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Anteayer Journal of Advanced Nursing

Shift‐Specific Patterns of Nursing Workloads in the Emergency Department: AI Powered Analysis

ABSTRACT

Aim

To identify and differentiate workload patterns across shifts and to provide evidence for optimizing nursing workforce allocation in emergency departments:

Design

A cross-sectional study.

Methods

Real time data were collected from an emergency department in a general hospital in Seoul, South Korea, between October 30, 2023 to October 24, 2024. Smartphones, beacons, and smartwatches were used to capture nursing time, physical activity, work-related characteristics, and location transitions across 238 shifts. A multiclass eXtreme Gradient Boosting model was developed and evaluated to classify working shifts (day, evening, night). Shapely Additive exPlanations were applied to identify key contributing features, and shift-specific differences were examined using analysis of variance with post hoc tests.

Results

The model demonstrated strong performance in distinguishing shifts. Key features included the number of admissions, discharges, assigned patients, and both direct and indirect nursing time, all of which varied across shifts. In contrast, location transition patterns were relatively consistent.

Conclusion

Shift-specific nursing workloads in emergency departments can be effectively identified using multidimensional, real-world nursing activity data.

Implications for the Profession and/or Patient Care

Findings support the development of staffing strategies that account for variation in workload across shifts, with potential to improve efficiency and maintain quality of care.

Impact

This study addresses the lack of objective evidence for shift-specific workload differences in emergency nursing. It demonstrates that multidimensional activity data can distinguish workload patterns across shifts. The findings may inform staffing decisions for emergency department nurses and support improvements in workforce management and patient care.

Reporting Method

This study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology guidelines.

Patient or Public Contribution

No patients or members of the public were involved in the design, conduct, analysis, or reporting of this study.

Surrogate Decision‐Making Practices Regarding End‐of‐Life Care for People With Dementia in Long‐Term Care Hospitals: A Qualitative Descriptive Study

ABSTRACT

Aim

To explore surrogate decision-making practices regarding end-of-life care for people with dementia in Korean long-term care hospitals from the perspective of healthcare providers.

Design

A qualitative descriptive study.

Methods

The data were collected through individual semi-structured interviews with 24 healthcare providers (physicians, oriental medicine doctors, registered nurses and social workers) involved in dementia end-of-life care in their current long-term care hospitals in South Korea. The data were analysed using a conventional content analytic technique.

Results

The analysis yielded three categories and nine subcategories describing surrogate decision-making practices regarding end-of-life care for people with dementia: (a) typical circumstances of end-of-life care planning, (b) expected roles of key personnel and related challenges and (c) important considerations. Participants discussed available treatment options within long-term care hospitals and the potential transfers to acute care hospitals during admission and periods of health decline. Physicians typically led such end-of-life care planning, with nurses playing a supportive role and family members making the final decisions. However, they faced challenges in performing their roles. In end-of-life care discussions, participants weighed the patients' autonomy and best interests alongside family members' interests and other external concerns such as potential lawsuits and insufficient medical resources.

Conclusion

Surrogate decision-making regarding end-of-life care in the context of dementia within long-term care hospitals is considerably complex and challenging for healthcare providers, requiring multifaceted institution-sensitive support.

Implications for the Profession and/or Patient Care

The study findings suggest the need for targeted education and training to enhance healthcare providers' competencies in end-of-life care discussions, advance care planning and the development of policies and regulations supporting end-of-life care-related practices within long-term care hospitals.

Reporting Method

This study was reported in accordance with the COREQ checklist.

Patient or Public Contribution

No patient or public contribution.

Longitudinal Mediating Role of Cancer‐Coping Self‐Efficacy Between Symptom Occurrence and Quality of Life Among Cancer Patients: A Cross‐Lagged Panel Model

ABSTRACT

Purpose

Although the positive correlation between self-efficacy and quality of life and the negative correlation between symptom occurrence and self-efficacy are well established in the cancer literature, the underlying mechanism, whether self-efficacy mediates the effect of symptoms on quality of life, remains unclear due to the cross-sectional design of prior studies. Longitudinal investigation is crucial for establishing the causal mechanism of self-efficacy in mitigating the adverse impact of cancer-related symptoms on quality of life.

Aim

To examine the longitudinal mediating effect of self-efficacy on the relationship between symptom occurrence and quality of life among 534 cancer patients on treatment with moderate to high symptoms.

