the effectiveness of these nursing practices.

Students’ perceptions of fairness and accuracy in clinical practice evaluation

Objectives: This study aims to investigate dental students' perceptions regarding the evaluation of clinical practice and to explore the factors influencing these perceptions.Methods: An online survey was conducted targeting third and fourth-year dental students from 11 nationwide dental schools. The survey focused on their perceptions of the accuracy and fairness of two clinical practices: 1) clinical clerkship in specialty clinics, and 2) direct patient care in pre-doctoral treatment centers. Additionally, the effects of different clerkship models (disciplinary block, longitudinal integrated), evaluation units (individual subject, integrated subject), and grading systems (grading, pass/fail) were assessed.Results: The overall perception of fairness and accuracy in clinical practice evaluation was found to be low. Students in disciplinary block clinical practice settings reported lower perceptions of evaluation accuracy and fairness compared to those in longitudinal integrated or mixed schedule types. Furthermore, the grading system influenced the perception of fairness and accuracy in the evaluation of clinical practices. Regarding direct patient care in pre-doctoral treatment centers, the evaluation units significantly impacted students' perceptions, although the grading system did not. Groups with grading systems showed lower perceptions compared to those with pass/fail or mixed evaluation systems.Conclusion: The study reveals that dental students perceive clinical practice evaluations as generally unfair and inaccurate, particularly within disciplinary block schedules. To improve future dental education, adopting longitudinal integrated schedules could be considered to enhance the perceived fairness and accuracy of clinical practice evaluations.

The hype of artificial intelligence in neonatology: How close are we to real AI?

Background. Artificial intelligence (AI) use in medicine has rapidly evolved, offering significant advancements in patient monitoring and diagnosis. However, the application of AI in neonatology presents unique challenges compared to adult medicine. While adult patients can often be monitored and treated autonomously through AI-powered tools like telemedicine, newborns, particularly preterm infants, are entirely dependent on continuous human care. In neonatology, human interaction—especially the tactile and empathetic care provided by nurses and doctors—remains critical, and AI systems are not equipped to replace this essential element of care. Concerns that AI might displace medical personnel in neonatal settings are unfounded, as human intervention remains irreplaceable. Discussion. Current AI technologies, often referred to as AI, are more accurately described as advanced machine learning algorithms and sophisticated software rather than true general artificial intelligence (AGI). These systems can efficiently perform well-defined tasks, such as monitoring vital signs and adjusting mechanical ventilators. However, they lack the broader understanding and adaptability necessary for independent clinical decision-making. They cannot interpret complex clinical contexts or address multifactorial medical decisions, which are still the domain of human expertise. Despite the limitations, AI holds significant potential in neonatology. It can assist in optimizing treatment protocols, such as adjusting mechanical ventilation in real-time or personalizing antibiotic treatments based on microbiological data. Furthermore, clinical decision support systems (CDSS) powered by AI can provide clinicians with evidence-based recommendations, thereby enhancing decision-making processes and improving patient outcomes. Conclusion. While promising, AI in neonatology remains a supplementary tool rather than a replacement for human judgment. Its role will likely expand, but direct human care and expertise will continue to be essential in neonatal medicine, mitigating concerns about job displacement among healthcare professionals.

Fostering apprenticeship in hospital medicine education: Establishing a taxonomy for direct care hospitalist teaching services.

Fostering apprenticeship in hospital medicine education: Establishing a taxonomy for direct care hospitalist teaching services.