Conectar
To examine the trajectories, core characteristics, and maintenance factors of social avoidance in patients with breast cancer during the first postoperative year.
Longitudinal, explanatory sequential mixed-method design.
This longitudinal study enrolled 176 postoperative breast cancer patients, conducting six follow-up assessments over 1 year. Latent class growth analysis was employed to identify heterogeneous trajectories of social avoidance behaviour, with multivariate logistic regression subsequently analyzing predictive factors. Building on these quantitative findings, semi-structured in-depth interviews were administered to target individuals identified through the analysis. Phenomenological methods were then utilized to elucidate core manifestations and maintenance factors of social avoidance.
Among the 176 enrolled breast cancer patients, 138 completed all six follow-up assessments. Latent class growth analysis identified two distinct subgroups with significant differences in social avoidance trajectories: ‘persistent high social avoidance’ and ‘persistent low social avoidance group’. Logistic regression revealed melancholic temperament as an independent risk factor for ‘persistent high social avoidance group’, while choleric temperament demonstrated protective effects. Phenomenological analysis of qualitative data systematically identified four core themes: (1) affective manifestations, (2) behavioural patterns, (3) psychological drivers, and (4) environmental determinants of social avoidance.
This study revealed heterogeneous dynamic trajectories of social avoidance behaviour in breast cancer patients, with core manifestations encompassing both affective and behavioural dimensions, sustained by multiple factors of personality, psychology, and environment.
This mixed-methods study systematically examined the developmental trajectories, core manifestations, and sustaining factors of social avoidance behaviour in breast cancer patients. The results provide robust evidence to inform precision screening for social avoidance risk, early prevention initiatives, and tailored intervention strategies in clinical nursing practice.
Journal article reporting standards for mixed-methods research.
No patient or public contribution.
To examine gender-based disparities across each link of the American Heart Association's Chain of Survival for women experiencing out-of-hospital cardiac arrest, highlighting systemic, cultural and educational barriers that compromise equitable outcomes.
A discursive review synthesizing epidemiological studies, public health data and qualitative research on cardiac arrest and gender disparities.
A comprehensive search of databases including PubMed and CINAHL identified studies on gender differences in out-of-hospital cardiac arrest recognition, bystander intervention, emergency response and post-arrest care. Literature was critically analyzed using constant comparative analysis and organized according to the five links of the American Heart Association's Chain of Survival to identify recurring themes and evidence of disparity.
Significant disparities were identified at every link in the Chain of Survival. Women are less likely to have cardiac symptoms recognized, receive bystander cardiopulmonary resuscitation or defibrillation and experience timely or guideline-concordant advanced life support and post-resuscitation care. Contributing factors include implicit bias, underrepresentation of women in resuscitation training materials and social norms that hinder rapid intervention.
Gender disparities in cardiac arrest survival are systemic and multifactorial, resulting in ‘broken links’ across emergency response systems, public perceptions and healthcare education. Addressing these inequities requires reforms in public education, resuscitation training and clinical protocols that prioritize gender-sensitive and inclusive care.
Nurses, as educators, advocates and caregivers, are uniquely positioned to drive transformational change in emergency and cardiac care. By championing women-centered and gender-sensitive resuscitation education, implementing inclusive practices and addressing intersectional barriers, nurses can help ensure equitable, responsive and just care. Advancing these priorities is essential for improving survival and neurological outcomes for women and advancing health equity in global healthcare.
We adhered to the principles of the EQUATOR guidelines. This discursive paper did not meet the criteria for a specific standardized checklist.
No patient or public involvement. This study did not include patient or public involvement in its design, conduct or reporting.
The Parent Support Team (PST) is an intensive early intervention home visiting programme delivered by child and family health nurses to families with infants aged 0–6 months experiencing psychosocial and health vulnerabilities. In contrast, mainstream services provide universal clinic-based care and scheduled developmental checks. This mixed-methods study aimed to: (1) describe demographic and psychosocial characteristics, service activity and well-baby check attendance among PST clients compared with mainstream service clients; (2) evaluate changes in maternal depressive symptoms following PST engagement; and (3) explore client experiences, including perceived outcomes and facilitators and barriers to change.
