The purpose of this study was to examine the association between hospital nurse staffing levels and 30- and 60-day readmissions among patients with intellectual and/or developmental disabilities (IDD). This cross-sectional correlational study utilized secondary data from 595 acute care, nonfederal hospitals in California, Florida, New Jersey, and Pennsylvania in 2016. Data were obtained from three sources: the American Hospital Association Annual Survey, the RN4CAST-US nurse survey, and state patient hospital discharge summaries. The analytic sample included 39,558 hospital stays for 28,446 adults with IDD aged 18 and older who were discharged alive. In adjusted models, every additional patient added to a nurse's workload was associated with 7% higher odds of 30-day readmission OR = 1.07 (95% CI [1.03, 1.12], p = 0.001) and 9% higher odds of 60-day readmission OR = 1.09 (95% CI [1.04, 1.13], p < 0.001) among patients with IDD. The average nurse staffing level across hospitals was 4.7 patients per nurse (SD = 0.99). Staffing levels varied by hospital characteristics, with large hospitals, major teaching hospitals, and hospitals in California having better staffing ratios. The study population had a 30-day readmission rate of 17.1%, which is 27% higher than the average adult hospital 30-day readmission rate in the US in 2018. This study demonstrates the association of nurse staffing levels with readmission odds for patients with IDD. Improving nurse staffing levels is a system-based solution that can potentially improve outcomes for patients with IDD, who often require intensive nursing care.

In South Korea, hypertension (HTN) is prevalent among deaf individuals, with a reported rate of 63.9%, which is higher than in the general population. To manage this condition effectively, a self-management education intervention is needed. In particular, since deaf individuals generally exhibit low levels of health literacy, it is essential to develop interventions that consider their limited health literacy. This study evaluates the impact of the Hypertension Self-Management Education for the Hearing Impaired Using Sign Language (H-SMILE) program. Using a quasi-experimental, nonequivalent control group design, 16 deaf participants received the 6-week H-SMILE program, whereas 17 participants attended a single traditional lecture session. Outcomes measured included depression, quality of life, HTN knowledge, health literacy, self-care, medication adherence, and clinical indicators, assessed at baseline, post-intervention, and 2 months post-intervention. Immediately post-intervention, the H-SMILE group showed improvements in self-care management, self-care confidence, and functional health literacy, alongside an increase in depression compared to controls. These effects did not persist at the 2-month follow-up. The H-SMILE program shows initial effectiveness but requires strategies for long-term sustainability of outcomes.

Cultural differences, along with various social and political determinants, affect the social isolation experienced by older adults. This study aimed to investigate the factor structure of the Traditional Chinese version of the Friendship Scale (FS-TC) and to assess its psychometric properties in relation to social isolation among Taiwanese older adults. In Phase 1, the scale underwent cultural adaptation and translation before being evaluated for face and content validity by ten older adults and five experts in nursing and geriatric care. Phase 2 involved a cross-sectional study with a convenience sample of 500 older adults from southern Taiwan to establish construct validity, criterion validity, and reliability. Of these participants, 100 were retested 2 weeks later to assess test-retest reliability. The scale-level content validity index was 1.0. A confirmatory factor analysis showed a two-factor structure of the FS-TC, consisting of "connection" and "isolation" factors. The Cronbach's α for the scale was 0.82, while the intraclass correlation coefficient reached 0.96. Convergent validity was demonstrated through significant correlations with the Geriatric Depression Scale, the Social Support Scales, and the Loneliness Scale. The FS-TC showed a sensitivity of 56% and a specificity of 89% for predicting Lubben Social Network Scale-6 measured social isolation. An optimal cut-off score of 14.5 was identified for predicting social isolation in older adults. Overall, the FS-TC was shown to be a reliable and valid measure of social isolation, making it a valuable tool for healthcare providers and researchers assessing the severity of social isolation among Taiwanese older adults.

