Conectar
To describe the outcomes of an e(electronic)-Delphi survey used to achieve consensus on the essential elements that should be included in a multidisciplinary, nurse-led service for patients with chronic heart failure (CHF).
The study design was based on a three-round e-Delphi survey.
A series of three survey rounds were used to gather expert opinions and achieve consensus on the key elements that should be included in a CHF disease management program from a sample of healthcare professionals and organizational leaders with expertise in existing CHF services. Consensus for each item was defined as at least 90% agreement.
There were 20 participants (18 healthcare professionals and 2 organizational leaders) in round-1, 22 (20 healthcare professionals and 2 organizational leaders) in round-2, and 17 (15 healthcare professionals and 2 organizational leaders) in round-3. Fifteen participants attended a final online meeting (13 healthcare professionals and 2 organizational leaders). Consensus was obtained on five essential components: (i) consumer education, (ii) treatment optimization using a multidisciplinary approach, (iii) discharge planning, (iv) provision of supportive community care and (v) mechanisms to respond to early symptoms of decompensated CHF.
Participants focused on mechanisms to improve treatment effectiveness, patient and family knowledge, communication between healthcare providers and supportive care in the community. The proposed model of care may be useful to other health service providers who are designing or adapting CHF models of care for the South-East Asian environment.
This research provides a solid basis for using a Delphi method to resolve the challenges and issues of transferring global model-based recommendations in CHF knowledge. The Delphi method proved successful as an important step in developing a culturally acceptable model of chronic care that meets the goals of local healthcare providers.
To explore the impact of international visiting scholars programmes on the academic and professional development of nursing PhD students and to inform future doctoral curriculum design.
Integrative review.
A systematic search was conducted across six databases (Embase, Medline, CINAHL, ERIC, Scopus and Web of Science) in December 2024, with no restrictions on publication year. After removing duplicates, 1300 records were screened by title, abstract and full text. Studies were included if they focused on nursing PhD students participating in international visiting programmes and addressed academic or professional development. Five studies met the inclusion criteria. Data were synthesised using a thematic analysis approach.
Four themes were identified: (1) advancing academic excellence through enhanced research skills and critical thinking; (2) cultivating cross-cultural learning by fostering cultural sensitivity and adaptability; (3) fostering global networks that promote sustained international collaboration; and (4) shaping doctoral education by encouraging structured and sustainable international experiences. These findings suggest that international visiting scholars programmes contribute meaningfully to the academic, cultural and professional growth of nursing PhD students.
International visiting scholars programmes provide a unique platform for doctoral nursing students to strengthen their academic foundations and expand their global outlook. Integrating such experiences into doctoral curricula can better prepare future nursing leaders for international health challenges.
This review addresses a gap in the literature by focusing on the doctoral-level outcomes of international visiting scholars programmes in nursing. The findings offer guidance for educators and policymakers to design curricula that integrate global engagement, build institutional support for mobility programmes and promote equitable access to international academic opportunities in nursing education.
The review adhered to the EQUATOR and PRISMA guidelines for systematic reviews.
No patient or public contribution.
To explore the lived experiences of Chinese older adult cancer patients in Hong Kong navigating the challenges of long COVID.
A descriptive phenomenological study.
Semi-structured interviews were conducted with 27 purposively sampled older Chinese cancer survivors in Hong Kong between January 2023 and January 2024. Data were analysed using Colaizzi's thematic analysis method.
Four key themes emerged: (1) the invisible scars of COVID-19: unrecognised and diverse symptoms; (2) the double-edged sword of protection: shielding from COVID-19 while battling cancer and long COVID; (3) forging strength in the crucible: adapting and thriving with cancer and long COVID and (4) nurturing resilience: the integral role of nursing in supporting cancer patients with long COVID during a pandemic.
Older Chinese cancer patients with long COVID experience a dual burden of unrecognised physical symptoms and profound psychological distress from isolation. Despite this, they demonstrate remarkable resilience, a process that can be actively supported through specialised nursing care.
