Conectar
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.
Mixed methods observational study.
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.
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.
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.
Consolidated criteria for reporting qualitative studies (COREQ)–32 item checklist.
This study did not include patient or public involvement in its design, conduct, or reporting.
This study examines the relationships between wage satisfaction, union perceptions, expectations, and union membership among Turkish nurses, identifying factors associated with union participation.
Sequential explanatory mixed-methods design.
This two-phase study (January–July 2023) included: (1) a quantitative survey of 210 nurses assessing wage satisfaction, union perceptions, and expectations, analysed using regression and PROCESS Macro (Model 4); and (2) qualitative interviews with 22 nurses, including 15 with union leadership experience, analysed through thematic analysis using MAXQDA.
Quantitative findings indicated that wage satisfaction was associated with nurses' perceptions of unions but did not independently predict union expectations. The study hypothesises that union perception functions as a key mediating mechanism, translating wage dissatisfaction into expectations for union action. Qualitative findings supported this pattern, showing that although wage dissatisfaction was widespread, nurses' expectations were primarily shaped by perceptions of unions' transparency, political independence, democratic participation, and representational capacity rather than by wages alone.
Union participation among nurses is influenced by both economic conditions and normative evaluations of unions. While wage dissatisfaction provides an important contextual background, expectations and engagement are mainly driven by perceptions of union credibility, fairness, and representational effectiveness.
Nursing unions should prioritise transparent governance, democratic participation, and political independence to enhance trust, member engagement, workforce stability, and quality of care.
This study addresses persistent wage dissatisfaction alongside declining union membership and trust. The findings demonstrate that union engagement depends not only on economic dissatisfaction but also on perceived representational fairness. The results are particularly relevant for nursing unions, professional organisations, and policymakers aiming to strengthen union legitimacy and workforce engagement in healthcare systems.
Compliant with COREQ guidelines and mixed-methods reporting standards.
No patient or public contribution.
To investigate what works when using Patient-Reported Outcome Measures (PROMs), for whom, in what contexts, and why in four Value-Based Healthcare (VBHC) programmes.
Realist evaluation.
Evaluation of Heart Failure, Parkinson's Disease, Epilepsy and Cataract surgery programmes using data from a scoping review, documentary analysis, questionnaires, quantitative routinely collected data and semi-structured interviews with staff, patients and carers (July 2022–August 2023). Programme theories and logic models were developed, tested and refined.
We conducted 105 interviews (67 patients, 21 carers and 17 staff) and collected data from 230 patients (66 Epilepsy, 140 Heart Failure and 24 Parkinson's Disease) and 14 staff via questionnaires. Clinicians used PROMs data to regularly monitor patients with Heart Failure and Epilepsy, which resulted in better triage and tailoring treatment, prioritisation of access based on the urgency of need, and facilitation of referral to relevant professionals. In Heart Failure, this further resulted in a more efficient provision of care and better use of resources, care closer to home, improved health outcomes (e.g., better symptom management) and service redesign. The same was not observed in Epilepsy, as patients who required mental health treatment had to be referred, but they were not always able to access specialist services. PROMs were discontinued in Cataract surgery services mainly due to the lack of integrated IT systems, which caused an increased workload and staff resistance. In Parkinson's Disease, patients were asked to complete PROMs even though the information was not consistently being used.
Findings challenge the orthodoxy that implementing PROMs is universally good and brings about real improvements in patient outcomes in a VBHC context. PROMs are generally ill-suited for long-term use with patients in routine care without further adaptation. Greater staff and patient involvement are imperative to enhance the acceptability and relevance of the programmes.
Patient-Reported Outcome Measures can improve care when embedded in well-supported systems. Implementation must be realistic, involve staff and patients, and be underpinned by clear leadership and robust digital infrastructure. Co-designed patient-facing tools can improve accessibility and engagement.
