Scholars@Duke
Michael Paul Cary

Michael Paul Cary

Associate Professor in the School of Nursing
School of Nursing
michael.cary@duke.edu
307 Trent Drive, Durham, NC 27710
307 Trent Drive, Office 1050 Clipp Building, Durham, NC 27710

Selected Publications

PReventing Injury in Skilled nursing facilities through optimizing Medications (PRISM), a protocol for a cluster randomized trial to reduce injurious falls in post-acute care.

Journal Article Trials · September 26, 2025 BACKGROUND: Patients who receive post-acute care in a skilled nursing facility (SNF) following a fracture are at high risk for subsequent fall-related injuries. Optimizing medication management may mitigate this risk. This manuscript describes the protocol ... Full text Link to item Cite

Algorithm-Based Clinical Decision Support: Evolving Regulatory Landscape and Best Practices for Local Oversight.

Journal Article Annu Rev Biomed Data Sci · August 2025 The potential of algorithm-based clinical decision support (CDS) in healthcare continues to increase with the growing field of artificial intelligence (AI)-enabled CDS. The use of these technologies to support clinicians, patients, and health systems is st ... Full text Link to item Cite

Integrating Artificial Intelligence Into Cancer Care: Enhancing Nursing Practice and Bridging Disparities.

Journal Article Clinical journal of oncology nursing · August 2025 Artificial intelligence (AI) in cancer care has the potential to transform nursing practice, reduce cancer disparities, and enhance patient outcomes across the continuum of care from prevention, screening, and treatment to su. ... Full text Cite

Preparedness for care transitions to home and acute care use of skilled nursing facility patients.

Journal Article BMC geriatrics · March 2025 BackgroundThe purpose of this study was two-fold: (1) describe the relationship between patient or caregiver reported preparedness for care transitions, and acute care use in 30 days after discharge from a skilled nursing facility (SNF); and (2) e ... Full text Cite

Empowering nurses to champion Health equity & BE FAIR: Bias elimination for fair and responsible AI in healthcare.

Journal Article J Nurs Scholarsh · January 2025 BACKGROUND: The concept of health equity by design encompasses a multifaceted approach that integrates actions aimed at eliminating biased, unjust, and correctable differences among groups of people as a fundamental element in the design of algorithms. As ... Full text Link to item Cite

State of Black men in nursing: An oral history of the challenges and the benefits of five Black male nurse leaders.

Journal Article Nursing outlook · January 2025 The underrepresentation of Black men in nursing continues to pose a significant challenge to diversity and equity in healthcare leadership. While systemic barriers, such as implicit bias, limited access to advanced education, and lack of mentorship, have b ... Full text Cite

"ROLE" Out of the Network of Black Male Nursing Leaders Mentorship Program.

Journal Article Nursing outlook · January 2025 Despite nursing being the largest segment in all of the healthcare workforce, with over five million practicing registered nurses in the United States, Black males remain significantly underrepresented, comprising merely about 0.67% to 1% of the nursing wo ... Full text Cite

Understanding the Multidimensionality of Caregiving Appraisal: A Concept Analysis

Journal Article Nursing Forum · January 1, 2025 Caregiving appraisal refers to how caregivers evaluate their caregiving situation. However, this concept, first introduced by Lawton et al. in 1989, has been inconsistently defined (e.g., often inaccurately interchanged with caregiving burden) over the pas ... Full text Cite

Building competency in artificial intelligence and bias mitigation for nurse scientists and aligned health researchers.

Journal Article Nurs Outlook · 2025 Healthcare systems are increasingly integrating artificial intelligence and machine learning (AI/ML) tools into patient care, potentially influencing clinical decisions for millions. However, concerns are growing about these tools reinforcing systemic ineq ... Full text Link to item Cite

Enhancing Clinical Decision Support in Nephrology: Addressing Algorithmic Bias Through Artificial Intelligence Governance.

Journal Article Am J Kidney Dis · December 2024 There has been a steady rise in the use of clinical decision support (CDS) tools to guide nephrology as well as general clinical care. Through guidance set by federal agencies and concerns raised by clinical investigators, there has been an equal rise in u ... Full text Link to item Cite

Skilled nursing facility staffing shortages: Sources, strategies, and impacts on staff who stayed.

