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Anteayer Journal of Advanced Nursing

A Tale of Two Conditions: 50 Years of Chronic Illness and Cancer From a Nursing Perspective

ABSTRACT

Introduction

In this commentary, I consider the disparity between the care we see as a necessity for cancer patients and the lack of care we afford to many persons with chronic disease.

Background

I ground my arguments in my own clinical practice and research experiences over a 50-year period augmented by reference to available literature sources.

Data Sources

In tracing developments within the fields of cancer and chronic illness care, I draw on my own research and that of others.

Overview of the Issue

Although chronic illness has long been recognised as causing the majority of the burden on our health care systems and as a significant source of suffering in our society, it has not attracted the level of enthusiasm from researchers, policy makers, and health care systems that we have seen in the context of other diseases such as cancer. Nurses have an intimate knowledge of the suffering occasioned by chronic illness; however, it has been difficult for nursing to mobilise coordinated action in prioritising a re-balance of health systems to better serve those with chronic conditions.

Findings

The advent of medical assistance in dying in Canada has shed a spotlight on the implications of the discrepancy between our prioritising patient need in the care and support of patients with conditions such as cancer, in contrast with the supports and services we make available to those with chronic conditions.

Discussion

Although nursing intimately engages with the burden of chronic illness, it has not mobilized coherent advocacy toward strengthening our societal commitment to this aspect of our care systems.

Conclusion

There is an opportunity for nursing to make a meaningful difference in a fundamental health care system inequity if we can come to understand that chronic illness is as deserving of our collective research, practice change, and policy attention as is cancer.

Patient or Public Contribution

No patient or public contribution.

A Descriptive Evaluation of Evidence‐Based Rounds in Critical Care Using Mixed Data Types

ABSTRACT

Objectives

To pilot and evaluate the implementation of a structured Evidence-Based Rounds (EBR) education model in critical care.

Design

A mixed data type design was used to evaluate Evidence-Based Rounds in a critical care setting. Structured observational data were captured and open-ended survey responses were submitted by attendees. Content analysis and descriptive statistics were used to analyse survey findings.

Results

Seventeen rounds were completed between March 2023 and January 2024 with a total of n = 83 clinical staff members. From these, n = 55 staff completed and submitted evaluation surveys. Rounds were most frequently attended by nurses of all bandings including senior clinical nurses, support workers and student nurses. Evidence-Based Rounds were globally perceived as a positive and useful education strategy and staff were very willing to attend future sessions. Patient outcomes were not directly assessed and rounds specifically facilitated three outcomes: (1) helping staff apply evidence to practice, (2) building staff confidence in presenting clinical information and (3) supporting staff in identifying local improvements to patient care.

Conclusion

Evidence-Based Rounds are an adaptable effective model of bedside education within critical care. In our setting, staff perceived that this model facilitated the application of evidence in clinical practice and positively influenced feelings of confidence. Importantly, this education strategy empowered nurses to explore and identify improvements locally to patient care. Whilst this model offers a practical education approach to address some of the key critical care workforce issues, such as an expanding curriculum and loss of senior staff, it could also be widely adopted to other clinical areas.

Implications for the Profession

Evidence-Based Rounds are perceived by staff as a successful bedside education model that facilitates nurses to apply evidence in practice. It is feasible that this strategy is a potentially sustainable, low-cost model for continuing professional development centred around routine clinical work.

Patient and Public Contribution

No patient or public contribution.

Relationship Between Empowering Leadership, Resilience and Organisational Learning from Incidents: A Cross‐Sectional Study

ABSTRACT

Aim

To examine the relationship between nurse managers' empowering leadership, nurses' resilience and organisational learning from incidents.

Design

Cross-sectional observational study.

Methods

Secondary data from a study conducted in June–July 2022 was used. The sample included 1049 nurses working in three special-functioning hospitals. The self-administered questionnaires assessed nurse managers' empowering behaviours, nurses' resilience and attitudes and behaviours fostering organisational learning from incidents. The analysis employed multilevel analysis with hierarchical linear modelling.