Convergent parallel mixed-methods study.
Retrospective data were extracted from electronic medical records for PST clients (909 mothers; 1038 children) and mainstream service clients (17,707 mothers; 21,764 children) between August 2019 and December 2022. Quantitative analyses described demographics, psychosocial characteristics, service use and maternal depressive symptoms. PST client experience surveys (166 mothers) were analysed using descriptive statistics and thematic analysis.
PST clients demonstrated greater psychosocial complexity and higher maternal depressive symptoms at entry than mainstream clients. PST mothers had more frequent service contacts and maintained stronger engagement with services after discharge. The proportion of mothers with clinically significant depressive symptoms decreased following programme participation. Survey findings indicated improved parenting confidence and practical skills. Positive outcomes were attributed to nurse qualities, opportunities to discuss concerns, a holistic care approach and the service model. Reported barriers included accessibility, scope of education topics and communication challenges.
The PST programme effectively engages vulnerable families, supports maternal mental health and promotes sustained connection with child and family health services.
Intensive early intervention home visiting programmes may improve outcomes for families with complex needs and warrant broader implementation.
SRQR guidelines were followed.
None.
To review the literature on the state of research on the impacts of assisted dying on nursing practice within specialised palliative care.
A scoping review was conducted in accordance with the Joanna Briggs Institute methodology for scoping reviews.
PubMed, Embase, CINAHL, PsycINFO and CENTRAL were searched between July and August 2024.
Articles were included if they referred to countries in which assisted dying is legally permitted and is understood as a practice that is not aligned with the philosophy of palliative care, enabling analysis of its impact on nursing practice in specialised palliative care. After the screening process, data were extracted and then synthesised using thematic analysis.
Fifteen studies published between 2019 and 2024, all from Canada or the United States, met the inclusion criteria. Three themes were identified: (1) positioning and meaning, describing how nurses are required to position themselves and to renegotiate their values; (2) impact on core competencies, capturing changes in key nursing responsibilities; and (3) challenges in interpersonal relationships, referring to increased team conflicts and shifts in relationships with patients and their families.
The legalisation of assisted dying impacts nursing practice in palliative care in various ways, challenging the established advanced practice role of specialist palliative care nurses. This calls for comprehensive ethical reflection within the nursing profession regarding its role and core values in this context.
This review identifies significant challenges facing advanced nursing roles and the palliative care discipline. It provides a foundation for future research and ethical deliberation, with relevance for nurses, educators, policymakers and researchers involved in end-of-life care.
This study did not include patient or public involvement in its design, conduct or reporting.
To assess the prevalence of workplace violence (WPV) against clinical nursing students during internships and quantify the prevalence of different types of violence, such as physical, verbal and sexual.
Systematic review and meta-analysis.
Eligible cross-sectional studies that reported WPV prevalence among clinical nursing students were included. Two researchers independently screened literature and extracted data. The Joanna Briggs Institute tool was used to evaluate bias risk. Pooled prevalence rates, heterogeneity and publication bias were examined.
A comprehensive search was conducted across eight databases, from the inception of each database to 31 March 2025.
A total of 16 cross-sectional studies from eight countries involving 8037 nursing students were included in the analysis, with 11 studies (n = 5550) contributing to the overall pooled estimate. Using a random-effects model, the pooled prevalence of WPV of any type was found to be 40%, with substantial heterogeneity. Verbal violence emerged as the most prevalent subtype (47%), followed by sexual violence (12%) and physical violence (10%). Significant publication bias was detected for both physical and sexual violence, indicating a potential underestimation of the true prevalence.
This systematic review indicated that WPV is a significant occupational hazard encountered by clinical nursing students across diverse international contexts represented during internships.