Journal Article Health services research · December 2024 ObjectiveTo examine skilled nursing facility (SNF) staffing shortages across job roles during the COVID-19 pandemic. We aimed to capture the perspectives of leaders on the breadth of staffing shortages and their implications on staff that stayed t ... Full text Cite

A roadmap for the nursing scientific workforce to eliminate health and healthcare inequities.

Journal Article Nursing outlook · November 2024 BackgroundThe National Academies of Sciences, Engineering, and Medicine's Ending Unequal Treatment report emphasizes immediate actions to eliminate health inequities (i.e., solutions-oriented health inequity research), versus incrementally advanci ... Full text Cite

Efforts to Support the Mental Health and Well-being of Nursing Home Staff: Insights From Leaders.

Journal Article Journal of the American Medical Directors Association · August 2024 ObjectivesThe sustained stress and trauma experienced by frontline nursing home (NH) staff throughout the COVID-19 pandemic has been described in health care literature and popular press. Yet, limited attention has been given to attempts to suppor ... Full text Cite

Advancing Health Equity Through Artificial Intelligence: An Educational Framework for Preparing Nurses in Clinical Practice and Research.

Journal Article Creative nursing · May 2024 The integration of artificial intelligence (AI) into health care offers the potential to enhance patient care, improve diagnostic precision, and broaden access to health-care services. Nurses, positioned at the forefront of patient care, play a pivotal rol ... Full text Cite

Psychosocial stressors associated with frailty in community-dwelling older adults in the United States.

Journal Article Journal of the American Geriatrics Society · April 2024 BackgroundFrailty is multifactorial; however, psychosocial stressors contributing to frailty are poorly understood. This study aimed to examine whether gender, race/ ethnicity, and education are associated with differential exposure to psychosocia ... Full text Cite

A Qualitative Study of the Social Relationship Experiences Across the Life Course Among Black/African American Women Aging With HIV in the South.

Journal Article The Journal of the Association of Nurses in AIDS Care : JANAC · March 2024 AbstractBlack/African American women continue to be disproportionately affected by HIV, facing multiple intersecting challenges that influence how they age and effectively manage their health. Supportive social relationships have been shown to hel ... Full text Cite

Hospital Utilization for Coronary Artery Disease, 1997-2014.

Journal Article The Journal of cardiovascular nursing · March 2024 BackgroundCoronary artery disease (CAD) is the leading cause of cardiovascular morbidity, mortality, and healthcare costs in the United States. There are few reports on how public health and payment reforms might have influenced inpatient hospital ... Full text Cite

Translating ethical and quality principles for the effective, safe and fair development, deployment and use of artificial intelligence technologies in healthcare.

Journal Article J Am Med Inform Assoc · February 16, 2024 OBJECTIVE: The complexity and rapid pace of development of algorithmic technologies pose challenges for their regulation and oversight in healthcare settings. We sought to improve our institution's approach to evaluation and governance of algorithmic techn ... Full text Link to item Cite

Structural determinants and cardiometabolic typologies related to frailty in community-dwelling older adults.

Journal Article Archives of gerontology and geriatrics · February 2024 Frailty is a geriatric syndrome linked to adverse outcomes. Co-occurring cardiometabolic factors increase frailty risk; however, their distinct combinations (typologies) associated with frailty are unclear. We aimed to identify subgroups of older adults wi ... Full text Cite

Does cumulative psychosocial stress explain frailty disparities in community-dwelling older adults?

Journal Article Archives of gerontology and geriatrics · October 2023 ObjectiveFrailty is a leading predictor of adverse outcomes in older adults. Although disparities in frailty are well-documented, it is unclear whether psychosocial stressors explain these disparities. This study aimed to examine the potential med ... Full text Cite

Mitigating Racial And Ethnic Bias And Advancing Health Equity In Clinical Algorithms: A Scoping Review.

Journal Article Health Aff (Millwood) · October 2023 In August 2022 the Department of Health and Human Services (HHS) issued a notice of proposed rulemaking prohibiting covered entities, which include health care providers and health plans, from discriminating against individuals when using clinical algorith ... Full text Link to item Cite

A call to action to improve the completeness of older adult sexual and gender minority data in electronic health records.