This study offers original contributions to the limited literature on the intersection of cancer, long COVID, and ageing. It provides in-depth insights into the lived experiences of this vulnerable population, highlighting the diversity of long COVID symptoms, the psychological impact of pandemic-related precautions, and the crucial role of nursing in fostering resilience.
This study highlights the urgent need for nurses to recognise the unique challenges of this population. It provides a foundation for developing nurse-led, resilience-focused interventions that integrate tailored education, emotional support, and resource navigation into oncology care. These findings can inform practice and policy to better support the well-being of a vulnerable and growing patient demographic.
The study adhered to the consolidated criteria for reporting qualitative research (COREQ) checklist.
No patient or public contribution.
Instant messaging-based applications are increasingly used to deliver interventions designed to promote health behavior change. However, the effectiveness of these interventions has not been evaluated.
This systematic review and meta-analysis aimed to evaluate the effectiveness of instant messaging-based interventions on health behavior change, addressing a gap in the literature regarding the impact of instant messaging on various health behaviors.
We conducted comprehensive searches of six electronic databases (PubMed, EMBASE, Cochrane Library, PsycINFO, CINAHL Plus, and Web of Science) from their inception until July 2024, utilizing terms related to health behavior and instant messaging. Two authors independently screened studies and extracted data. Randomized controlled trials published in English that investigated the effects of instant messaging-based interventions on health behavior change, including physical activity, sedentary behavior, sleep, diet/nutrition, cancer screening, smoking cessation, and alcohol consumption were included. We used the revised Cochrane Risk-of-Bias Tool to assess the quality of the studies.
Fifty-seven randomized controlled trials published between 2014 and 2024 were included. The results showed that compared with the control groups, instant messaging-based interventions had statistically significant differences in physical activity (SMD = 0.52, 95% CI [0.21, 0.83], p < 0.001) and sleep (SMD = −0.93, 95% CI [−1.44, −0.42], p < 0.001). It also significantly impacted smoking cessation (OR = 1.88, 95% CI [1.28, 2.7], p < 0.001). However, it did not influence sedentary behavior (SMD = 0.25, 95% CI [−0.24, 0.74], p = 0.01) or diet/nutrition (SMD = 0.01, 95% CI [−0.31, 0.34], p < 0.001).
Instant messaging-based interventions are promising in enhancing health behavior change, including physical activity, sleep, and smoking cessation. Leveraging real-time communication and multimedia content can improve patient engagement and intervention effectiveness.
To review the evidence on the experiences and perceptions of culturally and linguistically diverse informal carers supporting older adults during transitions from hospital to home, including their interactions with transitional care interventions.
Scoping review guided by Arksey and O'Malley's framework.
We searched CINAHL, MEDLINE, Embase, Emcare, AMED, PsycINFO, Global Health, Social Work Abstracts, JBI EBP, Scopus, Web of Science Core Collection, ProQuest and Informit for studies published between January 2010 and November 2024.
Two reviewers independently screened studies and extracted data. Analysis followed the Patterns, Advances, Gaps, Evidence for Practice and Research recommendations framework.
Seventeen studies involving 1275 carers were included. Carer experiences were summarised into four themes: (1) cultural and communication barriers; (2) role ambiguity and practical challenges; (3) limited involvement in discharge planning and (4) barriers to accessing support and services. Perceptions of transitional care interventions were mixed. While some interventions improved carer preparedness and reduced stress, most lacked cultural tailoring and did not address carers' psychosocial and communication needs.
Culturally and linguistically diverse informal carers face challenges navigating transitional care. While involving them in care planning improves outcomes, implementation remains inconsistent. Emotional support and culturally tailored services are insufficient.
There is a need for culturally and linguistically tailored transitional care programmes that prioritise carer education and communication support. Key areas for improvement include: (1) health literacy and system navigation; (2) involvement in care planning; (3) communication with providers; (4) psychosocial and emotional support and (5) culturally appropriate services. Future research should explore the unique emotional and psychosocial needs of these carers to inform targeted support strategies.
This review follows the PRISMA guideline for reporting.
