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Spirituality is a crucial yet complex element of holistic nursing care, particularly when providing care for older adults with depression. In Thailand, depression poses a significant mental health challenge. Thai cultural values are deeply interwoven with individuals' beliefs, making spirituality a critical factor in addressing the care of older adults with depression. This study aimed to explore how older adults with depression experience spirituality and construct meaning from it in their daily lives.
An interpretative phenomenological study.
In-depth interviews of 30 older Thai adults living with depression (aged 60–85 years) from an outpatient psychiatric clinic in southern Thailand were conducted using semi-structured interview questionnaires. Interpretive phenomenological analysis was employed. Data were collected from June to August 2024.
Five themes emerged from the phenomenological data analysis: (1) elusiveness of spiritual meaning, (2) holding oneself together through inner power, (3) finding acceptance through faith in a higher power, (4) family ties shaping peace and despair, and (5) being guided and cared for.
This study highlights that older adults with depression perceive spirituality as essential for their well-being. Personal practices, such as meditation and chanting, played a key role in strengthening spirituality and reducing the risk of relapse in depressive symptoms, which are distinct for each older adult. Understanding spirituality's role in mental health guides nurses to develop strategies for providing more empathetic spiritual care.
Nurses must address depression in older adults through individualized practices to effectively empower their inner strength and coping mechanisms. Understanding each individual's spiritual practices is essential to help them harness their inner strength when coping with depression.
Commentary on: Yang J, Chen Y, Tian Y, Li X, Yu Q, Huang C, Chen Z, Ning M, Li S, He J, Du J, Huang B, and Li Y (2024). Risk factors and consequences of mental health problems in nurses: A scoping review of cohort studies. International Journal of Mental Health Nursing. Advance online publication. https://doi.org/10.1111/inm.13337
Implications for practice and research Implement interventions to reduce workplace bullying, violence and job demands while promoting healthy lifestyles and social support for nurses. Future research should investigate nurses’ mental health in low-income and middle-income countries, explore gender differences and evaluate the effectiveness of mental health interventions.
Mental health issues among nurses are widespread and jeopardise healthcare systems and patient care.
Commentary on: Kata A, Dillon EC, Christina Keny RN, et al.‘There’s So Much That They're Enduring’: Experiences of Older Adults Undergoing Major Elective Surgery. Ann Surg. Published online April 9, 2024. doi:10.1097/SLA.0000000000006293
Implications for practice and research Routine psychosocial assessments for older adults may be implemented throughout the perioperative continuum to proactively identify emotional challenges and offer tailored support. The effectiveness of integrated mental health and social support in improving surgical outcomes should be investigated in this vulnerable population, including longitudinal studies on mental health interventions.
Elderly patients, defined as adults aged 65 years and above, represent a growing segment of the surgical population.
Understanding the quality of published research is essential for nurses, educators and healthcare researchers striving to implement evidence-based practice. However, ‘quality assessment’ can seem abstract or overly technical, primarily for those new to research appraisal. In an era where clinical decisions and policy recommendations are increasingly data-driven, evaluating the methodological rigour of quantitative studies is more critical than ever.
High-quality research provides trustworthy, valid and ethically sound conclusions. In contrast, poorly conducted studies can lead to misguided clinical decisions, suboptimal patient care and inefficient resource use.
Quality assessment involves evaluating a study’s design, methodology and reporting to determine its risk of bias and trustworthiness.
Commentary on: Hollingdale J, Woodhouse E, Tibber MS et al. The cumulative impact of attention deficit hyperactivity disorder, autism and intellectual disability for young people. J Intellectual Disability Research 2024;
Implications for practice and research Neurodevelopmental conditions frequently occur in groups, rather than as single entities. Awareness of this and the cumulative effects they can have on a person’s functioning is vital to providing the person with optimal healthcare. Further research is needed to better understand the factors that modify these cumulative effects.
Attention deficit hyperactivity disorder (ADHD), autism disorder and intellectual disability (ID) are increasingly identified, and the co-occurrence of these and other social-emotional conditions has raised awareness that treatment of people with multiple diagnoses becomes more complex. Hollingdale and colleagues
Assisted dying is changing. Countries around the world, including the UK,
The opportunity to write this editorial could not be more timely, having recently been invited to join the Independent Expert Panel of the UK Government’s Health and Social Care Committee, evaluating the state of palliative care in England.