Results

Nurse managers' empowering behaviours and nurses' resilience were significantly positively associated with attitudes and behaviours fostering organisational learning from the following incident subscales: make efforts to identify the problem, discuss safety in the workplace, identify and give feedback to address the at-risk behaviour. The interaction of empowering behaviours and resilience was not significant.

Conclusion

Nurse managers' empowering behaviours and nurses' resilience can contribute to attitudes and behaviours that foster organisational learning, even when nurses face stressful incidents.

Implications for the Profession and/or Patient Care

Fostering empowering leadership in nurse managers and resilience in nurses enhances organisational learning and improves safety and care quality.

Reporting Method

The reporting is based on the STROBE guidelines.

Patient or Public Contribution

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

Clinical Nurses' Workplace Spirituality and Moral Resilience: A Correlational Study

ABSTRACT

Aim

To investigate the current status of workplace spirituality and moral resilience among clinical nurses and to explore the relationship between these two factors, thereby providing a reference for developing strategies to enhance nurses' moral resilience.

Design

A cross-sectional survey design.

Methods

From February to April 2025, a convenience sampling method was used to select 1680 nurses from ten hospitals in the Pingliang area of China. Data were collected using the general data questionnaire, Workplace Spirituality Scale(WSS). Furthermore, the relationship between workplace spirituality and moral resilience was analyzed.

Results

A total of 1657 valid questionnaires were ultimately recovered, yielding an effective response rate of 98.63%. The mean score for workplace spirituality was 102.36 ± 21.65, and the mean score for moral resilience was 41.76 ± 6.31, both indicating a moderate level. A significant positive correlation was found between the two variables (r = 0.231, p < 0.05). Multivariate linear stepwise regression analysis revealed that monthly income, department, monthly night shifts, and workplace spirituality scores were significant predictors of moral resilience (p < 0.05).

Conclusion

The moral resilience of clinical nurses is at a moderate level. Enhancing workplace spirituality can contribute to improving their moral resilience.

Exploring Individual and Organisational Factors Related to Inclusive Leadership Among Healthcare Professionals: A Systematic Review and Meta‐Analysis

ABSTRACT

Aim

To offer a comprehensive overview of the individual and organisational factors related to inclusive leadership among healthcare professionals.

Design

Systematic review and meta-analysis.

Methods

The review was conducted following the Joanna Briggs Institute methodology for systematic reviews of effectiveness. Findings were synthesised using meta-analysis, a random effects model and narrative synthesis.

Data Sources

In January 2025, a systematic search was conducted with no time or geographical limits in the CINAHL, MEDLINE (PubMed), Mednar, ProQuest and Scopus databases. Studies in English, Swedish and Finnish were included.

Results

A total of 34 studies were included. The meta-analysis revealed a statistically significant positive relationship between inclusive leadership and psychological safety among healthcare professionals (n = 10). The narrative synthesis further identified individual and organisational factors related to inclusive leadership. Individual factors consisted of well-being at work, performance and productivity, social behaviour, innovativeness and creativity and psychological capacity. Organisational factors revealed work community cohesion and citizenship, as well as organisational fairness and appreciation.

Conclusions

Inclusive leadership is a promising leadership behaviour, with positive outcomes for healthcare professionals and organisations. By enhancing psychological safety, inclusive leadership offers broader benefits for individuals and organisations. As such, it could improve the retention of professionals and the attractiveness of organisations in the healthcare sector.

Implications for Healthcare Management

To strengthen the functioning of healthcare organisations, leaders should be educated in inclusive leadership and its practical benefits. Training should focus on developing inclusive leadership behaviours that foster belonging, value individual uniqueness and encourage participation across all professional groups, creating an environment where both individuals and organisations can thrive.