No patient or public contribution.
To operationalize the Caring Life Course Theory (CLCT) as a framework for improving cardiac rehabilitation (CR) engagement and informing ways to address disparities in rural, low socio-economic areas.
A secondary analysis of data collected from 15 CR programmes to identify CR patterns through the CLCT lens using a mixed-methods approach. All analytical processes were conducted in NVivo, coding qualitative data through thematic analysis based on CLCT constructs. Relationships among these constructs were quantitatively assessed using Jaccard coefficients and hierarchical clustering via dendrogram analysis to identify related clusters.
A strong interconnectedness among constructs: ‘care from others’, ‘capability’, ‘care network’ and ‘care provision’ (coefficient = 1) highlights their entangled crucial role in CR. However, significant conceptual disparities between ‘care biography’ and ‘fundamental care’ (coefficient = 0.4) and between ‘self-care’ and ‘care biography’ (coefficient = 0.384615) indicate a need for more aligned and personalized care approaches within CR.
The CLCT provides a comprehensive theoretical and practical framework to address disparities in CR, facilitating a personalized approach to enhance engagement in rural and underserved regions.
Integrating CLCT into CR programme designs could effectively address participation challenges, demonstrating the theory's utility in developing targeted, accessible care interventions/solutions.
Explored the challenge of low CR engagement in rural, low socio-economic settings. Uncovered care provision, transitions and individual care biographies' relevance for CR engagement. Demonstrated the potential of CLCT to inform/transform CR services for underserved populations, impacting practices and outcomes.
EQUATOR—MMR-RHS.
A consumer co-researcher contributed to all study phases.
To discuss the multi-centre qualitative methodology as a unique design, articulate its guiding paradigm/theoretical perspectives, and highlight its methodological and methodical issues. A secondary objective is to generate further scholarly discourse regarding the multi-centre approach within the broader qualitative research tradition.
Methodological discussion.
Rather than an emphasis on only experiences, the multi-centre approach is presented as a unique design which also focuses on uncovering why a phenomenon or problem exists and perceptions regarding the phenomenon/problem. With its focus on capturing multiple subjective realities, the multi-centre qualitative design is arguably underpinned by pragmatist constructivism which offers a robust framework for researching phenomenon in a way that is both theoretically informed and practically relevant. Methodologically, the multi-centre qualitative research design emphasises a problem-centred enquiry, collaborative approach and rigorous study protocols, systematic site selection, contextual immersion and sensitivity and methodical flexibility.
With the rapidly evolving nursing and global health landscape, the multi-centre design lends itself to exploring and capturing perceptions on a larger scale compared to single site studies. Careful planning, availability of adequate resources, rigorous protocols and quality assurance plans are critical to ensuring its success.
The multi-centre approach offers the possibility of undertaking the same study across multiple settings/locations which has the potential to improve representation and strengthen transferability.
This methodological discussion offers clarity regarding the use of the multi-centre approach and offering strategies for its subsequent uptake in nursing and healthcare research.
Not applicable.
No patient or public contribution.
To explore the experiences and support needs of Black Canadian parents with preterm infants and to engage them in co-creating a culturally informed framework to inform nurses, healthcare providers and community organisations to better serve this population.
Preterm birth (PTB) is a traumatic experience that places significant physical and emotional strain on families and other caregivers. Despite research showing that Black mothers are at risk of PTB, little is known about their experiences of giving birth to a preterm infant and the challenges they encounter caring for these children in Canada. This lack of research specifically on Black parents in Canada makes it difficult to identify their psychosocial needs and develop intervention programmes to address their unique challenges.
A two-phase qualitative exploratory design informed by a community engagement lens will be used.
In Phase 1, five focus groups (n = 48) and 6–8 in depth interviews will be conducted with Black parents of preterm infants. Questions will explore experiences in the NICU, transition home, access to support, coping strategies and mental well-being. One focus group will be conducted with the parent advisory council of the Canadian Premature Babies Foundation, our community partner to explore gaps in services. The data from Phase 1 will be analysed and findings will be used to informed Phase 2 concept mapping exercise. This research was approved by the Toronto Metropolitan University Research Ethics Board.