There is a wealth of research...
Commentary on: Haines S, Stanton R, Anderson C, Welsh A. Ethical challenges for nurses delivering coercive interventions in community mental health setting: a scoping review. Int J Mental Health Nurse. 2023; 33: 750-759. doi: 10.1111/inm.13290.
Implications for practice and research To prevent and reduce coercive interventions in mental health and community settings, collaborative and continued efforts should target creating policies and ethical and best clinical practice guidelines. Future research should focus on developing clear, consistent and effective global policies and ethical guidelines to prevent and reduce coercive behaviour in clinical and community settings, especially in psychiatry.
While the percentages of coercive interventions in psychiatry vary in different countries and clinical settings, global initiatives are increasingly aimed at preventing and reducing these interventions in the mental health and community settings.
Commentary on: Platz K, Metzger M, Cavanagh C, et al. Initiating and continuing long-term exercise in heart failure: A qualitative analysis from the GEtting iNTo Light Exercise-Heart Failure Study. J Cardiovasc Nurs; 2024 Feb 26. doi: 10.1097/JCN.0000000000001086. Epub ahead of print. PMID: 38411493
Implications for practice and research When clinicians have a better understanding of patient decisions regarding exercise, they are better equipped to redesign traditional cardiac exercise programmes. Themes from this study provide frameworks to design future quantitative and mixed-method studies that will inform clinicians about the patient experience with cardiac exercise programmes.
Management of heart failure (HF) is a challenge, with less than one-third of patients meeting physical activity recommendations.
Commentary on: Borumandnia et al. The impact of vitamin D changes during pregnancy on the development of maternal adverse events: a random forest analysis. BMC Pregnancy and Childbirth 2024;24:125.
Implications for practice and research Data presented in this paper do not demonstrate a cause-effect relationship between maternal vitamin D deficiency during pregnancy and increased risk of maternal adverse events. Randomised controlled trials are needed to resolve uncertainty regarding the effects of vitamin D supplementation in pregnancy on maternal and fetal outcomes.
Sustainable Development Goal Target 3.1 is to reduce maternal mortality to less than 70 maternal deaths per 100 000 live births by 2030. This remains elusive, with 223 maternal deaths per 100 000 live births reported worldwide in 2020.
Commentary on: Hassan, E. A., & El-Ashry, A. M. (2024). Leading with AI in critical care nursing: challenges, opportunities, and the human factor. BMC Nursing, 23(1), 752. doi: https://doi.org/10.1186/s12912-024-02363-4
Implications for practice and research Ensure transparent artificial intelligence (AI) systems to build trust and develop robust nurse training programmes to integrate AI effectively. Further studies on ethical AI use, reducing algorithmic bias, and AI’s long-term effects on nurse–patient relationships.
The integration of artificial intelligence (AI) in intensive care units (ICUs) marks a significant advancement in critical care, offering automated task management and enhanced data analysis. Historically, critical care has relied on high-acuity clinical decision-making, where nurses’ judgement and expertise are paramount. The rapid evolution of AI promises efficiency but raises concerns about ethical implications, role changes and trust. While AI tools improve clinical outcomes, their black-box nature and potential for...
Commentary on: Brewster RCL, Gonzalez P, Khazanchi R, et al. (2024) Performance of ChatGPT and Google Translate for Pediatric Discharge Instruction Translation. Pediatrics. 2024;154(1).
Implications for practice and research Artificial intelligence (AI) has significant potential to impact healthcare, but further research is required to evaluate validity of translation for communication. Enhanced clinician communication is needed for non-native speaking patient groups, and AI translations may be useful. However, content must reflect true clinical ‘meaning’.
Today’s world is increasingly augmented by AI, and use and application of natural language process-based translation services could enhance clinical communications. They have the potential to support confidential and cost-effective communication mechanisms for non-native language patients. This study
Commentary on: Flores JP, Kahn G, Penfold RB, et al. Adolescents who do not endorse risk via the Patient Health Questionnaire before self-harm or suicide. JAMA Psychiatry. 2024;81(7):717–26
Implications for practice and research Screening tools should not be used to determine the risk of self-harm and suicide in young people. Research should focus on novel approaches to predicting the risk of self-harm and suicide.