These findings highlight the urgent need for educational and healthcare institutions and policymakers to implement coordinated measures, such as enhanced preventive training, comprehensive reporting and support systems and a zero tolerance safety culture to protect the future nursing workforce.
This systematic review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
This study did not include patient or public involvement in its design, conduct or reporting.
The research protocol was registered with PROSPERO (CRD420251027354).
To examine which elements of thriving and PERMA may be associated with thriving and intentions to leave both the job and profession among early career nurses.
Retention of early career nurses is a global concern, with up to 60% leaving the profession within 2 years. While organisational factors have been widely examined, psychological constructs such as thriving and well-being are underexplored.
A cross-sectional design.
The study surveyed early career nurses (n = 90, response rate 34.1%) across Australia. Validated instruments assessed thriving, PERMA dimensions, organisational support and intention to leave. Multiple linear and logistic regressions identified key factors associated with thriving and intention to leave the job or profession. Reporting adhered to STROBE guidelines for observational studies.
Thriving was a significant factor associated with engagement (β 0.039, p = 0.031), relationships with colleagues (β 0.167, p = 032), and occupational hardiness (β 0.502, p = 0.001), while accomplishment was a negative factor associated with thriving (β −0.163, p = 0.001). Intention to leave the job was linked to lower levels of thriving (β −1.303, p = 0.048), reduced perceived organisational support (β −0.180, p = 0.048), and higher negative emotions (β 0.747, p = 0.009). Intention to leave the profession was associated with accomplishment (β 0.222, p = 0.048), perceived organisational support (β 0.193, p = 0.001), and years since graduation (β 0.299, p = 0.016).
Thriving was associated with engagement, peer support, and resilience, whereas attrition was associated with poor organisational support and negative affect. Accomplishment is negatively aligned with thriving and may reflect unmet expectations, increasing role strain, or other personal factors not directly related to organisational contexts. Results suggest psychologically supportive environments and PERMA-informed strategies may be important for enhancing early career nurse retention. Supporting nurses to thrive should be a key focus for managers seeking to sustain the nursing workforce.
This study provides actionable insights for creating psychologically supportive environments that may be associated with improved early career nurse retention. By applying the PERMA framework, healthcare leaders may consider implementing targeted strategies, such as fostering engagement, informing the importance of collegial relationships, and promoting resilience, in order to positively inform well-being and achieve lower levels of attrition in clinical settings.
No patient or public contribution.
To identify nurse practitioners' and registered nurses' willingness to participate in voluntary assisted dying, and the factors that influence these decisions.
A cross-sectional design.
An online survey was disseminated to members of 16 professional nursing organisations and associations between April and August 2024.
Responses from 396 participants were analysed. Most were registered nurses (n = 335, 84.6%), aged between 45 and 64 years (n = 217, 54.8%). Over half of the participants (n = 219, 55.3%) had some knowledge of voluntary assisted dying, and more than two-thirds (n = 274, 69.2%) strongly supported it. Respect for a person's rights (n = 345, 89.8%) and relieving suffering (n = 342, 89.1%) were the main reasons nurses participated. Most nurse practitioner participants would be prepared to assess a person's eligibility for voluntary assisted dying (n = 32, 82.1%) or prescribe a substance (n = 31, 79.5%), if permitted by law. Religion, age and years of experience were characteristics associated with reasons for participation.
In Australia, some RNs and NPs are willing to participate in a range of VAD-related activities. However, in some jurisdictions, nurses' engagement is limited by legislative and policy settings. Reconsideration of nurses' roles may enhance access.
With appropriate support, nurses can make a valuable contribution to the sustainability of the voluntary assisted dying workforce.
This study provides up-to-date knowledge on the correlates of workplace loneliness among Finnish nurses in the post-COVID-19 era. We examined the factors (background, work-related and dispositional) that were associated with loneliness among nurses. We also investigated the relationship between loneliness and job burnout, which was used as a mental health outcome in this study.
