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To evaluate the ‘Countdown to Theatre’ intervention, a co-designed nurse-led approach developed using the COM-B framework to address context-specific barriers and facilitators to preoperative fasting practices.
A prospective mixed-method, pre–post study assessed the intervention's impact on fasting adherence and patient experience.
Participants included children booked for a procedure under general anaesthesia. Adherence was assessed through audited fasting duration, and patient experience was evaluated using caregiver/patient surveys. The intervention was implemented and monitored by nursing staff as a part of a structured quality improvement process. Nurses played a central role in embedding the approach into daily workflows and reinforcing fasting timelines
Over 9 months, 901 observations were undertaken from 774 patients. Fasting duration decreased from 7.6 to 5.7 h (mean difference −1.94; 95% CI −3.04, −0.86). Parent-reported patient experience surveys showed improvement in many areas, including an increase in overall satisfaction (from 44.7% to 68.8%).
The intervention successfully reduced prolonged fasting and improved patient experiences, demonstrating the value of co-designed approaches in addressing evidence–practice gaps in perioperative care.
The principles of co-design, structured implementation and the application of the COM-B framework provide a replicable model for addressing similar challenges in healthcare. The study highlights the pivotal role of nurses in improving perioperative practices, supporting both patient safety and satisfaction. Future research should explore the intervention's applicability across diverse settings and patient populations.
Despite evidence-based guidelines, excessive preoperative fasting remains prevalent in practice. This study demonstrates that a structured, nurse-led intervention can successfully reduce fasting durations and enhance patient experience, reaffirming the nursing profession's capacity to lead meaningful change in perioperative care.
Standards for quality improvement reporting excellence (SQUIRE 2.0).
Patients and caregivers contributed to the co-design of the intervention, ensuring that it addressed practical challenges related to preoperative fasting.
To examine the relationship between moral courage, personality traits and organisational climate among nurses.
A cross-sectional, descriptive-analytical study.
A total of 264 nurses from three hospitals in Semnan, Iran, participated in the study. Stratified random sampling was used, and data were collected in summer and autumn 2024 through the Moral Courage Scale, Organisational Climate Scale and Personality Traits Inventory. Data analysis was conducted using SPSS 26.
Moral courage was positively associated with a supportive organisational climate. A weak inverse relationship was noted with agreeableness, while other personality traits showed no notable influence. Moral courage was more prevalent among married nurses, supervisors and those with permanent contracts.
A positive organisational climate enhances nurses' moral courage, emphasising the need to foster supportive work environments. While agreeableness may slightly inhibit moral courage, other personality traits did not show a significant effect.
Understanding the contributors to moral courage can assist healthcare institutions in developing training and policies that empower nurses to act ethically and confidently in challenging situations, ultimately improving care quality.
Problem addressed: The study explores the relationship between moral courage, personality traits, and organisational climate among nurses in clinical settings. Main findings: Organisational climate significantly impacts moral courage, while most personality traits do not play a major role. Where and on whom will the research have an impact? These findings can inform hospital leaders, educators, and policymakers in shaping ethics-centred strategies to support nurses in clinical settings.
This study adheres to EQUATOR guidelines for cross-sectional studies.
This study did not include patient or public involvement in its design, conduct or reporting.
This paper discusses data errors and offers guidance on data cleaning techniques, with a particular focus on handling missing values and outliers in quantitative datasets.
Methodological discussion.
This paper provides an overview of various techniques for identifying and addressing data anomalies, which can arise from incomplete, noisy, and inconsistent data. These anomalies can significantly affect data quality, leading to biased model parameter estimates and evidence-based decisions. Data cleaning, particularly the appropriate handling of missing values and outliers, is essential to improving data quality before analysis. Data cleaning includes screening for anomalies, diagnosing errors, and applying appropriate corrective measures.
Proper handling of missing values and the identification and correction of outliers are crucial aspects of data cleaning in ensuring data quality and the reliability of statistical analyses. Effective data cleaning enhances the validity and accuracy of research findings for evidence-based decision making that leads to optimal patient outcomes.
