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Anteayer Journal of Advanced Nursing

Thriving or Leaving? The Role of PERMA Being Associated With Thriving and Retention Among Early Career Nurses

ABSTRACT

Aim

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.

Background

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.

Design

A cross-sectional design.

Methods

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.

Results

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).

Conclusions

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.

Relevance to Clinical Practice

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.

Patient or Public Contribution

No patient or public contribution.

Factors Influencing Nurses' Participation in Voluntary‐Assisted Dying: A National Cross‐Sectional Study

ABSTRACT

Aim

To identify nurse practitioners' and registered nurses' willingness to participate in voluntary assisted dying, and the factors that influence these decisions.

Design

A cross-sectional design.

Methods

An online survey was disseminated to members of 16 professional nursing organisations and associations between April and August 2024.

Results

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.

Conclusion

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.

Implications for the Profession

With appropriate support, nurses can make a valuable contribution to the sustainability of the voluntary assisted dying workforce.

Antecedents and Outcomes of Workplace Loneliness in Finnish Nurses: A Cross‐Sectional Survey Study

ABSTRACT

Aim

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.

Background

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.

Design

Cross-sectional survey design was used.

Method

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.

Findings

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.

Conclusion

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.

Shift‐Specific Patterns of Nursing Workloads in the Emergency Department: AI Powered Analysis

ABSTRACT

Aim

To identify and differentiate workload patterns across shifts and to provide evidence for optimizing nursing workforce allocation in emergency departments:

Design

A cross-sectional study.

Methods

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.

Results

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.

Conclusion

Shift-specific nursing workloads in emergency departments can be effectively identified using multidimensional, real-world nursing activity data.

Implications for the Profession and/or Patient Care

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.

Impact

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.

Reporting Method

This study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology guidelines.

Patient or Public Contribution

No patients or members of the public were involved in the design, conduct, analysis, or reporting of this study.

Evaluation of Evidence‐Based Intervention Implementation in Adult Intensive Care Settings: A Scoping Review

ABSTRACT

Background

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.

Aim

To identify and map existing evidence on the evaluation of evidence-based intervention implementation in adults' intensive care.

Design

A scoping review was conducted by including original published and unpublished studies in English and Finnish.

Methods

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.

Results

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.

Conclusion

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.

Implications

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.

Impact

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.

Reporting Method

PRISMA 2020 statement.

Patient or Public Contribution

No Patient of Public Contribution: This study did not include patient or public involvement in its design, conduct or reporting.

Caregiver Burden Among Families of Paediatric Patients With Tuberculosis: A Mixed‐Methods Study

ABSTRACT

Aim

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.

Design

Explanatory sequential mixed-methods design.

Methods

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.

Results

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.

Conclusion

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.

Implications for Patient Care

Healthcare systems should routinely assess caregiver burden, and multidisciplinary teams should be trained to provide integrated targeted support.

Impact

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.

Reporting Method

This study adheres to the Good Reporting of A Mixed Methods Study checklist.

Patient or Public Contribution

None.

Attitudes Towards Remote Monitoring for Falls Prevention Among Staff, Patients, Residents and Families in Hospital and Aged Care: Scoping Review

ABSTRACT

Aim

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.

Design

Scoping Review.

Methods

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.

Results

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.

Conclusion

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.

Impact

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.

Reporting Method

PRISMA-ScR.

Patient/Public Contribution

None.

Workplace Incivility and Nurses' Job Satisfaction and Leaving Intentions in Taiwan: A Cross‐Sectional Study

ABSTRACT

Background

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.

Aim

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.

Methods

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.

Results

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.

Conclusions

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.

Implications for the Profession and/or Patient Care

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.

Reporting Method

The authors adhered to the STROBE guidelines.

Patient or Public Contribution

No patient or public involvement.

An Ecological and Processual Understanding of Family Resilience in Dementia: A Qualitative Meta‐Synthesis

ABSTRACT

Aim

To explore how family resilience emerges and unfolds in dementia.

Design

Qualitative meta-synthesis using thematic synthesis.

Data Sources

PubMed, CINAHL, Web of Science, PsycINFO were searched from inception through August 26, 2025.

Methods

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.

Results

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.

Conclusion

Family resilience unfolds as a dynamic process continuously reconstructed across ecological levels rather than a static outcome. Iterative and cyclical understanding is essential.

Implications for the Profession and/or Patient Care

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.

Impact

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.

Reporting Method

This review adhered to ENTREQ guidelines.