What problem did the study address? There is limited evidence on how Patient-Reported Outcome Measures function across different routine healthcare contexts. What were the main findings? Patient-Reported Outcome Measures improved care in Heart Failure but not in other services, largely due to contextual barriers. Where and on whom will the research have an impact? Findings are relevant for clinicians, service designers, and policymakers seeking to implement meaningful person-centred outcome measurement in long-term conditions.
We adhered to Realist and Meta-narrative Evidence Syntheses: Evolving Standards II guidance and to the Guidance for Reporting Involvement of Patients and the Public.
The study was developed alongside a wide range of patient and public stakeholders involved in the Aneurin Bevan University Health Board Value-Based Healthcare programme, third sector and specific individuals and groups representing the four included services (i.e., St. David's Hospice Care, British Heart Foundation, Digital Communities Wales, Epilepsy Action, Digital Communities Wales, Parkinson's UK Cymru, Race Equality First, Aneurin Bevan Community Health Council, Value- Based Healthcare Patient Reference Group and Wales Council of the Blind). A total of 10 virtual meetings were strategically planned to address gaps, assist in the interpretation of findings, and ensure that outcomes were pertinent and accessible to the specific needs and circumstances of under-represented or vulnerable groups.
To explore the views of health care professionals involved in initiatives that have led to successful research-related roles for nurses and midwives working in community settings.
A sequential mixed-methods study.
Between December 2022 and January 2023 a survey was completed by health care professionals with relevant experience of successful research-related initiatives for nurses and midwives in community settings. Survey responses were categorised into low, medium or high-priority examples of productive practice. Nineteen of the twenty responders who provided high-priority examples were interviewed between May and July 2023. The research capacity development for impact framework underpinned data collection and analysis. Data were thematically analysed using the framework method.
The seven themes of the research capacity development for impact framework: leadership and sustainability, skills and confidence building, infrastructures, linkages and collaborations, ownership and responsibilities, actionable dissemination and co-production were identified as important features of successful research-related roles in community settings. A new cross-cutting theme of trust and relationships was generated. The initiation, continued growth and ambition continuum guided the development of the planning change and features of success template.
This study highlighted the key features that matter when planning change and developing research-related roles for nurses and midwives in community settings.
Study findings have the potential to inform policy and practice for organisations focused on developing research capacity and capability in community settings.
This study adhered to the COREQ reporting guidelines.
No patient or public involvement.
Investigate if UK healthcare professionals have the resources and knowledge to provide cardiovascular prevention and rehabilitation to people with ischaemic non-obstructive coronary artery disease (INOCA), and explore what type of care healthcare professionals believe patients should receive.
Electronic cross-sectional survey of UK healthcare professionals, circulated between 7 January and 7 March 2022.
Quantitative data were analysed descriptively. Qualitative data were analysed inductively.
Healthcare professionals lacked knowledge and capacity to care for this patient group. Healthcare professionals recommended patients receive two unsupervised sessions per week, for 8 weeks, at home and in person. Recommend include physical activity advice/exercise training, health behaviour support, psychological support, smoking cessation, dietetics/nutritional support, weight management, counselling and medication titration.
In the UK, healthcare professionals lack resources and knowledge to provide cardiovascular presentation and rehabilitation to people with INOCA. Recommended care reflected care currently available to other patient groups.
There is a need to create and evaluate educational material for healthcare professionals.
Before people with INOCA are offered cardiovascular prevention and rehabilitation it was necessary to determine if healthcare professionals had sufficient clinical knowledge and resources to provide care. We conclude that additional training and resources are required to enable health professionals to deliver care to people with INOCA.
Researchers should create and evaluate educational material for cardiovascular prevention and rehabilitation programmes. Programmes also require additional resources to deliver care to this group.
Reporting adheres to the Cherries guidelines.
A patient (SB) was consulted on study design, data collection, and interpretation, and manuscript preparation.
To better understand what enables evidence-based practice, this study investigated contextual factors influencing evidence-based practice in general, and in relation to the implementation of bladder-monitoring guidelines in orthopaedic care.
Convergent parallel mixed method.