Online survey research has become an increasingly popular and effective method in the social sciences for exploring and addressing health-related issues. However, the increasing prevalence of fraudulent activities, particularly survey bots, threatens data integrity and can compromise health research by generating misleading data. The purpose of this paper was to describe the implementation of bot detection strategies in an online survey with Latine sexual minority men (SMM). Eleven bot detection indicators, including AI-detection software for open-ended responses, were used in two approaches to differentiate bot-generated from human responses. In the first approach, bot detection indicators were applied stepwise to identify valid entries. In the second approach, a fraud detection algorithm was used to identify three fraud categories. Key demographics and study variables were compared across fraud categories using chi-square/Fisher's Exact tests for categorical data and Kruskal-Wallis tests for continuous data (significance set at 0.05). Of the 1147 total survey entries, 837 (73%) completed at least 20% of the survey (814 completed all items). A total of 739 (88%) of the 837 completed surveys were classified as fraudulent. Among the 837 completed surveys, 333 (40%) had an AI-generated open-ended response and fast completion time (≤ 20 min) and 234 (28%) entries were flagged for all three of these indicators. Sociodemographic characteristics and HIV prevention outcomes were largely similar across bot-generated and human responses. Findings suggest that survey bots are a pervasive threat to online research and are effective at providing human-like responses. To protect data integrity and ensure the development of effective health policies and interventions, health science researchers should adopt comprehensive bot detection and prevention strategies.

Missed infection control practices may impact quality healthcare and patient safety. Hence, research is urgently needed to examine infection control practices left undone by nursing personnel, especially in Arab countries. This study aimed to identify missed infection control nursing practices and the underlying reasons among nurses working in medical and surgical wards in Jordan. A cross-sectional design was utilized. The study involved a convenient sample of 514 nurses from seven hospitals (six public and one tertiary hospital) in the North of Jordan during the period of October 2022 and August 2023. The Missed Nursing Care Infection Prevention and Control (MNCIPC) Survey was employed to collect the data. Data were analyzed using descriptive inferential and multivariate regression analysis. The results of this study revealed that nurses working at the medical ward reported more missed care infection activities compared to nurses working at the surgical ward. Nurses working overtime, with less clinical experience, and without formal training or qualifications reported more missed infection control. The most perceived reasons for the missed infection control activities related to labor resources, including inadequate staffing, urgent patient situations, or unexpected rise in patient volume and/or acuity. There is a need to recognize missed infection control activities and the reasons for their occurrence. The interventions to reduce missed infection control measures should aim at increasing staffing levels to manage increased and unexpected surges in nursing workload.

The aim of the study was to evaluate the effect of Transition Model-Based Discharge Training for Mothers of Preterm Infants (TRAMPRE) on (1) Kenner's three components of the transition to home; (2) post-partum depression; (3) unplanned hospital/family health center visits; and (4) post-discharge complications. Our study was conducted with 133 mothers who received services in the NICU of a hospital providing tertiary health care in Türkiye. The content of the intervention protocol consists of "Discharge Training for Mothers on Infant Care," the "Preterm Infant Care Guide," and "Telephone Follow-up and Counseling." Data were analyzed using descriptive statistics, t-tests, repeated measure ANOVA and chi-square tests. The time 2 scores for the Transition Questionnaire (TQ) were 101.88 ± 11.04 and 67.03 ± 7.71 for the intervention and control groups, respectively (p < 0.05). The time 2 scores for the intervention group on postnatal depression levels (4.55 ± 4.51) were significantly lower than those of the control group (10.94 ± 4.69) (p < 0.05). Comparing the intervention and control groups revealed a significant difference between the rates of thrush (i: 1.5%, c: 12.1%), diaper rash (i: 4.5%, c: 30.3%), hospitalization after discharge (i: 3%, c: 13.6%), attending routine controls (i: 100%, c: 90.9%), and exclusive breastfeeding (i: 43.3%, c: 19.7%). It was concluded that transition model-based discharge training offered to mothers of LPT infants was effective in improving the mothers' transition to home care and reducing the incidence of post-partum depression. Trial Registration: Clinical Trials number: NCT05525624.

