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Ayer — Abril 14th 2026 Journal of Advanced Nursing

Outcome Domains of Professional Doctorates in Nursing: An International Three‐Phase Exploratory Study

ABSTRACT

Aim

Professional Doctorate Programmes (PDP) in nursing continue to develop across many countries. However, there is a lack of evidence demonstrating the impact on nurses who graduate from these programmes and the outcomes they deliver. This exploratory study aims to identify graduate outcome domains that can be applied internationally to evaluate professional doctorate programmes in nursing.

Design and Methods

Underpinned by Kim's theory of knowledge development in nursing, this innovative exploratory study was carried out in three phases: (1) a scoping review of literature published between 1 January 2000 and 1 July 2023, guided by the methodology developed by Arksey and O'Malley; (2) a document analysis of the graduate outcomes of three different universities' Professional Doctorate Programmes in Nursing and (3) a thematic analysis and coalescence of the findings from the initial two study phases.

Results

A scoping review revealed three patterns in the literature related to graduate outcomes: personal transformation, critical self-awareness and bridging the theory–practice divide. An analysis of three universities' Professional Doctorate Programmes revealed insights into documented graduate outcomes. The third and final research phase identified five graduate outcome domains: Personal achievement, critical self-awareness and professional identity, professional citizenship, discipline, research and information literacy and community-based academic practice.

Conclusions

The impact of Professional Doctorate Programmes in nursing has traditionally lacked consensus and clarity. However, this research has led to the identification of graduate outcome domains that offer valuable insights for establishing new professional doctoral programmes and conducting meaningful evaluations of the outcomes of existing PDP and their graduates globally.

Impact

This exploratory study establishes five graduate outcome domains for evaluating the effectiveness of PDP in nursing internationally. These domains offer valuable benchmarks for the development and assessment of such nursing programmes globally.

Patient or Public Contribution

Not applicable.

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.

Position, Responsibilities and Practice Interventions Relevant for Danish Transitional Care Nurses to Perform During Discharge of Older People: Delphi Survey

ABSTRACT

Aim

To determine expert clinicians' consensus opinion on the position, responsibilities and practice interventions relevant for hospital-employed Transitional Care Nurses (TCNs) to perform a successful discharge process of older people with multi-morbidity and transition to home.

Design

A two-round Delphi survey.

Methods

An expert panel of 54 TCNs from five hospitals and 11 municipalities in a rural Danish region was invited to participate in the two Delphi rounds. The Delphi survey was developed using four key sources of data. The final questionnaire consisted of 120 items. The experts evaluated the relevance of the items in two rounds performed in September 2024.

Results

In the first Delphi round, 40 (74.1%) of the 54 experts replied to the questionnaire. Consensus agreement of ≥ 75% relevance (4–5 Likert) was found in 60 of the 120 items. In the second Delphi round, 57.4% of the 54 experts responded. Of the remaining 60 items, four items were evaluated as less relevant and were therefore excluded. The experts consented on the final relevance of 56 items.

Conclusion

Coordination and continuity of the discharge process combined with a high level of teamwork and collaboration with the patients, their relatives, and interdisciplinary colleagues at the hospital and in the municipality were rated as the most relevant responsibilities and practice interventions for the TCNs.

Implications and Impact

Inadequate description of Danish TCN's function may affect the planning and safety of older patients' transition. Consensus agreement was reached on 56 items addressing TCNs' position, responsibilities and practice interventions essential for older patients' transition. Knowledge will be used further to strengthen the Danish TCN's function.

Reporting Method

We have adhered to the ‘Guidance of Conducting and REporting of DElphi Studies’ (CREDES).

Patient or Public Contribution

No patient or public contribution.

Nurses' Experience of Redeployment to a New Intermediate Care Unit for Respiratory Patients: A Qualitative Study

ABSTRACT

Aim

To explore the experiences of nurses transitioning from a clinical ward to a newly established respiratory intermediate care unit (IMCU).

Design

A qualitative descriptive approach was adopted to capture the lived experiences of redeployed nurses. This design was selected to address the research question: What are the initial experiences of nurses transitioning from general ward settings to a newly established IMCU for respiratory patients?

Methods

Two focus groups were conducted in June 2024, involving 14 purposefully selected registered nurses. Data were analysed using Braun and Clarke's thematic analysis framework, with the study reported in line with the Standards for Reporting Qualitative Research.

