Current Issue : April-June Volume : 2026 Issue Number : 2 Articles : 5 Articles
Background/Objectives: Homeless populations have higher rates of chronic illness and mortality than more advantaged peers but have low primary care engagement. Nurse-managed clinics emerged as a possible solution to increase healthcare access for marginalized populations. This paper presents a comprehensive evaluation of feasibility (conceptualized as patient recruitment and retention) and acceptability (conceptualized as patient satisfaction) of a nurse-managed primary care clinic tailored to people experiencing homelessness and poverty. Methods: This is a three-year retrospective chart review study of the clinic’s services, patient characteristics, and patient satisfaction. All adult patients for the three-year period were included (N = 514). Feasibility was measured by the number of unique patients seen and visits completed, ratio of completed to scheduled visits, and number of returning patients. Acceptability was measured by a 19-item Likert format (1–5) patient satisfaction survey. Patient characteristics were captured from intake forms. Results: Most patients were male, African American or White, and non-Hispanic. Regarding social determinants of health (SDOH), most patients did not have college education, were unemployed or unable to work, experienced homelessness, had no primary care provider, and no health insurance. Over three years, 1972 visits were scheduled and 1372 (69.6%) completed. A total of 514 patients were seen (37.5% of all visits), with 858 follow-up visits (62.5%). Returning patients (≥2 visits) totaled 59.1%. Yearly data shows steady growth in recruitment and retention. Patient satisfaction with facets of care (access, communication, interpersonal relations) was very high (Mrange = 4.63–4.69), including with Nurse Practitioner care, as was global satisfaction (M= 4.71; SD = 0.61; 76.3% very satisfied). Conclusions: Results indicate that a homeless-tailored nurse-managed clinic can recruit and retain homeless and working poor patients (feasibility), with high patient satisfaction with its services and staff (acceptability), independently of patient demographics or SDOH. Challenges related to retention deserve further study as well as the impact of services on the continuity of care, health, and well-being....
Background: Ventilator-associated pneumonia (VAP) is a major cause of morbidity and mortality in intensive care units (ICUs), particularly in low- and middle-income countries (LMICs). Evidence-based practice (EBP) bundles have shown effectiveness in reducing VAP; however, the implementation in Bangladesh remains limited. This study aimed to evaluate the effectiveness of EBP to reduce the incidence rate of VAP among adult ICU patients in Bangladesh. Methods: A quasi-experimental study with a historical control group was conducted among 347 eligible ICU patients from October 2024 to April 2025. The intervention included nurse training on VAP bundle practices with advanced equipment support. Data on VAP incidence as a primary endpoint and VAP-related patients’ outcomes were analyzed. Results: The clinically suspected VAP incidence was 30.1 and 51.1 per 1000 ventilator-days, and the prevalence decreased significantly in the intervention group compared to the control group (26.9% vs. 46.1%; p < 0.001), respectively. Logistic regression indicated VAP bundle implementation was associated with reduced VAP (Exp(B) = 0.417, 95% CI: 0.262–0.666), while ventilation ≥96 h was a significant risk factor (Exp(B) = 2.6, 95% CI: 1.385–4.881). Early-onset VAP was reduced (25.0% vs. 10.2%), though late-onset predominated in the intervention group (75.0% vs. 89.8%). Conclusion: Implementation of an EBP-based VAP bundle by trained nurses significantly reduced VAP incidence. However, increased overall ICU mortality highlights the need for broader critical care improvements, including advanced comorbidity management and comprehensive ICU services. This study underscores the feasibility and effectiveness of VAP bundle implementation in the ICU of an LMIC....
Background/Objectives: Advanced Practice Nurses (APNs) counsel patients regarding diet and exercise behaviors and serve as role models for health promotion and prevention of chronic disease. This study evaluated personal diet and exercise behaviors of APNs and their association with body mass index (BMI) as a biomarker of obesity and disease risk. Methods: APNs (N = 1268) self-reported height and weight, and answered four questions regarding personal diet and exercise. Based on BMI, they were grouped as normal weight (≤24.9 kg/m2) and overweight/obese (≥25.0 kg/m2). Results: The prevalence of overweight/obesity was 55%. The majority of APNs engaged in muscle strengthening exercises (53%) and consumed fruits and vegetables (62%), and protein foods and/or supplements (94%), while less than half engaged in moderate–vigorous physical activity (46%). Exercise behaviors (moderate–vigorous physical activity and muscle strengthening exercises) had a statistically significant impact on BMI. The predicted decrease in BMI due to participation in moderate–vigorous physical activity was 2.06 kg/m2 and the predicted decrease due to muscle strengthening exercises was 1.35 kg/m2. Diet behaviors (consumption of fruit, vegetables, and protein) were not found to have a significant impact on BMI. Conclusions: The prevalence of overweight/obesity among APNs in the United States is less than what is reported for the general adult population. Exercise behaviors, especially moderate–vigorous physical activity, significantly impact BMI and are associated with clinically meaningful differences. By comparison, healthy diet behaviors, including consumption of fruits, vegetables, and protein, are relatively widespread among advanced practice nurses but do not appear to significantly impact BMI....
Background/Objectives: With the rising prevalence of mental health (MH) disorders, improving the effectiveness and quality of MH care has become increasingly imperative. To improve patient care outcomes, it is essential to accurately assess staffing needs and compare outcomes across providers to identify best practices. However, without a robust case-mix adjustment system that accounts for disease severity, efforts to measure staffing requirements and evaluate patient outcomes are of limited value. This study aimed to develop such a system by leveraging a large study population, more clinically homogeneous groups, and advanced modeling techniques. Methods: In this retrospective populationbased study, over two million MH patients (n = 2,088,174) were grouped into 162 clinically homogeneous categories using Clinical Classifications Software Refined (CCSR) to enhance predictive accuracy. We evaluated the performance of four statistical models and four artificial intelligence (AI) models to identify the model that delivered the highest predictive power. Results: Among the statistical models, the Box–Cox regression yielded the highest predictive power (R2 = 0.42; percent of variation explained [PVE] = 0.300). Among the AI models, CatBoost performed best (R2 = 0.458; PVE = 0.311). While the AI models outperformed traditional statistical models, the improvements were modest. Sensitivity analyses confirmed the robustness of these models. Conclusions: Both the Box–Cox and CatBoost models demonstrated superior predictive performance compared to those reported in the literature. These findings suggest that a case-mix system based on either model can be used for risk adjustment to optimize staffing levels and benchmark patient outcomes for quality improvement....
Background: Recovery is an emerging approach. In Chile, attempts are being made to introduce the Recovery Model with specific guidelines for the care of people diagnosed with Severe Mental Disorders. The participation of nurses in this process is peripheral to the biomedical model. Objectives: To explore the participation of nurses in the recovery process of people hospitalised in Psychiatric Intensive Care between 2023 and 2024. Methods: Qualitative research, collective-case multisite study design in four hospitals. With the approval of four ethics committees, 18 nurses who signed informed consent were interviewed. Rapid qualitative analysis was performed. Results: Nursing care is mainly related to the caregiving, educational, and management roles. Recovery is associated with clinical improvement, and different components are identified, such as family and social support, the ability to resume control of one’s life, the existence of a future life plan, and the ability to manage one’s own illness. Conclusions: The results are consistent with elements described in contemporary approaches to recovery, incorporating autonomy, confidence in the person’s abilities, and shared decision-making. However, they are still far from modern approaches to personal and non-clinical recovery. Nursing needs to redirect its efforts toward recovery with a paradigm shift toward a model in which the person affected by a mental health condition is the protagonist of their own health process....
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