Poor sleep quality and psychological stress are interrelated and disproportionately affect adults with multiple cardiovascular disease (CVD) risk factors. Maintaining an optimal home environment and engaging in healthy bedtime behaviors are important components of sleep hygiene practices that influence sleep health. This study sought to examine: (1) the association between sleep hygiene and psychological stress, and (2) the moderating effect of sleep quality in the relationship between sleep hygiene and psychological stress, among adults with multiple CVD risk factors. A cross-sectional study was conducted with 300 adults diagnosed with hypertension and diabetes. Individuals were recruited from a large academic health center and were asked to complete an online survey. Sleep hygiene was assessed by nine individual factors focusing on negative household environment (safety, physical comfort, temperature, noise, and light) and poor bedtime behaviors (watching TV, playing video games, using small screens, and eating), and by a composite score. Multivariable linear regression was employed to examine the associations. Of the sample, 78% reported poor sleep quality and 44% reported high psychological stress. The composite sleep hygiene score was significantly associated with higher psychological stress after controlling for sleep quality, and the relationship was not modified by sleep quality. Unsafe household, uncomfortable physical environment, uncomfortable temperature, and eating at bedtime were independently related to increased stress levels. The study highlights strong links between sleep hygiene and psychological stress. Current evidence suggests that promoting home environment and bedtime behaviors may alleviate psychological burdens in adults with multiple CVD risk factors.

Youth in psychiatric residential treatment (RT) are a highly vulnerable population in which parent involvement is critical to optimizing long-term outcomes. However, existing parent programs rarely address the unique challenges faced by families navigating RT. This study aimed to identify parent support needs and develop an adapted parenting program, Parenting Wisely for RT (PW). Using qualitative interviews with parents and input from an RT staff advisory board, we explored the informational, instructional, and emotional support needs of families with youth in RT. Findings guided the development of PW, a 6-week program that combines web-based modules (i.e., existing parent training program) with facilitated parent groups (i.e., adapted component). Parents expressed needs for education, skill generalization to complex RT-related situations, and reduction of social isolation. The advisory board co-developed the parent groups to include strengths-based, real-time skill practice, peer connection, and tailored psychoeducation that fosters shared learning and addresses challenges unique to the RT context. Facilitators provide coaching and help parents apply skills in diverse family situations, enhancing engagement and relevance. PW represents a promising adaptation of parent training for families with youth in RT, designed to enhance parent knowledge, skills, and connectedness. Future research should evaluate its feasibility, effectiveness, and implementation to support families during and after RT.

Black, Hispanic, and multiracial women in the U.S. experience higher rates of discrimination and mistreatment in perinatal care compared to White women, which can lead to fear, anxiety, and reduced engagement with obstetric healthcare providers. Black women are also more likely to experience high-risk pregnancies and health complications such as gestational diabetes and hypertensive disorders. As a result, Black women face a heightened risk of birth trauma and subsequent posttraumatic stress disorder (PTSD) in the postpartum period. Despite these inequities, little is known about Black birthing individuals' experiences of healthcare interactions. This study explores Black women's accounts of negative experiences of perinatal care in the context of high-risk pregnancy. Fourteen individuals from across the U.S. participated in semi-structured interviews conducted within 6 months postpartum between September 2022 and December 2024. Interview responses were analyzed using directed content analysis, with coding of their emotional distress guided by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) definition of PTSD. Their accounts aligned with the four DSM-5-TR symptom clusters: intrusive symptoms, avoidance, negative alterations in cognition or mood, and alterations in arousal and reactivity. PTSD-like symptoms resulted from pregnancy complications, traumatic birth experiences, mistreatment by clinicians or a combination of these factors. The findings suggest that birth trauma and mistreatment in perinatal care have significant emotional and behavioral impacts on Black women. The study results underscore the urgent need for trauma-informed, antiracist approaches in perinatal care to address these disparities and improve outcomes for Black birthing individuals.

