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To assess the prevalence of workplace violence (WPV) against clinical nursing students during internships and quantify the prevalence of different types of violence, such as physical, verbal and sexual.
Systematic review and meta-analysis.
Eligible cross-sectional studies that reported WPV prevalence among clinical nursing students were included. Two researchers independently screened literature and extracted data. The Joanna Briggs Institute tool was used to evaluate bias risk. Pooled prevalence rates, heterogeneity and publication bias were examined.
A comprehensive search was conducted across eight databases, from the inception of each database to 31 March 2025.
A total of 16 cross-sectional studies from eight countries involving 8037 nursing students were included in the analysis, with 11 studies (n = 5550) contributing to the overall pooled estimate. Using a random-effects model, the pooled prevalence of WPV of any type was found to be 40%, with substantial heterogeneity. Verbal violence emerged as the most prevalent subtype (47%), followed by sexual violence (12%) and physical violence (10%). Significant publication bias was detected for both physical and sexual violence, indicating a potential underestimation of the true prevalence.
This systematic review indicated that WPV is a significant occupational hazard encountered by clinical nursing students across diverse international contexts represented during internships.
These findings highlight the urgent need for educational and healthcare institutions and policymakers to implement coordinated measures, such as enhanced preventive training, comprehensive reporting and support systems and a zero tolerance safety culture to protect the future nursing workforce.
This systematic review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
This study did not include patient or public involvement in its design, conduct or reporting.
The research protocol was registered with PROSPERO (CRD420251027354).
To summarize the current evidence on reducing loneliness among informal caregivers of people with dementia, such as family members or friends.
A systematic review.
The methodological quality was evaluated using the revised Cochrane risk-of-bias tool for randomized controlled trials and the revised JBI critical appraisal checklist for quasi-experimental studies. Data were extracted as predefined and synthesized narratively. The Template for Intervention Description and Replication checklist was used to report the intervention characteristics.
Six electronic databases (MEDLINE via PubMed, EMBASE, Cochrane Library, PsycINFO, CINAHL Plus, and Web of Science Core Collection) were searched for studies published in peer-reviewed English journals from the inception of each database until 28 January 2024.
Eight studies were included in this review, published between 2002 and 2023, with three being randomized controlled trials. All included interventions were psychosocial. Only one study reported significant improvements in loneliness. Five studies utilized remote and online interventions, such as social networking, psychotherapy, and online social support. Interventions varied in their impact on secondary outcomes, including stress, depressive symptoms, anxiety, and caregiver burden. Four studies demonstrated a positive effect on caregiver stress levels. One pilot trial reported a positive impact on depressive symptoms, and another study noted potential improvements in anxiety. One pilot study reported an average improvement in caregiver burden.
While the evidence is insufficient for conclusive statements, this systematic review suggests potential benefits of interventions to reduce loneliness and improve mental health among these caregivers. It highlights the promise of remote interventions in addressing loneliness among dementia caregivers.
The findings suggest that tailored interventions, especially those delivered remotely, can enhance the support provided to caregivers, potentially improving their mental health and overall well-being.
This systematic review adhered to the PRISMA statement.
No patient or public contribution.
To assess the resilience of nurses exposed to workplace violence and analyse its influencing factors.
A cross-sectional study.
From October 2023 to April 2025, 396 nurses were recruited from hospitals in Shanghai and Nanjing, China. Personal Information Form, Hospital Workplace Violence Questionnaire, Resilience Assessment Scale for Medical Staff, General Self-efficacy Scale and Social Support Rating Scale were used to collect data. Descriptive statistics, t-tests, analysis of variance, Pearson's correlation analysis, multiple regression analysis and mediating effect analysis were used to analyse the data.
The mean resilience score was 67.38 ± 15.52. Professional title, self-efficacy and social support were the main influencing factors on resilience among nurses exposed to workplace violence. Resilience showed a significant positive correlation with both self-efficacy and social support. Self-efficacy was directly and positively associated with resilience, and was positively associated with social support, and social support partially mediated the relationship between self-efficacy and resilience.
Self-efficacy is directly and positively associated with resilience. Social support partially mediates the relationship between self-efficacy and resilience. These findings highlight the interaction between personal and environmental factors in shaping the resilience of nurses exposed to workplace violence.
Enhancing resilience among nurses exposed to workplace violence has important implications for increasing patient satisfaction and improving the quality of nursing.
Provided valuable insights into workplace violence within the nursing profession. Social support partially mediated the relationship between self-efficacy and resilience. Improving nurses' resilience requires enhancing personal self-efficacy and strengthening social support systems.
STROBE checklist was used.
