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Delirium, a common, serious and often preventable complication in older hospitalised adults, contributes to significant health and social care costs. Carers are uniquely positioned to identify early signs and support delirium prevention. The Prevention & Early Delirium Identification Carer Toolkit (PREDICT), a novel model of care designed to educate carers about delirium management and prevention strategies, enables them to actively participate in the care and recovery of their person. Developed through a comprehensive literature review, a co-designed eDelphi and pilot study, PREDICT demonstrated acceptability and feasibility.
To evaluate the effectiveness, implementation and cost-benefit of a PREDICT in hospital settings.
A stepped-wedge cluster randomised controlled trial (SW-cRCT), consisting of a cohort study, healthcare service evaluation, and process evaluation. The study will assess carer and staff knowledge of delirium, carer care giving stress, health service outcomes (e.g., incidence, length of stay, readmissions) and cost-benefit.
PREDICT is a scalable, person-centred approach that supports both patients and carers, with the potential to embed best-practice delirium management into routine healthcare.
This study was developed in consultation with older adults, carers and healthcare staff. Two consumer representatives joined the project steering committee and contributed to shaping the research question, refining the study protocol and selecting outcome measures relevant to families and healthcare staff. Carers were involved in reviewing participant information sheets and the PREDICT website, providing feedback to ensure clarity and accessibility. Results will be shared with participants and the wider community through plain-language summaries and public presentations.
Australian and New Zealand Clinical trial: ACTRN12625000705482 registered on the 3rd of July 2025
The aim of this study was to document the process of the implementation and the perceived impact and sustainability of the Expansive Learning in Practice Model and its associated costs to inform future rollout.
A mixed-method rapid evaluation was conducted, comprising both qualitative and economic workstreams to document the implementation of the Expansive Learning in Practice Model and its associated costs. Semi-structured interviews (n = 44) were carried out with student nurses, student assessors, and staff involved in the delivery of the Model. The qualitative workstream utilised a rapid cycle evaluation approach, where data were collected and analysed in parallel, and preliminary findings were shared with stakeholders as the study was ongoing. The quantitative workstream relied on routinely collected data about non-staff-related costs, staff-related costs, and data on students' participation.
The main themes developed from the qualitative data included the organisation of the Expansive Learning Experiences, the supportive environment, the enhanced learning experience, and capacity building. Participants perceived that the model had a positive impact on student practice (including preparation and confidence) and on student nurse satisfaction. At the end of the programme, it is estimated that the programme will have cost about £523,572.
This model can be used as a framework for hospitals aiming to improve the learning experiences for student nurses. Improvements could be made by increasing staff buy-in and the streamlining of spoke opportunities. Future studies should focus on evaluating the long-term impact of the model, particularly the impact on generating student placement capacity. The evaluation also highlights the need for solutions for potential educational staff shortages, which could pose a risk to maintaining sufficient practice placement capacity for student nurses in healthcare settings.
Study participants perceived an improvement in student nurses' learning experiences and student nurse placement capacity as a result of the implementation of this model.
The relevant EQUATOR guidelines followed for reporting were the GRAMM guidelines (Good Reporting of a Mixed Methods Study).
The study centred around student nurse and staff experiences.
To systematically identify, evaluate and synthesise the research literature about (a) the roles and responsibilities of advanced practice nurses (APNs) in the context of advance care planning (ACP) for older persons, (b) the characteristics of APNs' ACP practices and (c) the facilitators and barriers influencing APNs' involvement in ACP.
Mixed-methods systematic review.
Followed the mixed methods systematic review guidelines outlined by the Joanna Briggs Institute. Three researchers independently screened studies for eligibility using the Covidence Screening Application. The screening involved two stages: titles and abstracts, followed by full-text evaluation. The Mixed Methods Appraisal Tool was used for quality assessment. A convergent integrated synthesis combined quantitative and qualitative data by ‘qualitising’ quantitative findings into text, enabling integration and thematic analysis to synthesise the results.
Medline, CINAHL and Embase were searched from 2012 to 2024 for original research in English, focusing on APNs involved in ACP for individuals aged 65 or older, using qualitative, quantitative or mixed method designs.
The review included 19 studies: seven qualitative, nine quantitative and three mixed method designs. Thematic analysis revealed that APNs play a key role in ACP, aligning care with patient preferences through discussions and documentation. Studies from the United States (12), United Kingdom (4), Canada (2) and Australia (1) show varying APN roles and responsibilities.
APNs are crucial to ACP, but barriers limit their impact. Overcoming these is key to improving outcomes.
