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Ayer — Octubre 14th 2025Journal of Clinical Nursing

Exploring the Causes, Immediate Responses and Preventive Measures of Needle Stick Injuries Among Healthcare Workers: A Qualitative Evidence Synthesis

ABSTRACT

Aim

To combine, synthesise, and interpret qualitative evidence from studies exploring the causes, immediate responses, and preventive measures of needle stick injuries from the perspective of healthcare workers.

Design and Methods

In this qualitative evidence synthesis, the qualitative data from the included studies were synthesised to identify overarching themes. The Preferred Reporting Items for Systematic Reviews and Meta-analysis flowchart, Joanna Briggs Institute tool, and Enhancing Transparency in Reporting the Synthesis of Qualitative Research checklist were used in the meta-synthesis process.

Data Sources

The MEDLINE, Cumulative Index to Nursing and Allied Health Literature, Web of Science, ProQuest, ClinicalKey and Scopus databases were searched between December 14 and December 31, 2024 for studies published between January 2000 and December 2024.

Results

Nine primary research studies were included and the following themes were identified: unpredicted patient movement, casual attitude, recapping, excessive workload, scarcity of article or safety equipment, inadequate training or experience, vigilance, ongoing training, nurturing workplace culture, emotional response, re-living the injury and fear of reprimand.

Conclusion

Needle stick injuries result from a complex interplay of individual, administrative, engineering, and environmental factors, but there are potential solutions to address these issues.

Implications for the Profession and/or Patient Care

Policymakers in healthcare settings would benefit greatly from an understanding of the causes, immediate responses, and preventive aspects of needle stick injuries. These findings can direct the creation of focused interventions and safety procedures by identifying important risk variables and useful coping mechanisms.

Impact

The causes, immediate responses, and preventive measures of needle stick injuries were explored. Findings can help develop protocols to lower needle stick injury rates and increase worker safety.

Reporting Method

ENTREQ guidelines.

Patient or Public Contribution

This research is a systematic review of published peer-reviewed studies.

Clinical Registration

PROSPERO registration number: CRD42024620673.

AnteayerJournal of Clinical Nursing

Mutuality and Self‐Care in the Patient–Caregiver Dyads in the Context of Coronary Heart Disease: An Exploration of the Mediating Role of Self‐Efficacy

ABSTRACT

Aims

To evaluate the effect of mutuality on self-care in people with CHD and the contribution of their caregivers, and whether such relationships can be mediated by self-efficacy.

Design

Secondary analysis of baseline data from a multi-centre longitudinal study.

Methods

Patients at the onset of coronary artery disease who underwent angioplasty, along with their caregivers, were included in the sample. Data from 136 patients and 136 caregivers were used for the analysis. Mutuality between patients and caregivers was measured using the Mutuality Scale. Self-care was measured using the Self-Care of Coronary Heart Disease Index and the Caregiver Contribution to Self-Care of Coronary Heart Disease Index. The actor–partner interdependence mediation models were used to assess the mediating role of self-efficacy for self-care between perceived mutuality and self-care behaviours.

Results

An actor indirect effect was found between patient mutuality and their self-care maintenance, self-care monitoring, and self-care management, through the mediation of their self-efficacy. Caregiver mutuality had a positive indirect effect on their contribution to self-care maintenance, self-care monitoring, and self-care management, through the mediation of their self-efficacy. Caregiver mutuality had a positive indirect effect on patient self-care maintenance and on patient self-care monitoring, through the mediation of patient self-efficacy. All models demonstrated satisfactory fit to the data.

Conclusions

Mutuality between patients and caregivers enhances self-care behaviours in patients with coronary heart disease, and self-efficacy is a crucial mediator in this relationship. Interventions targeting both mutuality and self-efficacy within patient–caregiver dyads may improve self-care outcomes.

Reporting Method

We adhered to STROBE guidelines.

Patient or Public Contribution

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

The Characteristics and Effectiveness of Oral Healthcare Education Interventions for Stroke Clinicians: A Scoping Review

ABSTRACT

Aims

To explore the characteristics of oral healthcare education interventions for stroke clinicians and the effectiveness of these interventions in improving the oral health knowledge, attitudes, confidence, and practice among acute stroke clinicians.

Design

Scoping review, guided by Arksey and O'Malley's (2005) framework.

Methods

Original full-text studies reporting educational oral healthcare interventions for stroke clinicians, including but not limited to nurses, were eligible for inclusion. Included studies were extracted and appraised using the Joanna Briggs Institute (JBI) Checklist aligned to the study methodology. Narrative synthesis was used to describe heterogeneous findings.

