To investigate the prevalence of depression, anxiety and stress among primary caregivers of children with childhood-onset systemic lupus erythematosus (cSLE) in China and to explore their psychosocial correlates based on the stress process model.

A cross-sectional study.

3 tertiary public hospitals in Hunan Province, China.

242 primary caregivers were invited, and 211 completed the study (87.2% response rate). Convenience sampling was used. Eligible participants were unpaid adult caregivers (aged ≥18 years) of children (aged 1 month. Exclusion criteria included inability to complete questionnaires independently, cognitive impairment due to major physical or mental disorders and current participation in other psychological interventions.

Primary outcomes (depression, anxiety and stress) were measured using the Depression Anxiety and Stress Scale-21. Correlates included threat/challenge appraisal, coping style and perceived social support.

Among 211 caregivers (mean age 40.55±8.22 years; 77.3% female), 31.8% reported depression, 27.0% anxiety and 24.2% stress. Higher threat appraisal was consistently associated with depression (regression coefficients (B) =1.012, p

Caregivers of children with cSLE face substantial psychological distress, with threat perception and negative coping as key modifiable correlates. Interventions to reshape cognitive appraisal and promote adaptive coping, alongside expanded health insurance coverage and optimised caregiving role distribution, are needed to alleviate caregiver burden.

Oncology nurses are pivotal to delivering high-quality cancer care; yet, the uptake of evidence-based practices (EBPs) remains inconsistent. Though continuing professional education is widely used to support EBP uptake, persistent gaps remain, likely driven by the intricate and interrelated mechanisms that unfold differently across individual, organisational and system contexts.

To understand how, why, for whom and under what conditions continuing professional education interventions enhance (or fail to enhance) the uptake of EBPs among oncology nurses.

This realist review will adhere to the Realist and Meta-narrative Evidence Syntheses: Evolving Standards methodological standards. The Theoretical Domains Framework will guide the exploration of potential mechanisms. 33 initial programme theories, developed from the Theoretical Domains Framework, prior reviews, expert input and consultations with interested parties working in oncology (eg, oncology nurses, managers), will be refined through systematic searches (CINAHL, MEDLINE, EMBASE, PsycINFO and Google Scholar). These initial programme theories represent hypothesised Context-Mechanism-Outcomes Configurations that may influence the uptake of EBPs among oncology nurses. Eligible peer-reviewed and grey literature from high-income countries in English or French will be screened in duplicate. Data will be coded deductively and inductively in MaxQDA and synthesised into Context-Mechanism-Outcome Configurations. These configurations will be reviewed in collaboration with interested parties.

Findings will be disseminated through open-access, peer-reviewed publications and presentations at national and international conferences. Key stakeholders, including various professional associations (eg, the Canadian Association of Nurses in Oncology and the International Society of Nurses in Cancer Care), will be actively engaged to ensure the clinical relevance of the findings and to maximise their translation into nursing practice.

CRD420251133710.

To explore patients’ experiences of discharge readiness following acute pancreatitis (AP) and to identify perceived barriers and facilitators influencing readiness for discharge during the transition from hospital to home.

A descriptive qualitative study guided by Meleis’ Transitions Theory.

Emergency and gastroenterology wards of Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.

16 patients with AP were recruited; all 16 eligible patients approached agreed to participate (100% response rate).

Data were collected between December 2024 and January 2025 through semistructured in-depth interviews. Data were analysed using Elo and Kyngäs’s three-step qualitative content analysis framework, integrating conventional and directed content analysis. The study adhered to the Consolidated Criteria for Reporting Qualitative Research guidelines.

Patterns of response reflected variability in patients’ psychological adaptation during the transition process, including cognitive-emotional responses and relational interactions. Factors influencing discharge readiness were identified across three theoretical domains. Nature of Transitions captured the dynamics of self-management, including awareness, engagement and behavioural evolution. Transition Conditions reflected the complexity of socioecological determinants, including age and life stage, health literacy, financial resources and occupational and cultural influences. Nursing Therapeutics highlighted the discordance between professional support and patient needs, particularly in relation to information provision, dietary management and care continuity.