Methods

This is a secondary data analysis of the longitudinal mediating effect. A sample of patients with moderate to high symptoms on cancer treatments (N = 534) from a randomised controlled trial was used. We adopted a cross-lagged panel model (CLPM) approach to test the longitudinal mediating effect with three waves. The longitudinal invariance of the measurement was previously tested.

Results

The results showed that cancer-coping self-efficacy predicted the following assessment of symptom occurrence, but not vice versa. Also, cancer-coping self-efficacy had an immediate direct impact on quality of life and the influence sustained to the following assessment. Our mediating analysis showed that cancer-coping self-efficacy totally mediated the relationship between symptom occurrence and quality of life (unstandardized β = −0.008, standardised B = −0.036, p = 0.036, CI95 = [−0.001, −0.016]).

Conclusion

Our findings provide initial evidence supporting the causal mechanism of cancer-coping self-efficacy in interventions that aim for symptom management and quality of life improvement.

Implications

This study is the first to test the longitudinal mediating mechanism of cancer-coping self-efficacy in the relationship between symptom occurrence and quality of life among the cancer population. Further testing using a randomised controlled trial of a specifically designed self-efficacy-enhancing intervention is needed.

Patient or Public Contribution

No patient or public contribution.

Pluralising Scholarship: Repositioning Doctor of Nursing Practice Faculty Through Boyer's Framework: A Discursive Paper

ABSTRACT

Aim

To critically examine the structural exclusion of Doctor of Nursing Practice (DNP)-prepared faculty from academic advancement and promotion pathways and to propose reforms grounded in Boyer's model of scholarship.

Background

The DNP is a practice-focused doctorate established in the United States, distinct from the research-oriented PhD. Similar professional doctorates in the United Kingdom and Australia share the goal of integrating clinical expertise with scholarly inquiry. Despite the rapid growth of DNP programs and the increasing recognition of applied scholarship, many universities continue to privilege traditional research metrics in academic tenure and promotion. This narrow focus on discovery-based outputs marginalises the contributions of DNP faculty in implementation science, systems leadership, and education.

Design

Discursive position paper.

Data Sources

Analysis of policy reports, faculty promotion guidelines, AACN Essentials, and peer-reviewed literature on doctoral education, professional doctorates, and academic equity, 2000–2025.

Implications for Doctoral Education

Current academic evaluation systems sustain hierarchical norms that undervalue practice-based scholarship. This misalignment restricts the career trajectories of DNP-prepared faculty and constrains nursing's leadership in applied innovation. Reframing scholarly legitimacy through Boyer's model of discovery, integration, application, and teaching enables recognition of diverse expertise without compromising academic rigour.

Conclusion

Fully integrating professional doctorates into academic structures requires deliberate reforms in evaluation frameworks, mentorship programs, and institutional policies. Such changes would advance equity, reflect the realities of modern nursing, and align doctoral education with the evolving needs of healthcare systems.

Impact

This paper contributes to the international discourse on the future of doctoral education by offering a practical model for inclusive faculty advancement. It also advocates adopting pluralistic definitions of scholarship to support diverse academic career paths in nursing.

No Patient or Public Contribution

No patients, service users, caregivers, or members of the public were involved in the development of this discursive paper. The analysis synthesises existing scholarship, policy documents, and theoretical frameworks and does not draw on primary data requiring patient or public involvement.

Understanding Nurses' Needs Regarding Tailored, Evidence‐Based Sleep Education and Training

ABSTRACT

Aim

Identify desired training content for shift-working nurses to improve their sleep and fatigue.

Design

A descriptive qualitative design.

Methods

We recruited night shift nurses (N = 23) to provide feedback during virtual focus groups/interviews. Data collection occurred in the U.S. between March and June 2024. Participants were presented with sleep and fatigue topics derived from the literature. Focus group/interview data were collected and transcribed. Data were analysed using a hybrid deductive-inductive manifest content analysis with an a priori coding schema based on topics shared during data collection. Data not fitting the schema, yet informing content, were analysed inductively.

Results

Three themes aligned with literature-derived topics. Theme 1, Why We Sleep and Why Should Nurses Care, explains the importance of sleep to health. Theme 2, Sleep Practices for Nurses to Support Health and Social Relationships, describes healthy strategies to promote sleep for enhanced quality of life. Theme 3, Fatigue and Work, illustrates the significance of nurse sleep and fatigue risk mitigation to safe working conditions and patient care.