Increasing reliance on Internationally Educated Nurses (IENs) in the U.S. healthcare system, particularly in Long-Term Care (LTC) settings, necessitates an in-depth exploration of their transition experiences. The primary purpose of this qualitative study was to understand how IENs describe their experiences transitioning to work with older adults in LTC settings in the United States and the policies and practices that contribute to the successful integration of IENs. A qualitative descriptive design was used, including one-time individual interviews with 22 IENs working in various LTC settings across the United States via Zoom using a semi-structured interview guide. Demographic data were analyzed using descriptive statistics, while NVivo 14 software was utilized to organize the data; verified verbatim transcripts were subjected to thematic analysis. Three key themes were identified: Systemic and Practice-Based Barriers to IEN Integration, Structural and Social Enablers of IEN Integration, and Role of Structured Support Systems in the IENs' Transition. This study highlighted the critical challenges and facilitators that influence IENs during their integration into LTC settings in the United States. Participants reported concerns, specifically noting experiences of racial discrimination and xenophobia perpetrated by co-workers, patients, and patients' families. These experiences highlight the complex interpersonal dynamics faced by IENs, underscoring the need for proactive strategies to mitigate discriminatory practices and provide culturally sensitive orientation and mentorship programs to support the smooth integration of IENs into LTC settings. Addressing these challenges can have profound implications for strengthening inclusivity and enhancing the overall resilience of the U.S. nursing workforce, particularly within LTC environments.

To estimate the pooled prevalence of feeding difficulties among persons with dementia and to explore heterogeneity, including regional differences and study characteristics. Feeding difficulties, including impaired ability to feed oneself, swallowing problems, reduced appetite, and behavioral resistance to eating, are common among individuals with dementia, leading to malnutrition, and caregiver burden. Evidence on the prevalence of feeding difficulties is fragmented, with no prior meta-analysis available. Six databases were searched until April 2025 for observational studies. This systematic review and meta-analysis followed MOOSE and PRISMA guidelines with PROSPERO registration (CRD420251024333). Studies were included if they reported feeding difficulty prevalence in dementia using validated instruments or clinical observation. Two reviewers independently screened studies, extracted data, and assessed quality using the Newcastle-Ottawa Scale. Pooled prevalence and 95% prediction intervals were calculated using a random-effects model with Freeman-Tukey double arcsine transformation. Subgroup analyses and meta-regression explored heterogeneity. Fifteen studies involving 3175 participants were included. The pooled prevalence of feeding difficulties among persons with dementia was 48% (95% PI: 38%-59%), with significant heterogeneity (I² = 97%). Prevalence was notably higher in studies conducted in Asia (59%) compared to non-Asian regions (32%). Neither publication year nor mean participant age significantly moderated prevalence estimates. Nearly half of individuals with dementia experience feeding difficulties, with particularly high prevalence in Asia. This regional disparity stresses the importance of routine assessment. High heterogeneity and inconsistent disease staging reporting call for standardized assessments and further research across dementia stages to improve care globally.

Pain and pain-related functional limitations are common in fibromyalgia patients. In this regard, attempts to cope with pain and related symptoms are important. This study was conducted to investigate the effect of progressive muscle relaxation exercises on pain, kinesiophobia and functional status in fibromyalgia patients. This randomized controlled study has been conducted with 85 individuals diagnosed with fibromyalgia between November 2022 and June 2023. The study consisted of experimental and control groups. Progressive relaxation exercise was applied to the experimental group 2 days a week for 8 weeks. Data have been collected with Descriptive Information Form, Visual Analogue Scale, Tampa Scale of Kinesiophobia, and Revised Fibromyalgia Impact Questionnaire. In this study, it has been determined that Visual Analogue Scale, Tampa Scale of Kinesiophobia and Fibromyalgia Impact Questionnaire total mean scores of the progressive muscle relaxation exercise group have decreased significantly compared to the control group (p < 0.01). This study has shown that progressive muscle relaxation exercises improve pain, kinesiophobia and functional status in fibromyalgia patients. It is recommended to be applied by individuals with chronic pain and in clinics. Trial Registration: This study is registered in the Clinical Trial Registry (registration number NCT05695274).