There is a paucity of research addressing the experiences and needs of Black parents with preterm infants. Thus, this study is well positioned to generate the much-needed Canadian empirical knowledge on the unique experiences and stressors face by Black parents with preterm infants and inform the design of programmes and services to better support them.
This study is in collaboration with the Canadian Premature Babies Foundation, our community partner.
To discuss the dyadic and triadic interviewing techniques as distinct approaches to data collection in qualitative research.
Methodological/methodical discussion.
Underpinned by a layered theoretical basis involving interpretivism, social constructivism and symbolic interactionism, dyadic and triadic interviewing approaches represent a tapestry that seeks to illuminate not only what participants think at the individual level, but also how they think together to generate shared, nuanced meanings. Key methodical considerations include participant recruitment and selection to form the dyads or triads, ethical issues, navigating power dynamics, determining saturation at the dyad or triad level and shifting the unit of analysis from the individual level to the dyad or triad level. Notable challenges to using these approaches include logistical complexity, ethical risks and the great need for skilled moderation.
Dyadic and triadic interviewing techniques occupy a vital methodological niche in qualitative studies, particularly within the contexts of health and social care research where relational dynamics and collaborative decision-making are central. By foregrounding co-constructed narratives and real-time interactions, dyadic and triadic interviewing techniques illuminate the interplay of individual agency, power asymmetries and cultural norms, offering insights that transcend the limitations of individual interviews or focus groups.
The increasing complexity of care, treatment pathways, recovery and family-centered decision making warrants engagement beyond individual interviews. Dyadic and triadic interview techniques facilitate this by combining the in-depth benefit of individual interviews and shared interpretations of focus group discussions to capture meanings and experiences.
This methodological/methodical discussion offers clarity to employing dyadic or triadic interviewing approaches to improve their uptake in health and social care research.
Not applicable.
No patient or public contribution.
Background
The wear and tear from chronic stress exposure has been linked to premature aging through allostatic load; however, it is unclear how chronic stress exposure affects physical functioning and physical activity in older adults.
Objectives
The study aims were to examine the behavioral and functional adaptation to chronic stress in older adults and its mediational pathways.
Methods
Data from the Health and Retirement Study 2016 and 2020 (N = 3075, mean age 66 years) were analyzed. Chronic and perceived stress exposure was quantified using Troxel’s Chronic Stressors Scale and Cohen’s Perceived Stress Scale. Physical activity was quantified using self-reported questionnaires, including light, moderate, and vigorous physical activity. Physical functioning was operated as a latent construct with four perceived physical limitations (i.e., difficulty in movement, hand strength, shortness of breath, and balance). The cross-sectional data were analyzed using latent regression analysis. The longitudinal data were analyzed using serial mediation based on MacKinnon’s bias-corrected bootstrap confidence intervals.
Results
Cross-sectionally, psychological stress, as a latent construct indicated by stress exposure and stress perception, explained more variances in perceived physical limitation than physical activity. Longitudinally, perceived stress and physical activity mediated the relationship between chronic stress exposure and perceived physical limitation with significant indirect effects. Furthermore, perceived physical limitation suppressed the effect of chronic stress exposure on physical activity levels. The effects of mediation and suppression remained significant after the adjustment for age, gender, years of education, race, number of comorbidities, working status, and marital status.
Discussion
The promotion of physical activity and physical functioning in older adults might not achieve the optimal outcome if the program design overlooks the target population’s chronic stress process and functional limitations. To assess Digital Health Literacy (DHL) levels among hypertensive patients.
Cross-sectional study.
The study, conducted from March to August 2024 among hypertensive patients using convenience sampling, employed a 35-item questionnaire assessing: (I) sociodemographic; (II) physical activity, dietary habits, antihypertensive pharmacological treatment and medical history; (III) online health-related information knowledge and confidence; (IV) DHL, through the HLS19-DIGI questionnaire with subscales on: (i) dealing with digital health information (HL-DIGI), (ii) interaction with digital resources (HL-DIGI-INT), (iii) frequency of digital device use for health (HL-DIGI-DD).