Conclusions

Study findings highlight night shift nurses' interest in gaining evidence-based information to promote their sleep. Sleep education and training could fill a knowledge and skills gap, not often offered in school or workplace.

Implications for the Profession

Identifying themes relevant to nurses may help increase the development and availability of sleep education and training currently tailored for nurses.

Impact

Study findings describe content night shift nurses' desire for sleep and fatigue training, serving as an important first step in developing programmes most relevant to shift-working nurses. Our analysis found the findings largely align with key components workers should receive in sleep education and training and reinforced the need for employers to offer such training. This study could benefit the nursing workforce and employers who expect rested, high-functioning nurses to care for patients.

Reporting Method

Standards for Reporting Qualitative Research.

Patient or Public Contribution

No patient or public contribution.

Trial and Protocol Registration

Clinicaltrials.gov, NCT06105307

Feasibility and Acceptability of the Smarthealth Intervention for Dementia Caregivers. A Qualitative Analysis of a Single‐Group Pilot Study

ABSTRACT

Aim(s)

To explore the feasibility and acceptability of acoustic monitoring and real-time recommendations for stress detection and management (i.e., smarthealth intervention).

Design

This qualitative study used a framework of acceptability for healthcare interventions.

Methods

From January 2021 to December 2023 in the U.S.A., we interviewed 10 family caregivers who had completed the 4-month smarthealth intervention. The caregivers shared their user experiences and feedback on the system's feasibility and acceptability. Data were analysed using abductive thematic analysis, incorporating the framework of acceptability for healthcare interventions and the collected data.

Results

Seven themes and 19 categories emerged: attitudes, burden, ethicality, intervention adherence, intervention coherence, perceived effectiveness and suggestions. Feedback on the smarthealth intervention was mixed. Some found it beneficial, citing accuracy, ease of use and increased awareness. However, others felt burdened during its use, primarily due to time constraints.

Conclusion

The smarthealth intervention can potentially improve caregivers' awareness of themselves and caregiving situations.

Implications for the Profession and/or Patient Care

Future directions should involve adapting the smarthealth intervention to consider diverse caregiving scenarios and incorporating a larger sample of caregivers.

Impact

This is the first study to offer a voice detection system and real-time stress management recommendations to caregivers of people living with dementia. An individualised approach should be considered to improve the system's effectiveness. This includes providing personalised intervention components, considering caregivers' time and establishing a user-friendly system with high accessibility. The findings can be a cornerstone for smarthealth interventions influencing dementia caregivers' self-care and emotional regulation.

Reporting Method

Standards for Reporting Qualitative Research.

Patient or Public Contribution

Members of the public and service users from a memory clinic and social media platforms contributed to the study by reviewing recruitment materials.

Trial Registration: This trial's study protocol was registered with ClinicalTrials.gov (ID No. NCT04536701) on 3 September 2020 (https://classic.clinicaltrials.gov/ct2/show/NCT04536701)

A Conceptual Analysis of Psychological Burnout Among Nurses Providing Terminal Care

ABSTRACT

Aim

To analyse the concept of psychological burnout among nurses in the context of terminal care.

Design

Concept analysis.

Methods

The study was conducted according to the eightstep conceptual analysis procedure suggested by Walker and Avant.

Data Sources

Articles published in English or Korean between January 2014 and 2024 were reviewed in March 2024. A total of eight search engines were used for the literature review, including PubMed, Cumulative Index of Nursing and Allied Health Literature (CINAHL) and PsycINFO. A total of 19 articles were finally selected for the analysis based on criteria.

Results

The attributes of psychological burnout among nurses providing terminal care are depletion of energy, emotional numbness, disengagement, sense of powerlessness and emotional repression. Seven antecedents and six consequences of the concept were identified in this study.

Conclusion

The result of this study provides a foundation for the development of tailored interventions and further research related to the occurrence of psychological burnout among nurses providing terminal care. Additionally, considering the characteristics of terminal care, we suggest additional studies to confirm the attributes of burnout in this context across various cultural and religious backgrounds.

Implication for the Profession and/or Patient Care

This study helps clarify the concept of psychological burnout among nurses in terminal care and informs the development of various interventions, educational programmes and related policies.