Timely and adequate prenatal care (PNC) is essential for optimizing maternal and infant health outcomes. However, persistent disparities in PNC utilization exist in the United States, particularly among ethnic/racial minority populations. While discrimination has been recognized as a barrier, its multifaceted influence across social and structural contexts remains underexplored. This systematic review, guided by the Social-Ecological Model, synthesizes evidence on how various forms of discrimination affect PNC utilization. We conducted comprehensive searches in PubMed, Web of Science, and CINAHL for peer-reviewed studies published in the United States between 2010 and 2024. After screening 342 records, 11 studies met the inclusion criteria. Five studies employed qualitative methods, five used quantitative methods, and one utilized a mixed-methods approach. Findings revealed that structural discrimination, such as language barriers and institutional policies, was associated with delayed or insufficient PNC utilization. Interpersonal dynamics, including negative patient-provider interactions and implicit bias, discouraged engagement with care. Additionally, intrapersonal factors, like internalized discrimination, shaped perceptions of care quality and trust in healthcare systems. The review highlights how discrimination operates across multiple levels to influence PNC behaviors and outcomes. Addressing discrimination requires culturally responsive care models, provider training in cultural humility, and institutional reforms aimed at equity. Future research should explore protective factors, such as social support and resilience, that may buffer the negative effects of discrimination. Understanding these dynamics is crucial for developing interventions that promote equitable and effective PNC utilization.

Understanding how older adults make decisions about their self-care is essential for designing tailored interventions that promote autonomy and well-being. However, no instrument currently exists to specifically measure self-care decision-making styles in this population. The study aimed to develop and test the psychometric properties of the Self-Care Decision-Making Styles of Older Adult (DECIDE) Inventory, a new instrument designed to assess styles of self-care decision-making among older adults. A three-phase process was undertaken: (i) instrument development based on theory and previous studies; (ii) content validity evaluation with 10 experts and cognitive interviews with 10 older adults; and (iii) psychometric testing, including assessment of structural and construct validity, internal consistency, and test-retest reliability. A convenience sample of 350 older adults from various Italian regions participated in the validation phase. The study followed the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) reporting guidelines. Following content validation, an instrument was finalized, assessing four decision-making styles-independent, responsible, self-neglected, and guided-, with five items per scale. Confirmatory factor analyses supported the structural validity of the four-scale model. Construct validity was confirmed through hypothesis testing. Reliability indicators, including Omega coefficients, factor score determinacy, item-total correlations, and intraclass correlation coefficients, ranged from adequate to optimal across all scales. The Self-Care Decision-Making Styles of Older Adult Inventory demonstrated good validity and adequate reliability for assessing self-care decision-making styles in older adults. Further refinement and cross-cultural validation are recommended before its use in clinical practice.

Type 2 diabetes (T2D) is a growing global health concern, including in Israel. Effective Diabetes self-management (DSM) is critical for achieving glycemic targets and preventing complications. While several tools exist to assess DSM, none have been translated for Hebrew-speaking populations. This study aimed to translate the Diabetes Self-Management Questionnaire (DSMQ) into Hebrew (H-DSMQ) and evaluate its psychometric properties. The DSMQ was translated into Hebrew using a standard forward-backward translation procedure. A convenience sample of 220 community-dwelling adults with T2D in Israel was recruited via PANEL4ALL. Internal consistency was tested with Cronbach's α. Construct validity was examined via Confirmatory Factor Analysis and known-groups validity, and criterion validity through correlations between H-DSMQ scores, HbA1c, and BMI. The H-DSMQ construct validity was supported by CFA. In addition, known-groups validity was established, with participants with less than 7% reporting significantly higher self-management in glucose monitoring, dietary control/nutrition management, and healthcare use compared to those with above 7.1% HbA1c levels. Criterion validity was demonstrated by significant negative correlations between HbA1c and healthcare use/glucose monitoring, and between BMI and nutrition management/physical activity. The reliability of the H-DSMQ subscales ranged from poor (healthcare use, α = 0.461) to good (physical activity, α = 0.83). The H-DSMQ is a reliable and valid tool for clinical and research purposes to assess self-care behaviors related to blood glucose management in Hebrew-speaking adults with T2D. The H-DSMQ may support nurses by encouraging constructive and comprehensive dialog for assessing DSM.