This study was part of a hybrid research project across 17 Swedish orthopaedic sites. The data collection (2021–2023) included interviews with orthopaedic staff and patients post-hip surgery, patient survey free-text responses, and a staff survey on organisational context. Data were analysed with deductive content analysis and descriptive statistics, later integrated using a mixed methods approach.
Evidence-based practice was supported by context factors such as staff collaboration and multiprofessional engagement. Staff addressed patient safety and equality by using evidence-based guidelines, but rarely involved the patients. Orthopaedic fast-track procedures positioned patients as passive recipients, while staff voiced a call for a more person-centred context. Positive attitudes, leadership engagement, use of champions, and adequate staffing enabled evidence-based practice, though a shortage in evaluation and high staff turnover hindered its implementation.
Orthopaedic context is characterised by several enabling organisational context factors for evidence-based practice, although patients lacking recognition of their needs and queries justify greater focus on person-centredness and mutual information exchange. Audit and feedback are crucial for improvements, but were lacking in the orthopaedic care context.
Assessments of efforts made to implement evidence-based practice and its outcomes should incorporate nursing care. Slimmed care processes require attention to ensure patient participation.
The orthopaedic care context is enabling for evidence-based practice, although staff are challenged by fast-track procedures with extensive information exchange and insufficient person-centredness.
The Mixed Methods Reporting in Rehabilitation & Health Sciences checklist.
No patient or public contribution.
Identifier: NCT 04700969
This study aimed to investigate factors influencing the acceptance of smartphone applications among high-risk pregnant women in the Lao People's Democratic Republic to support continuous care.
An explanatory sequential mixed-methods design.
The quantitative phase included 167 high-risk pregnant women recruited from four tertiary hospitals in Vientiane, Lao PDR. Validated questionnaires were used to measure demographics, digital technology usage, eHealth literacy and anxiety. Data were analysed using descriptive statistics and multiple regression analysis. In the qualitative phase, in-depth interviews with 20 women were conducted to further explore experiences, perceptions and barriers related to smartphone application usage. Interviews were analysed via direct content analysis.
Quantitative findings indicated that smartphone application acceptance was significantly predicted by eHealth literacy (B = 1.53, 95% CI 1.22–1.84, p < 0.001) and pre-existing non-communicable diseases (B = 4.39, 95% CI 1.05–7.73, p = 0.010). Anxiety negatively impacted acceptance (B = −0.28, 95% CI −0.51 to −0.05, p = 0.019). The model explained 53.9% of the variance in smartphone application acceptance (R 2 = 0.539). Qualitative findings highlighted four key themes: awareness of pregnancy risks, unclear health information, perceived benefits of smartphone applications including accessibility and emotional reassurance and practical barriers such as internet costs and limited digital literacy.
Positive perceptions of smartphone applications regarding accessibility and reassurance were observed, alongside significant barriers, such as limited digital literacy and internet costs. Addressing these factors may enhance the adoption and effective utilisation of digital health technologies among high-risk pregnant populations.
No patient or public contribution.
To identify implementation strategies that effectively facilitate the adoption of social needs care coordination activities using enabling technologies among care management teams serving patients in community-based health centres.
Modified Delphi process.
Discrete, feasible implementation strategies were identified through literature review and semi-structured interviews with care management staff and subject matter experts in clinical informatics, workflow redesign, and product engineering. A modified Delphi was conducted with eight subject matter experts and nine health centre care management staff. Iterative rounds of online surveys were used to achieve consensus on the most relevant implementation strategies and their delivery methods.
The modified Delphi process achieved consensus on nine discrete implementation strategies needed to advance care management teams' ability to screen, refer and track social needs. Prioritised strategies included developing champions, enhancing quality improvement capacity, training staff on using enabling technologies and providing tailored technical assistance for workflow refinement. Consensus was also reached on a monthly cadence for most of the implementation strategies.
Consensus was reached on strategies to enhance care management teams' implementation of social needs screening, referrals and tracking using enabling technologies. These strategies will comprise an intervention to be pilot tested, refined and assessed in a cluster randomised clinical trial.
