{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T20:42:39Z","timestamp":1792701759875,"version":"4.5.0"},"reference-count":32,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T00:00:00Z","timestamp":1777334400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Brain Sciences"],"abstract":"<jats:p>Background\/Objectives: Ischemic stroke, hemorrhagic stroke, and transient ischemic attack (TIA) differ in terms of medical severity and prognosis; however, it remains unclear whether these differences are reflected in nursing complexity and nursing intensity when assessed using standardized nursing language. Methods: This retrospective study analyzed routinely collected nursing and administrative data from an acute care hospital. Hospitalizations were classified as ischemic stroke, hemorrhagic stroke, or TIA using ICD-9-CM codes. Nursing complexity was measured as the number of nursing diagnoses (NDs) documented within 24 h of admission, while nursing intensity was measured as the number of nursing actions (NAs) recorded during hospitalization. Group differences were tested using ANOVA and Kruskal\u2013Wallis tests, as appropriate. Results: A total of 728 hospitalizations were included: 429 ischemic strokes, 236 hemorrhagic strokes, and 63 TIAs. Overall, 4136 NDs and 27,528 NAs were recorded. Distinct patterns emerged across stroke categories. ND counts differed significantly (F = 5.81, p = 0.003), with TIA showing lower counts than both ischemic and hemorrhagic stroke, while no significant difference was observed between ischemic and hemorrhagic stroke. NA counts also differed significantly (H = 16.73, p &lt; 0.001), with the highest counts in hemorrhagic stroke, intermediate counts in ischemic stroke, and the lowest counts in TIA. In a sensitivity analysis standardized by length of stay, nursing intensity also differed significantly across stroke categories (H = 12.999, p = 0.002), although the pattern differed from that observed for cumulative counts. Conclusions: Nursing complexity and nursing intensity showed distinct patterns across stroke categories. While complexity was comparable between ischemic and hemorrhagic stroke and lower in TIA, intensity followed a clear gradient, highest in hemorrhagic stroke, intermediate in ischemic stroke, and lowest in TIA. Standardized nursing data may complement medical indicators by capturing additional dimensions of patient needs and care delivery in people with stroke.<\/jats:p>","DOI":"10.3390\/brainsci16050471","type":"journal-article","created":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T15:09:33Z","timestamp":1777388973000},"page":"471","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Differences in Nursing Complexity and Intensity Across Stroke Subtypes: A Retrospective Study Using Standardized Nursing Language"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2834-7594","authenticated-orcid":false,"given":"Manuele","family":"Cesare","sequence":"first","affiliation":[{"name":"A. Gemelli IRCCS University Hospital Foundation, 00168 Rome, Italy"},{"name":"Section of Hygiene, Department of Life Sciences and Public Health, Catholic University of the Sacred Heart, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8528-7834","authenticated-orcid":false,"given":"Augusto","family":"Fusco","sequence":"additional","affiliation":[{"name":"UOSD High-Intensity Neurorehabilitation, Department of Neurosciences, Sensory Organs and Thorax, A. Gemelli IRCCS University Hospital Foundation, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3028-6188","authenticated-orcid":false,"given":"Gianfranco","family":"Damiani","sequence":"additional","affiliation":[{"name":"Hospital Hygiene Unit, A. Gemelli IRCCS University Hospital Foundation, 00168 Rome, Italy"},{"name":"Section of Hygiene, Department of Life Sciences and Public Health, Catholic University of the Sacred Heart, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7694-4986","authenticated-orcid":false,"given":"Antonello","family":"Cocchieri","sequence":"additional","affiliation":[{"name":"A. Gemelli IRCCS University Hospital Foundation, 00168 Rome, Italy"},{"name":"Section of Hygiene, Department of Life Sciences and Public Health, Catholic University of the Sacred Heart, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"108426","DOI":"10.1016\/j.jstrokecerebrovasdis.2025.108426","article-title":"Mortality rates and long-term disability after cerebrovascular events: A prospective cohort study in general Villegas, Buenos Aires, Argentina. The EstEPA population study","volume":"34","author":"Alet","year":"2025","journal-title":"J. Stroke Cerebrovasc. Dis."