APNs clinical expertise and close patient relationships are crucial for aligning care with patient preferences and needs in ACP. However, to fully maximise their contribution, it is essential to overcome barriers such as time constraints, lack of role recognition and insufficient training. Addressing these challenges will enhance the effectiveness of APNs in providing person-centred care.
This review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement.
No patient or public contribution.
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.
Nursing students often experience anxiety, stress, and fear during a clinical rotation in a mental health setting due to stressors and biases toward the setting as well as lack experience in caring for patients with mental health conditions. One in four people worldwide suffers from a mental disorder; therefore, it is critical that nurses feel confident interacting with these patients to provide equitable care. Undergraduate training is a critical period for changing students' attitudes toward this population. This study's goal was twofold. First, we offered students’ exposure to common behaviors and symptoms displayed by a patient with mental illness through an engaging and immersive virtual reality simulation experience before taking care of patients in a clinical setting. Second, we aimed to determine if a virtual reality simulation will change students' attitude and stigma, favorably, toward patients with mental health conditions. We used a mixed-method comparative analysis to collect information and identify themes on undergraduate students’ attitudes and stigma toward patients with mental health conditions. Our findings demonstrate that virtual reality simulations enhance awareness and sensitivity to the situations of others (empathy) while improving their communication skills. The use of virtual reality in a baccalaureate curriculum deepens the understanding of health equity in behavioral health for nursing students. This study aimed to identify the spiritual responses of nurses providing direct patient care during the COVID pandemic and explore how religious/spiritual struggles are associated with selected nurse outcomes.
A quantitative, cross-sectional observational study was conducted, based on the STROBE checklist, with 364 registered nurses recruited via convenience sampling between January 24 and March 12, 2022, in hospitals in Iran admitting COVID-19 patients. Data were collected through a self-report questionnaire, including the Moral Injury Symptom Scale–Health Professionals, Religious/Spiritual Struggles Scale-Short Form, Posttraumatic Growth Inventory, Job Satisfaction Scale, Copenhagen Burnout Inventory, Turnover Intention Scale, and Employee Engagement Scale.
Nurses reported high levels of moral injury during the pandemic, with an average score of 43.79 ± 15.20. Religious/spiritual struggles were generally low, with demonic struggles scoring the lowest (0.36 ± 0.68) and ultimate meaning struggles the highest (1.54 ± 0.99). Posttraumatic growth scores for spiritual change were moderately high (26.17 ± 4.73). Work-related burnout was moderate (64.31 ± 100.00), intention to leave was low (8.84 ± 3.92), and job satisfaction was moderate (3.67 ± 1.75).
The study found that nurses experienced both positive and negative spiritual responses during the pandemic. While most nurses reported a high level of moral injury and moderate job satisfaction, they experienced low religious/spiritual struggles and some spiritual growth. Incorporating spirituality into nursing practice may enhance professional fulfilment and nurse outcomes.
To determine the frequency, timing, and duration of post-acute sequelae of SARS-CoV-2 infection (PASC) and their impact on health and function.
Post-acute sequelae of SARS-CoV-2 infection is an emerging major public health problem that is poorly understood and has no current treatment or cure. PASC is a new syndrome that has yet to be fully clinically characterised.
Descriptive cross-sectional survey (n = 5163) was conducted from online COVID-19 survivor support groups who reported symptoms for more than 21 days following SARS-CoV-2 infection.
Participants reported background demographics and the date and method of their covid diagnosis, as well as all symptoms experienced since onset of covid in terms of the symptom start date, duration, and Likert scales measuring three symptom-specific health impacts: pain and discomfort, work impairment, and social impairment. Descriptive statistics and measures of central tendencies were computed for participant demographics and symptom data.
Participants reported experiencing a mean of 21 symptoms (range 1–93); fatigue (79.0%), headache (55.3%), shortness of breath (55.3%) and difficulty concentrating (53.6%) were the most common. Symptoms often remitted and relapsed for extended periods of time (duration M = 112 days), longest lasting symptoms included the inability to exercise (M = 106.5 days), fatigue (M = 101.7 days) and difficulty concentrating, associated with memory impairment (M = 101.1 days). Participants reported extreme pressure at the base of the head, syncope, sharp or sudden chest pain, and “brain pressure” among the most distressing and impacting daily life.
Post-acute sequelae of SARS-CoV-2 infection can be characterised by a wide range of symptoms, many of which cause moderate-to-severe distress and can hinder survivors' overall well-being.
This study advances our understanding of the symptoms of PASC and their health impacts.
FreshRSS 