Findings from this study will inform the development of strategies to further the adoption of enabling technologies to support social needs care coordination.
This work is key to the design of a type 2 hybrid implementation-effectiveness trial that will assess whether user-informed, evidence-based implementation strategies can improve care management teams' adoption of enabling technologies to facilitate social needs care coordination for patients.
The research team includes a patient advisor with community-based nursing expertise and a nurse practitioner-clinical informaticist leader who was involved in data collection and interpretation of findings.
Trial registration: Clinicaltrials.gov registration # NCT06489002. Registered July 5, 2024, https://clinicaltrials.gov/study/NCT06489002?term=NCT06489002&rank=1.
This study investigates the impact of the hospital environment on nurse job productivity in the post-pandemic era, with a focus on the moderating role of occupational calling, based on the person-environment-occupation-productivity (PEOP) theory.
A mixed-methods approach was employed, combining two-stage quantitative surveys and qualitative interviews.
In April 2022, 230 nurses from 11 Chinese public hospitals participated in a two-stage quantitative survey. Additionally, qualitative interviews were conducted with 10 nurses and 2 physicians. Quantitative data were analysed using partial least squares structural equation modelling (PLS-SEM), while qualitative data were analysed through Colaizzi's method to identify themes. To ensure the validity and reliability of the mixed-methods design, the study adhered to the Mixed Methods Appraisal Tool (MMAT) guidelines. Both sets of data were used to evaluate the relationships between hospital environments, job productivity, and occupational calling.
The study found significant correlations between the hospital's indoor, spatial and sanitary environments and nurses' job productivity. Additionally, the research revealed that occupational calling moderates the relationship between indoor and spatial environments and job productivity to varying extents. However, occupational calling does not significantly moderate the impact of the sanitary environment on job productivity.
This study provides insights into the transformative effects on hospital environments in the post-pandemic era, emphasising the importance of combining personal intrinsic and environmental extrinsic factors to boost nursing productivity. It proposes strategies for optimising hospital indoor, spatial, sanitary environments and enhancing nurses' occupational calling, providing practical, theoretical and educational insights to healthcare policymakers and practitioners.
There was no patient or public contribution in this study, as the focus was on nurses.
To explore why parents consent to or decline organ donation after their child's death and identify the factors that influence their decision-making.
Mixed-methods analysis of routinely collected quantitative and qualitative data from 594 cases in the United Kingdom between 2018 and 2024.
Quantitative analysis of clinical and demographic variables of potential donors, including regression analyses examining associations with parental consent. Qualitative content analysis and frequency counts of anonymised clinical notes of parental discussions and decision-making. Integration of quantitative and qualitative findings on similar phenomena of interest.
For each additional life-year of the child, the odds of parental consent increased by 6%; the odds of consent among white families were five times higher than those of non-white families; and the odds of consent for donation after brainstem death were 1.78 times higher than those for donation after circulatory death. Parental non-support was influenced by the perception that organ donation prolonged or altered end-of-life care, cultural and religious beliefs and the need for surgery. Factors facilitating consent included altruism, creating a positive legacy, and prior knowledge of organ donation. Parents fell into four decision groups: those who immediately consented, hesitated but consented, hesitated but declined and immediately declined.
This study provides new insights and theories about which parents are more likely to consent to paediatric organ donation. Findings highlight a range of factors that shape parental decisions and the need for approaches tailored to the varied concerns and complexities that parents face in navigating end-of-life care for their child. Developing specific support strategies that acknowledge contextual, religious and procedural concerns may enhance consent rates and facilitate a more bespoke family-centred approach to paediatric organ donation and palliative care. Other countries achieve better paediatric consent rates, suggesting there is potential to further improve policy and practice, underpinned by a programme of research.