Reporting Method

The Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines were used to report the results.

Patient or Public Contribution

No patient or public contribution.

Trial Registration

The protocol was registered in the International Prospective Register of Systematic Reviews PROSPERO (ID: CRD42024503861)

Exploring Experiences, Perceptions and Preferences for Exercise in Australians Living With a Stoma: A Cross‐Sectional Survey

ABSTRACT

Aim

(1) Explore the role of core abdominal exercise in people living with a stoma in Australia; (2) determine whether the presence of a parastomal hernia influenced participant symptoms and complications, health status, experiences with different types of exercise, recall advice given by healthcare professionals; (3) determine whether there is an appetite for supervised/supported exercise programs.

Design

A cross-sectional, anonymous survey.

Methods

Between August and September 2022. The survey included Likert scales and a single free text response. Logistic regression and Cramer's V were used to explore relationships between variables.

Results

Approximately half (45.5%) of 105 participants reported a parastomal hernia. Those with a parastomal hernia were less likely to recall having received advice (15.20%) or demonstration (9.40%) pertaining to exercise. Less than a quarter of all participants completed strengthening (23.80%) or vigorous (22.90%) exercise. Fear of vigorous exercise, abdominal exercise and heavy lifting were high in both groups. Relationships between healthcare advice, exercise-related fears and avoidance of heavy lifting were observed.

Conclusion

Many Australians living with a stoma are not achieving physical activity recommendations. While exercise behaviours did not differ between people with and without a parastomal hernia, recall of healthcare advice around exercise did. Fear-avoidance relationships were observed.

Impact

Most people living with a stoma do not recall advice about core abdominal exercises. Healthcare practitioners need to be aware of fear-avoidance related to lifting among people living with a stoma. This was the first study in Australia, exploring perspectives and experiences regarding exercise; providing foundations for future research particularly exercise programs.

Reporting Method

This study adhered to relevant EQUATOR guidelines and the reporting of survey studies (CROSS).

Patient or Public Contribution

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

Older Persons' Participation in Life‐Enhancement Activities in a Long‐Term Care Facility: A Mixed‐Methods Observational Study

ABSTRACT

Aim

To examine older persons' experiences and participation in life-enhancement activities in a long-term care facility.

Design

Convergent mixed-methods design.

Methods

Naturalistic observations of 20 life-enhancement activity sessions were conducted in a single long-term care facility that includes 111 older persons in September 2024. Data were collected through guiding questions and fieldnotes for systematic observation. We used Kruskal-Wallis and Mann–Whitney U tests for quantitative analysis. Fieldnotes were analyzed using a six-phase reflexive thematic analysis approach.

Results

Engagement levels (self-initiative, assistance-seeking frequency, and social interaction frequency) significantly differed across 16 different life-enhancement activities. Social interaction frequency also varied by mobility status (wheelchair, walker, independent). Participants displayed significantly more distractions in the TV Room than in the Activity Room. Four themes emerged from thematic analysis: (1) participation barriers, (2) activity contextual factors, (3) facilitator support strategies, and (4) social interactions and emotional well-being.

Conclusion

Structural elements (purposefully designed rooms, activity design and complexity, and the resident-preferred music), relational elements (facilitators' hands-on support, conflict resolution, and positive reinforcement), and individual factors (mobility status) influence older persons' participation in life-enhancement activities. Life-enhancement activities benefit older persons when they are provided with choices and adaptive equipment.

Implication

Findings support allocating distraction-free spaces for life-enhancement activities, incorporating resident-preferred music and game-layered physical exercises, and providing facilitator training in adaptive coaching, hands-on support, and conflict resolution.

Impact

Life-enhancement programs can promote psychosocial well-being among older persons in long-term care facilities by transforming routine recreational activities into personalized and socially engaging experiences that may reduce feelings of loneliness.

Reporting Method

Journal Article Reporting Standards for Mixed Methods Research.

