Effectiveness of artificial intelligence vs. human coaching in diabetes prevention: a study protocol for a randomized controlled trial.

BACKGROUND: Prediabetes is a highly prevalent condition that heralds an increased risk of progression to type 2 diabetes, along with associated microvascular and macrovascular complications. The Diabetes Prevention Program (DPP) is an established effective intervention for diabetes prevention. However, participation in this 12-month lifestyle change program has historically been low. Digital DPPs have emerged as a scalable alternative, accessible asynchronously and recognized by the Centers for Disease Control and Prevention (CDC). Yet, most digital programs still incorporate human coaching, potentially limiting scalability. Furthermore, existing effectiveness results of digital DPPs are primarily derived from per protocol, longitudinal non-randomized studies, or comparisons to control groups that do not represent the standard of care DPP. The potential of an AI-powered DPP as an alternative to the DPP is yet to be investigated. We propose a randomized controlled trial (RCT) to directly compare these two approaches. METHODS: This open-label, multicenter, non-inferiority RCT will compare the effectiveness of a fully automated AI-powered digital DPP (ai-DPP) with a standard of care human coach-based DPP (h-DPP). A total of 368 participants with elevated body mass index (BMI) and prediabetes will be randomized equally to the ai-DPP (smartphone app and Bluetooth-enabled body weight scale) or h-DPP (referral to a CDC recognized DPP). The primary endpoint, assessed at 12 months, is the achievement of the CDC's benchmark for type 2 diabetes risk reduction, defined as any of the following: at least 5% weight loss, at least 4% weight loss and at least 150 min per week on average of physical activity, or at least a 0.2-point reduction in hemoglobin A1C. Physical activity will be objectively measured using serial actigraphy at baseline and at 1-month intervals throughout the trial. Secondary endpoints, evaluated at 6 and 12 months, will include changes in A1C, weight, physical activity measures, program engagement, and cost-effectiveness. Participants include adults aged 18-75 years with laboratory confirmed prediabetes, a BMI of ≥ 25 kg/m2 (≥ 23 kg/m2 for Asians), English proficiency, and smartphone users. This U.S. study is conducted at Johns Hopkins Medicine in Baltimore, MD, and Reading Hospital (Tower Health) in Reading, PA. DISCUSSION: Prediabetes is a significant public health issue, necessitating scalable interventions for the millions affected. Our pragmatic clinical trial is unique in directly comparing a fully automated AI-powered approach without direct human coach interaction. If proven effective, it could be a scalable, cost-effective strategy. This trial will offer vital insights into both AI and human coach-based behavioral change strategies in real-world clinical settings. TRIAL REGISTRATION: ClinicalTrials.gov NCT05056376. Registered on September 24, 2021, https://clinicaltrials.gov/study/NCT05056376.

Critical Care Nurses' Moral Resilience, Moral Injury, Institutional Betrayal, and Traumatic Stress After COVID-19.

BACKGROUND: Traumatic stress and moral injury may contribute to burnout, but their relationship to institutional betrayal and moral resilience is poorly understood, leaving risk and protective factors understudied. OBJECTIVES: To examine traumatic stress symptoms, moral injury symptoms, moral resilience, and institutional betrayal experienced by critical care nurses and examine how moral injury and traumatic stress symptoms relate to moral resilience, institutional betrayal, and patient-related burnout. METHODS: This cross-sectional study included 121 critical care nurses and used an online survey. Validated instruments were used to measure key variables. Descriptive statistics, regression analyses, and group t tests were used to examine relationships among variables. RESULTS: Of participating nurses, 71.5% reported significant moral injury symptoms and/or traumatic stress. Both moral injury symptoms and traumatic stress were associated with burnout. Regression models showed that institutional betrayal was associated with increased likelihood of traumatic stress and moral injury. Increases in scores on Response to Moral Adversity subscale of moral resilience were associated with a lower likelihood of traumatic stress and moral injury symptoms. CONCLUSIONS: Moral resilience, especially response to difficult circumstances, may be protective in critical care environments, but system factors (eg, institutional betrayal) must also be addressed systemically rather than relying on individual-level interventions to address nurses' needs.

A Qualitative Study of Midlevel Nurse Managers' Perspectives of Scholarly Inquiry.