Results

The analysis revealed two interconnected themes reflecting the complexity of the redeployment experience. The first theme, ‘The introspection of waiting amidst change and readiness’, captures the emotional ambivalence nurses felt, characterised by anticipation, uncertainty and a perceived lack of preparedness. This phase was marked by concerns over clinical competence, fear of errors and the weight of new legal and ethical responsibilities. The second theme, ‘The road to organizational change with both driving forces and obstacles’, highlights nurses' concerns about physician readiness, feeling undervalued and limited involvement in planning. At the same time, nurses emphasised the importance of teamwork, structured preparation, experiential training and having the right equipment.

Conclusion

The study underscores the complexity of role transitions for nurses moving into semi-critical care settings like IMCUs. It reveals the need for targeted support strategies to reduce uncertainty and enhance role readiness.

Implications for the Profession and Patient Care

To improve the redeployment experience and patient outcomes, healthcare organisations should prioritise structured training, tailored preceptorship programmes and inclusive decision-making processes. These measures can strengthen nurses' resilience, support workforce sustainability and ensure the delivery of high-quality, patient-centred care in intermediate care environments.

Impact

This study highlights the significant impact of inadequate preparation and communication on redeployed nurses' experiences in respiratory IMCUs, emphasising the need for structured training and supportive team dynamics. These findings can guide healthcare leaders, nurse managers and policymakers in developing evidence-based redeployment strategies that reduce anxiety, strengthen team cohesion and ultimately improve nurse adaptation and patient care in semi-critical settings.

Reporting Method

We used the SRQR guidelines for reporting qualitative studies.

Patient or Public Contribution

No patient or public contribution.

Anteayer Journal of Advanced Nursing

Experiences of LGBTQ+ Healthcare Providers in Workplaces in Taiwan: A Cross‐Sectional Survey

ABSTRACT

Aims

To examine workplace experiences, perspectives on coming out at work, organisational climate and mental health status of lesbian, gay, bisexual, transgender, queer/questioning and other sexual, and gender minority healthcare providers (LGBTQ+ HCPs) within an East Asian cultural context.

Design

Observational, cross-sectional study.

Methods

An online cross-sectional survey was conducted among 173 Taiwanese LGBTQ+ HCPs between May and August 2024.

Results

Most of the 173 respondents did not disclose their LGBTQ+ identities to any colleagues, and approximately two-fifths met the clinically significant threshold for depressive symptoms. Furthermore, compared to LGBTQ+ HCPs who disclosed to all, most, about half or a few colleagues, those who had not disclosed to any colleagues reported higher levels of depressive symptoms, lower self-esteem, less comfort with disclosure, greater perceived necessity to conceal their LGBTQ+ identities, lower scores for job stability or security, poorer interpersonal relations and lower agreement that an LGBTQ+-inclusive workplace climate would influence their willingness to remain in their current jobs. Although approximately 80% of the LGBTQ+ HCPs reported that they were familiar with national workplace antidiscrimination laws and that their organisations had grievance mechanisms, nearly two-fifths did not trust the grievance systems or procedures within their organisations.

Conclusion

Results emphasise the urgent need to create an LGBTQ+-inclusive workplace environment with clear and enforceable antidiscrimination policies and inclusive organisational practices to improve both disclosure safety and mental health outcomes for LGBTQ+ HCPs.

Impact

The study results extend existing knowledge by identifying the relationship between different levels of disclosure and mental health status among LGBTQ+ HCPs. They also highlight the importance of establishing support groups, a comprehensive mental health referral system and enforcement mechanisms that safeguard legal rights without compromising the privacy or safety of LGBTQ+ HCPs.

Patient or Public Contribution

No patient or public contribution.

“We're All in This Together”: A Mixed‐Methods Study of Provider and Patient Perceptions of Emergency Care for Opioid Use Disorder

ABSTRACT

Aims

To compare attitudes and perceptions towards opioid use disorder among people with opioid use disorder and emergency providers, describe interactions between the two groups, and identify barriers to providing and receiving care.

Design

Mixed methods observational study.

Methods

Participants were recruited from an academic, tertiary care hospital and a community-based harm reduction agency in New England. Emergency healthcare providers (nurses, physicians, and paramedics) and adult people with opioid use disorder were enrolled. Electronic surveys were administered to providers, and semi-structured interviews were conducted with people with opioid use disorder and a subset of providers. Descriptive statistics were calculated for surveys, and directed content analysis was used to analyse semi-structured interviews.

