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Anteayer Journal of Advanced Nursing

The Influence of Oral Health Related Knowledge, Attitudes and Practices on Oral Health Risk‐Related Behaviours of People in Custodial Settings: An Integrative Review

ABSTRACT

Aim

To explore the influence of oral health-related knowledge, attitudes and practices on oral health risk-related behaviours of people in custodial settings.

Design

Integrative review.

Data Sources

Scopus, ProQuest Central, Web of Science, Medline, CINAHL, Academic Search Complete, PsycINFO and Education Research Complete were searched in March 2024 and December 2025.

Methods

Studies reporting on any individuals in custodial settings, at least one oral health-related knowledge, attitude or practice and at least one oral health risk-related behaviour (either smoking, alcohol, illicit substances or sugar consumption). Data related to custodial population's oral health knowledge, attitudes, or practices and oral health risk-related behaviour were extracted, synthesised narratively and reported thematically.

Results

Findings from the 26 studies reveal that people in custodial settings had a general lack of oral health knowledge, and oral health risk-related behaviours were prevalent. The most common risk-related behaviours reported were tobacco use and free sugar consumption. Oral health knowledge, attitudes and practices of this population were influenced by custodial healthcare systems and attitudes of dental professionals.

Conclusion

This review highlights the influence custodial healthcare and dental professionals have on the knowledge, attitudes, practices and risk-related behaviours of people in custodial settings. Oral health targeted interventions and strategies are required to improve oral health-related knowledge and attitudes thereby encouraging oral health practices among people in custodial settings.

Implications for the Profession

This review will inform targeted oral health promotion programs that can improve oral health outcomes and experiences of this population.

Impact

People in custodial settings experience a disproportionate burden of oral diseases. This review underscores the need for proactive interventions and systemic reform to improve correctional healthcare experiences globally.

Reporting Method

Preferred Reporting Items for Systematic Reviews and Meta-Analysis, Extension for Scoping Reviews (PRISMA-ScR) 2018.

Patient or Public Contribution

No patient or public contribution.

What Does This Paper Contribute to the Wider Global Clinical Community?

Synthesises evidence on influencing factors contributing to poor oral health among people in custodial settings. Highlights impact of healthcare staff and custodial healthcare systems on population health. Highlights the necessity of oral health promotion programs to improve oral health knowledge and to promote oral health protective behaviours.

Social Isolation and Loneliness Among Older Asian Immigrants Through the Lens of Sense of Coherence: Systematic Review of Qualitative Studies

ABSTRACT

Aim

To explore the meaning older Asian immigrants attribute to social isolation and loneliness, their management strategies, utilisation of resources and impact on health.

Design

Systematic review of qualitative studies.

Data Sources

AgeLine, CINAHL, MEDLINE, ProQuest, PsycINFO, Scopus, and Web of Science databases were searched in September 2024.

Methods

Inclusion criteria: participants were Asian immigrants to Western countries aged 65 and over, community-living and experiencing social isolation and loneliness. Antonovsky's Sense of Coherence was used to frame the thematic analysis.

Results

Ten papers were included and analysed deductively using elements of the sense of coherence framework: • Comprehensibility: Social isolation and loneliness are viewed as multifaceted, influenced by cultural and environmental dislocation, language barriers, intergenerational conflicts, deteriorating health and mobility, and socioeconomic challenges. • Manageability: included engaging in culture-specific community programs, family and ethnic community support and living within ethnic enclaves mitigated isolation and loneliness. • Meaningfulness: Strong family ties, active community involvement, spirituality, volunteerism, and cultural practices fostered resilience. However, accepting the changing values of their new world, living independently, and carving their own niche provided meaning to their transformed reality.

Conclusion

Older Asian immigrants experience social isolation and loneliness through a cultural lens, shaped by migration experiences, language barriers, and shifting family dynamics. Cultural roots, family ties, spirituality, community, acceptance, and independence enhance sense of coherence. Recognising the dynamic interplay between cultural identity, resilience, and adaptation is key to understanding their lived experience.

Implications for the Profession and Patient Care

This review informs culturally sensitive interventions, guiding healthcare, community services, and policy to support social participation, mitigate loneliness through ethno-specific activities, and improve the quality of life for aging immigrant populations in Western countries.

Reporting Method

The review was undertaken and reported using the PRISMA guidelines.

Patient or Public Involvement

None.

Protocol Registration

PROSPERO (CRD42023425752)

Impacts of Financial Stress on Mental Health and Wellbeing of Nursing Students: A Systematic Integrative Review

ABSTRACT

Aim

To explore the direct relationship between financial stress and mental health and wellbeing of nursing students and characterise the effectiveness of available support mechanisms.

Design

Systematic integrative review.

