{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T15:29:30Z","timestamp":1788535770866,"version":"build-2803163510"},"reference-count":32,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T00:00:00Z","timestamp":1788480000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nurs. Rep.","Nursing Reports"],"abstract":"<jats:p>Background\/Objectives: Nursing diagnoses (NDs) support clinical reasoning, individualised care planning, and the visibility of nursing practice, yet their implementation remains inconsistent. This study prospectively examined whether TPB-informed beliefs, attitudes towards NDs, behavioural intention, and the nursing practice environment were associated with initial ND use and subsequent documentation intensity. Methods: A prospective observational cohort study was conducted across 14 adult inpatient units within a public healthcare organisation in Northern Italy. Baseline questionnaire data were linked with electronic nursing records, workforce data, and ward-level administrative data. Initial use was defined as documentation of at least one ND during follow-up. Results: The primary cohort included 144 nurses, of whom 122 (84.7%) documented at least one ND. Greater work exposure was associated with initial use (OR = 1.71, 95% CI [1.12, 2.60]). After additional adjustment for the overall PES-NWI, behavioural beliefs (OR = 1.93, 95% CI [1.09, 3.40]) and normative beliefs (OR = 2.09, 95% CI [1.16, 3.76]) were associated with initial use after multiplicity correction. These associations were attenuated and non-significant in the sensitivity cohort. Control beliefs, attitudes, and behavioural intention showed no consistent associations with initial use. No personal determinant was associated with documentation intensity. The nursing practice environment was not independently associated with either outcome. Conclusions: Initial ND use was associated with work exposure and, in the primary cohort, with behavioural and normative beliefs. Baseline individual and organisational factors did not explain documentation intensity, supporting a distinction between initiation and subsequent extent of use.<\/jats:p>","DOI":"10.3390\/nursrep16090321","type":"journal-article","created":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T15:09:28Z","timestamp":1788534568000},"page":"321","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Prospective Associations of Behavioural and Organisational Factors with Initial Nursing Diagnosis Use: A Longitudinal Study"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1644-2108","authenticated-orcid":false,"given":"Mattia","family":"Bozzetti","sequence":"first","affiliation":[{"name":"Direction of Health Professions, ASST Cremona, 26100 Cremona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8096-0199","authenticated-orcid":false,"given":"Ilaria","family":"Marcomini","sequence":"additional","affiliation":[{"name":"Center for Nursing Research and Innovation, Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, 20132 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberta","family":"Pendoni","sequence":"additional","affiliation":[{"name":"Direction of Health Professions, ASST Cremona, 26100 Cremona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alberto","family":"Silla","sequence":"additional","affiliation":[{"name":"Direction of Health Professions, ASST Cremona, 26100 Cremona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miriam","family":"Mariani","sequence":"additional","affiliation":[{"name":"Direction of Health Professions, ASST Cremona, 26100 Cremona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gianmario","family":"Pedretti","sequence":"additional","affiliation":[{"name":"Direction of Health Professions, ASST Cremona, 26100 Cremona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4301-8924","authenticated-orcid":false,"given":"Alessio","family":"Conti","sequence":"additional","affiliation":[{"name":"Research and Innovation Unit for Health Professions, San Luigi Gonzaga University Hospital, 10043 Orbassano, Italy"},{"name":"Department of Clinical and Biological Sciences, University of Turin, 10043 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5581-4114","authenticated-orcid":false,"given":"Alessio Lo","family":"Cascio","sequence":"additional","affiliation":[{"name":"Clinical Trial Unit, La Maddalena Cancer Center, 90146 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4192-7107","authenticated-orcid":false,"given":"Greta","family":"Ghizzardi","sequence":"additional","affiliation":[{"name":"Healthcare Professions Directorate, ASST Lodi, 26900 Lodi, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniele","family":"Napolitano","sequence":"additional","affiliation":[{"name":"SITRA\u2013Scientific Direction, Fondazione Policlinico Gemelli IRCSS, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Herdman, T.H., Kamitsuru, S., and Lopes, C. (2021). NANDA International Nursing Diagnoses: Definitions & Classification, 2021\u20132023, Thieme. [12th ed.].","DOI":"10.1055\/b000000516"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1111\/2047-3095.12363","article-title":"The quality of nursing documentation and standardised nursing diagnoses in the children\u2019s hospital electronic nursing records","volume":"34","author":"Nool","year":"2023","journal-title":"Int. J. Nurs. Knowl."