Results

Sixty-eight providers completed the survey, 11 of whom also completed a semi-structured interview. Twenty-two people with opioid use disorder completed the semi-structured interview. Both providers and people with opioid use disorder agreed that addiction is a disease; however, opinions differed on the extent to which personal choice played a role in the onset of opioid use disorder. Participants described how factors such as experiencing homelessness, alongside other personal or familial challenges, contributed to ongoing substance use and presented barriers to accessing healthcare. There was discordance in priorities between providers and people with opioid use disorder, which often drove conflict and perceived stigma. Both groups described physical and emotional trauma from prior interactions, which shaped expectations of future interactions and biases towards each other.

Implications for the Profession and/or Patient Care

Educational initiatives should arm providers not only with clinical knowledge about opioid use disorder but with skills to recognize implicit biases, navigate unique barriers related to social determinants of health, and effectively deploy shared decision-making techniques. Healthcare organizations should provide support for trauma that emergency care providers are exposed to in caring for people with opioid use disorder.

Reporting Method

Consolidated criteria for reporting qualitative studies (COREQ)–32 item checklist.

Patient or Public Contribution

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

Postpartum Contraceptive Care: A Qualitative Study of Australian Child and Family Health Nurses' Experiences

ABSTRACT

Aim

To address the gap in existing postpartum care literature by gaining an in-depth understanding of Australian child and family health nurses' experiences of providing postpartum contraceptive care.

Design

A qualitative exploratory study design, using semi-structured interviews.

Methods

Convenience and snowballing sampling methods were employed to recruit child and family health nurses currently practising in Australia. Semi-structured interviews were conducted with 15 nurses in July 2023, and data were analysed using reflexive thematic analysis as outlined by Braun and Clarke. The consolidated criteria for Reporting Qualitative research checklist were used to support the research process.

Results

Despite their frequent contact with postpartum women and acknowledging the importance of postpartum contraceptive care, most participants did not commonly discuss contraception or family planning with mothers and did not feel it was part of their role to do so. Participants cited role ambiguity, limited knowledge of postpartum contraception, lack of clinical practice guidance, time constraints, and competing priorities as contributing to inconsistencies in postpartum contraceptive care provision.

Conclusion

This study highlights critical gaps in the provision of postpartum contraceptive care by child and family health nurses in Australia and underscores the need for systemic changes to promote postpartum contraceptive care as a key component of routine maternal health services.

Implications for the Profession and Patient Care

This study provides actionable evidence for improving the delivery of postpartum contraceptive care, ensuring women are provided with accurate information about their options, and supporting contraceptive uptake to reduce the incidence of short interpregnancy intervals.

Impact

Our findings provide practical guidance relevant for healthcare policy and practice, emphasising the need to enhance child and family health nurses training in reproductive health, develop clear clinical practice guidelines, and address systemic barriers such as time constraints to improve the provision of postpartum contraceptive care and support women's reproductive health needs.

Reporting Method

Standards for reporting qualitative research (SRQR).

Patient or Public Contribution

No patient or public contribution.

Nurse Practitioners' Perspectives on Medical Errors and Caregiver Support

ABSTRACT

Aim

To explore nurse practitioners' attitudes towards medical error perception, approach and cause using the Medical Error Attitude Scale and examine their experiences following a medical error and the support received.

Design

A cross-sectional, descriptive study using an electronic survey.

Methods

A convenience sample of nurse practitioners licensed in Utah was invited to participate. The survey included the Medical Error Attitude Scale, demographic items, questions regarding error reporting, experiences after an error and support received or desired.

Results

Nurse practitioners generally have positive attitudes towards medical errors. Higher scores were observed among individuals with doctoral-level education, female respondents and those employed in organisations with formal support programmes. While most nurse practitioners reported their medical errors, many indicated they did not receive institutional support afterwards. Peer support emerged as the most frequently desired form of assistance.

Conclusion

Nurse practitioners experience medical errors while providing care and require meaningful, accessible support. Despite favourable attitudes, many reported limited institutional support. Additional research is needed to understand their support needs following medical errors better.

Reporting Method

We adhered to the STROBE guidelines for the reporting method.

Patient or Public Contribution

No patient or public contribution.