Patient or Public Contribution

No Patient or Public Contribution.

Addressing Inequities in Doctoral Nursing Education: A Scoping Review

ABSTRACT

Aim

The purpose of this scoping review is to map and summarise the current peer-reviewed literature on inequities in doctoral nursing education, with a specific focus on populations affected, barriers, facilitators and strategies to support equity in doctoral nursing education.

Design

This scoping review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR).

Methods

A comprehensive search for empirical evidence was completed using four databases: CINAHL, Scopus, ERIC and Google Scholar. A systematic screening process was applied, and data were extracted and charted guided by the Population, Concept, Context (PCC) framework.

Data Sources

Databases were searched for peer-reviewed articles published between 2000 and 2025.

Results

A total of 13 studies met the inclusion criteria. Most studies focused on racial/ethnic minoritized populations, and one focused on first-generation doctoral students. Common barriers included experiences of microaggression, systemic racism, lack of funding and feelings of isolation. Common facilitators were faculty mentorship, financial support, peer networks and targeted recruitment programs.

Conclusion

Inequities remain in doctoral nursing education, particularly for racial/ethnic minoritized populations. Although some effective interventions were identified, significant gaps exist in understanding how to support diverse doctoral nursing students, especially for those with intersecting identities.

Implications for the Profession

Addressing inequities in doctoral nursing education can enhance the diversity of the nursing workforce and faculty, promote inclusive academic environments and contribute to health equity.

Impact

Persistent inequities in access and experience among underrepresented groups in doctoral nursing education. Main findings: Key structural and social barriers persist, though several promising strategies have emerged. Impact area: Academic institutions, doctoral program designers and nurse leaders.

This study adheres to the PRISMA-ScR reporting guidelines. This study did not involve patients or the public in its design, conduct or reporting.

Evaluation of a Nurse Practitioner Led Procedural Support Service for Children With Procedural Anxiety: An Effectiveness–Implementation Study

ABSTRACT

Aim

To evaluate the clinical effectiveness of a Nurse Practitioner led procedural support service for children with procedural anxiety, and identify facilitators and barriers to its sustained implementation and optimisation.

Design

An effectiveness–implementation hybrid type 3 study used a prospective mixed methods evaluation approach.

Methods

From December 2022 to May 2023, data were collected from children, parents and clinicians using a nurse practitioner-led service at a quaternary paediatric hospital in Brisbane, Australia. A prospective audit assessed clinical outcomes, while qualitative interviews explored implementation barriers and facilitators.

Findings

The clinical audit (n = 40) confirmed the service was effective and safe, ensuring procedural completion with minimal distress. Descriptive statistics indicated low pain and anxiety scores. There was a moderate negative relationship between pain scores and the use of distraction techniques. Interviews with thirty-three participants showed the service improved access to procedural care, reduced the need for physical restraint and general anaesthesia, and enhanced clinical workflow through preadmission assessments.

Conclusion

Utilising a Nurse Practitioner support service represents a safe and effective strategy to enhance access for paediatric patients with procedural anxiety.

Implications for the Profession and Patient Care

This study underscores the significance of specialised nursing roles in managing paediatric procedural anxiety, offering a replicable model to enhance procedural outcomes and mitigate medical trauma across healthcare settings.

Impact

Minimising pain and distress is important in all clinical encounters with children to reduce the risk of medical-related trauma and the future avoidance of healthcare.

Reporting Method

The report of study outcomes was guided by the Standards for Reporting Implementation Studies (StaRI) initiative.

Patient or Public Contribution

Patients or the public were not included in the design, conduct or reporting of the study.

A Sisterhood of Women: The Process of Co‐Creating Recommendations for Improved Pessary Self‐Management Support

ABSTRACT

Aims

This work aimed to explore barriers to pessary self-management and co-create strategies to address these.

Design

Participatory Action Research.