Patient or Public Contribution

No patients or public contribution.

Culturally and Linguistically Diverse Informal Carer Experiences of Older Adult Care Transitions From Hospital to Home: A Scoping Review

ABSTRACT

Aim

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.

Design

Scoping review guided by Arksey and O'Malley's framework.

Data Sources

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.

Methods

Two reviewers independently screened studies and extracted data. Analysis followed the Patterns, Advances, Gaps, Evidence for Practice and Research recommendations framework.

Results

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.

Conclusion

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.

Implications for the Profession and/or Patient Care

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.

Reporting Method

This review follows the PRISMA guideline for reporting.

Patient or Public Contribution

No patient or public contribution.

Culturally and Linguistically Diverse Fathers' Experiences of Early Parenting: A Qualitative Study

ABSTRACT

Aim

This study aimed to explore culturally and linguistically diverse (CALD) fathers' early parenting support needs in the perinatal period in Australia.

Design

A qualitative descriptive research study. Participant fathers were recruited using purposive and snowball sampling who self-identified as CALD.

Methods

Data were collected through semi-structured telephone interviews with 15 Australian fathers aged between 29 and 56 years in July–November 2022. Data were analysed using Braun and Clarke's six stages of thematic analysis to code, categorise and identify themes from the data.

Findings

Four major themes and six sub-themes emerged from the data, ‘Under pressure’, ‘Slipping through the cracks’, ‘Gaining knowledge and support by health professionals’, and ‘Path ahead: changed roles and being supported by peers’ that encompassed fathers' early parenting experiences and support needs in the perinatal period.

Conclusion

Culturally and linguistically diverse fathers experience challenges in navigating maternal health care settings and at times interactions with health professionals. However, findings from this study showed that fathers were determined to navigate resources, services and networks that supported their transition to fatherhood in the early postpartum weeks. There is a need for maternity settings to be a ‘father-inclusive’ environment where informational and practical support is readily available to them. Legislation reform is needed that recognises fathers as parents who require adequate ‘paid’ parental leave entitlements that foster family relationships and recognises the role fathers play in the development of their child.

Implications for the Profession and/or Patient Care

This study provides insights into the support needs of CALD fathers in the perinatal period. Findings from this study have the potential to shape and design culturally appropriate health services and interventions tailored to CALD fathers that meet their nuanced needs through the lens of cultural competence and trauma informed maternity care.

Impact

What problem did the study address?: The study explored the support needs of CALD fathers in the perinatal period. What were the main findings?: The findings revealed CALD fathers feel a sense of responsibility and pressure to live up to socio-cultural expectations and support the family unit while engaging in paid employment to earn a living. At times fathers were not encouraged to be parenting partners by health professionals, and there was an expectation that they would be familiar and have knowledge about pregnancy, labour, birth and the transition to fatherhood. Some fathers struggled with their transition to parenthood either due to lack of paid parental support or limited to no family support. However, some fathers found alternatives to manage and adjust in the early weeks postpartum, which included peer support groups and online information. Where and on whom will the research have an impact?: The research has the potential to impact all fathers, as the findings may be transferrable across a number of communities. The research also has the potential to influence cultural competence training for health care professionals and inform policy development that employs a family centred model of maternity care inclusive of culturally diverse families.

Reporting Method

The paper has adhered to the EQUATOR COREQ reporting guideline.

No Patient or Public Involvement

This study did not include patient or public involvement in its design, conduct or reporting.

Mediating Effects of Family and Clinical Characteristics on the Quality of Life of Children With Spina Bifida and Their Parents

ABSTRACT

Aims

(1) To determine the mediating effects of children's transition readiness, which reflects self-management skill acquisition, and family resilience on the relationship between parenting stress and the quality of life (QOL) of parents and children with spina bifida (SB). (2) To conduct an exploratory analysis of the differences in the mediating pathways based on the presence of SB-related clinical characteristics.

Design

A cross-sectional study.

Methods

Data were collected from a single centre in South Korea between October 2022 and July 2024. Participants included children aged 7–13 years diagnosed with myelomeningocele, lipomyelomeningocele or tethered cord syndrome, along with their parents. Statistical analysis was conducted using SPSS and the MEDYAD macro for actor–partner interdependence mediation model analysis.