What is already known: Internationally, there is a shortage of organs for paediatric transplants, and parental consent is the limiting factor in most high-income countries. Paediatric organ donation is unique from adults, and there is limited research into why parents consent to or decline organ donation for their child. What this paper adds: This analysis identified a range of interconnected factors that could positively or negatively influence parental consent decisions, with emotional, logistical, procedural and religious factors acting as critical barriers to consent. Additionally, parents were categorised into four decision-making groups that have distinct decision-making patterns and characteristics. Implications for practice and policy: These findings provide a foundation for better understanding why parents choose not to consent to organ donation for their child, which can begin to inform the development of policies and practices that better create the conditions for consent and a more family-centred approach in paediatric end-of-life care.
This study highlights critical factors predicting and shaping parental decisions and indicates a need for approaches tailored to the emotional and logistical complexities that parents face. Specific support strategies that acknowledge contextual, religious and procedural concerns may facilitate a more bespoke family-centred approach to paediatric end-of-life care and enhance organ donation consent rates.
What problem did the study address? Internationally, there is a shortage of organs available for children in need of transplants. Parental consent for paediatric organ donation is a limiting factor in most high-income countries. The emotive nature of a child's death makes paediatric organ donation complex and unique, and there is limited research on the factors influencing parental decision-making and the reasons parents choose to consent to or decline organ donation after their child's death. What were the main findings? We identified a range of interconnected factors that could positively or negatively influence parental consent decisions, with emotional, logistical, procedural and religious factors acting as critical barriers to consent. For the first time, parents have been categorised into four decision-making groups that have distinct decision-making patterns and characteristics. A novel and prevalent factor that negatively impacted consent was that organ donation prolonged or altered end-of-life care, often due to organ donation being raised after plans had been made for end-of-life care. This highlights the need for health systems to adopt proactive and timely approaches to integrating paediatric organ donation with care pathways. This study also identified that parents were 1.78 times more likely to consent to organ donation via a donation by brain death pathway compared to a donation by circulatory death pathway. Where and on whom will the research have an impact? This is the largest study of paediatric organ donation outside of the United States (where the healthcare system is predominantly for-profit and therefore a different model and context compared to the United Kingdom) and provides new insights and understandings that can assist Specialist Nurses in Organ Donation, clinical teams and palliative care specialists in tailoring their approach to end-of-life care to achieve the best consent outcome for each child, their parents and wider family. Findings provide a valuable foundation for the development of future research and developments in policy and practice in the United Kingdom and countries with similar health systems. Findings also include generalisable insights that can be utilised internationally, irrespective of the health system.
This study adhered to the Good Reporting of a Mixed-Methods Study (GRAMMS) reporting standards.
Patients or the public were not involved in this study.
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.
A convergent mixed-methods design, comprising a cross-sectional study and a thematic analysis for quantitative and qualitative phases, respectively.
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.
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).
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.
Aspects related to closure and preparatory tasks were often overlooked. Strategies to enhance end-of-life communication and advance care planning are needed.
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.
No funding was received for the completion of this study.
The aim of this study was to determine how family care is implemented in the care of women with gynaecological cancer from the perspective of health professionals in Finland.
Multiphase convergent mixed-methods research.
This study is based on two datasets collected from one Finnish university hospital. The first dataset was collected from health professionals (n = 20) in one Finnish university hospital inpatient unit in 2023. The second dataset is based on non-participant observational cases (n = 137) of health professionals in the spring of 2024. The quantitative data were analysed using both parametric and non-parametric tests. The qualitative data were analysed using thematic analysis.
The quantitative results of the first and second phases together confirm the gap between the lack of competence and the attitudes of health professionals towards their own communication skills. The qualitative results revealed two main themes: (1) increasing competence towards a more comprehensive patient care process and (2) increasing the sense of safety by sharing timely information between professionals, patients, and relatives.
Family-oriented working and communication between professionals is incidental and individual-dependent. Increased competence and more effective sharing and exchange of care information between professionals can improve the quality of care.
The study was able to identify important areas of family care for professionals to improve their clinical practice.
This study addressed clinical competence, as demonstrated by the family care perspective. Family care is recognised as an important part of the care of gynaecological cancer patients and requires increased competence. This study aims to raise awareness among health professionals and policymakers about the current state of family care in Finland.