Workplace loneliness can be a notable stressor in contemporary working life. However, it has received little attention in nursing since COVID-19. Consequently, the present study focused on the antecedents and outcomes of workplace loneliness in nursing.
Cross-sectional survey design was used.
The dataset (n = 5893) was collected in the spring of 2024 from members of the Finnish Union of Practical Nurses. Analyses were conducted via regression analysis.
Regarding prevalence, over 20% of the nurses reported workplace loneliness at least occasionally. Psychosocial factors were most strongly related to greater loneliness: lack of co-worker and supervisory support, experiences of being bullied, and workaholism. Moreover, loneliness was also associated with the core symptoms of job burnout.
Loneliness can be experienced in nursing in contemporary working life, and it is likely to be one potential risk factor for nurses' job burnout. Social interventions should be developed and implemented in nursing organisations to tackle workplace loneliness. These interventions should concentrate on providing social support, preventing bullying, and increasing awareness of the ‘dark side’ of workaholism.
To identify and differentiate workload patterns across shifts and to provide evidence for optimizing nursing workforce allocation in emergency departments:
A cross-sectional study.
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.
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.
Shift-specific nursing workloads in emergency departments can be effectively identified using multidimensional, real-world nursing activity data.
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.
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.
This study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology guidelines.
No patients or members of the public were involved in the design, conduct, analysis, or reporting of this study.
Although implementing evidence-based interventions has been shown to improve the quality of care, there is limited evidence evaluating how these interventions are implemented. In intensive care settings, the use of evidence-based protocols, guidelines and care bundles has been associated with enhanced care quality and reduced burden on patients.
To identify and map existing evidence on the evaluation of evidence-based intervention implementation in adults' intensive care.
A scoping review was conducted by including original published and unpublished studies in English and Finnish.
The studies were retrieved from five databases (CINAHL, Scopus, Ovid Medline, Medic ja Mednar) from January 2000 to December 2024. The data search was performed on 29 November 2022 and updated on 10 December 2024. The results were synthesized and presented in a tabular and descriptive form.
A total of 19 studies were included in the review. These studies evaluated the implementation of evidence-based interventions, focusing on nurse and patient outcomes. Nurse outcomes included measures such as compliance, knowledge and self-confidence. Patient outcomes included indicators such as body temperature, blood glucose, incidence of pressure ulcers and length of stay.
The evaluation of evidence-based intervention implementation does not consistently extend to the evaluation of the entire implementation process. More consistent research reporting would improve disseminating the evidence. The evaluation implementation makes it possible to show the impact of nurse and patient outcomes. The evaluation results can reveal the success of the implementation. Further research on evaluation implementation, development of systematic and comprehensive evaluation implementation methods, or evaluation matrix is needed.
The review will be useful for nursing professionals in planning evidence of implementation, developing or researching evaluation implementation. Promoting evaluation of evidence-based intervention implementation in Nursing can improve the quality of patient care, improve disseminating evidence and uniformities of care practice.
What Problem Did the Study Address? There is limited evidence of evaluation of evidence-based interventions of implementation. Evaluating evidence-based implementation is important to ensure the quality of patient care and patient safety.
What Were the Main Findings? Evaluation of implementation of evidence-based interventions focused on nurse and patient outcomes. Evaluation of the entire implementation process was not identified, and implementation strategies were not evaluated.
Where and on Whom Will the Research Have an Impact? Evidence-based practice implementation in nursing for researchers, developers, nursing leaders and clinical nursing practitioners who implement and evaluate evidence-based practice implementation.
PRISMA 2020 statement.
No Patient of Public Contribution: This study did not include patient or public involvement in its design, conduct or reporting.
To assess caregiver burden and its relationship with health literacy, self-efficacy, stigma, and social support among caregivers of children with tuberculosis in Shanghai, China.