Methods

In October 2024, eight pessary-using women living in the United Kingdom participated in cooperative inquiry, discussion and co-creation of strategies in two virtual workshops.

Results

Pessary using women who participated in this research identified challenges affecting willingness to self-manage a pessary and proposed solutions to address these and better support women. Pessary practitioners should assess physical capabilities, consider softer, more malleable pessaries, and explore the possibility of a pessary applicator. Peer support was seen as empowering, enabling self-advocacy and improved care; therefore, establishing peer networks was prioritised. Major barriers included difficulty navigating services and limited access to a full range of pessaries, leading some women to buy devices online without medical oversight, creating a two-tier system based on ability to pay. The group called for improved, standardised pessary care, and for self-management to be reframed to avoid women feeling ‘fobbed off’ through better follow-up, positive language, and compassionate care.

Conclusions

The group identified strategies to address barriers to pessary self-management which require further exploration. Pessary practitioners have a responsibility to listen to these voices and take steps to improve care for women in the future.

Implications for the Profession and/or Patient Care

To support women's willingness to self-manage their pessary, pessary practitioners should consider and support women to overcome physical and emotional barriers; improve information provision; maximise social support; boost women's perceived self-efficacy; reframe pessary self-management and ensure robust, accessible follow-up is in place. This will ensure pessary-using women are supported to make an informed decision about pessary self-management. This research offers pessary practitioners insight into barriers women perceive to pessary self-management and guidance as to how women can be supported to self-manage their pessary.

Impact

Only 21% of women are willing to self-manage their pessary. Therefore, this research aimed to co-create strategies to better support women to self-manage their pessary and overcome barriers to willingness. Women reported individual, societal and service factors which affect willingness to self-manage a pessary. These research findings should be translated into clinical practice and care delivery for pessary using women in both a community and hospital setting.

Reporting Method

COREQ (COnsolidated criteria for REporting Qualitative research) Checklist.

Patient or Public Contribution

Patients and members of the public were involved in research prioritization, study design, data analysis, interpretation of findings and dissemination.

Study Registration

Study not registered.

Development and Psychometric Evaluation of the Forensic Nursing Competency Scale‐Short Form for Hospital Nurses

ABSTRACT

Aim

To develop and evaluate the psychometric properties of the Forensic Nursing Competency Scale-Short Form (FNCS-SF) for hospital nurses.

Background

Nurses who care for victims of sexual abuse, domestic violence and elder or child abuse require forensic nursing competencies. However, few valid and reliable tools exist to assess these competencies in hospital settings.

Design

A cross-sectional study.

Methods

The study was conducted in two phases. Phase 1 involved the development and refinement of the FNCS-SF with input from 10 nurses. Phase 2 tested the tool's psychometric properties. A total of 420 nurses from two tertiary hospitals in South Korea participated. Participants were divided into two groups: Study 1 (n = 200) for exploratory factor analysis and Study 2 (n = 220) for confirmatory factor analysis.

Results

The FNCS-SF consists of 27 items across six factors: awareness of the medicolegal problem, evidence-based practice in forensic nursing, collaborative forensic nursing with community partners, safety and security, professional career development and multidisciplinary integrated knowledge. An item analysis revealed significant correlations between each item and the total scale score. Criterion validity was supported by significant correlations between the FNCS-SF and attitudes and beliefs towards forensic nursing and the performance of the forensic nursing role. Confirmatory factor analysis supported a six-factor model with good fit indices. Cronbach's alpha indicated strong internal consistency.

Conclusion

The FNCS-SF is a valid and reliable tool for assessing hospital nurses' forensic nursing competencies, which can improve patient safety and treatment outcomes. Further validation in diverse clinical settings is recommended.

Impact

The FNCS-SF can be used to improve forensic nursing competency through professional development.

Patient or Public Contribution

None.

Implications for Clinical Practice

The FNCS-SF provides a standardised framework to evaluate nurses' forensic competency, guiding education and practice to enhance clinical preparedness and deliver victim-centred care.