To estimate the prevalence of loneliness, social isolation, and their co-occurrence among people living with HIV and to explore factors explaining heterogeneity between estimates.
A systematic review and meta-analysis.
PubMed, Cochrane Library, SciELO Citation Index (via Web of Science), Scopus, Embase, PsycArticles, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) were searched from inception until November 1, 2024 for relevant studies.
Study eligibility, data extraction, and methodological quality assessment were conducted independently by two reviewers. Random-effects meta-analysis was used to estimate pooled prevalence. Subgroup analyses were performed.
A total of 66 studies were included. The pooled prevalence of loneliness was 46.9% and that of social isolation was 25.9%. However, heterogeneity was very high across studies, and these pooled estimates should therefore be interpreted cautiously. Subgroup analyses suggested regional variation in both loneliness and social isolation. Other subgroup findings should be interpreted cautiously because some subgroup estimates were based on small numbers of studies.
Loneliness and social isolation are highly prevalent among people living with HIV. Population-specific intervention strategies are needed to reduce this burden, and future studies should further examine contextual and demographic differences to guide intervention design.
Routine HIV services should include screening and referral pathways for loneliness and social isolation.
This systematic review identified the pooled prevalence of loneliness and social isolation among people living with HIV, highlighting a substantial and clinically relevant burden. The findings may influence HIV nurses' practice and inform care approaches for other clinical populations experiencing loneliness and social isolation.
This systematic review followed the PRISMA and MOOSE reporting guidelines.
No patient or public contribution.
To systematically review the evidence on diagnostic prediction models for depression in patients with breast cancer.
Systematic review.
Ten databases were searched from inception to 22 August 2025, with an updated search on 17 December 2025, to identify original studies developing and/or validating diagnostic prediction models for depression in patients with breast cancer.
Data were extracted using the Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies (CHARMS) framework. Two reviewers independently assessed risk of bias and applicability of included studies using the Prediction Model Risk of Bias Assessment Tool (PROBAST).
Eleven studies were included. Reported area under the curve (AUC) values ranged from 0.784 to 0.890. All included studies were judged to be at high risk of bias, and seven raised high concerns regarding applicability. There was substantial heterogeneity in predictor selection across studies, with age, income level and family support being the most frequently reported predictors.
Although preliminary research on diagnostic prediction models for depression in patients with breast cancer has been undertaken, their methodological quality remains weak. Reporting of external validation and calibration assessment was limited. Current evidence is therefore insufficient to support their routine use in nursing practice. Future research should standardise model development and validation and strengthen the evaluation of model performance.
This review suggests that existing diagnostic prediction models for depression in patients with breast cancer are not yet sufficiently robust for routine nursing use, but may provide a reference for future nursing screening research and the optimisation of related tools.
This review synthesises the available evidence on diagnostic prediction models for depression in patients with breast cancer and provides a basis for future model development, validation and optimisation.
This review was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and the Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis: Systematic Reviews and Meta-Analyses (TRIPOD-SRMA) checklist.
No patient or public contribution.
To improve the rates of central line–associated bloodstream infections in an intensive care and non-intensive care setting in a large Australian health service.
Evidence-based care bundles targeting central line practices were developed and implemented using a pragmatic action research–approach.
Wards recruited change facilitators to implement the bundles. Compliance and ward engagement were measured, and pre-intervention and intervention central line–related infection rates were compared.
Wards showed a reduction in central line–related infections by 90% during the intervention for up to 2 years. Adherence to bundles was high in both settings. Improvements in insertion practices were observed after baseline and were sustained, with the largest improvement seen in documentation. Maintenance and removal practices showed less variation than insertion practices.
Care bundles are an effective intervention to reduce central-line-related infections over a sustained period when clinician adherence is high.
Care bundles can be effective in high-risk settings beyond intensive care units, including haemodialysis.
Central lines were identified from local hospital data as a major contributor to health care–associated infection rates. Care bundles were implemented in high-risk settings and demonstrated sustained reductions in central-line-related infections. Care bundles are an effective intervention for health care organisations to reduce and sustain preventable infections in high-risk patient cohorts.
We adhered to the Standards for Quality Improvement Reporting Excellence (SQUIRE 2.0) framework.
No patient or public contribution.
Cardiac rehabilitation (CR) is an effective intervention for improving outcomes in patients with coronary heart disease (CHD). However, the actual participation rate is unsatisfactory and exhibits significant gender disparities. This study aimed to investigate gender-specific determinants of the decision to participate in CR among patients with CHD, together with underlying causes.
Cross-sectional study.