This study was prepared and reported according to the STROBE checklist.
No patient or public contribution.
To investigate the experience and perceptions of the effectiveness of retention strategies of nurses and nursing associates in district nursing services.
Mixed methods cross-sectional online survey.
Electronic invitations were circulated via district nursing professional networks to complete an online survey in England. The survey questions were developed from international evidence-based guidance. Quantitative data were analysed descriptively and using multinomial regression analysis, tested the variation in experienced strategies by job and work characteristics. Content analysis informed qualitative data analysis.
Three hundred and forty-five completed surveys were received. Over 60% of respondents reported experiencing strategies related to a safe working environment (75%), flexible work schedules (65%), well-being (64%) and professional development opportunities (60%). The least frequently reported strategies experienced were involvement in service policymaking (26%), reducing job demands (31%); and creating cohesive nursing teams (40%). Nurses on lower pay grades were statistically less likely than those on the higher pay bands to experience strategies involving professional growth opportunities and involvement in service decision-making. Nurses working in affluent areas were statistically more likely to report experiencing more types of retention strategies than those working in socio-economically deprived areas. Participants' views on effective strategies were mixed but attention to financial aspects (particularly travel costs), manageable workloads, flexibility in work scheduling plus tailored induction/support for those new to district nursing were given the most testimony as effective.
Retention strategies are created and enacted by those within employing organisations, district nursing services and district nursing teams, but within the context of a wider health care and labour market system. We suggest the findings could be the starting point for review by district nursing services experiencing high vacancy rates. Our findings raise questions for subsequent investigation across health systems.
This paper adhered to the relevant Equator guideline A Consensus-Based Checklist for Reporting of Survey Studies (CROSS), https://doi.org/10.1007/s11606-021-06737-1.
This study did not include patient or public involvement in its design, conduct or reporting.
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.
Cross-sectional multi-method study.
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.
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.
Notable findings include age-related differences, the need for shared responsibility in workforce preparation, and a link between problem-solving ability and help-seeking.
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.
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.
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.
This study aims to explore occupational burnout among Chinese nurses from two perspectives: first, by comparing changes in emotional exhaustion, depersonalisation and personal accomplishment before and after the COVID-19 pandemic; and second, by identifying long-term work-related stressors and structural factors contributing to burnout.
A mixed-methods approach was adopted, combining a systematic review with qualitative interviews. The qualitative component involved semi-structured interviews with 53 hospital-employed nurses from various departments and regions across China, focusing on the three core dimensions of occupational burnout.
The systematic review included both Chinese and English-language studies published between 2016 and 2023 that used the Maslach Burnout Inventory to assess burnout among nurses. A total of 22 studies met the inclusion criteria, selected independently by two researchers using the JBI critical appraisal tool. In parallel, the qualitative interviews explored nurses' subjective experiences and coping strategies related to work stress, emotional fatigue and professional identity.
Bayesian factor analysis indicated no significant differences in emotional exhaustion (BF01 = 2.202), depersonalisation (BF01 = 2.761) or personal accomplishment (BF01 = 2.747) before and after the pandemic. Qualitative findings revealed that burnout was primarily driven by long-standing systemic stressors, including promotion pressure, clinical workload, organisational demands and work–family conflict. Although many nurses relied on self-regulation strategies to maintain psychological stability, they continued to experience ongoing physical and emotional exhaustion. Some reported emotional numbness, but most retained empathy and a strong sense of responsibility. Their sense of personal accomplishment often stemmed from patient recovery and recognition of professional value.
Occupational burnout among Chinese nurses remained largely stable before and after the COVID-19 pandemic. Its root causes stem from persistent work-related stressors and systemic issues, rather than the pandemic itself. Effective mitigation requires institutional strategies, including better staffing, clear career pathways and sustained emotional support.