Journal Article Journal of the American Medical Informatics Association : JAMIA · September 2023 Sexual and gender minority (SGM) older adults experience greater health disparities compared to non-SGM older adults. The SGM older adult population is growing rapidly. To address this disparity and gain a better understanding of their unique challenges in ... Full text Cite

Examining Human Capital Among Foreign- and U.S.-Educated Nurses in Long-term Care

Journal Article Journal of Nursing Regulation · July 1, 2023 Background: Recruiting foreign-educated nurses (FENs) is a strategy to reduce staffing shortages of registered nurses (RNs) practicing in long-term care (LTC) in the United States. However, little is known about how FENs compare to U.S.-educated nurses (US ... Full text Cite

Predictors of cognitive gains during inpatient rehabilitation for older adults with traumatic brain injury.

Journal Article PM R · March 2023 INTRODUCTION: Traumatic brain injury (TBI) among older adults is increasing and can affect cognition. To effectively meet the rehabilitation needs of older adults, a clearer picture is needed of patient-, clinical-, and facility-level characteristics that ... Full text Link to item Cite

Predictive Accuracy of Stroke Risk Prediction Models Across Black and White Race, Sex, and Age Groups.

Journal Article JAMA · January 2023 ImportanceStroke is the fifth-highest cause of death in the US and a leading cause of serious long-term disability with particularly high risk in Black individuals. Quality risk prediction algorithms, free of bias, are key for comprehensive preven ... Full text Cite

Sex and Racial/Ethnic Differences in Within-Stay Readmissions During Inpatient Rehabilitation Among Patients With Traumatic Brain Injury.

Journal Article Am J Phys Med Rehabil · December 1, 2022 OBJECTIVE: The aim of the study was to determine the association of sex and race/ethnicity with acute hospital readmissions ("within-stay readmissions") during inpatient rehabilitation facility care versus patients discharged home without a within-stay rea ... Full text Link to item Cite

Presurgical and Postsurgical Opioid Rates in Patients Undergoing Total Shoulder Replacement Surgery.

Journal Article Pain Manag Nurs · April 2022 BACKGROUND: The purpose of this study was to describe the pre- and postsurgical opioid prescription rates and average morphine milligram equivalents (MME) per day in patients undergoing total shoulder replacement (TSR) procedures. METHODS: Patients undergo ... Full text Link to item Cite

Registered Nurse Migration to the United States and the Impact on Long-Term Care.

Journal Article Journal of the American Medical Directors Association · February 2022 Full text Cite

The Association Between Cardiometabolic Risk Factors and Frailty in Older Adults: A Systematic Review.

Journal Article Innovation in aging · January 2022 Background and objectivesEnhanced management and prevention of frailty depend on our understanding of the association between potentially modifiable risk factors and frailty. However, the associations between potentially modifiable cardiometabolic ... Full text Cite

Age- and sex-specific predictors of inpatient rehabilitation facility discharge destination for adult patients with traumatic brain injury.

Journal Article Brain Inj · November 10, 2021 OBJECTIVE: : To determine age- and sex-specific predictors of discharge destination among patients with traumatic brain injury (TBI) receiving inpatient rehabilitation facility (IRF) care. DESIGN: : Secondary analysis of Uniform Data System for Medical Reh ... Full text Link to item Cite

Preoperative and Postoperative Opioid Prescription Rates in the Total Hip Replacement Surgical Patient.

Journal Article Orthop Nurs · November 2021 The United States is facing an opioid epidemic that has only worsened with the COVID-19 pandemic. There is little evidence regarding patterns of opioid use among patients with total hip replacement (THR). Although the Centers for Disease Control and Preven ... Full text Link to item Cite

Adaptive Challenges and Family Support: Patient Self-Management during Treatment for Chronic Hepatitis C.

Journal Article Nurs Sci Q · October 2021 The authors describe a family's adaptive challenges and adaptive work during a family member's treatment for Chronic Hepatitis C. We audiorecorded index and final clinical visits and interviewed participants (patients and providers) following the visits. W ... Full text Link to item Cite

Group Coaching Among African-American Individuals with Prediabetes in a Faith-Based Setting.