Explanatory sequential mixed-methods design.
In the quantitative phase, 132 caregivers were recruited from a Shanghai Hospital, and 21 participated in the qualitative interviews. Data were collected (April 2023–April 2025) using the Zarit Burden Interview scale, Chinese Health Literacy Scale for Tuberculosis, General Self-Efficacy Scale, Tuberculosis-related Stigma Scale, Multidimensional Scale of Perceived Social Support, and semi-structured interviews. Quantitative data were analysed using descriptive statistics and multiple regression analyses, and qualitative data were analysed using content analysis.
Most caregivers were mothers (72.7%). Burden levels were classified as mild (58.3%), moderate (27.3%), or severe (2.3%). The quantitative analysis identified lower health literacy, limited social support, reduced self-efficacy, and being a female caregiver as significant predictors. Social support partially mediated and self-efficacy mediated the effect of perceived stigma and health literacy on caregiver burden, respectively. Qualitative themes revealed psychological and physical effects, impact on social life, and coping strategies.
Caregiver burden in paediatric tuberculosis is multidimensional and influenced by complex mechanisms. Interventions should address health literacy gaps, enhance self-efficacy, strengthen social support systems, and implement targeted stigma-reduction strategies while considering developmental-stage-specific needs.
Healthcare systems should routinely assess caregiver burden, and multidisciplinary teams should be trained to provide integrated targeted support.
This study demonstrates distinct stigma pathways and comprehensively shows that caregiver burden is significantly associated with modifiable psychosocial factors. Consequently, healthcare providers should develop targeted support interventions that address both psychological and practical caregiving challenges, ultimately contributing to improved patient care outcomes and caregiver well-being in tuberculosis management.
This study adheres to the Good Reporting of A Mixed Methods Study checklist.
None.
To examine the reasons for and methods of using remote video monitoring to prevent falls across hospital and residential aged care, and explore how staff, patients, residents and families perceive its use and benefits.
Scoping Review.
Following JBI methodology, eight databases were searched in July 2025 with no date restrictions. Two reviewers independently screened studies using predefined criteria, and one reviewer extracted data. Narrative and thematic syntheses described how video monitoring is implemented for falls prevention and explored stakeholders' attitudes.
Thirty-five studies were included, with 77% conducted in hospitals and 86% focusing on staff perspectives, highlighting a critical underrepresentation of patients/residents and families. Perceived effectiveness was shaped by underlying motivations—falls prevention, workforce optimisation, or cost reduction. Attitudes were influenced by workload impacts, video monitoring knowledge, ethical and liability concerns. Three remote video monitoring models were identified: technician-based, automated alerts, and nurse-observed without alerts. Technician-based systems were only in hospitals, with no equivalent in aged care.
Research on remote video monitoring for falls prevention is heavily weighted towards hospitals and staff perspectives. Nurses generally viewed video monitoring as effective but still preferred in-person observers. Although there is interest in innovative monitoring systems in aged care that balance safety with a homelike environment, empirical research is lacking. Patient, resident, and family experiences remain underrepresented and require further research.
Remote video monitoring has emerged as an alternative to mobilisation alarms, given their uncertain effectiveness and negative consequences for patients and nurses. Much U.S. hospital research reflects a cost-reduction paradigm aimed at replacing in-person observers, a trend not seen internationally or in aged care. This research is relevant to decision-makers considering technological options for falls prevention and to nurse leaders seeking insight into the appeal and apprehension surrounding video monitoring.
PRISMA-ScR.
None.
Workplace incivility is a pervasive challenge in healthcare. Few studies drew on theoretical concepts to simultaneously examine organisational correlates of incivility and its associations with nurses' work outcomes.
This study examined workplace incivility among nurses, focusing on job control, psychological job demands and workplace justice as workplace characteristics, and assessing its association with job satisfaction and intentions to leave.