Results

Family resilience significantly mediated the relationship between parenting stress and both child and parent QOL. However, transition readiness was not a significant mediator in the overall sample. Among children with SB-related clinical characteristics, transition readiness significantly mediated the association between parenting stress and child QOL. In contrast, family resilience mediated the relationship between parenting stress and parent QOL. No significant mediators were found in children without SB-related clinical characteristics.

Conclusion

This study highlights the mediating role of family resilience and transition readiness in improving the QOL of children with SB, particularly those with clinical characteristics. The findings suggest that interventions should be tailored to address both family resilience and transition readiness, especially for children with SB-related clinical challenges.

Impact

These findings are valuable for nurses supporting children with SB, as the results highlight the importance of transition education tailored to SB-related clinical characteristics. In particular, nurse-led transition education may play a key role in enhancing transition readiness and improving the QOL of children with SB who have clinical characteristics.

Patient Contribution

None.

Reporting Method

STROBE Checklist for cross-sectional studies.

Healthcare Professionals' Advice to Guide End‐Of‐Life Care Education Delivery in Hospitals: A Qualitative Study

ABSTRACT

Aim

To explore the key advice healthcare professionals would give colleagues regarding end-of-life care delivery in hospitals, thereby informing training needs.

Design

Exploratory qualitative study.

Methods

Free-text responses from medical, nursing, and allied health professionals who completed online end-of-life care education modules (n = 597) from August 2022 to September 2023 were analysed using inductive content analysis. Results were explored and separated into two key findings: themes that were shared by all professional groups and themes that were profession specific.

Results

Five themes were consistent across all three professional groups: prioritise patient comfort, proactive communication, collaboration and inclusion, human approach and support and wellbeing, each with their own subthemes. Several profession specific subthemes were also identified.

Conclusion

The identification of common themes across healthcare professions helps to support the development of interprofessional training initiatives.

Implications for Profession and/or Patient Care

This research contributes valuable insights for developing targeted end-of-life care education programs. Results also underscore the potential of online learning platforms in providing accessible, evidence-based, continuing professional development in end-of-life care.

Impact

In Australia, most deaths occur in acute hospital settings. To inform and shape future training, this study collected the key advice healthcare professionals would give colleagues regarding end-of-life care delivery. The themes generated covered a range of potential training topics shared across all professionals, including prioritise patient comfort, proactive communication, collaboration and inclusion, human approach and support and wellbeing. Several profession-specific subthemes were also identified, providing additional insights for designing training for professional groups. Results underscore the potential of online learning platforms in providing accessible, evidence-based, continuing professional development in end-of-life care.

Reporting Method

Standards for Reporting Qualitative Research (SRQR).

Patient or Public Contribution

None.

Neonatal Twin Cobedding: A Mixed Method Study of Policy, Practice and Staff Perceptions in Australia

ABSTRACT

Aim

To explore neonatal unit policy and practice, and neonatal healthcare workers' experiences, beliefs and perceptions of twin cobedding in Australia.

Design and Methods

A two-part convergent mixed methods design was used. Part 1 data were collected via an online survey of neonatal units. Part 2 data were collected by focus groups and interviews with healthcare workers. Findings were integrated to create final results.

Results

21 neonatal units, and 17 healthcare workers participated in this study. Significant variations in twin cobedding practices were reported within and across neonatal units. Practice variation was influenced by several interlinked factors, captured in four themes: (1) Policy-Driven Practitioners in a Policy Vacuum; (2) Evidence, Knowledge and Education; (3) Personal Beliefs and Practice Observations; and (4) “The Parent Owns that Baby”—Being Family-Centred.

Conclusions

Due to widespread practice and policy variations, and a lack of evidence-based education for staff, healthcare workers appear to be making individual decisions regarding cobedding practice, potentially creating confusion for twin families navigating care.

Implications for the Profession and/or Patient Care

Improvements to twin cobedding practice education are needed to enable clinicians to support twin families in their care. Separation of twins in neonatal units needs to be addressed, regardless of twin cobedding practice. Research identifying benefits and any potential risks of twin cobedding practice is required.

Impact

Neonatal healthcare workers are policy-driven practitioners who value clear evidence and education to confidently support the families in their care. It is important that evidence-based guidelines for twin cobedding are developed to support them in family-centred clinical practice.

Reporting Method

MMAT guidelines were used to prepare this manuscript.

Patient or Public Contribution

No Patient or Public Contribution.