Among 311 participants (mean age 63.9 years, SD = 14.8), 42.1% completed high school, 25.4% held a bachelor's degree and 22.8% were physically inactive. While 49.8% were aware of online health-related information, 28.9% were uncertain and 47.6% lacked confidence in using it for health decisions. On average, participants showed a problematic level of DHL in HL-DIGI, a sufficient level in HL-DIGI-INT, and used digital health devices just over once a week. Older age emerged as a predictor of higher online health-related knowledge and DHL, while higher education level predicted higher knowledge, confidence and DHL. Physical inactivity was associated with lower online health-related information knowledge and confidence.
These findings point to the need to design proactive strategies and implement targeted training and educational interventions to improve DHL in hypertensive patients.
Enhancing DHL levels through targeted interventions in patient care allows patients to effectively benefit from digital healthcare, achieve positive health outcomes and reduce disparities in care pathways.
This study adhered to the STROBE checklist for reporting.
Patients were involved as the study population.
Local Ethical Committee of the University Hospital Company of the Marche Region, Italy (protocol: 2023/279, date: 28/09/2023).
This study proposes an evaluation of the efficacy of machine learning algorithms in classifying chronic pain based on Italian nursing notes, contributing to the integration of artificial intelligence tools in healthcare within an Italian linguistic context. The research aimed to validate the nursing diagnosis of chronic pain and explore the potential of artificial intelligence (AI) in enhancing clinical decision-making in Italian healthcare settings. Three machine learning algorithms—XGBoost, gradient boosting, and BERT—were optimized through a grid search approach to identify the most suitable hyperparameters for each model. Therefore, the performance of the algorithms was evaluated and compared using Cohen's κ coefficient. This statistical measure assesses the level of agreement between the predicted classifications and the actual data labels. Results demonstrated XGBoost's superior performance, whereas BERT showed potential in handling complex Italian language structures despite data volume and domain specificity limitations. The study highlights the importance of algorithm selection in clinical applications and the potential of machine learning in healthcare, specifically addressing the challenges of Italian medical language processing. This work contributes to the growing field of artificial intelligence in nursing, offering insights into the challenges and opportunities of implementing machine learning in Italian clinical practice. Future research could explore integrating multimodal data, combining text analysis with physiological signals and imaging data, to create more comprehensive and accurate chronic pain classification models tailored to the Italian healthcare system. To investigate unmet need trajectories among young stroke survivors, identify predictive factors and evaluate the lagged effects of unmet needs on post-stroke health outcomes.
Prospective longitudinal study.
We recruited 122 patients with stroke, assessed at four time points over a 6-month follow-up period. The Unmet Needs Questionnaire assessed unmet needs. Predictive factors included participant characteristics and stroke-related factors. Outcome variables included physical functions, quality of life, depressive symptoms and return-to-work status. Generalised Estimating Equations were employed.
Unmet need trajectories decreased over time. Sex, marital status, stroke history, stroke severity, fatigue and cognitive function were key unmet need predictors. Lagged unmet needs were associated with poorer post-stroke health outcomes.
This study highlights the dynamic nature of unmet needs in young stroke survivors and underscores the importance of addressing these needs to improve post-stroke health outcomes. Targeted interventions are essential to mitigate the negative impact of unmet needs on recovery.
Young stroke survivors continue to experience unmet needs in important areas even 6 months post-stroke. Nurses play a crucial role in addressing these challenges by regularly assessing patient care needs, monitoring their progress and implementing targeted interventions. Integrating routine nursing assessments into post-stroke care can help identify high-risk patients and ensure that individualised support is provided throughout the recovery process.
Strengthening the Reporting of Observational Studies in Epidemiology.
No patient or public contribution.
Previous studies regarding mind–body exercise among people with breast cancer mostly focused on one type of mind–body exercise and provided conflicting results.
