The TriService Nursing Research Program (TSNRP) has been a cornerstone of military nursing science for over three decades. Established in 1992, TSNRP has evolved from a visionary pilot project to the Gold Standard for the Joint Force, providing the empirical foundation for clinical practice guidelines used globally. With a focus on operational readiness, high-velocity science, and advanced professional development, TSNRP aims to bridge the cognitive and clinical strain on military nurses operating in contested environments. TSNRP's strategic trajectory has shifted towards addressing the complex physiological and environmental stressors inherent to modern warfare. Research initiatives have focused on warfighter health and performance, mental health and resilience, development of military nursing, and forward-looking broad research. The program has also expanded its reach through international collaboration, with the inaugural Global Tactical Nursing Research Symposium convening nursing professionals from across the globe. TSNRP's commitment to operational readiness is reflected in its strategic alignment with the National Defense Strategy and the Department of War. The program's funding priorities have shifted towards military operational research problems, recognizing that a sophisticated defense strategy requires a highly skilled and resilient nursing corps. TSNRP has also developed innovative training programs, such as the eCornell Leadership Certificate Program, to cultivate epistemic curiosity and critical thinking among nurses. With over $200 million in research funding and a legacy of publishing numerous studies and guidelines, TSNRP remains poised to meet the challenges of Large-Scale Combat Operations (LSCO). The program's dedication to evidence-based practice, international collaboration, and professional development ensures that military nurses are equipped with the most powerful weapon in medical science: rigorous, actionable, and life-saving knowledge. As the Military Health System confronts the daunting reality of LSCO, TSNRP stands ready to meet these challenges head-on, cementing its position as the leading authority on military nursing science.
Musculoskeletal pain (MSP) is among the most common occupational health problems for nurses. The purpose of this study was to evaluate the prevalence and severity of work-related MSP in clinical nurses. This cross-sectional and descriptive study was conducted with individuals who had been working as clinical nurses for at least 6 months. The study included 312 clinical nurses who were directly involved in patient care and met the eligibility criteria. Clinical nurses were assessed with the Ergonomic Risks Questionnaire (Ergo-Nurse), and work-related MSP was assessed with the Cornell Musculoskeletal Disorder Questionnaire (CMDQ). Spearman correlation, independent samples t-test, and hierarchical regression analysis were used to determine the relevant factors. Work-related MSP is a major health problem in clinical nurses, with MSP severity ranging from low lumbar > back > neck. Hierarchical regression analysis showed that biomechanical factors were the most important ergonomic factor associated with work-related MSP in clinical nurses (R2 Change: 17.178 p < 0.05), and other ergonomic subdimensions did not contribute significantly to the model (p > 0.05). In the gender variable, being female was found to be a significant risk factor for work-related MSP (p < 0.05). Biomechanical ergonomic risks and female sex were the main factors associated with work-related MSP among clinical nurses. These findings highlight the need for targeted ergonomic interventions, safe patient-handling practices, workload regulation, and institutional strategies to reduce musculoskeletal strain in clinical nursing settings.