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1177\/20473087261448767","article-title":"Utilization and psychometric properties of Quality of documentation of Nursing Diagnoses, Interventions, and Outcomes (Q-DIO): A scoping review","volume":"37","author":"Bozzetti","year":"2024","journal-title":"Int. J. Nurs. Knowl."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"105627","DOI":"10.1016\/j.ijmedinf.2024.105627","article-title":"Improving the quality of nursing care through standardised nursing languages: Call to action across European countries","volume":"192","author":"Nantschev","year":"2024","journal-title":"Int. J. Med. Inform."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"104431","DOI":"10.1016\/j.ijmedinf.2021.104431","article-title":"Use of standardised terminologies in clinical practice: A scoping review","volume":"149","author":"Fennelly","year":"2021","journal-title":"Int. J. Med. Inform."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Bozzetti, M., Marcomini, I., Parma, M., Dordoni, E., Magna, E., Staub, M.M., and Pendoni, R. (2024). Psychometric properties of the revised quality of nursing diagnosis, interventions, and outcomes instrument: A validation study. Int. J. Nurs. Knowl., Epub ahead of printing.","DOI":"10.1111\/2047-3095.12504"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Rodr\u00edguez-Su\u00e1rez, C.A., Gonz\u00e1lez-de la Torre, H., Hern\u00e1ndez-De Luis, M.N., Fern\u00e1ndez-Guti\u00e9rrez, D.\u00c1., Mart\u00ednez-Alberto, C.E., and Brito-Brito, P.R. (2023). Effectiveness of a Standardised Nursing Process Using NANDA International, Nursing Interventions Classification and Nursing Outcome Classification Terminologies: A Systematic Review. Healthcare, 11.","DOI":"10.20944\/preprints202306.1984.v1"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1269","DOI":"10.1002\/nop2.299","article-title":"Measuring the effects of guided clinical reasoning on the Advanced Nursing Process quality, on nurses\u2019 knowledge and attitude: Study protocol","volume":"6","author":"Mayer","year":"2019","journal-title":"Nurs. Open"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Bozzetti, M., Marcomini, I., Mariani, M., Pedretti, G., Silla, A., and Pendoni, R. (2025). Nurses\u2019 personal and environmental factors in approaches to nursing diagnoses: A cluster analysis. Int. J. Nurs. Knowl., Epub ahead of printing.","DOI":"10.1111\/2047-3095.70021"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1359","DOI":"10.1111\/jan.13545","article-title":"Nurses\u2019 beliefs about nursing diagnosis: A study with cluster analysis","volume":"74","author":"Pancani","year":"2018","journal-title":"J. Adv. Nurs."},{"key":"ref_11","first-page":"44","article-title":"Nursing Diagnosis Accuracy in Nursing Education: Clinical Decision Support System Compared with Paper-Based Documentation\u2014A Before and After Study","volume":"42","author":"Bertocchi","year":"2024","journal-title":"Comput. Inform. Nurs."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"665","DOI":"10.1111\/j.1559-1816.2002.tb00236.x","article-title":"Perceived Behavioural Control, Self-Efficacy, Locus of Control, and the Theory of Planned Behavior","volume":"32","author":"Ajzen","year":"2002","journal-title":"J. Appl. Soc. Psychol."},{"key":"ref_13","unstructured":"Krebs, D., and Schmidt, P. (1993). Attitude theory and the attitude-behavior relation. New Directions in Attitude Measurement, Walter de Gruyter."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1027\/2151-2604\/a000255","article-title":"How effective are behavior change interventions based on the theory of planned behavior? A three-level meta-analysis","volume":"224","author":"Steinmetz","year":"2016","journal-title":"Z. F\u00fcr Psychol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1016\/j.jclinepi.2007.11.008","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies","volume":"61","author":"Altman","year":"2008","journal-title":"J. Clin. Epidemiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2129","DOI":"10.1111\/jan.13285","article-title":"Prevalence of nursing diagnoses as a measure of nursing complexity in a hospital setting","volume":"73","author":"Sanson","year":"2017","journal-title":"J. Adv. Nurs."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1016\/j.apnr.2015.03.012","article-title":"Psychometric evaluation of the Positions on Nursing Diagnosis scale","volume":"29","author":"Vellone","year":"2016","journal-title":"Appl. Nurs. Res."