Reporting Methods

STROBE guidelines.

Comparative Analysis of Doctoral Programmes in Nursing in Latin America

ABSTRACT

Objective

To characterise and analyse doctoral programmes in nursing in Latin America through an exhaustive review of the official websites of the universities.

Design

Descriptive and multiple correspondence analysis. Existing programmes were mapped out, identifying their geographic distribution and curricular characteristics.

Methods

A review of 59 doctoral programmes in nursing was conducted through the official web portals of universities in Latin America that were currently available (as of 2025) and that provided the required information. Thereafter, a matrix was built in Excel to consolidate the data.

Results

The study identified an increase in the number of doctoral programmes in nursing offered in Latin America. Furthermore, these programmes were found to be more strongly concentrated in countries such as Brazil, Peru and Mexico, while other countries, including Guatemala and Uruguay, have recently incorporated such training.

Conclusion

Doctoral education in nursing in Latin America has experienced significant growth in recent years, consolidating itself as a fundamental pillar for the development of the discipline and the generation of knowledge in health. However, structural challenges persist, including limited funding for research, a lack of cooperation between universities, and the absence of programmes focused on Advanced Nursing Practice.

Implications for the Profession and/or Patient Care

This contribution helps identify trends in the offering of doctoral programmes and inequalities in their geographic distribution, allowing for an understanding of how training varies across countries in the region while also consolidating Nursing as an academic and professional discipline.

From the ICU Bedside: Applying the Transnational Clinical Academic Doctorate Lens to a Clinically Embedded PhD Journey

ABSTRACT

Aim

To critically reflect on a transnational, clinically embedded doctoral journey undertaken during and after the COVID-19 pandemic, and to draw conceptual and systemic lessons for doctoral education and clinical academic nursing pathways.

Background

Reflective accounts of doctoral study exist, yet few examine practice-based PhDs conducted across different countries and health systems during a global crisis. This paper analyses one such pathway—enrolment at an Australian university with research embedded within the UK National Health Service—to explore resilience, identity formation, mentorship ecologies and organisational conditions that support or hinder clinical academic development.

Method

Using analytic autoethnography and reflective case study logic, experiential data (field notes, supervisory records, ethics correspondence, project artefacts and publication trajectories) were synthesised with relevant scholarship. A conceptual framework, the TCAD lens, was developed to structure analysis across contexts, constraints, mechanisms and outcomes.

Discussion

Four phases are outlined: starting in crisis as a senior ICU nurse, transitioning to lead educator, serving as surgical matron while implementing changes, and moving into academia to complete the thesis by publication. Dual ethics and governance procedures, contractual arrangements and GDPR-compliant data stewardship imposed significant administrative burdens but fostered global literacy and networks. Mentorship functioned as an ecology—supportive, critical, pragmatic and strategic—evolving towards independence. COVID-19 served as a stress test, narrowing scope while improving the feasibility and sustainability of the family member's voice reorientation intervention. Personal adversity intersected with identity development, with compassionate supervision enabling timely completion (3.7 years) and five peer-reviewed publications.

Conclusion

Transnational, clinically embedded doctoral pathways can enhance nursing research capacity but require deliberate institutional design: genuine protected time, cross-jurisdictional support and mentorship ecosystems. The TCAD lens provides a transferable framework for educators, supervisors and health systems.

Implications for Nursing

Recommendations cover programme development, cross-border oversight, NHS–university collaborations, funding arrangements in different currencies and resilience infrastructure for clinician–researchers.

Profiling Healthcare Professionals' Digital Health Competence and Associated Factors: A Cross‐Sectional Study

ABSTRACT

Aim

To assess healthcare professionals' digital health competence and its associated factors.

Design

Cross-sectional study.