Data Sources

Academic Search Complete, CINAHL, Education Research Complete, MEDLINE, ProQuest Central, PsycNET, Scopus and Web of Science were searched in January and October 2024.

Methods

Studies reporting a direct relationship between financial stress and mental health and wellbeing in nursing students were included. Data related to sources of financial stress, mental health impacts, and support mechanisms were extracted, synthesised narratively, and reported thematically.

Results

Findings from nine studies reveal that financial stress significantly affects nursing students' mental health and wellbeing, contributing to emotional distress and reduced quality of life. Financial stress arises from personal, academic and clinical sources, with the intensity varying based on individual demographic profiles and fluctuating throughout their educational journeys. Marginalised and underserved groups experience greater impacts due to pre-existing disadvantages. Current support mechanisms are largely reactive, providing only short-term relief and failing to address root causes. Additionally, students' efforts to alleviate financial stress in one domain often exacerbated it in another.

Conclusion

This review highlights the multifaceted and compounding effects of financial stress on nursing students' mental health and wellbeing. Proactive strategies, including structured employment programs, embedded financial literacy education, and transparent pre-enrolment information offer promising solutions.

Implications for the Profession

While financial stress cannot be fully eradicated, targeted support for at-risk students can mitigate its impacts, improving their mental health and educational outcomes.

Impact

This review addresses the critical issue of financial stress among nursing students, highlighting its disproportionate impact on marginalised and underserved groups. It underscores the need for proactive interventions and systemic reform to improve educational experiences globally.

Reporting Method

Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 Statement.

Patient or Public Contribution

No patient or public contribution.

Trial Registration: PROSPERO: CRD42024514262

Implementing Evidence‐Based Practice in Critical Care Nursing: An Ethnographic Case Study of Knowledge Use

ABSTRACT

Aim

To explore how critical care nurses access, negotiate and apply knowledge in high-pressure clinical environments, focusing on organisational, cultural and leadership factors influencing evidence-based practice implementation in acute hospital settings.

Design

A focused ethnographic collective case study was conducted across two contrasting critical care units in England.

Methods

Methods included non-participant observation (56 sessions), semi-structured interviews (36 participants) and document review. Spradley's Developmental Research Sequence guided data generation and analysis. Data were collected over an eight-month period (February to September 2022).

Findings

Five major themes were identified: sources of knowledge and acquisition strategies; institutional and hierarchical influences on knowledge use; role of experiential knowledge and clinical intuition; challenges to evidence-based practice implementation; and strategies for integrating knowledge into practice. Organisational structures, leadership engagement, mentorship and access to updated digital resources were key enablers of evidence-based practice. Barriers included workload pressures, inconsistent guideline dissemination and hierarchical cultures. Adaptive blending of formal evidence, clinical experience and intuition characterised effective knowledge negotiation at the bedside.

Conclusion

Knowledge use in critical care nursing is a dynamic, relational process shaped by leadership, organisational culture and systemic pressures. The availability of evidence alone is insufficient; visible leadership, peer learning, protected educational time and valuing of experiential knowledge are critical to embedding evidence-based practice into routine practice.

Implications for Patient Care

Strengthening organisational systems, investing in nurse manager development, expanding simulation-based learning and legitimising experiential knowledge are vital strategies to enhance evidence-based critical care.

Impact

This study provides actionable insights for healthcare leaders, educators and policymakers seeking to optimise evidence-based practice adoption in high-acuity clinical environments and improve patient outcomes.

Reporting Method

The Consolidated Criteria for Reporting Qualitative Research checklist guided reporting.

No Patient or Public Involvement

Patients and the public were not involved in the design, conduct, reporting or dissemination of this research.

Recent Trends in Doctoral Theses in Nursing Across Eight Countries: A Scoping Review

ABSTRACT

Aim

To explore and map the landscape of doctoral nursing research across eight countries.

Design

A scoping review.

Methods

This review followed the Joanna Briggs Institute methodology for scoping reviews and included doctoral theses in nursing defended between 2020 and 2023 in Austria, Italy, Israel, the Netherlands, Poland, Portugal, Slovakia and the United Kingdom.

Data Sources

Searches were conducted across 15 national and university repositories (4 national, 11 university) in the eight participating countries.

Results

This review included 431 doctoral nursing theses, the majority of which employed quantitative methodologies and focused on patient populations and healthcare professionals. Key topics included clinical nursing care, quality of care, quality of life, home care, perinatal care and the work environments.

Conclusion

Nursing doctoral research shows progress in healthcare delivery, patient care and education via digital tools, holistic approaches and professional development. Yet gaps persist in mental health, paediatrics and marginalised groups. Limited qualitative/mixed-methods research and weak interdisciplinary collaboration reveal further opportunities.