The Impostor Phenomenon Syndrome (IPS) is characterized by persistent self-doubt and fear of being exposed as intellectually fraudulent despite objective evidence of competence. Increasing evidence suggests that IP is common among health professions students, and demanding academic environments, together with early clinical exposure, have been associated with greater psychological distress. This study examined the severity of impostor phenomenon among undergraduate nursing and allied health students at Shahid Sadoughi University of Medical Sciences, Yazd, Iran. This cross-sectional study was conducted in 2025 among 300 undergraduate students enrolled in Nursing, Midwifery, Operating Room Technology, Anesthesia Technology, and Medical Laboratory Sciences who had completed at least one clinical internship. These disciplines represent four-year undergraduate allied health degree programs. Participants were selected using stratified random sampling according to academic discipline. Impostor phenomenon was measured using the 20-item Clance Impostor Phenomenon Scale (CIPS), which assesses three dimensions: Fear of being exposed as a fraud (8 items), Discounting achievements (9 items), and Attributing success to luck (3 items). The total CIPS score ranges from 20 to 100 and is categorized as follows: 40 ≤ Mild IPS, 41-60 Moderate IPS, 61-80 Severe IPS, 80 > Very severe IPS. Group comparisons were performed using independent-samples t tests, one-way ANOVA, or Mann-Whitney U tests, as appropriate. Associations between participant characteristics and impostor severity were explored using an ordinal logistic regression model. Statistical significance was set at p < 0.05. Based on the conventional CIPS severity categories, 48.7% of students (n = 146) were classified as having severe IP symptoms, whereas 36.3% (109) experienced moderate symptoms. Only 7.0% of participants (n = 21) were classified as having mild symptoms, while 8.0% were categorized as having very severe symptoms (n = 24). The mean total CIPS score was 62.43 ± 14.06, placing the group means at the lower threshold of the severe symptom category. Among the CIPS dimensions, the highest mean score was observed for discounting achievements (28.26 ± 6.97), followed by fear of being exposed as a fraud (25.86 ± 5.69) and attributing success to luck (8.31 ± 2.81). Overall differences in impostor scores across disciplines were modest (p-value = 0.04), and analyses identified significant differences only for the attributing success to luck dimension (p-value = 0.01). Compared with Nursing students (reference category), Midwifery students (p = 0.004) and Anesthesia Technology students (p = 0.002) had significantly higher odds of belonging to higher impostor phenomenon severity categories. Operating Room Technology students showed a borderline association with higher severity (0.05), whereas no significant differences were observed for Medical Laboratory Sciences students compared with nursing (p > 0.05). Impostor phenomenon was highly prevalent among undergraduate nursing and allied health students, with the overall mean score falling within the severe range. Compared with Nursing students, those in Midwifery and Anesthesia Technology had significantly higher odds of experiencing more severe impostor phenomenon. However, the regression model explained only a small proportion of the variability, indicating that demographic and academic characteristics alone are insufficient to explain impostor experiences. These findings provide a foundation for future multicenter longitudinal and intervention studies to identify modifiable educational factors associated with impostor phenomenon and to evaluate strategies for reducing impostor-related distress during clinical training. None.
This scoping review follows the Arksey and O'Malley five-stage framework: (1) identifying research questions, (2) identifying relevant studies, (3) selecting studies, (4) extracting, mapping, and charting data, and (5) collating, summarizing, and reporting findings. The review seeks to identify the extent and type of literature and gain insights into nurses' and nursing students' experiences with using Generative Artificial Intelligence (GenAI). A comprehensive search was conducted across five databases. The search was limited to studies published between January 2020 and July 2025. The systematic screening process identified 20 papers for inclusion in this review. Nurses' experiences with GenAI were mainly positive, while nursing students had mixed perceptions, though mostly positive. Thematic analysis revealed that various factors underpinning their attitudinal, normative, and control beliefs are critical determinants of nurses' and students' overall experiences with GenAI and their intentions to use GenAI technologies. An overarching analysis using the theory of planned behavior mapped these factors and experiences, yielding predictions of behavioral intentions and actions regarding GenAI use. Nurse leaders are vital in shaping institutional policies and ethical guidelines to encourage responsible use of GenAI.
Rural communities face persistent health disparities and ongoing healthcare workforce shortages, especially in nursing. Despite national attention on strengthening the rural nursing pipeline, little synthesis exists on how rural health is integrated into nursing curricula. This narrative review provides an overview of the current landscape of rural health content within Bachelor of Science in Nursing (BSN) programs in the United States. A comprehensive search of peer-reviewed and institutional sources was conducted using CINAHL, PubMed, ERIC, Scopus, and the Commission on Collegiate Nursing Education (CCNE) database. U.S.-based BSN programs with explicit rural health training or learning components were included. Data were extracted and synthesized using a narrative approach to identify recurring themes and institutional variations. Sixty-three nursing programs met our inclusion criteria; however, many had various courses or initiatives for a total of 93 courses/initiatives. The majority of courses/initiatives were community-focused (n = 59), followed by underserved communities (n = 37). Few BSN programs had explicit rural health content (n = 20) that incorporated rural-specific courses or structured clinical experiences addressing rural practice. Rural health remains underrepresented in BSN curricula. Findings underscore the need for systematic integration of rural concepts through coursework, simulation, and partnerships with rural healthcare facilities to strengthen the rural nursing workforce.