A cross-sectional survey was conducted among 528 full-time nurses at a medical centre in Taiwan. Validated questionnaires assessed workplace incivility (the Workplace Incivility Scale), workplace characteristics, job satisfaction and intentions to leave. Multivariable linear regression examined associations of workplace characteristics with incivility, and associations of incivility with job satisfaction and intentions to leave, adjusting for demographic and workplace factors.
High workplace incivility was reported by 41.1% of nurses. In adjusted analyses, lower job control and lower workplace justice were associated with higher incivility scores. After adjustment for demographic and workplace factors, workplace incivility was negatively associated with job satisfaction and positively associated with leaving intentions. Among workplace characteristics, psychological job demands showed strong associations with both job satisfaction and leaving intentions.
Workplace incivility reflects underlying organisational conditions and is associated with lower job satisfaction and greater leaving intentions. Addressing job demands, autonomy and fairness may reduce incivility and sustain the nursing workforce.
Workplace incivility is associated with lower job satisfaction and greater leaving intentions, and may co-occur with lower job control and perceived organisational justice, highlighting the need for organisational strategies that foster fairness and supportive work environments to enhance nurse retention.
The authors adhered to the STROBE guidelines.
No patient or public involvement.
To explore how family resilience emerges and unfolds in dementia.
Qualitative meta-synthesis using thematic synthesis.
PubMed, CINAHL, Web of Science, PsycINFO were searched from inception through August 26, 2025.
Studies examining family-level resilience, adaptation or coping in home-based dementia care using qualitative methods were included. Two researchers independently screened and assessed quality. Thematic synthesis was applied to 18 studies selected through systematic prioritization until theoretical sufficiency.
Of 2437 records, 18 studies were analysed yielding 68 codes and 28 descriptive themes. Thematic synthesis revealed family resilience manifests three characteristics: ecological multidimensionality, iterative and cyclical progression and integrative manifestation. An ecological-processual interpretive framework was developed showing family resilience unfolds along two intersecting axes (ecological: intrapersonal, interpersonal, societal; processual: five iterative stages). Six analytical themes emerged integratively: multilevel adaptive resources and motivation; individual active adaptation; redefining dyadic relationships through dementia-personhood separation; family collaboration and structural reconstruction; social support construction and transcendent meaning expansion.
Family resilience unfolds as a dynamic process continuously reconstructed across ecological levels rather than a static outcome. Iterative and cyclical understanding is essential.
Practice requires longitudinal, process-oriented support for entire families including persons with dementia. Policy should establish family-unit assessment systems identifying changing patterns and respecting autonomy.
This study addressed how family resilience dynamically unfolds in dementia, which remained unclear despite research shifting from burden to resilience focus. An ecological-processual interpretive framework was developed integrating six themes across multiple ecological levels. Mental health nurses, dementia care practitioners, and policymakers will benefit from this framework when developing family-centered dementia care systems.
This review adhered to ENTREQ guidelines.
This study did not include patient or public involvement in its design, conduct or reporting.
Protocol registration PROSPERO: CRD42023485589
This paper aims to explain the process of formulating a robust theory that comprehensively explains the nurse's role during the transition from curative to the palliative phase in advanced cancer care.
A qualitative theory synthesis approach was applied, utilising Turner's 9-step theory synthesis method to integrate five grounded theories and 10 qualitative studies. The Walker and Avant method of concept development and analysis further ensured rigour.
Turner's theory synthesis was used to formulate a more comprehensive, testable theory from five existing grounded theories and 10 other qualitative studies that explain the nurse's role in supporting and facilitating the transition from curative to palliative care in oncology.
The synthesis preparation stage involved a detailed literature review that located five grounded theories and 10 qualitative studies. The theory synthesis phase from steps 1–8 produced the following theory. ‘During transitions from curative to palliative care in advanced cancer, nurses perform various roles that fall within the known and recognised—“visible spectrum” and the unknown and unrecognised—“invisible spectrum”. Step 9 involves the refinement of the theory by further interrogation of its merit in the real world.