Journal Article Journal of National Black Nurses' Association : JNBNA · July 2021 Roughly 88 million adults have prediabetes and over 84% are unaware that they even have prediabetes. African-Americans have an increased risk of being diagnosed with prediabetes. Faith-based organizations have a history of serving as a primary source of so ... Cite

Inpatient rehabilitation facility discharge destination among younger adults with traumatic brain injury: differences by race and ethnicity.

Journal Article Brain Inj · May 12, 2021 OBJECTIVE: : To determine the association of race and ethnicity with discharge destination among patients with traumatic brain injury (TBI) receiving inpatient rehabilitation facility (IRF) care. DESIGN: Secondary analysis using Uniform Data System for Med ... Full text Link to item Cite

Using Clinical Data to Improve the Quality of Health Care.

Journal Article Journal of perianesthesia nursing : official journal of the American Society of PeriAnesthesia Nurses · April 2021 Full text Cite

Machine Learning Algorithms to Predict Mortality and Allocate Palliative Care for Older Patients With Hip Fracture.

Journal Article J Am Med Dir Assoc · February 2021 OBJECTIVES: To evaluate a machine learning model designed to predict mortality for Medicare beneficiaries aged >65 years treated for hip fracture in Inpatient Rehabilitation Facilities (IRFs). DESIGN: Retrospective design/cohort analysis of Centers for Med ... Full text Link to item Cite

Creating a culture that values diversity and inclusion: An action-oriented framework for schools of nursing.

Journal Article Nursing forum · November 2020 An organizational culture that values diversity and inclusion is essential for the achievement of high-quality nursing education, yet little literature exists to guide schools of nursing (SON) in accomplishing this goal. All SONs, regardless of size, need ... Full text Cite

Health Equity Research in Nursing and Midwifery: Time to Expand Our Work

Journal Article Journal of Nursing Regulation · July 1, 2020 Full text Cite

Quality of life in older adults receiving hemodialysis: a qualitative study.

Journal Article Qual Life Res · March 2020 PURPOSE: Patient priorities for quality of life change with age. We conducted a qualitative study to identify quality of life themes of importance to older adults receiving dialysis and the extent to which these are represented in existing quality of life ... Full text Link to item Cite

Identifying treatment effects of an informal caregiver education intervention to increase days in the community and decrease caregiver distress: a machine-learning secondary analysis of subgroup effects in the HI-FIVES randomized clinical trial.

Journal Article Trials · February 14, 2020 BACKGROUND: Informal caregivers report substantial burden and depressive symptoms which predict higher rates of patient institutionalization. While caregiver education interventions may reduce caregiver distress and decrease the use of long-term institutio ... Full text Open Access Link to item Cite

Black Fathers' Preferences for Sexual Health Interventions with their Adolescent Sons.

Journal Article Journal of the National Medical Association · October 2019 Full text Cite

Learning about culturally humble care of sexual and gender minority patients.

Journal Article Teaching and learning in nursing : official journal of the National Organization for Assciate Degree Nursing · July 2019 Each day, nurses care for patients from diverse cultures and backgrounds, including those who self-identify as lesbian, gay, bisexual, transgender, or queer. To facilitate productive health partnerships, nurses need to be aware of a patient's sexual orient ... Full text Cite

Moderators of Treatment Outcomes from Family Caregiver Skills Training: Secondary Analysis of a Randomized Controlled Trial

Journal Article OBM Geriatrics · April 18, 2019 Background: Moderator analyses may be helpful for evaluating intervention effects. The objective of this study was to evaluate whether the effect of a caregiver skills training intervention – Helping Invested Families Improve Veterans' Experience S ... Full text Cite

Multimodal Pain Management for Major Joint Replacement Surgery.

Journal Article Orthopedic nursing · March 2019 Effective pain management for orthopaedic major joint replacement is key to achieving earlier recovery, better functioning, and high rates of patient satisfaction. In an effort to decrease opioid dependency, practitioners are turning to multimodal pain man ... Full text Cite

Hospital Readmission and Costs of Total Knee Replacement Surgery in 2009 and 2014: Potential Implications for Health Care Managers.