A cross-sectional survey of 264 patients with CHD from 3 Chinese tertiary hospitals between February 2024 and February 2025. Data were collected using questionnaires based on the Information Need in Cardiac Rehabilitation scale, the Chinese version of Cardiac Rehabilitation Barriers Scale, the Family APGAR index questionnaire, and the International Physical Activity Questionnaire-Short Form.
There were 158 men aged 66 (SD = 13.3) and 106 women aged 66 (SD = 11.0). 55.1% of men CHD patients decided to participate in CR, significantly higher than in women patients (34.0%; χ 2 = 11.351, p = 0.001). Logistic regression analysis for men indicated that the facilitators of the decision to participate in CR were the level of family functioning and ≥ 2 comorbidities. The barriers included emergency/safety information needs and functional status. For women, the facilitators were retirement, family functioning level, being overweight/obesity, ≥ 2 comorbidities, and work/vocational/social factors. The barriers included medication information needs, logistical factors, and functional status. Fairlie decomposition revealed gender differences primarily driven by work/vocational/social factors (contribution: 71.19%), functional status (50.50%), and retirement (−39.16%) (all p < 0.05).
This study highlights the necessity of gender-specific interventions during the decision-making phase for CR. Healthcare professionals should tailor CR strategies to address women's social role barriers and men's emergency risk concerns, while enhancing family functioning and targeting support for functional status and work-related factors.
STROBE checklist, cross-sectional.
Three tertiary hospitals assisted in participant recruitment.
This study aimed to retrieve, evaluate, and synthesize the best available evidence on noise management in neonatal wards to establish a foundational basis for implementing effective noise control practices.
Guided by the “6S” evidence pyramid model, a systematic search was performed across multiple sources including clinical decision support systems, guideline repositories, professional websites, and major databases up to April 12, 2025. Literature types encompassed guidelines, evidence summaries, expert consensuses, and systematic reviews. Following quality appraisal, two researchers independently extracted and synthesized the evidence.
Sixteen publications were included: one guideline, six evidence summaries, six systematic reviews, and three expert consensuses. From these, 33 pieces of best evidence were synthesized and categorized into five key domains: noise sources, measurement techniques, threshold levels, reduction interventions, and clinical effects of noise.
This work provides a scientifically rigorous and comprehensive evidence summary for neonatal ward noise management, offering valuable guidance for clinical practice. Successful application requires adaptation to local contexts. Developing tailored, evidence-based implementation plans is recommended to bridge the evidence-practice gap and enhance neonatal outcomes.
Given neonates' heightened vulnerability, standardized noise management in the NICU is crucial. This summary provides clinicians with a robust, evidence-based framework to develop localized protocols. Its implementation is expected to improve the acoustic environment, thereby promoting physiological stability, supporting neurodevelopment, and reducing noise-related complications.
This evidence summary followed the reporting specifications of the Fudan University Center for Evidence-Based Nursing (Joanna Briggs Institute methodology) and was registered (ES20257726).
No Patient or Public Contribution.
The aim of this study is to explore whether subjective cognitive decline and frailty were related to each other and whether nutrition mediated their association.
From January 2025 to May 2025, a total of 194 middle-aged and elderly MHD patients were selected by convenience sampling method. Cross-sectional data on patients' subjective cognitive decline, nutrition, and frailty were collected using questionnaires. Data were analysed using SPSS 27.0 and PROCESS macros.
The frailty score of middle-aged and elderly MHD patients was 4.00 (range 3.00 to 9.00), and 69 (35.57%) were identified as frailty. Spearman correlation analysis showed that subjective cognitive decline (SCD) was positively correlated with frailty. Nutrition was positively associated with SCD and frailty. When controlling for covariates, nutrition was observed to mediate a relationship between SCD and frailty. The intermediate effect value accounted for 31.29% of the total effect.
Nutrition plays a partial mediating role in the relationship between SCD and frailty in middle-aged and elderly MHD patients in this cross-sectional study with a one-way correlational model. The negative effects of SCD on frailty can be mitigated by improving nutritional status. Considering the bidirectional interaction among SCD, nutrition and frailty, this mediating pathway needs to be further verified by longitudinal studies.
Our findings indicate that nutrition plays a mediating role in the association between SCD and frailty. Routine screening for SCD and nutritional status could be considered in clinical practice to detect those at elevated risk of frailty at an early stage. Targeted nutritional and cognitive interventions may help alleviate frailty progression, reduce adverse clinical outcomes, and enhance self-management ability and quality of life, thus supporting the establishment of comprehensive strategies for frailty prevention and management in haemodialysis settings.
This article follows the STROBE guidelines for the reporting of cross-sectional studies.