This paper aims to systematically synthesize the evidence hierarchy and examine the credibility of previous meta-analyses of different types of mind–body exercises.
We searched PubMed, Embase, Cochrane Library, Web of Science, and Epitemonikos from database inception to February 2nd, 2024, for meta-analyses of randomized controlled trials. Included meta-analyses examined the effects of mind–body exercises on at least one outcome of health-related quality of life, cancer-related fatigue, depression, anxiety, and sleep quality in breast cancer patients. The random effects estimates (Hedges'G), 95% prediction interval, small study effect, and excess significance bias were calculated. Furthermore, we categorized meta-analyses based on the evidence credibility criteria and assessed quality using A Measurement Tool to Assess Systematic Reviews 2.
The umbrella review included a re-analysis of 16 meta-analyses of 9 articles including 134 randomized controlled trials involving 9469 breast cancer patients and survivors. We identified 3 articles as “low” quality and 6 articles as “critically low” quality. Convincing evidence supported the effectiveness of Yoga intervention in reducing depression symptoms (G = −0.77, 95% Confidence Interval [−0.93, −0.61]). However, 11 meta-analyses were supported by weak evidence (1 for Qigong alleviated depression, 4 for Qigong, Baduanjin, Tai Chi Chuan, and Yoga improved health-related quality of life, 3 for multiple mind–body exercises, Tai Chi Chuan, and Yoga reduced cancer-related fatigue, 2 of Baduanjin and Yoga reduced anxiety, as well as 1 of Yoga improved sleep quality).
Mind–body exercises, especially yoga, may be beneficial for improving health-related quality of life and mental health for breast cancer patients. Further high-quality interventions investigating diverse mind–body exercise interventions are warranted to ascertain the effectiveness of health-related quality of life and mental health outcomes.
An analysis of mental health nursing de-escalation logs for 249 days from a regional adult inpatient unit in New South Wales, Australia, was completed to identify groups of cooccurring nursing therapeutic responses to aggression and examine their associations with reductions in restrictive practices and situational aggression.
A single-centre retrospective study was undertaken.
Hierarchical clustering of nursing interventions established groups of cooccurring nursing responses. Poisson mixed-effect models were then used to determine the associations of the intervention clusters with restrictive practices.
Two intervention clusters emerged: Cluster 1 involved verbal de-escalation with active listening and rapport building, whereas Cluster 2 included additional limit setting and problem-solving, distraction, sensory modulation, environmental change and individual staff time. Cluster 1 was linked with a reduction in seclusion use by 83% [IRR = 0.17, 95% CI (0.07, 0.41), p < 0.001], physical restraint by 79% [IRR = 0.21, 95% CI (0.11, 0.40), p < 0.001] and average judged situational aggression by 1.56 [95% CI (0.86, 2.25), p < 0.001]. Cluster 2 was related to statistically insignificant increases in the three studied outcomes.
The intervention clusters prove the value of supplementary tools in surfacing nurses' therapeutic potential. The differences in restrictive practice use between intervention clusters signal the structure and progression of forming therapeutic relationships in aid of de-escalation and the possibility of assessing de-escalation components robustly.
Acknowledging and supporting nurses' therapeutic work support the development of recovery-oriented care and a positive professional identity for nurses.
This study followed the applicable STROBE guidelines.
Due to the study's retrospective nature, there was no service user or public involvement.
This study explored the factors associated with oncology nurses' behaviour and intention to provide cancer care to lesbian, gay, bisexual, and transgender (LGBT) individuals in Taiwan.
A qualitative descriptive study.
Semi-structured interviews were conducted with 25 oncology nurses between August and October 2023. The interview data were analysed using the framework method (the socio-ecological model) and constant comparative techniques.
Factors associated with oncology nurses' behaviour and intentions to provide cancer care for LGBT individuals were categorised and presented by the levels of the social-ecological model: (1) intrapersonal level: oncology nurses' attitudes toward LGBT populations and their experiences, confidence, and beliefs in providing cancer care for LGBT individuals; (2) interpersonal level: concerns or interactions with oncology nurses' colleagues, other heterosexual cancer patients, and managers; (3) community and organisation levels: organisational climate and related training courses; and (4) societal and policy level: policy regarding sexual orientation, gender identity collection, and social atmosphere.