Short-term crisis responses alone are insufficient to address enduring burnout. Nursing leadership should prioritise systemic reforms—such as optimising shift schedules, defining promotion channels and integrating regular psychological support—to enhance nurse well-being and care quality.
No patient or public contribution.
To analyse how suicide education is integrated into the curricula of nursing degree programmes in Spain.
A cross-sectional descriptive study was conducted.
A review of 123 nursing curricula and a questionnaire. Data were analysed using IBM SPSS, applying a non-parametric statistical test to assess the presence and depth of suicide education in nursing programmes.
Suicide was typically included in a single module, usually titled Mental Health Nursing, taught in the third year (69%). Overall, 76.42% of programmes included suicide content, dedicating an average of 3.59 h. Teaching was mainly expository, while 27.4% applied active methodologies and 23.3% combined both. Programmes using active methods tended to allocate more hours.
The study highlights the need to enhance suicide prevention training in nursing education, both in content and methodology, to better equip future nurses for this critical healthcare challenge.
This study reveals significant gaps in Spanish nursing programmes, encouraging improvements in curriculum design to better prepare nurses for real-world mental health challenges.
Although patients were not directly involved, the research is driven by the goal of enhancing care for individuals at risk of suicide by strengthening nurses' preparedness and response capabilities.
To explore the current status and associated factors of advance care planning intentions among people living with dementia in China.
An explanatory sequential mixed-methods design was adopted.
The research is guided by the knowledge-attitude-practice model and the theory of planned behaviour. Quantitative surveys were used to assess advance care planning intentions and associated factors in people living with dementia, followed by qualitative semi-structured interviews to delve into participants' perceptions and feelings about advance care planning. Quantitative data were analysed using multiple linear regression, while qualitative data were analysed using thematic analysis.
The overall advance care planning behavioural intention was at a moderately high level. The quantitative results revealed that higher education level, certain religious beliefs, greater advance care planning knowledge, positive behavioural attitudes and stronger subjective norms were significantly positively associated with advance care planning intentions. Qualitative analysis identified three themes: positive attitude but limited ACP awareness, supportive relationships enable early ACP consideration and cultural norms shape willingness to engage in ACP.
Advance care planning intentions among people living with dementia are shaped by a combination of social, familial and individual factors. Increasing public awareness, addressing cultural challenges and establishing professional teams are crucial to promoting advance care planning practices. Future research should focus on larger, multicenter studies to enhance intervention strategies.
Although the attitude toward advance care planning is more positive, various factors need to be carefully considered in the process of constructing relative intervention strategies.
This study did not include patient or public involvement in its design, conduct or reporting.
To evaluate the feasibility, effectiveness, and acceptability of a spherical video-based virtual reality training programme aimed at helping nurses manage workplace violence.
A convergent mixed-methods study.
This study included nurses from a tertiary medical centre in Taiwan. The training programme involved four interactive 360° scenarios focused on recognising, de-escalating, and responding to workplace violence. Quantitative measures included risk perception, confidence in coping with aggression, and technology acceptance. Qualitative measures included the participants' learning experiences. Quantitative and qualitative findings were integrated through joint displays.
The programme was feasible, with all participants completing the training. Nurses reported high levels of perceived usefulness and ease of use. Quantitative data revealed considerable improvements in risk awareness and confidence in responding to incidents of violence. Qualitative data revealed that immersion and emotional resonance enhanced engagement, fostered self-reflection, and reinforced learning. Technical challenges included subtitle placement and speech recognition accuracy.
Spherical video-based virtual reality is a feasible, acceptable, and effective training approach that improves nurses' preparedness for managing workplace violence by enhancing situational awareness and confidence in addressing high-risk situations.
Integrating spherical video-based virtual reality into continual education may strengthen nurses' workplace safety competencies, prevent harm from incidents of violence, and improve patient care in stressful environments.
Workplace violence undermines nurse safety and patient care. Current training modules often lack contextual realism. Our programme improved nurses' awareness, confidence, and reflective learning and was feasible and well accepted. The findings are relevant to nursing educators, hospital administrators, and policymakers seeking sustainable strategies for addressing workplace violence.