No patient or public contribution.
To explore nurses' lived experiences of a generative artificial intelligence-enabled shift handover innovation.
A descriptive phenomenological study guided by Husserl's philosophical framework and operationalized through Colaizzi's seven-step analytical method.
Purposive sampling was used to recruit 18 registered nurses at an Integrated General Hospital in Singapore. Semi-structured individual interviews (n = 12) served as the primary data source, followed by two confirmatory focus group discussions (n = 6 per group) incorporating six previously interviewed participants alongside six additional participants to validate and refine emerging themes. Data were collected between January and June 2025 and analysed using Colaizzi's seven-step phenomenological method.
Five interconnected themes emerged: (1) the burden of fragmented documentation; (2) navigating technological change with cautious optimism; (3) anchoring innovation in familiar clinical frameworks; (4) anticipating barriers to seamless integration; and (5) envisioning enhanced patient safety and professional practice.
Participants experienced a tension between documentation demands and direct patient care. Their conditional acceptance of AI assistance, contingent upon accuracy, clinical oversight, and workflow integration, reflects a sophisticated professional stance rather than resistance. The findings illuminate the essence of navigating the intersection of traditional practice and technological innovation.
This study offers insights into nurses' lived experiences of AI-enabled handover innovation. The findings can inform user-centred implementation strategies that align technological innovation with nursing values and workflow realities.
This study adhered to the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines.
Nursing staff contributed to the refinement of interview guides through pilot testing and provided feedback on preliminary findings through member checking procedures.
To identify different longitudinal trajectories of hypoglycaemia problem-solving ability in patients with diabetes mellitus (DM) and explore their predictive factors. To examine the impact of these heterogeneous trajectories on quality of life.
This study adopted a prospective longitudinal design.
A total of 272 patients who completed follow-up were longitudinally assessed for their hypoglycaemia problem-solving abilities over 6 months. Latent class growth modelling (LCGM) was used to identify heterogeneous trajectories of hypoglycaemia problem-solving ability. Multiple logistic regression was conducted to determine predictors, while univariate ANOVA and multiple linear regression analysis were applied to explore the effects of heterogeneous trajectories on quality of life.
The overall level of hypoglycaemia problem-solving ability in DM patients increased from hospitalisation to 1 month after discharge and gradually decreased from 3 to 6 months after discharge. LCGM identified three heterogeneous trajectories of hypoglycaemia problem-solving ability. Results of multinomial logistic regression analysis showed that employment status, monthly income, frequency of blood glucose monitoring, fear of hypoglycaemia, and social support were predictors of heterogeneous trajectories of hypoglycaemia problem-solving ability in DM patients. In addition, hypoglycaemia problem-solving ability positively predicts quality of life.
Our findings establish a critical theoretical foundation for designing and implementing effective interventions tailored to patients' distinct trajectories in diabetes management.
This study explores the trajectories and predictors of hypoglycaemia problem-solving abilities in DM patients, providing a theoretical basis for nurses to guide patients in diabetes management.
Research findings indicate that nurses should regularly assess the hypoglycaemia problem-solving abilities in DM patients, and use trajectory subgroups to identify distinct patient characteristics in hypoglycaemia problem-solving abilities in order to implement personalised interventions.
This study was based on the STROBE guideline.
No patient or public engagement.
To explore how children, caregivers and healthcare providers experience shared decision-making in real time within an interdisciplinary paediatric feeding clinic in multicultural Singapore.
A qualitative ethnographic approach was used.
Data collection involved one-time participant observations of interdisciplinary feeding clinic consultations, observations of healthcare providers-only debrief and follow-up interviews with caregivers. Data were collected from July 2024 to November 2024. Participants included caregivers, healthcare providers and otherwise well children presenting with feeding difficulties. Fieldnotes, including observational matrices, reflexive journals and interview transcripts, were analysed thematically using Braun and Clarke's six-step process for thematic analysis.
Twenty observations and 11 interviews were conducted. Four themes were identified: (1) Centring the child: building trust and respect; (2) Tensions and teamwork: negotiating expertise and expectations; (3) Feeding across cultures; and (4) Parenting under pressure: the social context of feeding choices.
In an interdisciplinary feeding clinic, shared decision-making extends beyond the clinical encounter, reflecting relational, cultural and structural realities. The feeding clinic modelled effective shared decision-making through child-centred care practices, balancing biomedical expertise with lived experiences, actively engaging caregivers and codesigning culturally responsive and sustainable feeding strategies with the family. However, divergent perceptions of what problematic feeding entails, caregivers' hesitancy in taking on an active role in consultations, and the external pressures caregivers contended with constrained this process. These findings highlight the need for inclusive, culturally responsive care models and more caregiver support interventions that acknowledge the full complexity of feeding care.