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1177\/17474930241308142","article-title":"World Stroke Organization: Global Stroke Fact Sheet 2025","volume":"20","author":"Feigin","year":"2025","journal-title":"Int. J. Stroke"},{"key":"ref_3","first-page":"e86820","article-title":"Acute Stroke Management and Nursing Intervention","volume":"17","author":"Madu","year":"2025","journal-title":"Cureus"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1236","DOI":"10.3390\/nursrep13030106","article-title":"Nursing Care for Stroke Patients: Current Practice and Future Needs","volume":"13","author":"Babkair","year":"2023","journal-title":"Nurs. Rep."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"108413","DOI":"10.1016\/j.jstrokecerebrovasdis.2025.108413","article-title":"Discrimination of ischemic versus hemorrhagic stroke type by presenting symptoms or signs: A systematic review and meta-analysis","volume":"34","author":"McDermott","year":"2025","journal-title":"J. Stroke Cerebrovasc. Dis."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"107952","DOI":"10.1016\/j.jstrokecerebrovasdis.2024.107952","article-title":"Longitudinal outcomes of ischemic versus hemorrhagic stroke: Differences may impact future trial design","volume":"33","author":"Girgenti","year":"2024","journal-title":"J. Stroke Cerebrovasc. Dis."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e282","DOI":"10.1161\/STR.0000000000000407","article-title":"2022 Guideline for the Management of Patients with Spontaneous Intracerebral Hemorrhage: A Guideline From the American Heart Association\/American Stroke Association","volume":"53","author":"Greenberg","year":"2022","journal-title":"Stroke"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"795","DOI":"10.1016\/S1474-4422(21)00252-0","article-title":"Global, regional, and national burden of stroke and its risk factors, 1990\u20132019: A systematic analysis for the Global Burden of Disease Study 2019","volume":"20","author":"Feigin","year":"2021","journal-title":"Lancet Neurol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e344","DOI":"10.1161\/STR.0000000000000211","article-title":"Guidelines for the Early Management of Patients with Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association\/American Stroke Association","volume":"50","author":"Powers","year":"2019","journal-title":"Stroke"},{"key":"ref_10","first-page":"19","article-title":"Recent advances in the management of transient ischemic attacks","volume":"11","author":"Gomez","year":"2022","journal-title":"Fac. Rev."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1097\/DCC.0000000000000734","article-title":"Stroke Severity and Nursing Care Complexity: A 2-year Analysis from a Comprehensive Stroke Unit in a Middle-income Country","volume":"45","author":"Ferreira","year":"2026","journal-title":"Dimens. Crit. Care Nurs."},{"key":"ref_12","first-page":"e20240302","article-title":"Influence of neurological severity and degree of dependence of patients after stroke on nursing workload: A retrospective cohort","volume":"59","author":"Lima","year":"2025","journal-title":"Rev. Esc. Enferm. USP"},{"key":"ref_13","first-page":"268","article-title":"Essential elements in determining patient\u2019s complexity of nursing care","volume":"74","author":"Ivziku","year":"2021","journal-title":"Prof. Inferm."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Cocchieri, A., Cristofori, E., Nurchis, M.C., Nursing and Public Health Group, Damiani, G., and Cesare, M. (2025). Nursing Complexity and Health Literacy as Determinants of Patient Outcomes: A Prospective One-Year Multicenter Cohort Study. Nurs. Rep., 15.","DOI":"10.3390\/nursrep15040135"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2748","DOI":"10.1111\/jocn.17460","article-title":"Exploring the Impact of Medical Complexity on Nursing Complexity of Care in Paediatric Patients: A Retrospective Observational Study","volume":"34","author":"Cesare","year":"2025","journal-title":"J. Clin. Nurs."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1016\/j.ijmedinf.2019.02.009","article-title":"Enhancing the performance of predictive models for Hospital mortality by adding nursing data","volume":"125","author":"Sanson","year":"2019","journal-title":"Int. J. Med. Inform."