Self-harm is defined as self-injury or self-poisoning, irrespective of the presence or absence of suicidal intent.
The prevalence of self-harm is just under...
Commentary on: Down L, Barlow M, Bailey SER, et al. Association between patient ethnicity and prostate cancer diagnosis following a prostate-specific antigen test: a cohort study of 730,000 men in primary care in the UK. BMC Med 2024 Mar 1;22(1):82.
Implications for practice and research Clinicians should consider ethnic differences when interpreting prostate-specific antigen test results, particularly for black men, to ensure timely prostate cancer diagnosis and avoid overtreatment or undertreatment. Further studies are needed to explore genetic, environmental and healthcare access factors that contribute to ethnic differences in prostate cancer incidence and progression.
Prostate cancer is a common cancer worldwide, with incidence and mortality varying significantly across ethnic groups.
Identify desired training content for shift-working nurses to improve their sleep and fatigue.
A descriptive qualitative design.
We recruited night shift nurses (N = 23) to provide feedback during virtual focus groups/interviews. Data collection occurred in the U.S. between March and June 2024. Participants were presented with sleep and fatigue topics derived from the literature. Focus group/interview data were collected and transcribed. Data were analysed using a hybrid deductive-inductive manifest content analysis with an a priori coding schema based on topics shared during data collection. Data not fitting the schema, yet informing content, were analysed inductively.
Three themes aligned with literature-derived topics. Theme 1, Why We Sleep and Why Should Nurses Care, explains the importance of sleep to health. Theme 2, Sleep Practices for Nurses to Support Health and Social Relationships, describes healthy strategies to promote sleep for enhanced quality of life. Theme 3, Fatigue and Work, illustrates the significance of nurse sleep and fatigue risk mitigation to safe working conditions and patient care.
Study findings highlight night shift nurses' interest in gaining evidence-based information to promote their sleep. Sleep education and training could fill a knowledge and skills gap, not often offered in school or workplace.
Identifying themes relevant to nurses may help increase the development and availability of sleep education and training currently tailored for nurses.
Study findings describe content night shift nurses' desire for sleep and fatigue training, serving as an important first step in developing programmes most relevant to shift-working nurses. Our analysis found the findings largely align with key components workers should receive in sleep education and training and reinforced the need for employers to offer such training. This study could benefit the nursing workforce and employers who expect rested, high-functioning nurses to care for patients.
Standards for Reporting Qualitative Research.
No patient or public contribution.
Clinicaltrials.gov, NCT06105307
To synthesise the evidence on implementation strategies used to implement transitional care interventions for adult surgical patients.
Scoping review.
Medline, CINAHL and EMBASE were searched in August 2023 and updated June 2025, followed by citation searches. Studies were screened independently by two researchers, and one extracted data, another verified its accuracy. Studies about transitional care interventions for adult surgical patients were coded according to the ‘Five classes of implementation strategies’ and the ‘Patterns, Advances, Gaps, Evidence for practice and Research recommendations’ framework, to illuminate the review findings.
Based on 27 studies included in the scoping review, staff education, changes to staffing and electronic systems, and change management techniques were frequently used implementation strategies. Implementation strategies were mostly used with patients undergoing colorectal and cardiac surgery in Asia and the United States. Scale-up strategies and capacity-building initiatives for people in charge of spearheading the change initiatives were less common.
To further the field, future research could focus on capacity-building and scale-up strategies, fidelity reporting, and financial implications of implementation in a wider range of surgical populations and settings. Work is needed to effectively implement surgical transitional care interventions in real-world settings.
Our findings provide strategies for hospital leaders to adopt when implementing transitional care interventions for surgical patients.
Scoping Reviews (PRISMA-ScR) checklist.
Determined review focus, interpreted findings, and contributed to manuscript.
The Open Science Framework.
To investigate factors influencing the implementation of advanced practice nursing roles within healthcare organisations in seven European countries from the perspective of advanced practice nurses.
A cross-sectional survey was conducted between September 2021 and December 2022, involving advanced practice nurses from Belgium, Finland, Germany, Iceland, Ireland, Spain and the Netherlands. The countries were selected to represent different stages of implementing advanced practice nursing roles, from emerging to well-established.