Exploring Factors Influencing Advanced Practice Nurse Implementation: A Comparative Cross‐Sectional Study in Seven European Countries

ABSTRACT

Aim

To investigate factors influencing the implementation of advanced practice nursing roles within healthcare organisations in seven European countries from the perspective of advanced practice nurses.

Design

A cross-sectional survey was conducted between September 2021 and December 2022, involving advanced practice nurses from Belgium, Finland, Germany, Iceland, Ireland, Spain and the Netherlands. The countries were selected to represent different stages of implementing advanced practice nursing roles, from emerging to well-established.

Methods

A self-administered questionnaire was used to address five domains: patient care, practice patterns, policy and legal, educational and workforce-related factors. Descriptive statistics, chi-squared tests and correspondence analysis were employed to identify patterns and country-specific differences across these domains of implementation factors.

Results

A total of 491 advanced practice nurses participated in the study. While almost three-quarters of the participants indicated satisfaction with their job, the study highlighted multifaceted factors influencing the implementation of advanced practice nursing roles across countries. The Netherlands, Ireland and Belgium reported mainly facilitators, whereas Finland, Iceland and Germany noted barriers or a lack of knowledge. Spain mostly reported neutral or moderate positions. Key challenges included role ambiguity, interprofessional collaboration gaps, limited managerial support, workload imbalances, limited mentorship and underutilised competencies. Results also indicated that advanced practice nurses are partially hindered by operating in isolation from other professions.

Conclusion

The findings emphasise the need for robust organisational support, interprofessional collaboration and clear role definitions to facilitate the integration of advanced practice nursing roles. Addressing professional isolation through networking and mentorship is crucial to sustaining the advanced practice nursing workforce.

Implications for the Profession

Policy should prioritise support for advanced practice nursing, including structured mentoring and networking opportunities. Further research on advanced practice nurses' well-being and long-term role sustainability in Europe is recommended.

Impact

What problem did the study address? What were the main findings? Where and on whom will the research have an impact?

This study reported factors influencing advanced practice nurse role implementation across seven European countries with different levels of role development. Key challenges included role ambiguity, interprofessional collaboration gaps and limited support. The findings can guide healthcare managers and policymakers on the key factors to consider when integrating advanced practice nursing roles into their teams.

Workshops as a Research Method in Health Science: Epistemological and Methodological Perspectives

ABSTRACT

Aim

The aim of this paper is twofold: (1) to introduce a phenomenological-hermeneutic approach and discuss its application within the context of WSs in the field of health science, (2) To present a method and a practical guide when conducting WSs in the field of health science.

Design and Methods

Epistemological and methodological discussions based on workshops as a self-standing research method.

Results

The epistemological and methodological discussions show that workshops conducted in health science are a self-standing research methods and align with a phenomenological-hermeneutical approach. Examples of research studies within this framework are provided to illustrate how workshops can be conducted in health science within this epistemological approach.

Conclusion

The phenomenological-hermeneutical approach embraces workshops as a research method as it includes individual experiences through self-reflection and shared contributions through interpretation. Furthermore, a systematic approach with regard to planning, conduction, data collection, and data analysis leads to reliable findings, enhancing the transparency of the research method and thus creating scientific knowledge. This paper argues that the systematic approach of “the how” to conduct workshops with “the why” enhances the transparency and trustworthiness of the research.

Implications for the Profession

Workshops are a way to involve and engage users in co-design processes that aim to develop solutions in clinical practice. User involvement has become an important part in academia and is essential in all aspects of the research process. However, we need solid systematic methods to create valid knowledge. Workshops are a self-standing research method, and a phenomenological-hermeneutical approach allows for an understanding of the phenomena as they unfold, emphasising subjective perceptions and meanings, which will finally lead to the development of a suitable solution for clinical practice.

Impact

This paper contributes theoretical knowledge about the use of workshops as a research method. It combines “the how” to conduct a workshop with “the why” and highlights the relevance of a phenomenological-hermeneutical approach. The main argument is that workshops are a self-standing research method; hence, this paper adds value in the academic field as it provides a scientific framework. The paper presents a method and a practical guide for researchers who plan to conduct workshops in the field of health science.

Reporting Method

No available EQUATOR guidelines were applicable to this methodological paper because no new data was created or analysed.