Theory synthesis offers a new possibility of cumulating all the evidence research that is already done to adapt it to practice and helping to build theory-driven evidence-based practice.
This paper offers a novel theoretical framework that explicates the visible and invisible roles of nurses in transitioning patients with advanced cancer from curative to palliative care. It contributes to clinical practice by clarifying complex nursing responsibilities that are often unacknowledged, such as brokering referrals, emotional reframing and cultural advocacy. The theory, validated through expert review, can inform curriculum development, support professional recognition and guide practice standards. Broader impacts include enhancing patient-centred care, improving interdisciplinary collaboration and shaping policies that acknowledge the full scope of nursing work in oncology and palliative care transitions.
No patient or public contribution.
This mixed-method systematic review synthesised quantitative and qualitative empirical evidence on how cognitive dissonance triggered by care experiences and circumstances affects nurses' well-being, professional behaviour, patient care and on the coping strategies nurses use to manage these experiences.
Following Joanna Briggs Institute guidance, a convergent integrated synthesis approach combined qualitative and quantitative findings.
Sixteen studies were included following a comprehensive search across five databases in August 2024.
Sixteen studies were included: 12 qualitative, two quantitative and two mixed-methods. Four key themes were identified: (i) dissonance is triggered by conflicting demands, (ii) dissonance discomfort may generate lasting distress, (iii) dissonance influences nursing practice and quality of care and (iv) dissonance reduction efforts varied. Overall, the evidence base was limited in scope and predominantly qualitative, with included studies generally showing moderate to high methodological quality.
Cognitive dissonance is a common but under-recognised challenge in nursing. It arises when actions conflict with professional standards or when nurses are prevented from providing necessary care. If unresolved, it harms nurses' psychological well-being, causing stress, emotional strain and reduced job satisfaction. It may also reduce the quality of care in nursing practice. There is a need for validated measurement tools, longitudinal research exploring long-term impacts and targeted interventions to support nurses.
This review is the first to systematically synthesise qualitative and quantitative evidence on cognitive dissonance in nursing. It addresses an important gap by bringing together findings on how dissonance arises in clinical settings, how nurses experience and manage it and its effects on practice and patient care. It also contributes to our understanding of coping strategies nurses use to cope with cognitive dissonance. The findings will support future research, education and interventions aimed at improving care quality and nurse well-being.
No patient or public involvement.
To identify and report how gender justice is conceptualised and discussed in contemporary health literature in relation to the Triple Planetary Crisis of climate change, pollution and biodiversity loss, with a particular focus on the experiences of women and gender-diverse populations, and the representation of nurses and other healthcare professionals dominated by women.
Scoping review.
Searches were conducted across MEDLINE (Ovid), Scopus, CINHAL, Embase and ProQuest, focusing on studies published from January 1 2000–23 September 2024.
The review was conducted in accordance with the JBI methodology for scoping reviews and reported against the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. Data were extracted according to a pre-specified extraction framework, developed a priori, encompassing components of gender justice and intersectionality.
A total of 39 studies were included: 17 (43.6%) qualitative, 17 (43.6%) quantitative and 5 (12.8%) mixed methods. The focus of the studies included gendered experiences of climate change (30.8%), decision-making and governance (20.5%), health and wellbeing (17.9%), women's economic participation (15.4%), cultural and spiritual connections to land (7.7%), and intersectionality and human rights (7.7%). Gender-diverse populations, nurses and other healthcare professions dominated by women were not represented in the literature.
The literature reported that women experienced differentiated exposure to the Triple Planetary Crisis. The underrepresentation of gender diverse people and nurses in recent studies remains a significant barrier to advancing understanding of gender justice. Integrating gender justice into health systems is increasingly important to prevent women from being disproportionately impacted by the Triple Planetary Crisis.