Patient or Public Contribution

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

Trial Registration

Protocol registration PROSPERO: CRD42023485589

The Nurse's Role in Curative‐to‐Palliative Transitions in Advanced Cancer: A Theory Synthesis Using Turner's Method

ABSTRACT

Aim

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.

Design

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.

Methods

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.

Results

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.

Conclusion

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.

Impact

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.

Patient or Public Contribution

No patient or public contribution.

Issue Information

Journal of Advanced Nursing, Volume 82, Issue 6, June 2026.

Cognitive Dissonance in Nursing: A Mixed Systematic Review of Its Impact and Coping Strategies

ABSTRACT

Aim

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.

Design

Following Joanna Briggs Institute guidance, a convergent integrated synthesis approach combined qualitative and quantitative findings.

Data Sources

Sixteen studies were included following a comprehensive search across five databases in August 2024.

Results

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.

Conclusion

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.

Impact

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.

Patient or Public Contribution

No patient or public involvement.

Gender Justice in the Triple Planetary Crisis: A Scoping Review

ABSTRACT

Aim

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.

Design

Scoping review.

Data Sources

Searches were conducted across MEDLINE (Ovid), Scopus, CINHAL, Embase and ProQuest, focusing on studies published from January 1 2000–23 September 2024.

Review Methods

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.

Results

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.

Conclusion

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.

Impact

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.

Patient or Public Contribution

No patient or public involvement.

The Influence of Oral Health Related Knowledge, Attitudes and Practices on Oral Health Risk‐Related Behaviours of People in Custodial Settings: An Integrative Review

ABSTRACT

Aim

To explore the influence of oral health-related knowledge, attitudes and practices on oral health risk-related behaviours of people in custodial settings.

Design

Integrative review.

Data Sources

Scopus, ProQuest Central, Web of Science, Medline, CINAHL, Academic Search Complete, PsycINFO and Education Research Complete were searched in March 2024 and December 2025.

Methods

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.

Results

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.

Conclusion

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.

Implications for the Profession

This review will inform targeted oral health promotion programs that can improve oral health outcomes and experiences of this population.

Impact

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.

Reporting Method

Preferred Reporting Items for Systematic Reviews and Meta-Analysis, Extension for Scoping Reviews (PRISMA-ScR) 2018.

Patient or Public Contribution

No patient or public contribution.

What Does This Paper Contribute to the Wider Global Clinical Community?

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.

Simulation‐Based Education to Support Nurses' Critical Thinking in Delirium Recognition: A Scoping Review

ABSTRACT

Aim

To map how simulation-based education supports the development of critical thinking skills required for nurses to recognize delirium in clinical practice.

Design

A scoping review guided by the Joanna Briggs Institute methodology and the framework developed by Arksey and O'Malley, refined by Levac and colleagues.

Methods

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.

Data Sources

The search was conducted on 4 September 2025, using MEDLINE, CINAHL and PsycINFO. No timeframe was applied to the search.

Results

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.

Conclusion

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.

Implications for the Profession and/or Patient Care

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.

Impact

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.

Reporting Method

This review adhered to PRISMA-ScR reporting guidance.

Patient or Public Contribution

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

Shared Decision‐Making and Trajectories of Self‐Management Confidence in Nurse‐Led Chronic Condition Care: A Longitudinal Evaluation

ABSTRACT

Aim

To examine whether shared decision-making at baseline is associated with trajectories of self-management confidence over 12 months among individuals living with chronic conditions attending nurse-led clinics.

Design

A longitudinal design.

Methods

Individuals with at least one clinician confirmed chronic condition were recruited from six nurse-led primary care clinics between March and September 2022. Data collection took place between March 2022 and September 2023, with baseline, 6 and 12-month assessments completed within routine follow-up contacts. Self-management confidence was measured using the Self-Efficacy for Managing Chronic Disease Scale, and perceived shared decision-making was assessed using the nine-item Shared Decision-Making Questionnaire (SDM-Q-9). Linear mixed-effects modelling examined changes in confidence over time and associations with baseline shared decision-making, adjusting for age, gender, education and number of chronic conditions.

Results

Of 157 eligible individuals approached, 151 consented to participate (96.2%), and 146 were retained at 12 months (96.7%). Mean self-management confidence increased from 40.2 at baseline to 44.5 at 12 months. In adjusted models, confidence was significantly higher at 6 months (β = 2.63, 95% CI: 1.54–3.72, p < 0.001) and 12 months (β = 4.21, 95% CI: 2.93–5.49, p < 0.001) compared with baseline. Higher baseline shared decision-making was positively associated with repeated confidence scores across follow-up (β = 0.10, 95% CI: 0.04–0.16, p = 0.002). The association was stronger among participants aged under 60 years.