This study adhered to the Revised Standards for Quality Improvement Reporting Excellence.
Patients or the public were not involved in the design, conduct, or reporting of this study.
The rise in smartphone use presents opportunities and challenges in clinical settings. Despite guidelines restricting mobile phone use, nurses frequently rely on them for various purposes. While beneficial, smartphone use poses risks to information security, patient safety, and care quality, prompting the need for monitoring.
This study examined smartphone usage among nursing students and their perspectives on acceptable and unacceptable use during clinical placements.
This cross-sectional study used convenience sampling to recruit undergraduate nursing students from five universities in Australia and New Zealand. Participants completed the Attitude Towards Digital Device Use during Clinical Placement (Adduct) Scale online between September 2021 and August 2022. The survey included closed and open-ended questions. Descriptive and inferential analyses were conducted using SPSS. Exploratory factor analysis identified attitudinal dimensions, while group comparisons assessed demographic variations. Qualitative responses were thematically analysed. Reporting followed the Consensus-Based Checklist for Reporting of Survey Studies (CROSS).
Among 279 respondents, drawn from an eligible population of 2682 students, the response rate was 10.4%. Age significantly influenced perceptions of unacceptable smartphone use. Younger students (mean age = 25.0, SD = 9.8) were more likely to view such use as acceptable, with those up to 21 years reporting higher scores on the Unacceptable Use sub-scale compared to older peers (p = 0.024). Most respondents found smartphone use beneficial for accessing information and learning, though concerns included distractions and confidentiality breaches. Younger students were at greater risk of non-adherence to guidelines.
Smartphones can enhance learning and efficiency, but clear guidelines and education are needed to balance benefits with risks, particularly for younger students.
This study highlights the need for clear guidelines and structured training to balance educational benefits of smartphone use with the risks of distraction and breaches of patient confidentiality in clinical practice.
No patient or public pontribution.
To combine qualitative and quantitative data to evaluate the feasibility, participant satisfaction and effectiveness of a hybrid pulmonary rehabilitation programme following hospital discharge for an exacerbation of chronic obstructive pulmonary disease (COPD).
Convergent parallel mixed method study nested in a larger ongoing prospective study; this report includes a subset of 21 participants who complete the qualitative and quantitative assessments between May 2023 and January 2024.
Semi structured interviews using open-ended questions were conducted and analysed using a thematic analysis approach. Participants were interviewed after completing an 8-week hybrid home-based rehabilitation programme, including four face-to-face and four remote sessions. Quantitative assessments—covering disease impact, anxiety and depressive symptoms, and exercise tolerance—were conducted at the beginning and end of the intervention in the same participants who took part in the interviews, and a 10-item satisfaction questionnaire was also completed after the programme.
May 2023 to January 2024.
GRAMMS checklist was followed.
21 people with chronic obstructive pulmonary disease (11 females; mean age 62 ± 7 years; mean FEV1 30% ± 10% of predicted) were interviewed. Five major themes were identified: (i) accessibility and adaptation to individual needs; (ii) confidence in the transdisciplinary care manager model, confirmed by high satisfaction score (95/100); (iii) integration of informal carers; (iv) perceived benefits supporting maintenance of health behaviour, consistent with the statistically and clinically significant improvements observed across all quantitative outcomes; and (v) hybrid programme challenges (technical issues and preference for face-to-face visits).
The hybrid programme resulted in significant improvements in physical and psychological outcomes, and participants reported high levels of satisfaction. Qualitative findings highlighted the value of home-based delivery, supervision by a single care manager, informal carer involvement and emotional support in shaping feasibility and satisfaction. However, challenges related to remote sessions indicate that telerehabilitation may not be suitable for all patients and should not be used as a standalone PR option.
Given the strong preference of participants for face-to-face visits over remote visits, telerehabilitation should always include a minimum of individual or group face-to-face supervised sessions. The balance between supervision modalities should be personalised according to participants' needs and progress.
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