Positive childhood experiences (PCEs), such as supportive relationships and household routines, promote and protect well-being in later life. However, the mechanisms through which PCEs act remain unclear. This study examines whether emotion regulation mediates the association between PCEs and flourishing in a large sample of Chinese young adults. Data were collected from 9468 Chinese university students via online surveys (August-November 2020). Measures included the Chinese versions of the PCE Scale, Flourishing Measure (which characterized point-in-time flourishing and secure flourishing over an extended period), and Emotional Regulation Questionnaire (which assessed cognitive reappraisal and expressive suppression). Bivariate Pearson correlations assessed associations, and mediation analysis was conducted using the PROCESS procedure in SPSS 4.1. Experiencing more PCEs was correlated with greater cognitive reappraisal (r = 0.28, p < 0.01), lower expressive suppression (r = -0.11, p < 0.01), and greater flourishing (r = 0.49, p < 0.01). Cognitive reappraisal was correlated with greater flourishing (r = 0.43, p < 0.01), while expressive suppression was correlated weakly with lower secure flourishing (r = -0.02, p < 0.05). Mediation analysis showed cognitive reappraisal (indirect effect b = 0.06, 95% CI [0.05, 0.06]) and expressive suppression (b = 0.002, [-0.004, -0.001]) significantly mediated the PCEs-flourishing relationship. Similar results were found with secure flourishing. Findings suggest that emotion regulation, particularly cognitive reappraisal, may be a key psychological mechanism linking PCEs to flourishing later in life among young adults in China.

Acute kidney injury (AKI) affects approximately 20% of hospitalized patients and is associated with higher mortality, extended hospital stay, and increased costs. While various strategies have been proposed to improve AKI management, the impact of nursing resources on AKI outcomes has not been explored. We sought to examine the association between nursing resources and 30-day mortality among patients hospitalized with AKI. Using a cross-sectional study design, we linked data from the CMS Medicare Provider Analysis and Review file, American Hospital Association Annual Survey, and RN4CAST-NY/IL survey of registered nurses. We identified 24,368 Medicare beneficiaries aged 18-99 years with a primary diagnosis of AKI hospitalized in 155 hospitals in New York and Illinois in 2021. The primary outcome was 30-day mortality. Key independent variables included nurse staffing (patient-to-nurse ratio) and nurse education (proportion of nurses holding a bachelor's degree or higher). Covariates were patient demographics, comorbidities, and hospital characteristics. The 30-day mortality rate was 10.5%. In adjusted logistic regression models, each additional patient per RN increased the odds of 30-day mortality by 7% (OR = 1.07, 95% CI [1.01-1.13], p < 0.05). For each 10-point increase in the proportion of nurses with a bachelor's degree or higher, the odds of 30-day mortality decreased by 9% (OR = 0.91, 95% CI [0.88-0.95], p < 0.001). Better nurse staffing and higher proportions of nurses with a bachelor's degree or higher are associated with lower 30-day mortality among patients hospitalized with AKI. These findings underscore the significance of nursing in AKI outcomes and suggest that hospitals should prioritize investing in nursing resources to enhance AKI outcomes.

Depressive symptoms in youth are influenced by psychosocial stressors and cognitive vulnerabilities. Perceived everyday discrimination (PED) is a common stressor linked to mental health issues, while dysfunctional attitudes (DAs), per Beck's cognitive theory of depression, may mediate these effects. Additionally, depressive symptoms have been associated with physical health outcomes, such as inflammation. We examined relationships between PED, DAs, depressive symptoms, and interleukin-6 (IL-6), a marker of inflammation, in a sample of 98 youth (13-16 years old; 36.4% female, 63.6% male) from diverse racial/ethnic backgrounds (41.4% Black/African American, 34.8% White/European American, 7.1% Multiracial, 2% Hispanic, 1% Native American, 1% Other). Measures included the Everyday Discrimination Scale, Dysfunctional Attitudes Scale, Center for Epidemiological Studies Depression Scale, and saliva samples. Our regression analyses demonstrated that PED was significantly associated with both DAs and depressive symptoms as well as that DAs were significantly associated with depressive symptoms and IL-6, while neither PED nor depressive symptoms were significantly associated with IL-6. Consistent with the regressions, our mediation analyses revealed no significant indirect effects of PED on IL-6 through DAs, depressive symptoms, or their sequential combination. Our findings support the role of PED as a stressor within Beck's cognitive theory and expand the theory's application by linking DAs to inflammatory processes. Given these connections, nurses can play a crucial role in implementing cognitive interventions to mitigate the effects of DAs and advocating for systemic change to reduce discrimination.