Data Sources

Key electronic bibliographic databases including CINAHL, Cochrane, MEDLINE (Ovid), ProQuest, Pubmed, and Scopus, in addition to grey literature, were searched for studies published between 1st January 2000 and 20th January 2024.

Results

Five studies conducted in acute inpatient settings were included: two randomised controlled trials, two mixed-methods studies, and one quality improvement project. Most (n = 4) studies developed complex interventions that included education and other components (products, referral pathways, assessment tools), and were delivered either face-to-face or as an online program. Most studies reported positive changes in oral health knowledge, attitudes, and confidence. There was limited measurement of the acceptability and feasibility of the interventions, with only one study reporting positive feedback from clinicians. There was no evidence to support changes in clinical practice following any of the included interventions.

Conclusion

Existing evidence indicates interventions for stroke clinicians have some potential for building stroke clinicians' capacity to provide adequate oral healthcare. There is however no evidence linking these interventions to optimised patient outcomes. There is a need for research focused on the implementation and dissemination of tailored oral health educational interventions incorporating clinically meaningful outcomes.

Implications for Profession/Patient Care

Existing oral healthcare educational interventions appear to have a positive effect on stroke clinicians' oral health knowledge, confidence, and attitudes. Educational interventions in oral healthcare are perceived to be acceptable and feasible; however, further research is needed to design and test the effect of new interventions.

Impact

Integrated oral healthcare is particularly important for stroke survivors who are at greater risk of preventable aspiration pneumonia. This scoping review highlights the characteristics of existing educational programs for stroke clinicians, their effectiveness, and gaps in existing evidence. Review findings substantiate the need for future research to enhance existing oral healthcare interventions, to translate knowledge acquired from training into clinical practice, and to capture appropriate measures of effect.

Reporting Method

The PRISMA-ScR Checklist.

Protocol Registration

This review was registered with the Open Science Framework registry (https://doi.org/10.17605/OSF.IO/4BWVF).

Validation of an Oral Health Tool for Clinicians to Screen Patients With Cardiovascular Disease

ABSTRACT

Aims

To develop and validate a screening tool to identify patients with cardiovascular disease at risk of poor oral health and requiring referrals.

Design

This study was part of a larger pilot study involving a cross-sectional survey and an oral health assessment conducted with patients with cardiovascular disease.

Methods

A four-item screening tool was developed by an expert panel and validated through a cross-sectional survey of patients with cardiovascular disease. The survey contained the tool and the oral health impact profile (OHIP-14) (first gold standard). Additionally, all survey participants were provided a clinical oral health assessment (second gold standard). Sensitivity and specificity analysis was undertaken comparing the tool to the two gold standards to assess patients with cardiovascular disease at risk of poor oral health.

Results

Three hundred and twenty-one participants completed the cross-sectional survey and eighty nine undertook the oral health assessment. Results from both approaches showed that the tool had high sensitivities (OHIP-14 = 89%, Oral assessment = 88%) and low specificities (OHIP-14 = 33% and Oral assessment = 24%).

Conclusion

The four-item screening tool is a simple and valid tool to identify patients with cardiovascular disease at risk of poor oral health and requiring a dental referral. The tool could be incorporated into routine practice of nurses across various cardiac settings.

Risky Business. Interventions to Prevent Aggression Against Health Workers From Patients at Risk: An Integrative Review

ABSTRACT

Aim

To identify best practices to prevent violence against healthcare workers by patients at risk for aggression in the adult inpatient setting.

Design

An integrative review.

Methods

Conducted using the Johns Hopkins Evidence-based Practice for Nurses and Healthcare Professionals Model. Title and abstract screening on 4186 articles resulted in 156 for full text review. Full text screening yielded 14 articles that met inclusion criteria.

Data Sources

A search of the databases PubMed, CINAHL, Embase, and JBI from January 2019 to February 2023.

Results

The review revealed behavioural intervention teams, environmental changes, and coordinated communication plans were the most used strategies, however none demonstrated significant decreases in violence.

Conclusions

Health systems can implement strategies shown to decrease the incidence of violence in healthcare settings globally. Lack of consistency in the evidence suggests the need for further research to assess mitigating strategies for violence against healthcare workers in inpatient hospital settings.

Implications for the Profession and/or Patient Care

Patient safety is a cornerstone of nursing practice; however, healthcare workers need to feel safe in their work environment. Violent events are chronically underreported, ill defined, and when reported, do not address change in the practice setting. Identifying strategies to address escalating behaviour before it results in violence is crucial for everyone's safety.

