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To evaluate the clinical effectiveness of a Nurse Practitioner led procedural support service for children with procedural anxiety, and identify facilitators and barriers to its sustained implementation and optimisation.
An effectiveness–implementation hybrid type 3 study used a prospective mixed methods evaluation approach.
From December 2022 to May 2023, data were collected from children, parents and clinicians using a nurse practitioner-led service at a quaternary paediatric hospital in Brisbane, Australia. A prospective audit assessed clinical outcomes, while qualitative interviews explored implementation barriers and facilitators.
The clinical audit (n = 40) confirmed the service was effective and safe, ensuring procedural completion with minimal distress. Descriptive statistics indicated low pain and anxiety scores. There was a moderate negative relationship between pain scores and the use of distraction techniques. Interviews with thirty-three participants showed the service improved access to procedural care, reduced the need for physical restraint and general anaesthesia, and enhanced clinical workflow through preadmission assessments.
Utilising a Nurse Practitioner support service represents a safe and effective strategy to enhance access for paediatric patients with procedural anxiety.
This study underscores the significance of specialised nursing roles in managing paediatric procedural anxiety, offering a replicable model to enhance procedural outcomes and mitigate medical trauma across healthcare settings.
Minimising pain and distress is important in all clinical encounters with children to reduce the risk of medical-related trauma and the future avoidance of healthcare.
The report of study outcomes was guided by the Standards for Reporting Implementation Studies (StaRI) initiative.
Patients or the public were not included in the design, conduct or reporting of the study.
Limited literature has focused on people with cancers' preference for care providers in scenarios where trade-offs may have to be made.
To report the results of a comprehensive search and synthesis of discrete choice experiments or best-worst scaling studies (± willingness to pay estimates) in scenarios involving cancer nurses, with a focus on: (1) preferred care provider; and (2) relative importance of attributes of care provision for people with cancer.
A search was conducted across: CINAHL, Cochrane Central Register of Controlled Trials, EconLit, Medline, PsycINFO, Scopus, Web of Science Core Collection, and Google Scholar for discrete choice experiments published between January and July 2025. Data were extracted and appraised by two authors. Results were narratively synthesised.
Of 461 studies screened, 11 were included, published in Australia (n = 3), UK (n = 3), and China (n = 5) including people with breast (n = 4), gastric (n = 4), prostate (n = 1), or mixed cancers (n = 2). In six studies exploring scenarios of follow-up care (i.e., survivorship/surveillance), cancer medical specialists were the preferred care provider, followed by cancer nurses, and then general practitioners. In four of the five studies of supportive care scenarios (i.e., diet and exercise advice, anxiety and depression screening), cancer nurses were the preferred care provider, followed by allied health professionals, then cancer medical specialists. The highest WTP estimate was $US226.15 for a medical specialist to provide follow-up care. For supportive care, the highest WTP was $US137.52 for a cancer nurse to provide diet-based lifestyle advice post-treatment for breast cancer.
Cancer nurses are highly valued by people with cancer, particularly for supportive care provision. Opportunities exist for an increase in cancer nurse specialists with expanded scope of practice, to support the preference of people with cancer to have cancer medical specialists, or cancer nurse specialists provide expert cancer follow-up care.
Employees of a cancer patient advocacy group were involved in the design of the study, interpretation of the data, and the preparation of the manuscript. No patients were involved in this work. However, this systematic review prioritized patient voices by including studies that reported on the preferences of people with cancer.
This study examined cultural, contextual and psychological risk and protective factors for suicide risk (i.e., suicide ideation, planning and attempting in the past year) in a cross-sectional sample of nursing students in the United States.
A cross-sectional study design was employed.
Nursing students (n = 9871) were selected from the national 2020–2021 Healthy Minds Study (HMS). Students reported their demographics, suicidality and non-suicidal self-injurious behaviour (NSSIB). They also completed validated self-report measures of depression, belonging and flourishing.
Logistic regressions revealed that racial minority nursing students were at risk for suicidal ideation and attempts, and sexual minority students were at risk for suicidal ideation. Nursing students with a history of mental illness severe enough to seek treatment and those who reported more NSSIB also evidenced greater odds of reporting all forms of suicide risk. Specifically, the odds of suicidal ideation and attempts were more than three times greater for nursing students who reported NSSIB. Additionally, positive elements of flourishing only marginally protected against suicidal ideation, and belonging was not associated with any form of suicide risk.
Findings highlight the high number of nursing students at risk for suicidality and highlight potential demographic and psychological targets for suicide interventions. Impact: Early intervention during nursing school could impact suicide risk throughout a nurse's educational and professional journey. Thus, nurse educators should consider implementing suicide and mental health interventions in their programmes.
No direct patient or public contribution.
To evaluate the impact of a participatory, action-oriented implementation study, guided by the integrated Promoting Action on Research Implementation in Health Services framework, for optimising pain care processes in a tertiary paediatric emergency department.
Hybrid type 3 implementation effectiveness.
A collaborative appraisal of the context and culture of pain care informed two interdependent action cycles: Enabling nurse-initiated analgesia and involving families in pain care. The Kids Pain Collaborative, an authentic clinical–academic partnership, was central to facilitating successful implementation. Summative evaluation explored the impact of implementation on processes of pain care using an interrupted time series analysis and emotional touchpoint interviews with families.