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"3440","DOI":"10.1111\/jonm.13808","article-title":"The structure of the Italian version of the Practice Environment Scale of the Nursing Work Index","volume":"30","author":"Zanini","year":"2022","journal-title":"J. Nurs. Manag."},{"key":"ref_19","unstructured":"Brooks, M., Bolker, B., Kristensen, K., Maechler, M., Magnusson, A., McGillycuddy, M., Skaug, H., Nielsen, A., Berg, C., and van Bentham, K. (2026, July 28). glmmTMB: Generalized Linear Mixed Models Using Template Model Builder. Available online: https:\/\/cran.r-project.org\/web\/packages\/glmmTMB\/index.html."},{"key":"ref_20","unstructured":"Bolker, B., Robinson, D., Menne, D., Gabry, J., Buerkner, P., Hua, C., Petry, W., Wiley, J., Kennedy, P., and Sz\u00f6cs, E. (2026, July 28). broom.mixed: Tidying Methods for Mixed Models. Available online: https:\/\/cran.r-project.org\/web\/packages\/broom.mixed\/index.html."},{"key":"ref_21","unstructured":"Revelle, W. (2026, July 28). psych: Procedures for Psychological, Psychometric, and Personality Research. Available online: https:\/\/cran.r-project.org\/web\/packages\/psych\/index.html."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"324","DOI":"10.1111\/2047-3095.12449","article-title":"Romanian nurses\u2019 beliefs on nursing diagnosis. A survey study based on the theory of planned behavior","volume":"35","author":"Gligor","year":"2024","journal-title":"Int. J. Nurs. Knowl."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1891\/0889-7182.4.1.47","article-title":"The relationship of attitude, subjective norm, and behavioural intent to the documentation behavior of nurses","volume":"4","author":"Renfroe","year":"1990","journal-title":"Sch. Inq. Nurs. Pract."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1186\/1748-5908-3-36","article-title":"Healthcare professionals\u2019 intentions and behaviours: A systematic review of studies based on social cognitive theories","volume":"3","author":"Godin","year":"2008","journal-title":"Implement. Sci."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1007\/s10488-010-0319-7","article-title":"Outcomes for implementation research: Conceptual distinctions, measurement challenges, and research agenda","volume":"38","author":"Proctor","year":"2011","journal-title":"Adm. Policy Ment. Health Ment. Health Serv. Res."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"2540","DOI":"10.1093\/jamia\/ocae239","article-title":"Electronic health record system use and documentation burden of acute and critical care nurse clinicians: A mixed-methods study","volume":"31","author":"Cho","year":"2024","journal-title":"J. Am. Med. Inform. Assoc."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1186\/s13012-017-0551-6","article-title":"Planning to be routine: Habit as a mediator of the planning-behaviour relationship in healthcare professionals","volume":"12","author":"Potthoff","year":"2017","journal-title":"Implement. Sci."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e64616","DOI":"10.2196\/64616","article-title":"Factors Influencing the Implementation and Adoption of Digital Nursing Technologies: Systematic Umbrella Review","volume":"27","author":"Walzer","year":"2025","journal-title":"J. Med. Internet Res."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1097\/MLR.0000000000001109","article-title":"A Meta-Analysis of the Associations Between the Nurse Work Environment in Hospitals and 4 Sets of Outcomes","volume":"57","author":"Lake","year":"2019","journal-title":"Med. Care"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1186\/s13012-022-01245-0","article-title":"The updated Consolidated Framework for Implementation Research based on user feedback","volume":"17","author":"Damschroder","year":"2022","journal-title":"Implement. Sci."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1186\/s13012-015-0242-0","article-title":"Making sense of implementation theories, models and frameworks","volume":"10","author":"Nilsen","year":"2015","journal-title":"Implement. Sci."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1186\/s13012-024-01369-5","article-title":"A systematic review of experimentally tested implementation strategies across health and human service settings: Evidence from 2010\u20132022","volume":"19","author":"Ashcraft","year":"2024","journal-title":"Implement. Sci."}],"container-title":["Nursing Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2039-4403\/16\/9\/321\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T15:11:24Z","timestamp":1788534684000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2039-4403\/16\/9\/321"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,4]]},"references-count":32,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["nursrep16090321"],"URL":"https:\/\/doi.org\/10.3390\/nursrep16090321","relation":{},"ISSN":["2039-4403"],"issn-type":[{"value":"2039-4403","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,4]]}}}