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Cesare, M., Gray, R., and Cocchieri, A. (2026). Stop Silencing Nursing Complexity: Why Standardized Nursing Terminologies Must Be Heard. Nurs. Rep., 16.","DOI":"10.3390\/nursrep16010028"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Benchimol, E.I., Smeeth, L., Guttmann, A., Harron, K., Moher, D., Petersen, I., S\u00f8rensen, H.T., von Elm, E., and Langan, S.M. (2015). The REporting of studies Conducted using Observational Routinely-collected health Data (RECORD) statement. PLoS Med., 12.","DOI":"10.1371\/journal.pmed.1001885"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2064","DOI":"10.1161\/STR.0b013e318296aeca","article-title":"An updated definition of stroke for the 21st century: A statement for healthcare professionals from the American Heart Association\/American Stroke Association","volume":"44","author":"Sacco","year":"2013","journal-title":"Stroke"},{"key":"ref_20","first-page":"1011","article-title":"Clinical Care Classification (CCC) System Charting Model","volume":"122","author":"Saba","year":"2006","journal-title":"Stud. Health Technol. Inform."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"E39","DOI":"10.1097\/NCC.0000000000000581","article-title":"Nursing Diagnoses, Interventions, and Activities as Described by a Nursing Minimum Data Set: A Prospective Study in an Oncology Hospital Setting","volume":"42","author":"Sanson","year":"2019","journal-title":"Cancer Nurs."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1111\/2047-3095.12008","article-title":"Development and validation of a computerized assessment form to support nursing diagnosis","volume":"25","author":"Zega","year":"2014","journal-title":"Int. J. Nurs. Knowl."},{"key":"ref_23","unstructured":"Joint Commission International (2024). Joint Commission International Accreditation Standards for Hospitals: Including Standards for Academic Medical Center Hospitals, Joint Commission Resources. [8th ed.]."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"23779608231158157","DOI":"10.1177\/23779608231158157","article-title":"Standardized Nursing Diagnoses in a Surgical Hospital Setting: A Retrospective Study Based on Electronic Health Data","volume":"9","author":"Cesare","year":"2023","journal-title":"SAGE Open Nurs."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"152","DOI":"10.3390\/nursrep12010016","article-title":"Assessment of Neurological Status in Patients with Cerebrovascular Diseases through the Nursing Outcome Classification: A Methodological Study","volume":"12","author":"Lima","year":"2022","journal-title":"Nurs. Rep."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"E1344","DOI":"10.1503\/cmaj.220344","article-title":"Transient ischemic attack and minor stroke: Diagnosis, risk stratification and management","volume":"194","author":"Perry","year":"2022","journal-title":"CMAJ"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1097\/JNN.0000000000000677","article-title":"Low-to-Moderate Risk Transient Ischemic Attack Patients Can Be Safely Discharged From the Emergency Department to a Nurse Practitioner-Led Clinic","volume":"54","author":"Alfandy","year":"2022","journal-title":"J. Neurosci. Nurs."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1111\/jnu.13045","article-title":"Determinants of Prolonged Hospitalization in Children and Adolescents: A Retrospective Observational Study","volume":"57","author":"Cesare","year":"2025","journal-title":"J. Nurs. Scholarsh."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"764","DOI":"10.1177\/01939459231178495","article-title":"The Role and Contributions of Nurses in Stroke Rehabilitation Units: An Integrative Review","volume":"45","author":"Tanlaka","year":"2023","journal-title":"West. J. Nurs. Res."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1735","DOI":"10.1002\/nop2.1430","article-title":"Association of nursing hours with cognitive function, balance, and dependency level of stroke patients","volume":"10","author":"Lee","year":"2023","journal-title":"Nurs. Open"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"809","DOI":"10.1111\/jan.16241","article-title":"Trajectory patterns and influencing factors of supportive care needs in stroke patients: A longitudinal study","volume":"81","author":"Xi","year":"2025","journal-title":"J. Adv. Nurs."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"102931","DOI":"10.1016\/j.ejon.2025.102931","article-title":"Prevalence and accuracy of nursing diagnoses in patients with malignant bronchial and lung cancer: A retrospective observational study","volume":"77","author":"Cesare","year":"2025","journal-title":"Eur. J. Oncol. Nurs."}],"container-title":["Brain Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-3425\/16\/5\/471\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T15:38:32Z","timestamp":1777390712000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-3425\/16\/5\/471"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,28]]},"references-count":32,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,5]]}},"alternative-id":["brainsci16050471"],"URL":"https:\/\/doi.org\/10.3390\/brainsci16050471","relation":{},"ISSN":["2076-3425"],"issn-type":[{"value":"2076-3425","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,28]]}}}