Implications for the Profession and/or Patient Care

This review underscores that nursing doctoral research is addressing major healthcare and professional challenges. Nonetheless, the identified gaps emphasise the need for more comprehensive and inclusive research to enhance equity and guide future nursing practices and policies.

Impact

This review provides an overview of the scope of doctoral nursing research across eight countries, identifying key trends and research gaps. The findings are expected to inform nursing academia, policymakers, and healthcare professionals by guiding future research priorities, fostering interdisciplinary collaboration, and promoting equitable, patient-centred care practices.

Patient or Public Contribution

No direct involvement in data collection; one lay reviewer gave feedback on readability and practice implications, informing minor refinements.

Recruitment by Chance, Retention by Choice: A Qualitative Study of Managers Perspectives on Personal Care Workers' Intention to Stay in Residential Aged Care

ABSTRACT

Aim

To explore the perceptions and experiences of managers in residential aged care settings regarding personal care workers' intention to stay and build a career. Specifically, this study sought to identify enablers and challenges influencing personal care workers' retention and to explore strategies that could improve workforce sustainability.

Design

A qualitative study utilising semi-structured interviews underpinned by the Theory of Planned Behaviour.

Methods

The study was conducted in Australia from July 2023 to March 2024. Eleven managers participated in this study. Data were analysed using inductive thematic analysis.

Results

Four themes emerged from the analysis and were conceptualised to illustrate the intricate relationship between recruitment practices, work environment, organisational culture and leadership in influencing personal care workers' intentions to stay in residential aged care. A botanical metaphor was used for each theme. The ‘Diverse Seeds of Varied Potential’ theme highlighted how ad-hoc recruitment processes were a primary driver of workforce instability. Challenging work conditions and differing expectations from personal care workers and management led to ‘Wilting in Adverse Environments’, which also contributed to a broader misalignment between facility culture and values, encapsulated within ‘Mismatched Habitats’. Participants emphasised the need for ‘Building a Greenhouse’, a metaphor for cultivating sustainable leadership and workforce development to address these issues.

Conclusion

This study's findings underscore the critical need for a cohesive approach to workforce development strategies in residential aged care. Transitioning from reactive, ad-hoc recruitment to strategic workforce planning, fostering a supportive organisational culture that aligns with personal care workers' expectations, and prioritising sustainable leadership practices are essential steps. Addressing these interconnected challenges can help build a more stable, committed and skilled workforce, ultimately enhancing the quality and continuity of care for residents.

Implications for the Profession and Patient Care

Strategic workforce planning and sustainable leadership development are essential for building a stable workforce, which directly impacts the quality and continuity of resident care.

Impact

This study addressed the critical issue of high turnover among personal care workers in residential aged care facilities, specifically examining managers' perspectives on retention challenges: an underexplored area that is crucial for developing sustainable workforce strategies. The findings revealed that current ad hoc recruitment practices, misalignment between diverse personal care worker profiles and established organisational cultures, have great impact on long-term engagement and retention. These insights are particularly valuable for residential aged care facilities struggling with staffing stability, industry bodies focused on workforce development and educational institutions preparing future aged care workers. Furthermore, the findings can inform policy development aimed at strengthening the aged care workforce, ultimately benefiting the quality of care received by residents.

Reporting Guideline

The Consolidated Criteria for Reporting Qualitative Research (COREQ).

Patient or Public Contribution

There was no patient or public contribution.

Individual and Institutional Factors Associated With Urinary Incontinence Among Nursing Home Residents: A Multilevel Analysis

ABSTRACT

Aims

(1) To analyse individual and institutional-level factors associated with urinary incontinence in older adults living in nursing homes; (2) to estimate the prevalence of urinary, faecal and double incontinence in nursing home residents.

Design

Cross-sectional study.

Methods

Residents aged 65+ living in 22 nursing homes in Catalonia (Spain) were included. Descriptive, bivariate, and multilevel analyses were performed.

Results

The final sample comprised 452 residents (75.9% female, mean age of 87.0 years). The prevalence of urinary, faecal and double incontinence was 77.5%, 46.1% and 45.7%, respectively. Urinary incontinence was statistically significantly associated with neurological conditions, moderate cognitive impairment, moderate dementia, severe cognitive impairment, very severe cognitive impairment and age.

Conclusion

Approximately three out of four nursing home residents suffered from urinary incontinence and almost half of the sample from faecal or double incontinence. Individual-level factors (cognition, neurological conditions and age) played a more important role than institutional-level factors for urinary incontinence.

Implications for the Profession and Patient Care

The findings of this study highlight the importance of individual-level interventions to prevent and manage urinary incontinence in nursing homes.