Factors Affecting the Quality of Life of Parents of Children With Spina Bifida: The Mediating Role of Family Resilience

ABSTRACT

Aims

To investigate factors affecting the quality of life of parents of children with spina bifida and examine how family resilience mediates between parental depression and quality of life.

Design

Cross–sectional study.

Methods

Secondary data analysis was performed using first-year data from a five-year spina bifida cohort project (2022–2026) in South Korea. The study included 162 parents of children aged 4–12 years with spina bifida. Data were collected using the Korean version of the Family Resiliency Scale, the Center for Epidemiologic Studies Depression Scale, and the WHO Quality of Life Scale.

Results

Factors were found to have a statistically significant influence on the quality of life of parents of children with spina bifida: the child's need for enemas, parental stress, parental depression, and family resilience. Baron & Kenny's mediation analysis and bootstrap analysis in SPSS further confirmed that family resilience plays a mediating role between parental depression and quality of life. The indirect effect of parental depression on quality of life through family resilience was statistically significant, with a 95% confidence interval of [−0.2615, −0.0516].

Conclusion

The quality of life of parents with children with spina bifida is significantly influenced by both their child's daily symptom management and their psychological health. Family resilience plays a positive mediating role between parental depression and quality of life.

Implications for the Profession and/or Patient Care

These findings support a two-track approach to family resilience building programs and the development of core intervention strategies to enhance the quality of life in spina bifida families.

Reporting Method

This study adhered to Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines.

Patient Contribution

There was no direct patient involvement in the study design, data collection, or analysis.

Systematic Reviews of Psychosocial Interventions for Loneliness Among Older Adults in Community and Residential Care Settings: An Umbrella Review

ABSTRACT

Aim

To describe the latest information on types of psychosocial interventions and their effectiveness on loneliness reduction among older adults in community and residential care settings, and the experience with these interventions.

Design

Umbrella review.

Methods

The Joanna Briggs Institute methodology for umbrella reviews.

Data Sources

Cochrane Database of Systematic Reviews; Cumulative Index of Nursing and Allied Health Literature; Medline; Embase; Emcare; PsycINFO; ProQuest Dissertation & Thesis Global; Ovid Nursing Database; MedRxvi.

Results

Twenty-two reviews were included. Seven major types of psychosocial intervention were identified: (1) social facilitation interventions, (2) psychological therapies, (3) health and social care provision, (4) animal-assisted interventions, (5) befriending interventions, (6) leisure and skill development, and (7) other interventions. Social facilitation interventions that provide synchronised interaction, psychological therapies, health and social care provision, and animal (−assisted) interventions demonstrated positive effects while leisure/skill development and befriending interventions warrant more rigorous evidence. Group settings, synchronised interaction and purpose-driven are identified as facilitators, whereas technological issues and safety issues are barriers to participation.

Conclusion

Seven types of psychosocial interventions are currently available for loneliness among community-dwelling older adults, and a positive effect in reducing loneliness was demonstrated in some types. Facilitators and barriers to their participation were synthesised. Two future research directions are suggested: (1) reviews on meaning-centred interventions to provide a comprehensive understanding and (2) implementation studies employing community-based paraprofessionals to promote programme scalability and accessibility.

Implications for the Profession

Health and social care practitioners (e.g., nurses), researchers and policymakers are recommended to employ social facilitation interventions with synchronised interaction, psychological therapies, health and social care provision and animal-assisted interventions to address loneliness among community-dwelling older adults.

Impact

This review provided empirical information on available effective interventions to address loneliness among community-dwelling older adults. It also provided information for nurses to implement psychosocial interventions in the community.

Reporting Method

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines

Patient or Public Contribution

This study did not include patient or public involvement in its design, conduct or reporting.

Trial Registration

PROSPERO CRD 42023482852, registered 25/11/2023

A 28‐Day Ecological Momentary Assessment of Mental Health Among Psychiatric Outpatients With Suicidal Ideation

ABSTRACT

Aims

Considering that suicide has remained a public health challenge in South Korea since 2009, the development of a real-time monitoring system for suicide risk is urgently needed, especially for those living in the community. The aims of this study were to explore the 28-day longitudinal pattern of suicidal ideation, compare momentary depression, anxiety and stress between different risk groups, and identify the association of suicidal ideation with momentary indicators in community-dwelling outpatients at risk of suicide.