A self-administered questionnaire was used to address five domains: patient care, practice patterns, policy and legal, educational and workforce-related factors. Descriptive statistics, chi-squared tests and correspondence analysis were employed to identify patterns and country-specific differences across these domains of implementation factors.
A total of 491 advanced practice nurses participated in the study. While almost three-quarters of the participants indicated satisfaction with their job, the study highlighted multifaceted factors influencing the implementation of advanced practice nursing roles across countries. The Netherlands, Ireland and Belgium reported mainly facilitators, whereas Finland, Iceland and Germany noted barriers or a lack of knowledge. Spain mostly reported neutral or moderate positions. Key challenges included role ambiguity, interprofessional collaboration gaps, limited managerial support, workload imbalances, limited mentorship and underutilised competencies. Results also indicated that advanced practice nurses are partially hindered by operating in isolation from other professions.
The findings emphasise the need for robust organisational support, interprofessional collaboration and clear role definitions to facilitate the integration of advanced practice nursing roles. Addressing professional isolation through networking and mentorship is crucial to sustaining the advanced practice nursing workforce.
Policy should prioritise support for advanced practice nursing, including structured mentoring and networking opportunities. Further research on advanced practice nurses' well-being and long-term role sustainability in Europe is recommended.
What problem did the study address? What were the main findings? Where and on whom will the research have an impact?
This study reported factors influencing advanced practice nurse role implementation across seven European countries with different levels of role development. Key challenges included role ambiguity, interprofessional collaboration gaps and limited support. The findings can guide healthcare managers and policymakers on the key factors to consider when integrating advanced practice nursing roles into their teams.
To evaluate the safety, feasibility and acceptability of weighted blankets for patients with dementia who experience agitation in acute care.
Randomised controlled trial.
Patients with dementia experiencing agitation at a single hospital were recruited between May 2023 and January 2024. Participants were randomly assigned to the intervention (weighted blanket) or control (standard care) group. Agitation scores, vital signs, skin integrity, pharmacological interventions and general observations were recorded at baseline and at 15-, 30-, 60- and 75-min (or 15-min post-blanket removal) post-baseline. Nursing staff completed a survey on the intervention's acceptability, appropriateness and feasibility.
There was a recruitment rate of 86.7%, 70% of patients tolerated the intervention for the full duration. Nursing staff agreed the intervention was appropriate (100%), acceptable (100%) and feasible (92.9%). The intervention reduced patient heart and respiratory rates. No significant impact on patient temperature, oxygen saturations, skin integrity or risk of falls was found. The intervention reduced agitation scores, pharmacological and non-pharmacological interventions.
Weighted blankets in acute care settings are safe and have some effect on agitation and pharmacological use. Staff found the use of weighted blankets to be acceptable and most patients tolerated use of the blankets without increased risk of adverse events.
This study provides evidence that weighted blankets may be used safely with the acceptance of patients with dementia and staff in hospitals.
This study addressed the use of weighted blankets for persons with dementia who are experiencing agitation and found that they are safe and feasible for use in acute care. Future research is feasible and should focus on blanket weight dosing and the effect on agitation, pharmacological and non-pharmacological interventions.
Adheres to the CONSORT 2010 checklist for a feasibility trial.
Patients and public did not contribute to this study.
ACTRN12623000003673
To describe symptom patterns in first-time mothers through 3 months postpartum.
Longitudinal, descriptive correlational.
Secondary analysis of data from a randomised clinical trial of first-time mothers. Symptoms were assessed at 1, 2 and 3 months postpartum using the Memorial Symptom Assessment Scale for dimensions of 32 symptoms.
New mothers (n = 114) reported an average of 7.0 (SD 4.7) symptoms at 1 month, decreasing to 5.3 (SD 4.3) at 3 months. Physical symptoms decreased to the greatest degree. Symptoms reported by over 33% of participants included lack of energy, worrying, pain, difficulty sleeping or concentrating and feeling irritable, sad or drowsy. The most distressing were lack of energy, feeling irritable, pain, nervousness and hair loss. Symptoms did not differ by type of birth or infant feeding. Older mothers (≥ 35 years) had significantly more symptoms and distress than younger mothers.