Multilevel barriers associated with oncology nurses' behaviours and intentions to provide cancer care to LGBT individuals were identified. The study findings emphasised the importance of related training courses offered by organisations to reduce cancer care disparities among LGBT individuals. These courses also aim to enhance oncology nurses' confidence and comfort in delivering holistic and patient-centred cancer care for this population.
The study findings can be employed to assist in developing related training courses and understand the challenges oncology nurses face when providing cancer care to LGBT individuals.
No patient or public contributions.
To investigate clinicians' views on barriers and facilitators to implementing pressure injury prevention guideline recommendations for nutrition assessment and treatment, and de-implementing inappropriate alternating pressure air mattress allocation.
A qualitative descriptive study adhering to the COnsolidated criteria for REporting Qualitative research (COREQ) guidelines.
We conducted face-to-face or videoconference focus groups and semi-structured individual interviews with clinicians recruited from a metropolitan tertiary hospital. Participants were purposively sampled according to their years of clinical practice. Interview transcripts were thematically analysed inductively to derive barriers and facilitators to guideline uptake. These were then mapped to the Theoretical Domains Framework and behaviour change techniques to inform an evidence-based implementation intervention development to improve guideline uptake.
Thirteen nurses, four occupational therapists and three dietitians were interviewed. Six themes illustrate three guideline-specific barriers and three common facilitators influencing nutrition- and mattress-related guideline uptake. The three barriers were: (1) nurses devalue the use of validated tools in nutrition screening; (2) nurses prioritise vital-sign-related nursing duties over feeding assistance according to clinical urgency; and (3) nurses consider air mattresses a preventative strategy irrespective of patient PI risks. Facilitators to improve guideline uptake were: (1) nurse-led interdisciplinary collaboration, (2) carer involvement and (3) easily accessible updated guidelines. Different Theoretical Domains Framework domains and behaviour change techniques were mapped to the identified nutrition- and mattress-related barriers.
The findings highlight three key nurses' attitudinal barriers to nutrition- and mattress-related guideline uptake, which inform the development of theory- and end-user-informed implementation interventions in pressure injury prevention.
An implementation strategical plan that addresses attitudinal barriers to improving guideline uptake for nutrition assessment and treatment and reducing air mattress overprescription appears critical in developing an intervention to enhance value-based practice, which will need to be evaluated in future trials.
No Patient or Public Contribution.
To examine how empowerment, strength use, and their interactions with nursing skill level are related to nurse-perceived time pressure.
Nurse-perceived time pressure increases the chance of missed patient care and turnover intention. Time pressure may be reduced by nurses' placement in jobs that make use of their particular strengths (professional abilities, skills and expertise), rather than in jobs that fail to take advantage of these strengths. Empowerment (access to resources, information, support, and opportunities) may also contribute to a reduction time pressure. However, it is not known how strength use and empowerment impact time pressure and how such an impact differs among nurses, indicating a research gap.
This was a cross-sectional study.
The 501 nurse participants were approached at a medical center located in northern Taiwan. Complete survey responses were collected in November and December 2023. The sampling method was proportionate random sampling, which can help ensure sample representativeness. This study used scales of empowerment, strength use and time pressure.
Strength use is negatively related to time pressure. Nursing skill level strengthens the negative relationship between strength use and time pressure, while reducing the negative relationship between empowerment and time pressure.
This study uniquely highlights the pivotal role of nursing skill level in moderating the effects of empowerment and strength use.
This study impacts nurse managers by informing them how to devise policies regarding empowerment and task allocation to best utilise nurses' strengths.
It is suggested that nurse managers offer flexibility in their application of nurses' empowerment and strength use, as they may exert varied effects on different nurses.
STROBE statement was chosen as the EQUATOR checklist.
No patient or public contribution.