Design

Observational and longitudinal investigation.

Methods

A total of 50 community-dwelling psychiatric outpatients were included herein. Those with a history of suicide attempts were classified into the high-risk group (n = 40, 80%), whereas the rest were classified into the low-risk group (n = 10, 20%). Real-time data on depression, anxiety, stress and suicidal ideation were collected from May 2021 to July 2023 based on ecological momentary assessment. Each participant provided reports at least three times a day for 4 weeks. A total of 3195 ecological momentary assessment responses were collected, among which 1345 with the highest mood intensity per day were selected for analysis. Panel mixed-effect linear regression models examined differences in ecological momentary assessment responses between high- and low-risk groups and elucidated the separate effects of depression, anxiety and stress on suicidal ideation in each risk group.

Results

Momentary depression, anxiety and stress were positively associated with momentary suicidal ideation in both risk groups, with these associations being higher among the high-risk group. In both risk groups, momentary suicidal ideation was more strongly associated with momentary depression than with momentary anxiety and stress.

Conclusions

Psychosocial stress indicators were associated with momentary suicidal ideation. Moreover, a strong association was observed between momentary depression and suicide attempts. Further research with larger samples should be conducted to evaluate whether depression interventions could reduce momentary suicidal ideation.

No Patient or Public Contribution.

Self‐Determination Theory as a Framework for Research and Design of Digital Applications for Nurses' Well‐Being

ABSTRACT

Aim

To establish the suitability of self-determination theory as a theoretical framework to inform research and design of digital applications for nurses' well-being.

Design and Method

This discursive paper describes the background and core premises of self-determination theory and explains its relevance as a theoretical framework to support research and the design of digital applications to promote nurses' well-being.

Findings

Increasing numbers of digital applications are being used by nurses, but few are supported by clearly explicated theoretical frameworks. Self-determination theory focuses on how people's innate psychological needs interact and are influenced by the social environments where they live and work. Given the influence the social environment can have on well-being, self-determination theory is well suited as a theoretical framework to inform research and design of digital applications promoting nurses' well-being.

Conclusions

Stress and burnout impact nurses worldwide, to the detriment of staff well-being, their retention in health services, and provision of patient care. The rapid development and ubiquitous use of digital applications by nurses make researching their effectiveness vitally important if nurses' well being is to be supported. Self-determination theory provides a theoretical framework useful for these applications.

Implications for the Profession

Through the lens of self-determination theory, researchers, digital application designers, and organisations can garner further insights to support digital application development and implementation for the well-being of nurses.

Impact

This paper has international relevance and can assist researchers, application designers, and organisations interested in promoting nurses' well-being through understanding the applicability and usefulness of self-determination theory as a theoretical framework for the design of digital applications for nurses' well-being.

Patient or Public Contribution

No Patient or Public Contribution.

‘Giving and Receiving’—Peer Volunteers' Experiences of Online Perinatal Support: A Qualitative Study

ABSTRACT

Aim

To explore peer volunteers' experiences of delivering online support through SMART to at-risk mothers during the perinatal period, to inform future improvements to mobile-health-application (mHealth app) based peer-support interventions.

Design

Descriptive qualitative research.

Methods

The study was conducted between February 2024 and June 2025 in a tertiary public healthcare institution in Singapore. Twenty peer volunteers were recruited via convenience and snowball sampling and participated in individual semi-structured interviews. Interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis.

Results

Four themes were identified: (a) Giving and receiving: the inner world of peer volunteers; (b) Navigating relational complexity in digital peer support; (c) Facilitating connection and continuity in digital peer support; and (d) Building better connections through supportive ecosystems.

Conclusion

Peers reported experiencing reciprocal benefits, such as a sense of fulfilment and achievement, while supporting mothers. Shared experiences and psychosocial vulnerabilities enhanced relatability, reassurance and rapport, which sustained supportive relationships. Challenges encountered by peers highlighted the need for strengthening both intervention design and peer training.

Implications for Patient Care

Regular check-ins by programme facilitators, alongside clear information, flexible guidelines and reassurance, can improve peer volunteers' motivation and resilience, thereby ensuring consistent and sustainable support for at-risk mothers.