More attention to inclusion of frontline healthcare professionals, including nurses, in governance, policy discussions and leadership roles could strengthen the response to systemic environmental threats.
No patient or public involvement.
To explore the influence of oral health-related knowledge, attitudes and practices on oral health risk-related behaviours of people in custodial settings.
Integrative review.
Scopus, ProQuest Central, Web of Science, Medline, CINAHL, Academic Search Complete, PsycINFO and Education Research Complete were searched in March 2024 and December 2025.
Studies reporting on any individuals in custodial settings, at least one oral health-related knowledge, attitude or practice and at least one oral health risk-related behaviour (either smoking, alcohol, illicit substances or sugar consumption). Data related to custodial population's oral health knowledge, attitudes, or practices and oral health risk-related behaviour were extracted, synthesised narratively and reported thematically.
Findings from the 26 studies reveal that people in custodial settings had a general lack of oral health knowledge, and oral health risk-related behaviours were prevalent. The most common risk-related behaviours reported were tobacco use and free sugar consumption. Oral health knowledge, attitudes and practices of this population were influenced by custodial healthcare systems and attitudes of dental professionals.
This review highlights the influence custodial healthcare and dental professionals have on the knowledge, attitudes, practices and risk-related behaviours of people in custodial settings. Oral health targeted interventions and strategies are required to improve oral health-related knowledge and attitudes thereby encouraging oral health practices among people in custodial settings.
This review will inform targeted oral health promotion programs that can improve oral health outcomes and experiences of this population.
People in custodial settings experience a disproportionate burden of oral diseases. This review underscores the need for proactive interventions and systemic reform to improve correctional healthcare experiences globally.
Preferred Reporting Items for Systematic Reviews and Meta-Analysis, Extension for Scoping Reviews (PRISMA-ScR) 2018.
No patient or public contribution.
Synthesises evidence on influencing factors contributing to poor oral health among people in custodial settings. Highlights impact of healthcare staff and custodial healthcare systems on population health. Highlights the necessity of oral health promotion programs to improve oral health knowledge and to promote oral health protective behaviours.
To map how simulation-based education supports the development of critical thinking skills required for nurses to recognize delirium in clinical practice.
A scoping review guided by the Joanna Briggs Institute methodology and the framework developed by Arksey and O'Malley, refined by Levac and colleagues.
Two reviewers independently screened and extracted data to identify studies evaluating simulation-based education designed to strengthen nurses' delirium recognition and associated critical thinking processes. A narrative approach was used to chart and synthesize findings across varied simulation modalities and clinical contexts.
The search was conducted on 4 September 2025, using MEDLINE, CINAHL and PsycINFO. No timeframe was applied to the search.
Fourteen studies met inclusion criteria. Simulation-based education consistently enhanced skills aligned with critical thinking, including observational accuracy, recognition of fluctuating cognitive cues, clinical reasoning, reflective awareness, empathy and communication within interprofessional teams. Structured debriefing played a central role in helping nurses analyse decision-making processes and integrate experiential learning into clinical judgement. Several studies reported changes in practice, including more consistent use of delirium identification tools and improved clarity of clinical documentation.
Simulation-based education strengthens interconnected domains of critical thinking that underpin nurses' capacity to recognize delirium early and respond effectively to its fluctuating presentation. These findings highlight the educational value of immersive, theory-informed simulation for developing the clinical judgement required in cognitively complex patient situations.
Integrating structured simulation into nursing education and professional development may enhance timely delirium recognition, foster more effective interprofessional communication and support safer, higher-quality care for hospitalized adults.
Simulation-based education offers a practical and scalable strategy for improving delirium recognition across care settings. By supporting nurses in noticing subtle cognitive changes, interpreting clinical patterns and communicating concerns with clarity and confidence, simulation contributes to stronger workforce preparedness and patient safety.
This review adhered to PRISMA-ScR reporting guidance.
This study did not include patient or public involvement in its design, conduct or reporting.
FreshRSS