Conclusions

Within established nurse-led chronic condition care, perceived shared decision-making was statistically associated with subsequent trajectories of self-management confidence over 12 months. Confidence demonstrated gradual change rather than stability within routine practice.

Implications

Strengthening the visibility and consistency of collaborative dialogue within nurse-led consultations may support self-management confidence. Structured conversational approaches that help nurses enact shared decision-making more explicitly warrant further evaluation in primary care.

Patient or Public Contribution

No patients were involved in study design.

Mentors' Experiences of Nursing Students' Peer Learning in Clinical Practice: A Systematic Review of Qualitative Studies

ABSTRACT

Aim

To synthesise the best available evidence on mentors' experiences in mentoring nursing students during peer learning clinical practice.

Design

A systematic review of qualitative studies.

Methods

Qualitative or mixed-methods (with a qualitative component) studies that met the inclusion criteria based on the phenomenon of interest were included. The selected studies were critically appraised using the standardised JBI Critical Appraisal Checklist. Findings from qualitative research were extracted and synthesised by using the JBI meta-aggregation approach.

Data Sources

A comprehensive search was conducted in September 2024 across six databases: Scopus, CINAHL, Ovid MEDLINE, Web of Science, ProQuest (Education collection) and MEDIC.

Results

A total of 542 studies were screened, and 17 met the inclusion criteria. Three synthesised findings were identified: (1) Importance of pedagogical support for peer learning, (2) Mentors' support needs for mentoring in a peer learning model and (3) Characteristics of a favourable peer learning environment in clinical practice.

Conclusion

Mentors perceive peer learning as beneficial for nursing students' learning. The transition from the traditional mentoring model to the peer learning model requires distinct pedagogical approaches and competences from mentors, which can be enhanced by strengthening mentors' peer-learning competence.

Implications for the Profession and/or Patient Care

It is essential to support mentors' competence in mentoring through peer learning by providing mentoring education. Learning models based on collaborative learning are beneficial for improving performance in clinical placements because they enable more nursing students to learn simultaneously in clinical practice.

Impact

This systematic review provides synthesised evidence of mentors' experiences in mentoring nursing students during peer learning in clinical practice. Mentors' role is to provide pedagogical support for nursing students in clinical practice conducted with peer learning. Before implementing peer learning in clinical practice, it is essential to consider the conditions for peer learning across various clinical settings and to provide support for mentors as they mentor nursing students through peer learning. These findings can support healthcare administrators, educators, mentoring education providers and mentors of peer learning in clinical practice.

Reporting Method

This review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement.

Patient or Public Contribution

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

Protocol Registration

The protocol is registered in The Open Science Framework (OSF): 10.17605/OSF.IO/5F9HP

Mapping the Drivers of Engagement in Mentorship in Nursing Clinical Practicums: A Network Analysis

ABSTRACT

Aim

To map factors influencing nurses' engagement in clinical mentorship in nursing education and explore their interactions using network analysis.

Design

Observational cross-sectional study employing an online survey from July 2024 to May 2025.

Methods

A total of 261 clinical mentors from healthcare institutions in Catalonia, Spain, completed the survey. Key variables included engagement in clinical mentorship (implication, motivation, satisfaction, compromise), perceived obstacles, ward manager support, emotional intelligence, emotional wellbeing, working and employment conditions. Data were analysed using regularized partial correlation network analyses. Centrality indices were calculated to determine the most influential variables within the network structure.

Results

Motivation, ward manager support, and emotional intelligence emerged as the most central, interconnected drivers of engagement. Motivation showed positive associations with commitment and implication in the mentoring role and a negative association with perceived obstacles. Ward manager support was linked to emotional wellbeing and peer support, reflecting the importance of psychosocial resources. Emotional intelligence appeared to support motivation, work control, and satisfaction with the mentoring role. In contrast, professional experience and employment conditions showed limited influence within the network.

Conclusion

This study provides a comprehensive understanding of how multiple factors interact to shape nurses' engagement in clinical mentorship. Motivation, ward manager support, and emotional intelligence represent key leverage points for strengthening mentorship practices.

Implications for the Profession

Sustainable, high-quality clinical practicums require supportive work environments that recognize and foster mentors' intrinsic motivation, leadership support, and emotional skills.