Impact

This integrative review exposes the scarcity of evidence available to address rising concerns about patients on healthcare provider violence (Type II) in the workplace. Although several assessment tools for identifying violent patients exist, evidence regarding prevention is woefully absent. The review highlights potential interventions for further study to equip healthcare workers to manage patients safely and effectively before an escalation occurs.

Reporting Method

PRISMA checklist for integrative reviews.

Patient or Public Contribution

No patient or public contribution was part of this review.

Self‐care behaviours and their determinants in people affected by coronary heart disease

Abstract

Objective

To describe self-care in Italian adults with coronary heart disease and to identify sociodemographic and clinical determinants of self-care.

Design

This is a cross-sectional analysis of data from the Italian multicentre longitudinal study.

Methods

We used the follow instruments: Self-Care of coronary heart disease inventory, Self-care Self Efficacy Scale, Charlson Comorbidity Index and Sociodemographic questionnaire. Descriptive statistics including absolute numbers, percentages, means and standard deviations were used to describe the sociodemographic and clinical characteristics of the sample, and the items. A structural equation model was fitted to understand sociodemographic and clinical variables associated with self-care, and possible effects mediated by self-efficacy.

Results

We enrolled 427 patients. Self-care maintenance, monitoring, management and self-care self-efficacy means scores were 58.27 (SD = 20.07), 48.53 (SD = 26.97), 65.34 (SD = 22.85) and 77.16 (SD = 20.76), respectively. Except for the self-care self-efficacy scale, all the scores lay below the cut off 70 for adequacy. Older age, higher comorbidities, a higher number of stents placed, and the presence of a caregiver predicted poor self-care.

Conclusion

Self-care in Italian CHD populations is poor. Several associations were found between the dimensions of self-care and sociodemographic factors. Implications for the profession these findings are important for health care providers to plan interventions to improve self-care behaviour.

Impact

The study addressed self-care behaviours of coronary heart disease patients. Self-care was poor in this population; several associations were found between the dimensions of self-care and sociodemographic and clinical determinants. Our results can be used to support health professionals in planning interventions to improve specific self-care domains.

Reporting Method

STROBE checklist was followed.

Pain management interventions of the non‐communicating patient in intensive care: What works for whom and why? A rapid realist review

Abstract

Aim

The utility and uptake of pain management interventions across intensive care settings is inconsistent. A rapid realist review was conducted to synthesise the evidence for the purpose of theory building and refinement.

Design

A five-step iterative process was employed to develop project scope/ research questions, collate evidence, appraise literature, synthesise evidence and interpret information from data sources.

Methods

Realist synthesis method was employed to systematically review literature for developing a programme theory.

Data Sources

Initial searches were undertaken in three electronic databases: MEDLINE, CINHAL and OVID. The review was supplemented with key articles from bibliographic search of identified articles. The first 200 hits from Google Scholar were screened.

Results

Three action-oriented themes emerged as integral to successful implementation of pain management interventions. These included health facility actions, unit/team leader actions and individual nurses' actions.

Conclusion

Pain assessment interventions are influenced by a constellation of factors which trigger mechanisms yielding effective implementation outcomes.

Implications

The results have implications on policy makers, health organisations, nursing teams and nurses concerned with optimising the successful implementation of pain management interventions.

Impact

The review enabled formation of a programme theory concerned with explaining how to effectively implement pain management interventions in intensive care.

Reporting Method

This review was informed by RAMESES publication standards for realist synthesis.

Public Contribution

No patient or public contribution.

The study protocol was registered in Open Science Framework.

10.17605/OSF.IO/J7AEZ

Transgender and non‐binary peoples experiences of cervical cancer screening: A scoping review

Abstract

Aim(s)

To synthesise the literature about transgender and non-binary people's experiences of cervical cancer screening and identify ways to improve screening.

Background

Transgender people often face barriers to accessing health services including cervical screening, where transgender people have a lower uptake than cisgender women.

Design

A scoping review was undertaken following the Arksey and O’Malley (2005) framework and the PRISMA-ScR checklist. Following database searching of Medline via PubMed, Web of Science, Scopus and CINHAL, 23 papers published between 2008 and 2003 were included. Papers were included if they shared trans and non-binary people's experiences of cervical screening and were written in English. There were no date or geographical data restrictions due to the paucity of research.