Patient or Public Contribution

This is a methodological paper, and thus, there was no direct patient or public involvement.

Early Postpartum Symptoms Differ Between Older and Younger First‐Time Mothers

ABSTRACT

Aim

To describe symptom patterns in first-time mothers through 3 months postpartum.

Design

Longitudinal, descriptive correlational.

Methods

Secondary analysis of data from a randomised clinical trial of first-time mothers. Symptoms were assessed at 1, 2 and 3 months postpartum using the Memorial Symptom Assessment Scale for dimensions of 32 symptoms.

Results

New mothers (n = 114) reported an average of 7.0 (SD 4.7) symptoms at 1 month, decreasing to 5.3 (SD 4.3) at 3 months. Physical symptoms decreased to the greatest degree. Symptoms reported by over 33% of participants included lack of energy, worrying, pain, difficulty sleeping or concentrating and feeling irritable, sad or drowsy. The most distressing were lack of energy, feeling irritable, pain, nervousness and hair loss. Symptoms did not differ by type of birth or infant feeding. Older mothers (≥ 35 years) had significantly more symptoms and distress than younger mothers.

Conclusion

Most symptoms improved over time, yet some were still prevalent at 3 months. Symptoms not appraised as particularly distressing may still be of clinical concern for safety reasons. Frequent postpartum assessments and interventions are important, particularly for older mothers.

Impact and Implications for Patient Care

In the first 3 months, postpartum symptoms not perceived as distressing may lead to adverse health outcomes. These symptoms may threaten maternal–infant welfare beyond the first 3 months postpartum. Older first-time mothers merit particular attention by clinicians.

Reporting Method

The authors complied with STROBE reporting guidelines.

Patient or Public Contribution

No patient or public contribution.

Quality of Dying Among Institutionalised Nursing Home Residents From the Caregivers' Perspective: A Mixed‐Methods Study

ABSTRACT

Aims

To examine how family caregivers of deceased nursing home residents scored and justified their ratings for each item on the Quality of Dying in Long-Term Care scale and to identify the consistencies and discrepancies between their perceptions and the scores assigned when assessing the residents' end-of-life experience.

Design

A convergent mixed-methods design, comprising a cross-sectional study and a thematic analysis for quantitative and qualitative phases, respectively.

Methods

Quantitative and qualitative data were collected simultaneously between May 2018 and February 2019. The two sets of data were analysed separately. For the quantitative component, family caregivers completed the quality of dying in long-term care scale and a single-item question assessing the final month of the residents' life. Descriptive statistics, Mann–Whitney U-tests for comparative analyses and Spearman's correlations were applied to the quantitative data, while deductive thematic analysis was conducted for the qualitative data obtained through semi-structured interviews.

Results

Sixty-nine family caregivers completed the QoD-LTC, and 11 participated in qualitative interviews. The mean overall QoD-LTC score was 39.29 (SD = 7.58). The highest-rated domain was ‘Personhood’ (M = 4.32; SD = 0.68), while the lowest was ‘Preparatory Tasks’ (M = 2.66; SD = 1.26). Interviewed family caregivers reported effective management of pain and other symptoms, satisfaction with the care provided and respectful and appropriate treatment. However, they identified significant shortcomings in communication concerning end-of-life issues, coping with death and advance care planning. Residents with cognitive impairment had significantly lower scores on the ‘closure’ (p < 0.01) and ‘preparatory tasks’ (p = 0.03) domains as well as on the overall QoD-LTC score (p = 0.01).

Conclusions and Implications

The findings demonstrate consistency between the quantitative and qualitative data, with high scores reported across most domains of the QoD-LTC scale, with the exception of the ‘Preparatory Tasks’ domain. Cognitive impairment among residents was associated with lower perceived quality of the dying process from the perspective of family members.

Clinical Relevance

Aspects related to closure and preparatory tasks were often overlooked. Strategies to enhance end-of-life communication and advance care planning are needed.

Reporting Method

The study adhered to the EQUATOR guidelines. The Mixed Methods Reporting in Rehabilitation & Health Sciences (MMR-RHS) checklist for mixed-methods studies, the STROBE checklist for cross-sectional studies, and the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines for qualitative studies were used for reporting.

Patient or Public Contribution

No funding was received for the completion of this study.