Nurses, with their central role in relational and communicative care, are uniquely positioned to bridge tensions between medical paternalism and collaborative, family-centred approaches. By facilitating trust, clarifying goals and supporting caregiver participation in feeding decisions, they play a critical role in advancing child health outcomes while strengthening caregiver agency within multicultural healthcare systems.
This study revealed how cultural, familial and systemic pressures shape caregiving practices, often constraining caregiver participation and shared decision-making in clinical encounters. Shared decision making in an interdisciplinary feeding clinic comprised of child-centred care practices, balancing biomedical expertise with lived experiences, actively engaging caregivers and codesigning culturally responsive and sustainable feeding strategies with the family. This study expounds on the potentially critical role nurses could play within the multidisciplinary team to negotiate expectations, foster caregiver agency and contribute to culturally responsive, family-centred feeding care.
The reporting of this study is guided by the Standards for Reporting Qualitative Research (SRQR).
This study did not include patient or public involvement in its design, conduct or reporting.
To clarify the definition and evolution of Patient and Public Involvement and Engagement (PPIE) and identify its attributes, antecedents, and consequences in health-related research.
This study follows Rodgers' evolutionary concept analysis with a seven-step framework.
Datasets were searched using terms related to PPIE and key categories (i.e., attributes, antecedents, and consequences). Data were sourced from CINAHL, PsycInfo, Scopus, PubMed, and Web of Science covering publications from inception to October 31, 2024. Document titles, abstracts, and keywords were manually screened to identify relevant studies for full-text review.
A total of 1751 documents were screened, resulting in 38 eligible studies included in the final analysis. PPIE has evolved from a narrow focus on patient inclusion and participation, where patients had minimal influence on research and researchers resisted sharing control of research, to a collaborative model emphasising sustained partnerships, shared contributions, equitable power distribution, and active involvement across research stages. This shift has been driven by research innovation, a growing emphasis on healthcare equity and patient-centred care, technological advances, and stakeholder advocacy (e.g., patients, funders, ethics committees). While PPIE enhances research relevance and impact, barriers, such as resource constraints, power imbalances, patient limited research capabilities and increased researcher workload persist. Facilitators, such as training programmes, standardised guidelines, flexible arrangements and transparent communication can enable meaningful partnerships.
The concept of PPIE is evolving toward greater clarity and consistency in research, positioning patients and the public as active, essential contributors rather than passive participants. Barriers and facilitators were identified to inform its utilisation in research.
This study clarifies the conceptual ambiguities of PPIE, informs theory development, and provides actionable insights. Healthcare and nursing researchers can draw on its findings to utilise PPIE to enhance collaborative and inclusive research practices that align with the needs of patients and the public.
This study adheres to the PRISMA (2020) reporting guidelines for systematic reviews.
One of our co-authors is a patient with lived experience of cancer, who contributed valuable comments and suggestions to enhance this paper.
To systematically review published studies on the post stroke delirium risk prediction models; and to provide the evidence for developing and updating the clinically available prediction models.
Systematic review.
Systematically searched studies on 10 databases, which were conducted from inception to 9 January 2025. The studies of post-stroke delirium risk prediction models were included.
Extracted the data from the selected studies. The Prediction Model Risk of Bias Assessment Tool checklist was used to evaluate the risk of bias of the models. The meta-analysis of model performance and common predictors was performed by Revman 5.4 and Medcalc.
A total of 12 studies were included, and 21 risk prediction models for post-stroke delirium were constructed. The combined effect size of area under the receiver operating characteristic curve was 0.84. All studies were found to have a high risk of bias and good applicability. Meta-analysis showed: National Institutes of Health Stroke Scale score, age, neutrophil-to-lymphocyte ratio, neglect, visual impairment and atrial fibrillation were independent predictors of post-stroke delirium.
The included studies all found to have a high risk of bias; future studies should focus on adopting more scientifically rigorous study designs and following the standardised reporting guidelines to enhance extrapolation and facilitate its clinical application.
This review may promote clinical healthcare workers to develop and update clinically available prediction models, thereby establishing risk prediction models with strong clinical utility.
This study presents the first systematic evaluation of delirium risk prediction models in stroke patients, thereby facilitating the choice, use and develop of the clinical usable post stroke delirium risk prediction models.
This review adhered to the PRISMA guidelines.
No patient or public contribution.
RD42024620360 (PROSPERO According to JAN Guidelines).
FreshRSS 