To perform a bibliometric analysis of the scientific literature published over the past 3 decades on the relationship between temporomandibular disorders (TMDs) and headache, examining scientific production, citation impact, and the conceptual structure and temporal evolution of research topics in this field. TMDs are the most common chronic orofacial pain condition, whereas migraine and tension-type headache are among the leading causes of pain and disability worldwide. These conditions frequently co-occur and share underlying pain-related mechanisms, contributing to increased symptom burden and challenges in clinical management. Understanding how this relationship has been investigated over time is essential for identifying gaps in the literature and supporting more integrated approaches to diagnosis and management. A bibliometric analysis was conducted using the Web of Science Core Collection, including original articles and reviews published between 1995 and 2025. Performance analysis, citation metrics, and keyword-based approaches were applied to evaluate scientific production, collaboration patterns, and the conceptual and temporal evolution of research topics. A total of 177 publications from 86 sources were analyzed, involving 641 authors and 5738 references, with a mean of 5.19 coauthors per document. Annual scientific production increased over time, with an annual growth rate of 10%. Research output was concentrated in a limited set of countries, led by the United States (n = 179 coauthorship occurrences) and Brazil (n = 106), followed by Finland, Italy, Poland, and Denmark. The most globally cited study was Ohrbach et al. (2011; 289 citations), with other highly cited works focusing on epidemiology, symptom characterization, and comorbidity patterns (e.g., LeResche et al. 2005; Ballegaard et al. 2008; Gonçalves et al. 2010, 2011). Keyword frequency and co-occurrence analyses showed a structured organization centered on clinical and epidemiological domains, with migraine and diagnostic criteria acting as bridging elements across clusters. Trend analyses indicated a shift from broader descriptors (e.g., gender, general population) toward standardized diagnostic frameworks and methodological refinement (e.g., diagnostic criteria, management), and, more recently, the incorporation of chronic pain, psychosocial factors, and mechanisms (e.g., chronic pain, depression, mechanisms). Research on the relationship between TMD and headache has evolved into a structured and expanding field, with increasing thematic diversification. Recent developments indicate a shift toward more complex and multidimensional research frameworks, reflecting broader approaches to understanding these conditions. Temporomandibular disorders often occur together with migraine and tension‐type headache, making diagnosis and treatment more complex. In this study, we analyzed 30 years of published research to understand how this relationship has been investigated. We found that there has been a shift from general descriptions to more structured approaches that consider individual factors and other chronic pain conditions that may provide clearer input into the relationship among these disorders.
The U.S. Army perioperative nurse (66E) plays a pivotal role in delivering surgical care that directly influences battlefield survivability, operational readiness, and overall force health. Rooted in a legacy dating back to the American Revolutionary War, Army perioperative nurses embody a unique blend of clinical precision, operational agility, and leadership excellence. These nurses serve as circulating or scrub personnel in operating rooms, managing sterile technique, surgical equipment, implants, and intraoperative imaging, while coordinating preoperative and postoperative care in both domestic and deployed settings. Their responsibilities extend beyond the surgical suite, encompassing trauma response, setting up field hospitals, managing mass casualties, and providing surgical logistics in austere environments. Specialization in perioperative nursing offers distinct career advancement opportunities and aligns with the Military Health System's goals of maintaining a medically ready force. Through training, mentorship, research dissemination, and advanced academic programs such as the Doctor of Nursing Practice Adult-Gerontology Clinical Nurse Specialist with a perioperative focus at USUHS, 66Es contribute to surgical innovation and quality improvement across the continuum of care. In 2024, 66Es demonstrated significant impact through leadership roles, global deployments, scholarly achievements, and clinical education initiatives. Looking forward, strategic efforts to reintegrate 66Es into forward surgical units and expand CNS authorizations will further strengthen the specialty's influence. Army perioperative nurses remain essential to military surgical capability, shaping the future of combat care and enhancing patient outcomes across operational and humanitarian missions.