The quality of study results depends on how a dataset and its complexities are processed or handled before the analysis. Nursing researchers must use a framework to identify and address important data anomalies and produce reliable results.
This paper describes data cleaning, often overlooked during the data mining process, as a crucial step before conducting data analysis. By addressing missing values and outliers, identifying and fixing data anomalies, and enhancing data quality prior to analysis, data cleaning techniques can produce precise research findings for evidence-based decision making.
In this methodological paper, no new data were generated.
No patient or public contribution.
Climate change has serious consequences for the morbidity and mortality of older adults.
To identify the effects of climate change on older people's health.
A scoping review was conducted following the Joanna Briggs Institute guidelines and the PRISMA-ScR checklist. Quantitative research and reports from organizations describing the effects of climate change on older people were selected.
Sixty-three full-text documents were selected. Heat and air pollution were the two factors that had the most negative effects on cardiovascular and respiratory morbidity and mortality in older people. Mental health and cognitive function were also affected.
Climate change affects several health problems in older individuals, especially high temperatures and air pollution. Nursing professionals must have the necessary skills to respond to the climate risks in older adults. More instruments are required to determine nursing competencies on climate change and the health of this population group.
No patient or public contribution.
This integrative review aims to identify what nurses currently offer through digital technology and their success in managing chronic pain.
An integrative review guided by Whittemore and Knafl was conducted.
Five databases—CINAHL, Medline, PsycINFO, PubMed, and Scopus—were utilised to gather relevant studies from January 2018 to November 2024.
Selected studies were assessed using the Mixed Methods Appraisal Tool and the Joanna Briggs Appraisal Tool. Braun and Clarke's thematic analysis was applied to identify pertinent themes.
Digital nursing technologies such as telehealth and web-based interventions effectively deliver interventions to assess and manage chronic pain; these technologies can reduce healthcare resource utilisation and increase accessibility. This review highlights that nurses commonly deliver exercise, cognitive-behavioural therapy, acceptance and commitment therapy and self-management techniques through digital technology.
This review indicates that web-based interventions and telemedicine are the primary digital technologies employed by nurses for chronic pain management providing psychosocial interventions, with evidence supporting their effectiveness. Digital and web-based technology is essential to bridge healthcare access gaps as nurses can provide this successfully with minimal nursing support and cost to the patient.
Evidence supports nurses in providing psychosocial interventions for the management of chronic pain, particularly web-based psychosocial interventions. Nurses need to adopt digital technology to improve access to care and patient outcomes and to maintain professional development in an increasingly digital world.
No patient or public contribution was used for this study.
To uncover perspectives and refine 12 initial program theories concerning the implementation of pain management interventions in intensive care units. Contexts enabling implementation are delineated, and causal mechanisms within these contexts are described.
A realist evaluation approach was employed.
Fourteen purposively selected Australian nurses of variant roles were virtually and individually interviewed between July and September 2023. Participants were presented with initial program theory, and their perspectives were collated. Data were analysed using an integrated approach of context (C), mechanism (M), outcome (O) categorisation coding, CMO configurations connecting and pattern matching.
Pain management interventions work if perceived to be beneficial, precise, comprehensive and fit for purpose. Nurses should be willing to change attitudes and update knowledge. Unit leaders should nurture the development of nurses' professional identity, access to learning, autonomy and self-determination. Organisations should change the infrastructure, provide resources, mitigate barriers, develop shared mental models, update evidence and institute quality assurance. Adherence to interventions is affected by the outcomes of implementation and intrinsic merits of interventions. In these contexts, confidence is boosted; feelings of empowerment, self-efficacy, reflective motivation, trust, awareness and autonomy are developed; and capacity is built. Furthermore, frustration from the variability of practices is reduced, accountability and ownership are augmented, yielding positive implementation outcomes.
Findings have implications on nurses, team leaders and organisations concerned with implementation.