Results

Transgender people experience barriers to cervical screening including gender dysphoria, a history of sexual trauma, and mistrust in health professionals or health services, which can result in having negative experiences of screening or avoiding screening. Health professionals can help to create a positive experience by informing themselves about best practices for trans+ health.

Conclusion

Changes are required to improve transgender people's experiences and uptake of cervical screening. Improving medical education about trans health and updating health systems would help to combat issues discussed.

Implications for the Profession and/or Patient Care

Having an understanding of the reasons why accessing health services can be more difficult for transgender people will help health professionals to provide appropriate care for transgender patients. This paper details this in the context of cervical cancer screening and can be applied to other areas of healthcare.

Reporting Method

We have adhered to relevant EQUATOR guidelines and used the PRISMA-ScR reporting method. No Patient or Public Contribution.

Coping profiles and their association with vicarious post‐traumatic growth among nurses during the three waves of the COVID‐19 pandemic

Abstract

Aims

This study aimed to examine (a) changes in coping strategies and vicarious post-traumatic growth (VPTG) across three timepoints of the COVID-19 pandemic among nurses; (b) discrete groups of nurses with unique coping profiles and (c) the association of these coping profiles with VPTG across the timepoints.

Background

Although literature abounds with the negative mental health consequences of the pandemic among healthcare professionals, much less is known about the positive consequences on nurses, the coping strategies that they use, and how these change over time.

Design

This was a cross-sectional web-based survey at three timepoints during the pandemic.

Methods

A sample of 429 nurses completed online the Post-Traumatic Growth Inventory (PTGI) and the Brief Coping Orientation to Problems Experienced Inventory (COPE) to measure vicarious post-traumatic growth (VPTG) and coping strategies, respectively. The STROBE checklist was used to report the present study.

Results

Significantly higher VPTG scores were observed during the third timepoint. Different coping strategies were employed across the three timepoints. Nurses responded to the pandemic either with an active, an avoidant or a passive coping profile. Significantly higher VPTG levels were reported by the nurses of the active profile compared to those of the passive profile, whereas the difference between active and avoidant profiles was not significant.

Conclusions

Notwithstanding the preponderance of the nurses with the active coping profile in achieving high VPTG, the avoidant copers had more gains (VPTG) than the passive copers, suggesting that doing something to cope with the stressor—let it be trying to avoid it—was better than doing nothing.

Relevance to Clinical Practice

The identification of distinct coping profiles among nurses and their association with VPTG is of particular use to policymakers and practitioners in developing tailored prevention and intervention efforts to help the nurses effectively manage the demands of the pandemic.

Patient or Public Contribution

No patient or public contribution since the study was exclusively conducted by the authors.

Post‐operative nursing activities to prevent wound complications in patients undergoing colorectal surgeries: A scoping review

Abstract

Aims

To identify postoperative interventions and quality improvement initiatives used to prevent wound complications in patients undergoing colorectal surgeries, the types of activities nurses undertake in these interventions/initiatives and how these activities align with nurses' scope of practice.

Design

A scoping review.

Data Sources

Three health databases were searched, and backward and forward citation searching occurred in April 2022. Research and quality improvement initiatives included focussed on adult patients undergoing colorectal surgery, from 2010 onwards. Data were extracted about study characteristics, nursing activities and outcomes. The ‘Dimensions of the scope of nursing practice’ framework was used to classify nursing activities and then the Patterns, Advances, Gaps, Evidence for practice and Research recommendations framework was used to synthesise the review findings.

Results

Thirty-seven studies were included. These studies often reported negative wound pressure therapy and surgical site infection bundle interventions/initiatives. Nurses' scope of practice was most frequently ‘Technical procedure and delegated medical care’ meaning nurses frequently acted under doctors' orders, with the most common delegated activity being dressing removal.

Conclusion

The full extent of possible interventions nurses could undertake independently in the postoperative period requires further exploration to improve wound outcomes and capitalise on nurses' professional role.

Impact Statement

Nurses' role in preventing postoperative wound complications is unclear, which may inhibit their ability to influence postoperative outcomes. In the postoperative period, nurses undertake technical activities, under doctors' orders to prevent wound infections. For practice, nurses need to upkeep and audit their technical skills. New avenues for researchers include exploration of independent activities for postoperative nurses and the outcomes of these activities.

Implications for the Profession and/or Patient Care

There may be opportunities to broaden nurses' scope of practice to act more autonomously to prevent wound complication.

Reporting Method

Scoping Reviews (PRISMA-ScR) checklist.

Patient or Public Contribution

A health consumer interpreted the data and prepared the manuscript.

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