Nursing ethics guides practice, but European Union national codes were developed in diverse socio-legal contexts, generating heterogeneous emphases. To compare European Union nursing codes of ethics, mapping convergences, divergences, and emerging ethical dimensions. Qualitative documentary analysis with thematic content analysis examined 22 European Union member-state codes plus the European Nursing Council and International Council of Nurses (ICN) codes, with input from nursing, qualitative, and health-law experts. Fourteen themes were identified: Dignity, Respect and Non-Discrimination; Autonomy and Informed Consent; Professional Secrecy and Data Protection; Safety and Evidence-Based Practice (EBP); Interprofessional Collaboration and Shared Responsibility; Protection of Vulnerable Groups and Violence Prevention; Palliative Care and Dignity at the End of Life; Conscientious Objection and Continuity of Care; Technologies and Artificial Intelligence; Environmental Sustainability and Public Health; Social Justice and Advocacy; Organizational Well-being; Governance, Integrity, and Professional Discipline; Training and Professional Development. Fundamental principles showed strong convergence, while newer areas (AI, One Health, organizational well-being) appeared unevenly. The findings suggest the existence of a shared ethical core across European nursing while highlighting differences in the formalization of emerging ethical challenges. These variations may reflect contextual priorities, regulatory traditions, and different stages of ethical adaptation across national frameworks. This study provides an updated overview of the European nursing ethics landscape and may inform future discussions on the evolution of ethical guidance in response to contemporary healthcare challenges while respecting national contexts.
Clerkship students encounter ethically significant dilemmas but have limited opportunities to rehearse ethically grounded decision-making and difficult conversations in realistic clinical contexts. We evaluated an immersive, sequential simulation-based clinical ethics education program. We conducted an explanatory sequential mixed-methods pre-post study with clerkship students at Kaohsiung Medical University from September 1, 2022, to May 31, 2023. Participants completed a core e-learning curriculum (digital modules/videos) before a two-day immersive simulation. The simulation comprised six longitudinal standardized patient cases, each with four sequential scenarios. Quantitative outcomes included ethical knowledge, ethical sensitivity, vignette-based ethical decision-making, and confidence in managing clinical ethical dilemmas; satisfaction was measured post-intervention. Pre-post comparisons were made using Wilcoxon signed-rank tests. Focus groups were audio-recorded, transcribed verbatim, and analyzed using reflexive thematic analysis. Findings were integrated using a joint display. Thirty-eight clerkship students participated. Post-intervention ethical knowledge showed gains across all seven assessed domains. Ethical sensitivity increased across three issues, and ethical decision-making improved across all six vignettes. Confidence increased in nine of 11 items, including dilemma awareness, clarifying ethical problems, ethical reasoning, communication to reach consensus, and confidence in ethical decision-making. Satisfaction with simulation education was high. Qualitative integration identified three themes explaining these gains: confidence through enactment, structured ethical decision-making, and voice and consensus under pressure. The program was associated with short-term gains in ethics knowledge, ethical sensitivity, vignette-based decision-making, and confidence. Qualitative findings suggested that enactment, feedback, and reflection made ethics learning more practical and increased learners' perceived readiness for challenging clinical encounters. Sequential simulation may help clerkship students connect principle-based ethics teaching with real-time reasoning and communication demands. Controlled longitudinal studies are needed to examine durability, transfer, and workplace-based performance. ClinicalTrials.gov identifier: NCT05547893.
To explore how neonatal nurses in Level III (high-acuity) neonatal intensive care units recognise, interpret, and escalate early signs of clinical deterioration. A qualitative interpretive description study underpinned by critical realism. Twenty-two registered nurses were purposively recruited from four Level III units in the Jouf Region of northern Saudi Arabia using criterion-based maximum-variation sampling. Semi-structured interviews were conducted in Arabic or English and analysed in their original language. Situation awareness and invisible work scholarship served as sensitising lenses. Rigour was supported through member reflection, negative-case analysis, peer debriefing and an audit trail. Four interrelated themes were identified: (1) 'the infant tells you before the monitor does', reflecting recognition of subtle deviation from the infant's baseline; (2) 'building the case', in which nurses tested and assembled evidence to make concern clinically credible before escalation; (3) 'the escalation calculus', describing how anticipated physician responses, hierarchy and previous dismissal shaped escalation and (4) 'the unit works against you', showing how alarm burden, documentation demands and staffing variability constrained vigilance. Recognition and escalation formed a cyclical, organisationally situated process rather than a single response to abnormal observations. Escalation involved interpretive, relational and legitimising work before early concern became actionable. Participants' accounts suggest that timely response depends on clinical expertise and environments that protect bedside attention and legitimise early escalation. Neonatal services should protect surveillance capacity through staffing and workload design, alarm reduction, simulation of ambiguous deterioration and constructive escalation feedback. The study identifies case-building as a distinct stage between noticing deterioration and escalating concern and indicates how organisational conditions may constrain early nursing surveillance. Consolidated Criteria for Reporting Qualitative Research. Patients and the public were not involved.
