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Adaptive Classification Methods for Predicting Transitions in the Nursing Workforce

Open Journal of Statistics 2018年第3期8卷 497-512页

作者： George J. Knafl mark toles Anna S. Beeber Cheryl B. Jones School of Nursing University of North Carolina at Chapel Hill Chapel Hill NC USA

Earlier analyses of transitions from licensed practical nurse (LPN) to registered nurse (RN) in the North Carolina (NC) nursing workforce in terms of 11 categorical predictors were limited by not considering parsimonious classifications based on these predictors and by substantial amounts of missing data. To address these issues, we formulated adaptive classification methods. Secondary analyses of data collected by the NC State Board of Nursing were also conducted to demonstrate adaptive classification methods by modeling the occurrence of LPN-to-RN transitions in the NC nursing workforce from 2001-2013. These methods combine levels (values) for one or more categorical predictors into parsimonious classifications. Missing values for a predictor are treated as one level for that predictor so that the complete data can be used in the analyses;the missing level is imputed by combining it with other levels of a predictor. An adaptive nested classification generated the best model for predicting an LPN-to-RN transition based on three predictors in order of importance: year of first LPN licensure, work setting at transition, and age at first LPN licensure. These results demonstrate that adaptive classification can identify effective and parsimonious classifications for predicting dichotomous outcomes such as the occurrence of an LPN-to-RN transition.

关键词： Adaptive Classification LPN-to-RN Transition LPN Workforce

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Patient Participation in Communication about Treatment Decision-Making for Localized Prostate Cancer during Consultation Visits

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Health 2015年第11期7卷 1419-1429页

作者： Lixin Song mark P. toles Jinbing Bai Matthew E. Nielsen Donald E. Bailey Betsy Sleath Barbara mark School of Nursing University of North Carolina (UNC) Chapel Hill USA Lineberger Comprehensive Cancer Center University of North Carolina (UNC) Chapel Hill USA Department of Urology School of Medicine University of North Carolina (UNC) Chapel Hill USA School of Nursing Duke University Durham USA Eshelman School of Pharmacy University of North Carolina Chapel Hill USA

Objectives: To describe the communication behaviors of patients and physicians and patient par-ticipation in communication about treatment decision-making during consultation visits for local-ized prostate cancer (LPCa). Methods: This is a secondary analysis of data from 52 men enrolled in the usual care control group of a randomized trial that focused on decision-making for newly diagnosed men with LPCa. We analyzed the patient-physician communication using the transcribed audio-recordings of real-time treatment consultations and a researcher-developed coding tool, including codes for communication behaviors (information giving, seeking, and clarifying/ verifying) and contents of clinical consultations (health histories, survival/mortality, treatment options, treatment impact, and treatment preferences). After qualitative content analysis, we categorized patient participation in communication about treatment-related clinical content, including “none” (content not discussed);“low” (patient listening only);“moderate” (patient providing information or asking questions);and “high” (patient providing information and asking questions). Results: Physicians mainly provided information during treatment decision consultations and patients frequently were not active participants in communication. The participation of patients with low and moderate cancer risk typically was: 1) “moderate and high” in discussing health histories;2) “low” in discussing survival/mortality;3) “low and moderate” in discussing treatment options;4) “none and low” in discussing treatment impacts;and 5) “low” in discussing treatment preferences. Conclusions: Findings suggest opportunities for increasing patient participation in communication about treatment decision-making for LPCa during clinical consultations.

关键词： Localized Prostate Cancer (LPCa) Decision-Making Patient-Provider Communication Patient Participation Audio-Recording Consultation

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