Impact

Clinical mentors are essential to student learning, and so is their engagement in the mentoring role. This study is the first to apply network analysis to this process, revealing that motivation, emotional intelligence, and ward manager support are central to engagement, while professional experience and employment conditions are less relevant. These findings can guide institutional strategies to promote supportive and nurturing clinical learning environments.

Reporting Method

The manuscript is based on the Checklist for Reporting Results of Internet E-Surveys (CHERRIES).

Patient or Public Contribution

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

Advancing Nurse Mentors' Development Through a Mentoring Intervention: A Mixed Methods Study

ABSTRACT

Background

Mentoring in nursing is crucial for supporting newly qualified nurses, enhancing retention and promoting professional development. Despite its significance, limited research has explored nurse mentors' perspectives and their own development through mentoring.

Aim

To explore how a structured mentoring intervention influences nurse mentors' clinical teaching behaviour, self-efficacy and experiences of their professional role development.

Design

A convergent mixed-methods study was conducted during a mentorship intervention across healthcare units in hospitals and municipalities in northern Sweden and Norway.

Methods

Forty-one experienced registered nurses participated as nurse mentors. Quantitative data were collected via validated instruments on clinical teaching behaviour and self-efficacy before and twice after the intervention. Qualitative data were collected through post-intervention focus group interviews. Quantitative data were analysed using Wilcoxon signed rank test; qualitative data were analysed using qualitative content analysis. Findings were triangulated to identify convergence and divergence.

Results

Nurse mentors reported personal and professional growth, especially in relationship-building, mentoring skills and role clarity. Results showed consistently high ratings in clinical teaching behaviour and self-efficacy, with an increase in clinical teaching behaviour scores post-intervention.

Conclusions

Structured mentoring interventions support nurse mentors' development, improving clinical teaching practices and reinforcing their professional identity—key factors in nurse retention.

Implications for the Profession

The findings highlight the need for sustained nurse mentor support and tailored mentorship frameworks to ensure effective, long-term mentoring in nursing.

Impact

What problem did the study address? Mentoring is essential for supporting newly qualified nurses, improving retention and fostering their professional development. Most mentorship research focuses on mentees, with limited insight into nurse mentors' perspectives and development.

What were the main findings? Nurse mentors experienced development in several areas throughout the intervention, particularly in building relationships, fostering meaningful mentoring skills and refining their role as nurse mentors.

Where and on whom will the research have an impact? This study can inform policy and practice by contributing knowledge on the development of sustainable mentoring frameworks. These frameworks support the formation of collaborative and stable work groups in clinical settings, enhancing nurse retention, professional development and the overall quality of patient care.

Reporting Method

This study adhered to the Good Reporting of A Mixed Methods Study (GRAMMS) guidelines, by O'cathain et al. as recommended by the EQUATOR network.

Patient or Public Contribution

No patient or public contribution.

Prison Abolition: An Evolutionary Concept Analysis With Implications for Nursing

ABSTRACT

Aims

To clarify the concept of prison abolition in the context of United States mass incarceration and to discuss its implications for nursing ethics, knowledge production, and practice.

Design

A critical literature review using Rodger's evolutionary concept analysis.

Methods

We coded and thematically analysed sources to identify associated terms, attributes, antecedents, and consequences of the concept of prison abolition.

Data Sources

We searched six databases and a book catalogue between May 2024 and April 2025 to yield a sample of 30 interdisciplinary academic texts. No date limits were set.

Results

We identified nine attributes: Counterhegemonic, Recognizing Carceral Harm and Failure, New Public Discourse, Incremental, Culture of Care, Equitable Justice, Elimination Not Reform, Evolving, and Grassroots with consistent interdisciplinary and temporal characterization. There is a relative absence of this concept in nursing literature even though it addresses health concerns.

Conclusion

Prison abolition aligns with the American Nursing Association's Nursing Code of Ethics and could inform and guide nurses toward improvements in health equity.

Implications for the Profession

Nursing in the United States has not engaged with abolition as much as other disciplines, but our Code of Ethics compels us to. Prison abolition is concerned with health equity, and marginalized populations could benefit if we incorporate the concept into our practice, scholarship, and advocacy.

Impact

This review addressed a potential lack of understanding or awareness of the concept of prison abolition within nursing discourse. The main finding is that this concept aligns with U.S. nursing ethics. This research may impact nurses looking to incorporate a theory and practice to improve approaches to health equity.

Reporting Method

We were unable to find an EQUATOR reporting method for concept analyses.

Patient or Public Contribution

No patient or public contribution.

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