Advance care planning (ACP) enables individuals with life-limiting illnesses to make decisions regarding future healthcare. It involves patients, families and healthcare providers in discussions on treatment preferences and end-of-life care. Understanding their experiences is key to improving ACP practice.
To systematically review and analyse the experiences of patients, families and healthcare providers with ACP for life-limiting illnesses.
This study employed a mixed-methods systematic review (MMSR) with a convergent integrated approach.
Literature searches were conducted using CINAHL, Cochrane Library, ERIC, MEDLINE, Scopus and Web of Science, as well as hand searches and reference list checking, for articles published between 2010 and August 2024. Two independent reviewers extracted and analysed the data using the JBI guidelines for MMSR.
Of the 1405 citations, 26 studies involving 1599 participants (1076 patients, 398 healthcare providers and 125 family members) were included. The main findings highlight the importance of patient empowerment, family involvement and the integration of ACP into routine care. Eliminating barriers, such as lack of training, resource limitations and challenges with timing discussions, are essential for effective ACP implementation.
The MMSR emphasises the need for patient-centred ACP that actively involves families and addresses systemic barriers. Early initiation, tailored emotional support and equitable care across conditions are crucial for an effective ACP.
The MMSR highlights the importance of family involvement and enhanced training for healthcare providers in ACP, emphasising the need for emotional support and systemic changes to improve patient care. These improvements should include better educational programs and policies to ensure early, effective and equitable ACP discussions among various patient groups.
The MMSR underscores the need for structured ACP practices that are currently limited by insufficient training and vague guidelines. Early initiation of ACP discussions and inclusion of patient and family preferences are essential for improving care for individuals with life-limiting conditions. These findings are vital for healthcare providers, policymakers and educators to implement more effective patient-centred ACP approaches. Family involvement remains a key aspect, with the review advocating for a support system that empowers families to play an active role in ACP.
Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA).
No Patient or Public Contribution.
To ascertain the current evidence about the support, education and learning needs of experienced registered nurses who are transitioning their work to intensive care nursing as a new context.
A scoping review was conducted using established frameworks from JBI, Arksey and O'Malley.
A search was conducted in CINHAL and MEDLINE (April 2023). Two researchers independently screened the records, extracted and cross-checked the data. The results were consolidated narratively in answer to the review questions. The PRISMA-ScR checklist was used to guide reporting.
Eight articles (seven research, one evaluation) were included. The data were widely heterogenous. Evidence pays more attention to education experiences and needs during transition than to mechanisms used informally to engender socialisation of experienced registered nurses into the intensive care team. Key education strategies include orientation, skill and knowledge development, self-directed learning, preceptorship and mentorship, situated clinical nurse education and expertise sharing from the wider intensive care team. Four papers related to the COVID-19 pandemic reported education related to patient surges; three papers described team or buddy nursing as an educational strategy. Several articles reported that learning needs and experiences evolve as transition occurs, and intensive care is a specialised learning environment where required skills and knowledge are domain specific. Reality shock can be encountered, education needs can be influenced by prior experience and social connection with and support from the team can make a difference.
This review has identified the current state of evidence regarding the support education and learning needs of experienced registered nurses who are transitioning to work in intensive care. The evidence is limited and very heterogeneous. Findings highlight several areas of evidence paucity and some basis for further research. Given the importance of this group to the intensive care workforce, it will be imperative to invest in future research.
Attending to the specific learning and support needs of experienced registered nurses who are making transitions to work in intensive care may impact their experiences of transition shock and quality of learning and may make some differences to recruitment and retention of staff.
By consolidating the evidence, this scoping review highlights important support, education and learning needs of experienced nurses who are transitioning to intensive care. Insight arising from the review will assist experienced nurses, and those working in education and management, as they seek to engage with and support registered nurses who are making transitions to this context of work. There are genuine gaps in research evidence which will require the investment of nursing researchers internationally.
Preferred Reporting Items for Systematic Reviews and Meta-Analyse extension for Scoping Reviews (PRISMA-ScR).
No patient or public contribution.
FreshRSS 