PurposeTo explore how undergraduate nursing students from different academic years experience and describe their spiritual development, and to explain how this process contributes to holistic professional formation.DesignA qualitative grounded theory study informed by Corbin and Strauss was conducted.MethodsTwenty-one undergraduate nursing students from different academic years participated in semi-structured interviews, and 11 of them also completed reflective online diaries. Data collection and analysis were conducted concurrently using constant comparative analysis. Ethical approval was obtained.FindingsSpiritual development emerged as a meaning-oriented process situated within holistic professional formation, characterized by a movement from externally guided reassurance toward internally grounded meaning-making. Emotionally demanding clinical experiences disrupted students' assumptions and generated uncertainty. When supported through reflection and relational engagement, these experiences contributed to self-awareness, internal grounding, and students' capacity for presence, compassion, and engagement in care.ConclusionsFindings challenge the assumption that clinical exposure alone supports students' spiritual development. The MAMA-BEAR model offers a substantive grounded theory explaining how academic and clinical environments may support spiritual development as part of holistic professional formation, with implications for curricula, educator preparation, and whole-person care.
BackgroundBrazil has recognized the need to investigate the health context of Indigenous Peoples by (a) collecting data on service coverage, barriers, needs, and gaps in access to health care; (b) developing, funding, and implementing plans and strategies for multilingual service delivery (c) reducing gender, social, and cultural inequalities as well as geographical barriers that hinder equitable access to quality health services; and, (d) incorporating an intercultural-intersectoral approach in the development of policies and inclusive-participatory research.PurposePropose an original conceptual framework for action research on the socio-cultural aspects of pregnancy, childbirth, and the postpartum cycle among Brazilian Indigenous women.ResultsAn online consultation with healthcare professionals was conducted (April-June 2024) using audio recorded narratives to gather information about the health of pregnant and postpartum Indigenous women. The Canadian model of population health promotion guided information analysis. Fourteen healthcare professionals with experience working in four Brazilian states and with 11 ethnic groups were consulted. A total of 23 modifiable situations were identified, and an original conceptual framework was developed that encompasses the following health promotion areas as modifiable situations: structure of the healthcare network; administrative barriers in healthcare management; operationalization of care delivery; and clinical and social contexts.ConclusionThis article conceptualizes areas for innovative and socially responsive solutions to amend vulnerabilities in Brazilian Indigenous maternal health. The conceptual framework proposed offers a useful operational foundation for designing future interventions in Indigenous maternal health and for strengthening action research as a transformative methodological strategy in contexts marked by persistent historical and social inequalities.
Turnover intention predicts actual turnover and is vital in nursing. Despite many tools to assess turnover intention, few are culturally adapted or validated for Thai nurses. This study aimed to translate, culturally adapt, and evaluate the psychometric properties of the Thai version of the Turnover Intention Scale (T-TIS). A two-phase methodological study was conducted. Phase 1 involved translating and cross-culturally adapting the original scale in accordance with established international guidelines. Phase 2 evaluated the psychometric properties of the translated instrument among 1005 registered nurses at two tertiary government hospitals in Thailand. Content validity, known-group validity, confirmatory factor analysis (CFA), internal consistency, and Rasch analysis were assessed. The T-TIS demonstrated excellent content validity (I-CVI = 1.00; S-CVI = 1.00). Known-group validity was supported by significant differences in T-TIS scores across groups defined by burnout, emotional labour, work-family conflict, nursing practice environment, work engagement, and effort-reward imbalance (all p < 0.001; η2 = 0.05-0.30; Cohen's d = 0.93). CFA reasonably supported the hypothesized unidimensional structure, with acceptable model fit (CFI = 0.96, TLI = 0.92, SRMR = 0.04), although the RMSEA indicated marginal fit (0.09). Internal consistency was satisfactory (Cronbach's α = 0.77; McDonald's ω = 0.78). Rasch analysis further supported the scale's measurement properties, demonstrating acceptable item fit (infit/outfit MNSQ = 0.77-1.27), acceptable person separation index (0.77), and strong item separation (17.00). The T-TIS is a reliable, valid instrument for assessing turnover intention among Thai nurses, providing a practical tool for workforce monitoring, retention research, and policy in Thailand.