Most symptoms improved over time, yet some were still prevalent at 3 months. Symptoms not appraised as particularly distressing may still be of clinical concern for safety reasons. Frequent postpartum assessments and interventions are important, particularly for older mothers.
In the first 3 months, postpartum symptoms not perceived as distressing may lead to adverse health outcomes. These symptoms may threaten maternal–infant welfare beyond the first 3 months postpartum. Older first-time mothers merit particular attention by clinicians.
The authors complied with STROBE reporting guidelines.
No patient or public contribution.
To: (i) examine Stroke Coordinators' perspectives of factors influencing sustained adherence to evidence-based protocols to manage Fever, Sugar (hyperglycaemia) and Swallow (FeSS) and (ii) compare findings between hospitals with consistently high FeSS Protocol adherence versus those with consistently low or variable adherence.
Qualitative descriptive process evaluation using in-depth, individual semi-structured interviews.
Hospitals that participated in ≥ 3 national stroke audit cycles were ranked by mean adherence to FeSS Protocols and stratified by consistently high, low and variable adherence. Three hospitals from each adherence strata were purposefully selected after further stratification by (i) previous participation in a FeSS Intervention study; and (ii) location (state, remoteness). Inductive thematic analysis was undertaken, with themes mapped to factors from the framework to compare findings by adherence level and contextualise the findings in relation to sustainability.
Analysis of 14 interviews identified two themes [and sub-themes]: (1) Stroke Coordinator as sustainability champions and boundary spanners [maintenance of implementation strategies; fostering working relationships, communication and influence] mapped to Workforce factors, organisational and Innovation-specific factors; and (2) Hospital executive and middle management respect of stroke specialty [designated area for stroke care; recognition of stroke specialist nursing skills; previous FeSS Intervention study participation] mapped to Workforce and Political factors. Key differences by adherence groupings related to the Stroke Coordinator model, workplace configuration, and the impact of interdepartmental relationships and competing organisational directives.
The Stroke Coordinator role was pivotal for sustained use of evidence-based FeSS Protocols for acute stroke care, driving multidisciplinary collaboration.
Internationally, many patients do not receive evidence-based acute stroke care. Despite the proven benefits of the FeSS Protocols, consistent implementation remains a challenge. This study recognises the critical importance of a dedicated Stroke Coordinator for all acute stroke hospitals. Their advocacy for the use of evidence-based interventions is key to improving stroke outcomes.
This study did not include patient or public involvement in its design, conduct, or reporting as it focused solely on the professional experiences of stroke care providers.
ACTRN 12623000445673. Registered 1 May 2023
To explore the feasibility and acceptability of acoustic monitoring and real-time recommendations for stress detection and management (i.e., smarthealth intervention).
This qualitative study used a framework of acceptability for healthcare interventions.
From January 2021 to December 2023 in the U.S.A., we interviewed 10 family caregivers who had completed the 4-month smarthealth intervention. The caregivers shared their user experiences and feedback on the system's feasibility and acceptability. Data were analysed using abductive thematic analysis, incorporating the framework of acceptability for healthcare interventions and the collected data.
Seven themes and 19 categories emerged: attitudes, burden, ethicality, intervention adherence, intervention coherence, perceived effectiveness and suggestions. Feedback on the smarthealth intervention was mixed. Some found it beneficial, citing accuracy, ease of use and increased awareness. However, others felt burdened during its use, primarily due to time constraints.
The smarthealth intervention can potentially improve caregivers' awareness of themselves and caregiving situations.
Future directions should involve adapting the smarthealth intervention to consider diverse caregiving scenarios and incorporating a larger sample of caregivers.
This is the first study to offer a voice detection system and real-time stress management recommendations to caregivers of people living with dementia. An individualised approach should be considered to improve the system's effectiveness. This includes providing personalised intervention components, considering caregivers' time and establishing a user-friendly system with high accessibility. The findings can be a cornerstone for smarthealth interventions influencing dementia caregivers' self-care and emotional regulation.
Standards for Reporting Qualitative Research.
Members of the public and service users from a memory clinic and social media platforms contributed to the study by reviewing recruitment materials.
Trial Registration: This trial's study protocol was registered with ClinicalTrials.gov (ID No. NCT04536701) on 3 September 2020 (https://classic.clinicaltrials.gov/ct2/show/NCT04536701)
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