Staff achieved clinically important and sustained improvements in the rate of nurse-initiated analgesia and pain assessment. Family involvement in pain care shifted from task-orientated practices towards more person-centred ways of working and decision-making. As capacity for collective leadership developed, frontline staff found ways to integrate the KPC approach into ED systems to lead pain care innovation beyond the life of the research project.
The Kids Pain Collaborative, as the overarching implementation strategy, created a practitioner-led coalition for change. Successful implementation was facilitated by working with four interdependent principles: Collaborative and authentic engagement; enabling context for cultural transformation; creating safe spaces for critical reflection and workplace learning; and embedding sustainable practice change.
A multi-level model of internal–external facilitation enabled sustained improvement in pain care practice. An embedded researcher was pivotal in this process.
Authentic engagement of clinicians and families was pivotal in transforming systems of pain care and enabling a culture where "it is not ok for children to wait in pain"
The principles underpinning the Kids Pain Collaborative are transferable to other emergency department and acute care contexts.
Standards for Reporting Implementation Studies checklist.
The longitudinal programme of research described in this paper seeks to generate knowledge about factors influencing the implementation of a system-level intervention, the clinical nurse leader care model, involving nurses as leaders at the frontlines of care and the outcomes achievable with successful implementation. The research programme has the following aims, (a) to clarify clinical nurse leader practice, (b) develop and empirically validate a translational model of frontline care delivery that includes clinical nurse leader practice and (c) delineate the patterns of and critical outcomes of successful implementation of the clinical nurse leader care model.
This programme of research follows a knowledge-building trajectory involving multiple study designs in both qualitative (grounded theory, case study) and quantitative (descriptive, correlational and quasi-experimental) traditions.
Multiple mixed methods within a system-based participatory framework were used to conduct this programme of implementation–effectiveness research.
Findings are demonstrating how the clinical nurse leader care model, as a complex system-level intervention, can be implemented in diverse healthcare contexts to make a difference to patient care quality and safety. Findings also contribute to implementation science, helping to better understand the dynamic interdependencies between implementation, the interventions implemented and the contexts in which they are implemented.
Findings translate into sets of evidence-informed implementation ‘recipes’ that health systems can match to their specific contexts and needs. This allows health systems to take on strategies that both maximize resource impact within their existing structures and support achieving intended outcomes.
This programme of research is producing actionable implementation and outcome evidence about ways to organize nursing knowledge and practice into care models that can be successfully adopted within real-world healthcare settings to achieve safer and higher quality patient care.
To gain an understanding of the experiences of mentors and mentees engaging in a national mentoring programme within nursing and midwifery in Ireland.
A two-phased convergent parallel mixed methods study was undertaken.
The first phase was a quantitative non-experimental descriptive study using an online survey with mentors (n = 12) and mentees (n = 6). The second phase was a qualitative descriptive study and involved focus group discussions with mentors (n = 5). No mentees took part in the focus group discussions. There was a disproportionate representation of mentors versus mentees in the total sample across both phases of this study. Data were collected between December 2023 and April 2024.
Mentorship has a positive impact on professional growth, job satisfaction and career development for both mentors and mentees in nursing and midwifery professions. Significant challenges to effective nursing and midwifery mentorship include time constraints, irregular work patterns and a need for additional managerial and structural support. Areas identified for improvement in programme implementation include clearly defined roles, dedicated time and space for mentorship meetings and tailored support systems to address cultural diversity.
This study highlights the significant benefits of a national formal mentorship programme; however, substantial barriers continue to underscore the need for strategic improvements. Addressing these challenges through clearer role definitions, dedicated protected mentorship time and culturally responsive support systems may enhance mentorship programme effectiveness and ensure long-term sustainability.
None.
To synthesise primary qualitative studies reporting experiences of post-hospital recovery for critical care survivors, their family and the healthcare professionals supporting them with a particular focus on physical impairment.
The review was conducted through a meta-ethnography using the seven stages of Noblit and Hare.
Qualitative studies or mixed-method studies which included qualitative research were included if they were based on the phenomenon of interest. Study quality was assessed using the Critical Appraisal Skills Programme checklist and confidence in the findings with the GRADE CERQual framework.
Five electronic databases (PubMed, EMBASE, CINAHL, AMED and PEDro) were searched from inception to February 2022 and updated in November 2024. Grey literature for primary qualitative studies was also searched.
A total of 26,249 studies were initially screened, and 38 eligible studies were analysed. Four themes were distilled describing the experiences of critical care survivors, their family members and staff involved in their care: ‘I survived, but I didn't thrive’, ‘Healthcare was there to save my life, but not for my long-term recovery’, ‘I am a burden on my family, and they feel the weight of carrying me’ and ‘My body still doesn't work like it used to’.
This meta-ethnography is unique in bringing together the experiences of patients recovering from critical illness, their families, and the staff who support them after hospital discharge. Ongoing diverse physical impairments prevented patients from thriving, significantly impacting family members. All groups clearly identified unmet rehabilitation needs following critical illness.
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