Journal Article Health Care Manag (Frederick) · 2019 The purpose of this article is to describe changes in hospital readmissions and costs for US hospital patients who underwent total knee replacement (TKR) in 2009 and 2014. Data came from the Healthcare Cost and Utilization Project net-Nationwide Readmissio ... Full text Link to item Cite

Clinical Encounters and Treatment Initiation for Chronic Hepatitis C Patients: Applications of Adaptive Leadership Framework for Chronic Illness.

Journal Article Sage Open · 2019 Chronic Hepatitis C (CHC) is the most common blood-borne infection in the U. S. Patients with CHC undergoing treatment face many challenges including adherence to medications and management of symptoms; health care practitioners are well positioned to faci ... Full text Link to item Cite

Successful Community Discharge Following Postacute Rehabilitation for Medicare Beneficiaries: Analysis of a Patient-Centered Quality Measure.

Journal Article Health Serv Res · August 2018 OBJECTIVE: To determine the sociodemographic and clinical characteristics as well as health services use associated with successful community discharge. DATA SOURCE: Inpatient Rehabilitation Facility-Patient Assessment Instrument and Medicare Provider Anal ... Full text Link to item Cite

Preparing Clinicians for Transitioning Patients Across Care Settings and Into the Home Through Simulation.

Journal Article Home healthcare now · July 2018 Assuring home care staff competencies through simulation has the potential to improve care transitions and clinical outcomes. Recreating a home environment can be used for orientation of home care staff and to meet other learning needs. Lessons learned fro ... Full text Cite

Hospital Readmission in Total Hip Replacement Patients in 2009 and 2014.

Journal Article Arch Phys Med Rehabil · June 2018 OBJECTIVE: To document changes in 30-day hospital readmission rates and causes for returning to the hospital for care in THR patients. DESIGN: Retrospective cross-sectional descriptive design. SETTING: Community-based acute care hospitals. PARTICIPANTS: To ... Full text Link to item Cite

Management Team Perceptions of Risks and Strategies for Preventing Falls Among Short-Stay Patients in Nursing Homes.

Journal Article Health Care Manag (Frederick) · 2018 We sought to understand strategies reported by members of the nursing home management team used to prevent falls in short-stay nursing home patients. Using Donabedian's model of structure, process, and outcomes, we interviewed 16 managers from 4 nursing ho ... Full text Link to item Cite

Improving Quality and Safety Through Use of Secondary Data: Methods Case Study.

Journal Article Western journal of nursing research · November 2017 Researchers need to evaluate the strengths and weaknesses of data sets to choose a secondary data set to use for a health care study. This research method review informs the reader of the major issues necessary for investigators to consider while incorpora ... Full text Cite

Effect of Promoting High-Quality Staff Interactions on Fall Prevention in Nursing Homes: A Cluster-Randomized Trial.

Journal Article JAMA Intern Med · November 1, 2017 IMPORTANCE: New approaches are needed to enhance implementation of complex interventions for geriatric syndromes such as falls. OBJECTIVE: To test whether a complexity science-based staff training intervention (CONNECT) promoting high-quality staff interac ... Full text Link to item Cite

Student-Developed Simulations: Enhancing Cultural Awareness and Understanding Social Determinants of Health.

Journal Article The Journal of nursing education · April 2017 BackgroundNational and global initiatives to address the social determinants of health (SDH) are on the rise. On a parallel trajectory, increased cultural awareness is emerging as an integral strategy to improve the understanding of these social c ... Full text Cite

The Effects of Social Support on Physical Functioning in Older African Americans: Longitudinal Results from the Baltimore Study of Black Aging.

Journal Article Journal of the National Medical Association · December 2016 IntroductionCompared with other racial/ethnic groups, African Americans have higher rates of chronic conditions and suffer a disproportionate burden of disability. We aimed to examine the effects of social support on physical functioning among old ... Full text Cite

The Relationship between Pain, Disability, and Sex in African Americans.

Journal Article Pain management nursing : official journal of the American Society of Pain Management Nurses · October 2016 Older African Americans consistently report diminished capacities to perform activities of daily living (ADL) compared with other racial groups. The extent to which bodily pain is related to declining abilities to perform ADL/ADL disability in African Amer ... Full text Cite

Benefits and Challenges of Delivering Tele-rehabilitation Services to Rural Veterans.