Effects of Psychosocial Interventions on Loneliness Amongst Long‐Term Care Residents: A Systematic Review and Meta‐Analysis

ABSTRACT

Background

Loneliness significantly affects the physical and mental health of older adults, particularly those in long-term care settings. Despite the high prevalence of loneliness, comprehensive reviews on psychosocial interventions targeting loneliness in these populations are scarce.

Aims

To evaluate the effects of psychosocial interventions in reducing loneliness among long-term care residents.

Study Design

A systematic review and meta-analysis.

Methods

We conducted a comprehensive search across five databases—CINAHL, EMBASE, PubMed/Medline, PsychINFO and The Cochrane Library—from inception to 14 February 2025. The inclusion criteria encompassed randomised controlled trials, quasi-experimental studies and pilot studies published in English that assessed psychosocial interventions for loneliness amongst long-term care residents. The Effective Public Health Practice Project framework was utilised for the quality assessment.

Results

A total of 19 studies with 1646 participants were included. Results indicated that psychosocial interventions significantly reduced loneliness in long-term care residents. The interventions were categorised into lifestyle and leisure activities, psychological interventions, social support interventions and animal/robot-assisted interventions. Subgroup analyses revealed significant effects for lifestyle and leisure activities, group-based interventions, face-to-face delivery and interventions that less than 8 weeks.

Conclusion

Psychosocial interventions demonstrated a large effect size in reducing loneliness amongst long-term care residents. Interventions that incorporated lifestyle and leisure activities with a physical activity component, delivered face-to-face in group settings and lasted for less than 8 weeks may be particularly effective.

Implication of Practice

This review provides updated evidence that psychosocial interventions could improve loneliness amongst residents in long-term care settings. Consequently, it offers solid information to inform policy changes and intervention strategies.

Reporting Method

The researching results were reported in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis checklist.

No Patient or Publication Contribution

This study is a systematic review with meta-analysis, and such details do not apply to our work.

Trial Registration: This protocol was registered in the PROSPERO database (ID: CRD42024534009)

Bridging the Digital Divide: A Multi‐Method Evaluation of Nursing Readiness for Digital Health Technology

ABSTRACT

Aim

The aim of this study was to explore the digital health technology readiness of nurses, nursing students, nurse-academics, and nurses in leadership roles. Workforce digital readiness impacts the adoption of digital health technologies and quality and safety outcomes. This study sought to identify key factors affecting nurses' readiness for specific digital health technologies and provide recommendations to accelerate readiness levels in alignment with rapidly advancing digital health technologies.

Design

Cross-sectional multi-method study.

Methods

An online survey was followed by semi-structured interviews. Survey data (N = 160) were analysed using descriptive and inferential statistics, whereas qualitative responses (N = 8 interviews, 43 open-ended responses) were thematically analysed.

Results

Participants were confident regarding openness to innovation, reporting highest confidence Levels around telehealth, wearable devices, and information technology. The lowest confidence scores were seen in health smart homes technology, followed by health applications, social media, patient online resources, and EHRs. Four themes were developed from the qualitative interviews including ‘opportunities for efficient ways of working’, ‘digital technology turning experts into novices’, ‘disillusionment between expectation and reality’ and ‘shared responsibility for development of digital expertise’. Open-ended data was focused on the need for comprehensive education, ongoing support, and infrastructure improvements to prepare healthcare professionals for digital health environments.

Conclusions

Notable findings include age-related differences, the need for shared responsibility in workforce preparation, and a link between problem-solving ability and help-seeking.

Implications for the Profession and/or Patient Care

Low confidence among nurses around the use of digital health technologies such as electronic health records, in-home monitoring technology, and other wearable technologies could impact adoption readiness. Because patient safety is increasingly and inextricably linked to digital health technologies, nurses must not only be digital health literate but also included in the design and implementation process of these technologies.

Reporting Method

This study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines for the reporting of cross-sectional survey research, and the Consolidated Criteria for Reporting Qualitative (COREQ) research guidelines.

Patient or Public Contribution

Limited patient and public involvement was incorporated, focusing on feedback from digital health researchers and practitioner-academics during the academic peer review process. Their insights informed the clarity and relevance of the survey design and data interpretation, ensuring alignment with real-world workforce development priorities in nursing.

Weight Bias Interventions for Healthcare Professionals: An Integrative Review

ABSTRACT

Aim

To describe interventions to mitigate weight bias among practicing healthcare providers and examine their effectiveness.