Impact

Examined peer volunteers' experiences in providing online perinatal support to mothers with diverse psychosocial vulnerabilities. Peers offered emotional, informational and practical support, while mothers benefited from learning how peers had coped with their psychosocial vulnerabilities. Shared experiences fostered confidence and reassurance among mothers that they, too could overcome similar adversities. Valuable in providing both medically accurate perinatal information and meaningful social support to perinatal mothers.

Reporting Method

The reporting of the study adheres to the standards outlined in the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist.

Patient or Public Contribution

Mothers and peer volunteers contributed valuable insights and suggestions that helped in the design of the intervention.

Timely Implementation of Patient‐Reported Outcomes in Clinical Care: Insights From Clinicians and Health Informatics Experts

ABSTRACT

Aim

To explore the optimal timing of patient-reported outcome assessment, defined as the collection and use of patient-reported outcomes at clinically meaningful points such as before or during encounters, treatment initiation and follow-up, and to identify the facilitators and barriers to timely use.

Design

A qualitative analysis of semi-structured interviews with healthcare professionals across diverse US health systems.

Methods

Thematic analysis was used to identify key themes related to the timing and implementation of patient-reported outcomes assessments. Interviews were analysed iteratively to develop a coding framework and synthesise overarching themes.

Results

Fourteen healthcare professionals, including nurse practitioners, cardiologists and health informatics experts across seven U.S. health systems from academic and community hospitals, were interviewed in February 2024. Three major themes emerged: (1) value proposition of timely patient-reported outcome data collection (2) key facilitators for timely implementation and (3) multilevel barriers. The value proposition focused on the use of patient-reported outcomes for prevention and active disease management. Critical facilitators for the timely implementation of patient-reported outcomes included the involvement of research and clinical coordinators, strategies for pre-visit and on-site patient-reported outcome collection, the use of standardised templates within EHRs and the alignment of patient-reported outcome collection with patients' long-term treatment goals. Finally, multilevel barriers included time constraints, patient-level challenges (e.g., fatigue, literacy, language) and systemic issues (e.g., technical limitations, lack of reimbursement and unclear guidelines).

Conclusion

Timely collection and use of patient-reported outcomes is critical for improving symptom monitoring and supporting patient-centered clinical decision-making. However, multilevel barriers hinder consistent implementation across health care settings.

Implications for the Profession and/or Patient Care

Integrating patient-reported outcomes into clinical workflows can improve the patient-centeredness of patient-healthcare professional interactions, and provide a more holistic picture of a patient's health status. Addressing barriers to patient-reported outcome implementation, including lack of time, poor health literacy and workflow integration barriers, is crucial for improving clinical outcomes.

Reporting Method

This study adhered to the COREQ (Consolidated Criteria for Reporting Qualitative Research) checklist, in accordance with EQUATOR Network guidelines.

Patient or Public Contribution

No patient or public involvement: This study did not include patient or public involvement in its design, conduct or reporting.

Nurses' Perceptions and Behaviours Regarding Climate Change and Health: A Quantile Regression Analysis

ABSTRACT

Aims

The aim of this study is to identify the factors associated with nurses' perceptions and behaviours related to climate change and health (PBCH) according to their PBCH levels.

Design

A cross-sectional study was used.

Methods

This study included a sample of 499 Korean nurses and adhered to the STROBE checklist. Data were collected from March 23 to May 10, 2023. Quantile regression analysis was performed, and PBCH levels were measured using the Korean version of the Climate Health and Nursing Tool.

Results

Across all quantile groups, the experience of extreme weather events and awareness of climate change-coping facilitators were associated with PBCH. Differences were observed in factors associated with PBCH levels. Significant associations with PBCH were observed within the 75th percentile group, for having a religion, household income, and workplace climate friendliness. In the 25th percentile group, having a child, the number of sources for climate change–health-related information, and experience in setting climate change–health goals and strategies significantly influenced PBCH.

Conclusion

We propose a differentiated strategy by elucidating the factors associated with high and low quantiles of PBCH levels.

Implications

By verifying specific factors associated with PBCH levels, nurses can enhance their preparedness to respond to the health risks posed by climate change in their clients.

Impact

Identifying common factors associated with all quantiles of nurses is important for establishing universal PBCH characteristics. Recognising the distinctions between high and low PBCH levels can aid in developing tailored nursing strategies to enhance PBCH among nurses.

Reporting Method

This study adhered to the STROBE guidelines.

Patient or Public Contribution

No Patient or Public Contribution.

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