Journal Article Home Healthc Now · September 2016 Veterans residing in underserved rural areas face many barriers to accessing high-quality rehabilitation services. This article describes the benefits and challenges of using technology for delivery of rehabilitation services to rural Veterans using TeleHO ... Full text Link to item Cite

Brain Gaming: A User's Product Guide for the Clinician.

Journal Article Archives of physical medicine and rehabilitation · August 2016 Full text Cite

Sustaining complex interventions in long-term care: a qualitative study of direct care staff and managers.

Journal Article Implement Sci · July 16, 2016 BACKGROUND: Little is known about the sustainability of behavioral change interventions in long-term care (LTC). Following a cluster randomized trial of an intervention to improve staff communication (CONNECT), we conducted focus groups of direct care staf ... Full text Link to item Cite

Self-Care and Mobility Following Postacute Rehabilitation for Older Adults With Hip Fracture: A Multilevel Analysis.

Journal Article Arch Phys Med Rehabil · May 2016 OBJECTIVE: To examine contextual (facility and community) and individual factors associated with self-care and mobility outcomes among Medicare hip fracture patients receiving inpatient rehabilitation. DESIGN: Retrospective cohort study of 3 linked data fi ... Full text Link to item Cite

Changes in Payment Regulation and Acute Care Use for Total Hip Replacement: Trends in Length of Stay, Costs, and Discharge, 1997-2012.

Journal Article Rehabilitation nursing : the official journal of the Association of Rehabilitation Nurses · March 2016 PurposeTo describe trends in the length of stay (LOS), costs, mortality, and discharge destination among a national sample of total hip replacement (THR) patients between 1997 and 2012.DesignLongitudinal retrospective designMethods Full text Cite

Relationship Between Chronic Conditions and Disability in African American Men and Women.

Journal Article Journal of the National Medical Association · February 2016 BackgroundRace differences in chronic conditions and disability are well established; however, little is known about the association between specific chronic conditions and disability in African Americans. This is important because African America ... Full text Cite

Inpatient Rehabilitation Outcomes in a National Sample of Medicare Beneficiaries With Hip Fracture.

Journal Article Journal of applied gerontology : the official journal of the Southern Gerontological Society · January 2016 Effects of patient characteristics on rehabilitation outcomes (functional status at discharge, discharged home) were assessed in a retrospective study of Medicare beneficiaries admitted to Medicare-certified inpatient rehabilitation facilities (IRFs) follo ... Full text Cite

Performance-based outcomes of inpatient rehabilitation facilities treating hip fracture patients in the United States.

Journal Article Archives of physical medicine and rehabilitation · May 2015 ObjectiveTo examine the influence of facility and aggregate patient characteristics of inpatient rehabilitation facilities (IRFs) on performance-based rehabilitation outcomes in a national sample of IRFs treating Medicare beneficiaries with hip fr ... Full text Cite

Exploring cancer support needs for older African-American men with prostate cancer.

Journal Article Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · September 2011 OBJECTIVE: The purpose of this study was to explore cancer support and financial issues related to cancer care experienced by African-American men with prostate cancer and to understand whom they relied on for resource issues during diagnosis and treatment ... Full text Cite

Geriatric assessment: Essential skills for nurses

Journal Article American Nurse Today · July 2011 Link to item Cite

Cognitive work analysis to evaluate the problem of patient falls in an inpatient setting.

Journal Article Journal of the American Medical Informatics Association : JAMIA · August 2010 OBJECTIVE: To identify factors in the nursing work domain that contribute to the problem of inpatient falls, aside from patient risk, using cognitive work analysis. METHODS: A mix of qualitative and quantitative methods were used to identify work constrain ... Full text Cite

An engineering work analysis applied to patient falls in the nursing domain.

Conference AMIA ... Annual Symposium proceedings. AMIA Symposium · November 2008 Patient falls in hospitals result in negative outcomes such as prolonged lengths of stay, various injuries, and even death. Nurses are responsible for identifying patients at risk for falls and implementing preventative measures. The focus of this research ... Cite