Design

An integrative review.

Methods

The framework of Whittemore and Knafl (2005) was utilised to identify and synthesise studies of weight bias interventions. Covidence reference management software facilitated screening using predetermined eligibility criteria that is, published in peer-reviewed journals, reported in English, and described outcomes for weight bias mitigation interventions among healthcare providers with a professional practice licence. We evaluated study quality using Joanna Briggs Institute's Critical Appraisal Tools for qualitative and quantitative studies.

Data Sources

Five databases were searched (CINAHL, Embase, EBSCOhost, APA PsycINFO, and Scopus) in July 2024.

Results

Sixteen articles met the inclusion criteria. Four themes emerged: (1) active learning lessens weight bias more than passive learning, (2) multicomponent approaches yield better outcomes, (3) healthcare providers are willing to change their practices, and (4) explicit attitudes and beliefs are more amenable to change than implicit ones. Four sub-themes within theme one included the use of in-person workgroups; films, computer-based, and podcast delivery; written modules; and physical characteristic modifications, such as the use of an adiposity empathy suit. Intervention designs using a theory-based, active learning approach with repeated sessions were most successful at decreasing negative weight-biased attitudes and beliefs.

Conclusions

Interventions that effectively reduce weight bias among practicing healthcare providers vary, yet evidence suggests that weight bias mitigation is achievable. These interventions offer strategies to improve patient-centred care among patients living with obesity.

Impact

Healthcare providers often display weight bias. This review synthesises information on effective interventions for reducing bias, which may limit the subsequent negative patient outcomes associated with it.

Reporting Method

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses was the structure used for this paper.

Patient or Public Contribution

There were no patient or public contributions.

Italian Version of the Fundamentals of Care Framework and the Fundamentals of Care Practice Process: A Comprehensive Validation Study

ABSTRACT

Aims

To translate, culturally adapt and validate the Italian version of Fundamentals of Care Framework and the Fundamentals of Care Practice Process.

Design

Qualitative tool validation study.

Methods

The study followed internationally recommended procedures, including forward–backward translation, expert committee review, content validation through cognitive interviews and face validity testing with nurses and nursing students. Data were collected between January and October 2023.

Results

Key terms were culturally and linguistically adapted to enhance clarity and contextual relevance, with changes informed by expert feedback. Content validation confirmed conceptual equivalence, and face validity testing demonstrated that Italian versions were perceived as clear, appropriate and applicable across clinical and educational settings.

Conclusion

Cultural adaptation of theoretical frameworks is essential for ensuring their relevance and usability in local contexts. The Italian versions of the Fundamentals of Care Framework and the Fundamentals of Care Practice Process will provide a robust, evidence-based foundation for person-centred care across education, research and clinical practice.

Impact

By making these tools accessible in Italian, this study supports the integration of fundamentals of care into national nursing education and practice, promoting international consistency in person-centred care. It lays the groundwork for curriculum reform, clinical implementation and global collaboration in nursing.

Reporting Method

Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist.

Patient or Public Contribution

This study did not involve any patient or public contribution.

Trial Registration

ClinicalTrials.gov identifier: NCT05177627

The Knowledge, Attitudes and Practices of Practice Nurses in the Provision of Medication Abortion: A Cross‐Sectional Survey

ABSTRACT

Aim

To examine practice nurse knowledge, attitudes, and practices about medication abortion in Australia.

Design

Cross-sectional survey.

Methods

A national online survey was conducted from July to December 2021. Nurses working in general practice were recruited using convenience sampling. Data collected included demographics, knowledge, attitudes, and practices in abortion care. Analyses used included descriptive statistics and Poisson regression.

Results

From 489 responses, knowledge about medication abortion, its provision, and efficacy was low. Although many respondents felt it was acceptable to assist in medication abortion, few indicated involvement. Those with advanced qualifications had greater perceived knowledge of abortion counselling. Respondent involvement in medication abortion was more likely if they had worked in general practice for a long time, their primary place of work was outside of general practice, or had advanced nursing qualifications.

Conclusions

Given their role in the community, there is an opportunity to better utilise practice nurses for abortion care. Incorporation of abortion into the nursing curriculum and routine practice, including supportive funding mechanisms for care, is needed.

Implications

Low knowledge and a lack of practice nurses providing abortion services adversely impact patient access.