OBJECTIVE: This study explored the key characteristics and needs of midlevel nurse managers (MLNMs) who support and engage clinical nurses (CNs) in scholarly inquiry. BACKGROUND: Healthcare organizations expect CNs to participate in scholarly inquiry, incorporating evidence-based interventions to improve outcomes and safety. How the MLNM supports and engages CNs in scholarly inquiry remains unclear. METHODS: Twelve semistructured interviews of MLNMs occurred at several facilities in the mid-Atlantic region utilizing the institutional review board-acknowledged protocol. Theme interpretation utilized inductive analysis. RESULTS: Four recurrent themes emerged from the interviews related to the value of scholarly inquiry: 1) securing organizational resources to promote scholarly inquiry; 2) knowledge and experience in scholarly inquiry; 3) actions supporting scholarly inquiry; and 4) the value of scholarly inquiry within the organization. CONCLUSIONS: Senior nursing leadership and healthcare organizations must recognize the value and provide the infrastructure to support scholarly inquiry. Infrastructure includes education, dedicated time, access to expertise, and resources.

The Long Tail of COVID-19: Implications for the Future of Emergency Nursing.

INTRODUCTION: COVID-19 has led to exacerbated levels of traumatic stress and moral distress experienced by emergency nurses. This study contributes to understanding the perspectives of emergency nurses' perception of psychological trauma during COVID-19 and protective mechanisms used to build resilience. METHOD: The primary method was qualitative analysis of semistructured interviews, with survey data on general resilience, moral resilience, and traumatic stress used to triangulate and understand qualitative findings. Analyses and theme development were guided by social identity theory and informed by the middle range theory of nurses' psychological trauma. RESULTS: A total of 14 emergency nurses were interviewed, 11 from one site and 3 from the other. Almost all nurses described working in an emergency department throughout the pandemic as extraordinarily stressful, morally injurious, and exhausting at multiple levels. Although the source of stressors changed throughout the pandemic, the culmination of continued stress, moral injury, and emotional and physical exhaustion almost always exceeded their ability to adapt to the ever-changing landscape in health care created by the pandemic. Two primary themes were identified: losing identity as a nurse and hopelessness and self-preservation. DISCUSSION: The consequences of the pandemic on nurses are likely to be long lasting. Nurses need to mend and rebuild their identity as a nurse. The solutions are not quick fixes but rather will require fundamental changes in the profession, health care organizations, and the society. These changes will require a strategic vision, sustained commitment, and leadership to accomplish.

An academic and regional nurse research collaborative: Implications for nursing research.

INTRODUCTION: A diverse group of nurses and research Network Coordinators formed a collaboration to advance nursing research within Johns Hopkins Clinical Research Network, a partnership of academic and community hospitals in the mid-Atlantic region. The purpose of the Nurse Research Collaborative (NRC) is to provide mentoring, mutual growth, and assist the health care organizations to fulfill nursing research requirements. BACKGROUND: We created a multiinstitutional nursing research organization with diversity of member participants and health care facilities. The NRC structure allowed nonacademic facilities to engage in a variety of nursing research projects. This allows for increases in study sample sizes of diverse populations to support and expand nursing research. The NRC is modeled after a physician clinical research network with an aligned mission, vision, goals, and strategic priorities across member organizations. MAIN IDEAS: To strengthen multiinstitutional nursing research capability, the NRC developed an infrastructure of leadership, regular meetings, and formal educational presentations. The NRC completed three research studies, facilitating the Institutional Review Board application process, reviewing documents and contracts, providing individual institutional support, and coordinating site leader functions. CONCLUSION: A research collaboration of nurses, across multiple hospitals provides efficiencies and expertise not otherwise available in every organization.

The Impact of Traumatic Stress, Resilience, and Threats to Core Values on Nurses During a Pandemic.

OBJECTIVE: The aim of this study was to understand the traumatic stress and resilience of nurses who cared for patients with COVID-19. BACKGROUND: Studies have shown a high proportion of healthcare workers are at risk for developing posttraumatic stress disorder after a pandemic. Resilience factors are believed to play an important role in the well-being of healthcare professionals. METHODS: This was a triangulated mixed methods study; a phenomenological qualitative approach with survey data was used to triangulate the findings, and sensemaking was used as the theoretical framework. RESULTS: Four themes emerged from the study: 1) phases of traumatic stress response to perceived threats; 2) honoring their sacrifice; 3) professional self-identity; and 4) sustaining resilience in a stressful work environment. Quantitative results on traumatic stress, general resilience, and moral resilience supported the themes. CONCLUSIONS: The findings will help leaders understand the potential for postpandemic mental health problems and the role of resilience in maintaining well-being.

Beyond Terminology Confusion: Creating a Culture of Nursing Inquiry.

Inquiry is the foundation of nursing practice. Inquiry projects impact safety, quality measures, and patient/staff outcomes. As the profession with closest proximity to the patient, nurses must not only participate in but also spearhead inquiry work. This article addresses the knowledge gap that continues to exist among clinical nurses regarding the three forms of nursing inquiry and provides recommendations for nursing professional development practitioners to support clinical nurses' understanding and participation in these endeavors.