Methods

The study was conducted from October 2023 to April 2024 among healthcare professionals in Italy, using convenience and snowball sampling. The questionnaire included four sections assessing: (i) socio-demographic and work-related characteristics; (ii) use of digital solutions as part of work and in free time, and communication channels to counsel clients in work; and DigiHealthCom and DigiComInf instruments including measurements of (iii) digital health competence and (iv) managerial, organisational and collegiality factors. K-means cluster analysis was employed to identify clusters of digital health competence; descriptive statistics to summarise characteristics and ANOVA and Chi-square tests to assess cluster differences.

Results

Among 301 healthcare professionals, the majority were nurses (n = 287, 95.3%). Three clusters were identified: cluster 1 showing the lowest, cluster 2 moderate and cluster 3 the highest digital health competence. Most participants (n = 193, 64.1%) belonged to cluster 3. Despite their proficiency, clusters 2 and 3 scored significantly lower on ethical competence. Least digitally competent professionals had significantly higher work experience, while the most competent reported stronger support from management, organisation, and colleagues. Communication channels for counselling clients and digital device use, both at work and during free time, were predominantly traditional technologies.

Conclusion

Educational programmes and organisational policies prioritising digital health competence development are needed to advance digital transition and equity in the healthcare workforce.

Implications for the Profession

Greater emphasis should be placed on the ethical aspects, with interventions tailored to healthcare professionals' digital health competence. Training and policies involving managers and colleagues, such as mentoring and distributed leadership, could help bridge the digital divide. Alongside traditional devices, the adoption of advanced technologies should be promoted.

Reporting Method

This study adheres to the STROBE checklist.

Patient or Public Contribution

None.

Doctoral Education in Nursing in Ibero‐America: An Analysis of Its Evolution and Perspectives for the Future

ABSTRACT

Aim

To provide an overview of doctoral programs in nursing offered in Ibero-American countries to inform regional collaboration and academic development.

Design

This study was a descriptive, document analysis.

Methods

A systematic mapping was conducted using data obtained from official university and program websites, national postgraduate databases, and academic documents. The variables analysed included country, institution, year of implementation, number of faculty and students, course duration, delivery modality, costs, scholarship availability, internationalisation activities, and research lines.

Results

A total of 94 active nursing doctoral programs were identified. Brazil emerged as the pioneer, launching the first doctoral program in 1982, and remains the regional leader, accounting for 43 programs. Most programs are offered by public institutions (76.6%), delivered primarily in face-to-face format (64.1%), and emphasise research (90.4%). There has been a consistent upward trend in the establishment of programs since 2000, with notable expansion between 2011 and 2025. Despite this progress, regional disparities persist, along with a lack of data standardisation and a limited presence of professional doctorates. While 69.1% of programs reported international activities, few offer joint or dual degrees. The most common thematic axis, “Health Care and Nursing,” proved to be broad and non-specific.

Conclusion

The study reveals the expanding landscape of nursing doctoral education in Ibero-America, while also exposing persistent challenges regarding access, curricular clarity and regional articulation.

Implications for the Profession and/or Patient Care

Doctoral programs are essential for developing research capacity, academic leadership and evidence-based care. Strengthening these programs could enhance nursing responses to local health needs and promote scientific progress in care delivery.

Impact

This study provides the first comprehensive mapping of nursing doctoral programs in Ibero-America, highlighting regional disparities and areas for academic collaboration, with potential impact on policy-making, curriculum development, and the strengthening of research capacity in nursing education.

Reporting Method

STROBE (Strengthening the Reporting of Observational Studies in Epidemiology).

Patient or Public Involvement

No patient or public contribution.

Nurses' Experiences of Psychological Safety in Ad Hoc Teams During Emergency Care: An Interview Study

ABSTRACT

Aim

To investigate specialist nurses' experience of psychological safety in ad hoc teams during emergency care.

Design

Interpretive descriptive qualitative study.