Critically ill children in pediatric intensive care units (PICUs) are highly vulnerable during fires. Metaverse-based education platforms such as Roblox offer immersive, accessible training in clinical disaster preparedness for nursing students. To develop a PICU disaster evacuation simulation program using Roblox and evaluate its effectiveness vs. lecture-only education in improving nursing students' disaster evacuation competency, learning presence, learning flow, and learning satisfaction. A nonrandomized, quasi-experimental, pretest-posttest design was used to develop, implement, and verify a metaverse-based disaster evacuation enhancement program at nursing schools in South Korea. Nursing schools in South Korea; the program was delivered in an online, metaverse-based learning environment. Forty-seven fourth-year nursing students who had completed pediatric nursing theory and practice were assigned to two groups: the experimental and control groups. We developed the metaverse-based FLAME-SIM (Fire Learning and Metaverse-Based Evacuation Simulation) program to enhance disaster evacuation competency by creating a pediatric field using the metaverse platforms Gather Town and Roblox. The program included an online lecture, a Gather Town-based pre-briefing, a Roblox-based simulation on managing fire disasters, and a debriefing. Disaster evacuation competency, learning presence, learning flow, and learning satisfaction were measured before and after the program. The experimental group showed higher disaster evacuation competency than the control group (t = 2.141, p = .038). Learning presence increased in the experimental group, including cognitive presence (z = -2.008, p = .045) and emotional presence (z = -2.174, p = .030). No statistically significant differences were observed in learning flow (z = -1.873, p = .061) or learning satisfaction (z = -1.484, p = .138). The FLAME-SIM program improved disaster evacuation competency and learning presence. This program could help students to prepare disaster evacuation competency by navigating the nature and complexities of pediatric nursing practice.
This study aims to evaluate and synthesize the best available evidence for improving the self-awareness of falls in elderly postoperative patients with osteoporotic vertebral compression fracture (OVCF), so as to provide a reference for clinical practice. This evidence summary was conducted in accordance with the reporting standards established by the Fudan University Center for Evidence-Based Nursing. Guided by the "6S" evidence pyramid model, we systematically searched relevant domestic and international databases and official websites to retrieve literature concerning the improvement of the self-awareness of falls in elderly postoperative patients with OVCF, covering the time frame from database inception to December 2025. Two researchers independently assessed the quality of all included literature, and subsequently performed evidence extraction, synthesis, and grading in strict compliance with established evidence-based criteria. A total of 15 studies were included, consisting of 1 clinical decision, 5 guidelines, 5 expert consensuses, 3 systematic reviews, and 1 evidence summary. From these, 28 best-evidence recommendations were identified and categorized into six domains: establishing a multidisciplinary team, fall-related assessment and screening, health education and guidance, osteoporosis self-management, rehabilitation therapy, and follow-up and evaluation. This study summarizes the best available evidence on improving the self-awareness of falls in elderly postoperative patients with OVCF, thereby providing guidance for clinical practice. However, high-quality direct evidence in this research field remains limited, and further rigorous studies are required to continuously update and enrich the evidence base. In clinical application, individualized intervention plans should be formulated based on personalized fall risk profiles and patient preferences, to effectively reduce fall incidence and prevent postoperative refractures.