Impact

In Catalonian nursing homes, individual factors such as cognitive impairment and neurological conditions were more strongly associated with urinary incontinence than institutional factors. This has implications for improving care provided to older adults, particularly those with dementia and neurological conditions.

Reporting Method

STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines.

Patient or Public Contribution

Nursing home residents were not involved in this study.

Clinical Reflections of Doctoral Education in Nursing: A Qualitative Study on the Perspectives of Doctoral Students and Graduates

ABSTRACT

Aims

This study aims to examine the reflections of doctoral education in nursing on clinical practice, focusing on the perspectives of doctoral students and graduates.

Design

This study was conducted as qualitative research.

Methods

The study was conducted in February 2025 with 14 nurses who were either pursuing or had completed doctoral education in nursing and were working as nurses in Türkiye. Data were collected through face-to-face interviews using an introductory information form and a semi-structured interview guide. The data were analysed using an inductive content analysis method.

Findings

Four main themes were depicted throughout the study: the visibility of doctoral education in clinical practice, the reflection of doctoral education on nursing identity, challenges encountered during the doctoral education process and recommendations to strengthen the reflection of doctoral education in the clinic.

Conclusion

The study highlighted the importance of doctoral education, which has positively contributed to the professional development of nurses and nursing care.

Implications for Profession and/or Patient Care

Collaboration between clinical administrators and faculty members is needed to support the transfer of the gains achieved by doctoral nursing students and graduates during their doctoral education to clinical practice and to overcome the challenges encountered.

Patient or Public Contribution

No Patient or Public Contribution.

Reporting Method

The study was reported using the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist.

Inequalities in Doctoral Education From the Perspective of Nursing Doctoral Students

ABSTRACT

Aims

This study aims to identify the inequalities encountered during the nursing doctoral process and propose potential solutions.

Design

This study was conducted as qualitative and descriptive research.

Methods

The study was conducted between January and February 2025 with 18 students who were pursuing doctoral education in nursing and working as nurses in Türkiye. Data were collected through face-to-face interviews using an introductory information form and a semi-structured interview guide. The data were analysed using an inductive content analysis method.

Findings

Four main themes emerged from the study: Challenges: Dancing at Two Weddings at the Same Time, Academic Competition and Inequalities, Glass Ceilings in Hospitals and Solution Strategies for Inequalities.

Conclusion

The study highlighted the inequalities experienced by students who were simultaneously continuing their doctoral education while working as nurses in the same clinical setting.

Implications for Profession and/or Patient Care

Faculty members providing doctoral education could organise meetings to help students overcome the challenges they face during their educational process. Nurse managers, on the other hand, should organise regular meetings where nurses can share the difficulties they encounter and offer suggestions for improving their units.

Reporting Method

The Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist was used for reporting the study.

Patient Contribution

No patient or public contribution.

Exploring Mother–Daughter Perceptions of Weight, Shape and Physical Activity in a Refugee Camp

ABSTRACT

Aim

This study explored the perceptions of weight, shape and physical activity of Palestinian refugee adolescent girls and their mothers living in Baqa'a camp, Jordan.

Design

A descriptive qualitative design.

Methods

A purposive sampling approach was employed to recruit 12 Palestinians (six adolescent girls and their mothers) from a Palestinian refugee camp between March 2019 and mid-January 2020.

Results

The socioecological model framed the analysis process and revealed four main themes. At the individual level: ‘The Perfect Body’ explained how mothers and daughters conceptualised ideal body weight and shape and factors that influenced this perception. At the relationship level: ‘it's tough love I give, it's tough love I accept’ explored the tumultuous mother–daughter relationship and impact on weight, shape and physical activity. At the community level: ‘The camp community is insular and the setting, spartan’ highlighted how people within the community and the environment itself impacted on healthy behaviours, and at the society level: ‘The influence of where you are and who you are’ explored how the broader levels of society and the culture determined attitudes and perpetuated body weight and shape ideals among women.

Conclusion

Greater effort involves collaboration among nurses, educators, community leaders, parents, media professionals and researchers to deliver positive health messaging on weight, shape and the importance of physical activity, with further investment in resources and infrastructure to support behaviour change.

Implications for the Profession and/or Patient Care

Findings assist nurses in addressing sociocultural issues regarding body image among women and girls in refugee camps and in advocating for policies and practices that reduce health disparities.

Impacts

The findings provide nurses, educators and community leaders' insight in designing interventions that incorporate family dynamics and parenting styles to promote healthy body image, weight management and physical activity among adolescents and their mothers. Schools, with the support of school nurses, can implement programmes that promote open communication and positive modelling of body image, leading to healthier self-esteem and attitudes among adolescents.

Reporting Method

We have adhered to relevant EQUATOR guidelines using the COREQ reporting framework for qualitative research.

Patient or Public Contribution

No patient or public contribution.

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