The findings provided a fortified understanding of conditions favouring successful implementation of pain management interventions. Actions should be undertaken at an individual, unit and organisation level to ensure successful implementation.
RAMESES II Reporting Standards for Realist Evaluations informed presentation of study.
Intensive care nurses contributed insights to refine the program theory.
Explore and describe the triggers, preventive strategies, and sociocultural dynamics of violence in healthcare settings, focusing on the experiences and perspectives of nurses Damietta Governorate, Egypt.
A cross-sectional design.
A stratified random sampling approach was followed to ensure representation from all departments by recruiting 424 nurses from several hospitals in Egypt. Self-administered questionnaires were applied, using validated instruments such as the Hospital Safety Climate Scale, the Coping Strategies Inventory, the Maslach Burnout Inventory, the Perceived Causes of Workplace Violence Questionnaire, and the Workplace Violence Scale to collect data. Data analysis using SPSS version 26 was carried out with descriptive statistics including means and standard deviations. STROBE reporting guidelines were followed.
Nurses had a moderate level of verbal abuse (mean 3.50) and bullying/harassment (mean 3.00) and lesser incidences of physical violence (mean 2.80) and sexual harassment (mean 2.70). The most common cause was perceived as organisational factors (mean 3.80) and then environmental (mean 3.60) and sociocultural (mean 3.40). Problem-focused coping strategies, which were used mostly (mean 3.45), emotional exhaustion (mean 4.20), making the overall burnout level moderate (mean 3.83). The safety climate had positive perceptions concerning management support (mean 3.80), an area needing improvement in safety communication (mean 3.70) and staff training (mean 3.60).
The study underscores the prevalent issues of workplace violence and emotional exhaustion among nurses, highlighting the need for targeted interventions and support systems to address these challenges.
Implementing comprehensive support programs, enhancing safety protocols, and focusing on both problem-focused and emotional support strategies are essential for improving nurse well-being and reducing workplace violence. These measures will contribute to a safer working environment and better patient care outcomes.
What problem did the study address? The study explored and described the high incidence of workplace violence and its impact on nurses' emotional well-being and job satisfaction in Egyptian healthcare settings.
What were the main findings? Prevalent verbal abuse and bullying were noted in the study, with the organisational factors identified as the most important cause. High levels of emotional exhaustion and moderate burnout, coupled with positive but improvable perceptions of safety climate, were reported.
Where and on whom will the research have an impact? Impacts from the research would touch every nurse working in hospitals around the cities of Damietta Governorate in Egypt, including Damietta General Hospital, Central Hospital in Faraskour, Elzarqa General Hospital, and probably other healthcare settings in the locale. It is anticipated that the results will give way to new hospital policies and practices on improving nurse safety and job satisfaction, which could lead to enhanced overall patient care.
The STROBE checklist was followed.
No patient or public contribution.
No abstract available This study aimed to use wearable technology to predict the sleep quality of family caregivers of people with dementia among underrepresented groups. Caregivers of people with dementia often experience high levels of stress and poor sleep, and those from underrepresented communities face additional burdens, such as language barriers and cultural adaptation challenges. Participants, consisting of 29 dementia caregivers from underrepresented populations, wore smartwatches that tracked various physiological and behavioral markers, including stress level, heart rate, steps taken, sleep duration and stages, and overall daily wellness. The study spanned 529 days and analyzed data using 70 features. Three machine learning algorithms—random forest, k nearest neighbor, and XGBoost classifiers—were developed for this purpose. The random forest classifier was shown to be the most effective, boasting an area under the curve of 0.86, an F1 score of 0.87, and a precision of 0.84. Key findings revealed that factors such as wake-up stress, wake-up heart rate, sedentary seconds, total distance traveled, and sleep duration significantly correlated with the caregivers' sleep quality. This research highlights the potential of wearable technology in assessing and predicting sleep quality, offering a pathway to creating targeted support measures for dementia caregivers from underserved groups. The study suggests that such technology can be instrumental in enhancing the well-being of these caregivers across diverse populations. 
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