Methods

Semi-structured interviews with nine specialist nurses were conducted in Sweden from May to June 2024 and analysed using reflexive thematic analysis (Braun & Clarke).

Results

Four themes were identified: Interpersonal skills: implications for psychological safety; Individuality and team dynamics; Confidence, competence and collaboration; and Organisational responsibility for promoting psychological safety.

Conclusion

Psychological safety in ad hoc emergency care teams is a fragile and multifaceted phenomenon, shaped by interpersonal skills, leadership and organisational culture. Supportive environments characterised by open communication and proactive leadership enable specialist nurses to collaborate confidently and safely, even under acute stress. Targeted efforts to strengthen these factors are essential for optimising teamwork and patient outcomes.

Implications for the Profession

The psychological safety implications for specialist nurses in ad hoc teams during emergency care are profound. Psychological safety fosters an environment that empowers nurses to leverage clinical expertise, collaborate in ad hoc teams and improve patient outcomes. Promoting psychological safety ensures specialist nurses feel respected, valued and secure, leading to better care and a more resilient workforce.

Impact

This qualitative study investigated specialist nurses' experience of psychological safety in ad hoc teams in acute care. The results will influence the awareness of nurses, specialist nurses, other professions, managers and organisations about the importance of feeling psychologically safe.

Reporting Method

Presentation follows COREQ 32-item checklist.

Patient and Public Involvement

No patient or public involvement.

Contribution to Global Community

Shows that psychological safety helps nurses perform in ad hoc emergency teams. Identifies key factors that affect teamwork and patient care.

Identifying the Virtual Workload of Advanced Practice Nurses in the Delivery of Direct Patient Care: A Time and Motion Study

ABSTRACT

Aim

To identify the proportion of Advanced Practice Nurses' workload that takes place virtually in the delivery of direct patient care.

Design

An observational study was conducted for this research.

Methods

An overt non-participatory time and motion study was undertaken using a predefined data collection tool to identify the activities of the study participants, and the mode used for delivery of the activities identified.

Results

Fourteen Advanced Practice Nurses were observed. A total of 5190 min of observation time was conducted. The time participants were observed delivering direct patient care virtually (care delivered without in-person contact) was recorded in minutes and calculated as a percentage of their overall observation time. The proportion of time recorded in the delivery of virtual direct patient care was calculated as 22% of participants' work time. The primary modes of telecommunication technologies used in this research were landline telephones and desktop computers. The most frequently performed direct patient care activity was gathering and interpreting assessment data to formulate a plan of care.

Conclusion

This is the first research to calculate the proportion of Advanced Practice Nurses' time that is spent delivering direct patient care virtually. The findings indicate that a substantial proportion of Advanced Practice Nurse time is spent delivering virtual care.

No Patient or Public Involvement

No patient or public contribution in this research.

Implications for the Profession

Implications for the profession and/or patient care.

Impact

What problem did the study address? There is an increase in the digitalisation of healthcare delivery, resulting in virtual care provided by nurses. It is therefore important to explore what and how much virtual care is delivered by Advanced Practice Nurses in Ireland. The study calculated the proportion of Advanced Practice Nurses' time spent in the delivery of virtual direct patient care. What were the main findings? A significant volume of work is conducted virtually. It should be conducted in a secure environment using secure devices. The nurses conducting virtual direct patient care ought to be adequately resourced with appropriate technology supported by electronic recording of care delivered to ensure accurate communication between healthcare professionals. Education for nurses conducting virtual work should be provided from the outset. Where and on whom will the research have an impact? The research will impact nurse leaders by providing them evidence of the delivery of virtual direct patient care by nurses. This leads to an opportunity to explore funding models where direct patient care is delivered yet unseen. There is a requirement to provide nurses with the necessary equipment to support the delivery of virtual patient care. Further research is recommended on the virtual role of nurses in healthcare delivery.

Reporting Method

The STROBE cross-sectional guidelines were followed to report the research.

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