Impact

Practice nurse provision of medication abortion has not yet been optimised. While practice nurses reported acceptability to provide abortion care, this could be enhanced with funding, education, and service normalisation. These results will inform policy makers, educators, patients, general practices, and nurses to support patient access to abortion care. Incorporating abortion care into nursing curriculum and practice will support women's access to these services.

Reporting Method

CHERRIES guideline.

Patient or Public Contribution

Professional groups, family planning organisations, industry, and government grant partners supported the study's recruitment.

Trial Registration

ACTRN12622000655741

Let's Talk About the Elephant in the Room: A Psychological Safety Climate Intervention Among Nursing Teams—A Qualitative Evaluation

ABSTRACT

Aim

To explore how a staff and managers experienced a multi-component and multi-level intervention to influence the psychological safety climate within nursing teams.

Design

Qualitative, to explore the experiences of registered nurses, licensed practical nurses, and managers in a Swedish hospital.

Methods

Four focus group discussions were conducted in March 2023 with staff and managers (n = 20). A deductive thematic analysis was conducted, guided by a theoretical model of psychological safety, to examine work climate perceptions and antecedent conditions. An inductive approach was used to explore how participants experienced the intervention.

Results

Participants experienced a shift from a blame-oriented to a more psychologically safe work climate. These developments were enabled by enhanced self-awareness, more supportive interpersonal dynamics, and leaders adopting a more accessible and vulnerable role. The intervention created a safe space to reflect on team dynamics.

Conclusion

Sustained efforts that integrate self-awareness, interpersonal dynamics, and managerial support are important to intentionally develop psychological safety. The creation of safe spaces can serve as a first step to confront unaddressed group beliefs.

Implications for the Profession and/or Patient Care

Interventions aimed at improving psychology safety can have positive effects if they focus on developing individual trust and vulnerability, targeting group dynamics, and including leaders.

Impact

Problem addressed: Inadequate psychological safety among nursing teams, hindering effective collaboration. Main findings: By changing work conditions, the intervention led to improved perceived psychological safety. Research impact: Creating conditions for psychological safety can improve how teams function.

Reporting Method

COREQ-checklist.

Patient or Public Contribution

No PPI patient or public contribution.

Self‐Management of Chronic Illness Among Chinese Immigrants: An Integrative Review

ABSTRACT

Aim

To advance the understanding of chronic illness self-management among Chinese immigrants in Western countries by synthesising evidence and through the lens of the Middle Range Theory of Self- and Family Management of Chronic Illness.

Design

Integrative review following Whittemore and Knafl.

Methods

Two reviewers used Covidence software to screen potential articles. After identifying the sample, reviewers extracted data into a matrix and appraised study quality using Critical Appraisal Skills Programme checklists. Reviewers used the constant comparative method to categorise data into categories: (1) facilitators/barriers, (2) processes and (3) outcomes. Findings were then synthesised and mapped to the theory domains.

Data Sources

MEDLINE, CINAHL, Web of Science, Embase, PsycINFO and ProQuest Central (database inception—August 2025).

Results

Of 3205 records screened, 20 studies met the inclusion criteria with acceptable quality. Personal characteristics/health status, resources/environment, Chinese-Western cross-cultural experiences, family and healthcare systems, and linguistic barriers shaped the processes of Focusing on Illness Needs (developing illness insights, taking ownership of health needs, and health promotion); Activating Resources (Western health care, traditional Chinese practices, community and family support, and blended spiritual resources); and Living with a Chronic Illness (processing emotions, adjusting, integrating, and meaning-making). These processes lead to outcomes including improved disease control, psychological/cognitive well-being, and healthcare utilisation and unintended negative consequences such as emotional burden and delayed care-seeking.

Conclusion

While Chinese immigrants share certain aspects of self-management with Western populations, their approaches are shaped by culturally grounded, family-centred values, traditional health practices, and immigrant experiences, which underscore the need for culturally and contextually sensitive self-management support. The findings also expand the applicability of the guiding theory by identifying new cultural elements.

Implications for the Profession and Patient Care

Nurses can support self-management among Chinese immigrants by developing culturally and linguistically tailored interventions, engaging family members in health education and treatment planning, enhancing accessible digital, community and navigational resources, providing language assistance and strengthening staff training.

Reporting Method

We used the PRISMA 2020 checklist for adherence to review protocols.

Patient or Public Contribution

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

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