Mechanically ventilated intensive care unit patients receive sedatives based on clinician observations of arousal and motor activity with potential for negative consequences and poor mitigation of symptoms. To test the preliminary efficacy of patient self-managed sedative therapy compared to usual care of nurse-administered sedation on self-reported anxiety, duration of mechanical ventilation, and delirium incidence (CAM-ICU). A two-group, open-label, randomized, multicenter clinical trial in 5 Midwestern hospitals enrolled 161 patients receiving invasive mechanical ventilation who were willing and able to use a push-button device to self-administer sedation for up to 7 days. Patients were randomized 1:1 using center-stratified blocks to usual care (n = 81) or intervention (n = 80) with self-administered dexmedetomidine. Intervention patients were allowed 3 self-administered dexmedetomidine boluses per hour (0.25 mcg/kg) with 20-minute lock-outs. The initial basal infusion (0.2 mcg/kg/hr) was adjusted by nurses between 0.1-0.7 mcg/kg/hr based on patient-delivered boluses in the prior 2 hours. Analysis consisted of linear mixed-effects model for comparisons of anxiety ratings over time and duration of mechanical ventilation. Incidence of delirium was analyzed using generalized estimating equations. Sample characteristics had a female (54.7%) and Caucasian preponderance (92.5%) with a median age of 62 years on protocol for a median of 88 hours. Nine intervention patients were extubated prior to protocol initiation. Patient self-reported three times daily anxiety ratings with a visual analog scale (VAS) ranged from 0-100 over time but were not significantly different between groups in either an intention-to-treat (ITT) or per protocol (PP) analysis (p = 0.94, p = 0.30 respectively). While intervention patients had shorter duration of MV [(mean 50.8(52.8) vs. usual care 68.7(58.2) hours), p = 0.02 ITT], PP analysis resulted in no difference between groups (mean 56.4 (53.0) vs. 68.7(58.2), p = 0.23). 10.2% of intervention patients developed new incidence of delirium vs. 8.5% of usual care which was not significantly different between groups by either ITT (p = 0.65) or PP analyses (p = 0.58). Intervention patients had similar outcomes compared to usual care patients. Self-administration of sedative therapy is a safe, novel patient-centered intervention warranting further rigorous investigation for anxiety self-management.
Nursing home residents (NHRs) remain among the most vulnerable to severe outcomes from SARS-CoV-2 infection. While mRNA-1273 (Spikevax, Moderna) and BNT162b2 (Comirnaty, Pfizer-BioNTech) vaccines are widely used in this population, comparative data on their immunogenicity, particularly after bivalent boosters, remain limited. We conducted a longitudinal immunologic evaluation of U.S. NHRs who received either the mRNA-1273 or BNT162b2 bivalent vaccine. Serum samples were collected 10-30 d post-vaccination. Anti-spike IgG levels were measured using a Luminex bead-based assay, and neutralizing titers were assessed via pseudovirus neutralization. Comparative analyses of the titer distributions were performed using two-sided Wilcoxon rank-sum tests. Both vaccine groups demonstrated strong humoral responses to the ancestral Wuhan strain and Omicron BA.4/5 subvariants. Spike-binding antibody levels and neutralization titers were comparable between the mRNA -1273 and BNT162b2 vaccine formulations. Conclusions: Both mRNA-1273 and BNT162b2 mRNA vaccines elicit similarly robust humoral immunity in NHRs, supporting their interchangeable use in booster strategies. Our findings underscore the importance of timely booster administration over exact product selection in protecting this high-risk, immunosenescent population.
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The Individualized Positive Psychosocial Interaction (IPPI) program is a person-centered intervention that has demonstrated positive effects on mood and behavioral expressions of distress for nursing home (NH) residents. This study sought to identify demographic and clinical factors associated with positive response to IPPI. An embedded pragmatic clinical trial of IPPI was completed, whereby NH staff were trained in emotion-focused communication skills and how to conduct short and individualized, preference-based interactions (ie, IPPIs) 2 times per week for 6 months with persons living with dementia with current documentation of behavioral or depressive symptoms. Within 7 NHs owned or managed by 1 long-term care organization, 130 residents were enrolled in the IPPI program. We created a rate of positive response variable that computed the percentage of completed IPPIs that resulted in maintenance of a positive mood or improved mood for a resident. We examined the association (correlations and regression) of demographic and clinical attributes with positive response; we accounted for the number of IPPIs completed. On average, 82% of IPPIs (SD, 21%) per person resulted in a positive response (ie, stable positive or improved mood). Positive response was associated with greater ability to make onseself understood and an ability to understand others, less incontinence (urinary and bowel), and greater functional ability. After accounting for the count of IPPIs a person completed, regression models indicate unique associations of making oneself understood and functional ability (self-care) with IPPI-positive response. Findings suggest that individuals who are more clinically complex (ie, communication challenges, incontinence, and functional disability) may be less likely to consistently respond positively to IPPIs. Individuals with clinical risk factors might need additional support to maximize positive impact.