Building on Meleis’ Transitions Theory, this study provides an empirically grounded understanding of discharge readiness among patients with AP as a dynamic, multifactorial process. Our findings extend the theory by demonstrating that discharge readiness is shaped by the interaction between individual self-management, socioecological determinants, psychological adaptations and professional support. Addressing gaps in professional health information, personalised and structured dietary management and continuity of care is essential to enhance discharge readiness and support safe, sustainable recovery.

This study utilises the Positive Emotion, Engagement, Relationships, Meaning, Accomplishment (PERMA) framework to explore positive experiences in medication self-management among older adults with chronic multimorbidities from a positive psychology perspective.

A descriptive phenomenological qualitative research method was adopted. Data were analysed using Colaizzi’s seven-step method.

Two community health service centres in Zhengzhou City, Henan Province, China.

A total of 24 older adults with chronic multimorbidities were recruited and interviewed face-to-face between January and June 2025.

Analysis of the collected data yielded five overarching themes: (1) positive emotional experiences in medication self-management; (2) proactive engagement in medication management; (3) perceived social support from multiple sources; (4) profound understanding of the intrinsic value of medication management; (5) personal growth and realisation of life value through medication self-management.

Older adults with chronic multimorbidities demonstrate a wide range of positive experiences during medication self-management. This finding suggests that healthcare professionals may consider integrating positive psychology principles into clinical practice and consistently provide positive reinforcement for patients. This approach may help foster and sustain comprehensive and long-term medication management behaviours, thereby exerting a positive impact on their quality of life.

Non-suicidal self-injury (NSSI) is a growing mental health concern among adolescents. While not intended as a suicidal act, it has significant implications for individuals and families. Primary caregivers, often the frontline support, face emotional distress, psychological strain and disrupted family dynamics. However, most research has centred on adolescents leaving a critical gap in understanding caregivers’ perspectives. Addressing this gap is essential for developing effective, family-centred interventions.

This review will include original qualitative studies examining the lived experiences of primary caregivers supporting adolescents who engage in NSSI. Studies must address caregivers’ emotional responses, psychological impacts, changes in family relationships and their perspectives on mental health service needs. There will be no restrictions on settings, geographic locations or sample sizes. Research published in both English and Chinese will be included with no restrictions on the starting year up to 31 December 2025. Systematic searches will be conducted across several databases, including PubMed, Embase, CINAHL, PsycINFO, Web of Science, CNKI, Wanfang Data and CBM and reference lists and grey literature will also be reviewed. Two independent reviewers will screen studies, assess their methodological quality, and extract relevant data. The data will be synthesised using meta-aggregation, and the ConQual approach will be used to evaluate the confidence in the synthesised findings.

This systematic review will not require ethical approval, as it will only include secondary data from previously published studies. The findings will be disseminated through publication in a peer-reviewed journal and presented at relevant academic conferences to inform both research and clinical practice.

CRD420251113508.

Midwives/nurse midwives are the healthcare professionals most often present on the birth scene. However, they have been the professionals who are most justified to defend their legally established position by arguing their competence and autonomy. Thus, it is important to show their reality through experiences, particularly when autonomy does not

align with regulations. This meta-synthesis aims to bring together scientific evidence regarding midwife/nurse midwife’s autonomy experience in caring for labouring women in health facilities.

The meta-aggregation will be used to conduct a systematic review of qualitative studies. In January 2025, a search was carried out in scientific databases: EBSCOhost (CINAHL Ultimate, MEDLINE Ultimate and Academic Search Complete), LILACS, PubMed, Wiley Online Library, Scopus and Web of Science. The articles will be independently reviewed by two authors who will assess data quality, extraction and synthesis. Studies will be assessed for rigour using critical appraisal tools provided by the Joanna Briggs Institute. Data extraction and synthesis will be carried out using software, and results will be presented in tables. The results of the qualitative research will, where possible, be grouped according to the meta-aggregation approach proposed by the Joanna Briggs Institute.

Ethical approval to analyse secondary data is not required. The results will be published in peer-reviewed journals and presented at international and national conferences.

CRD42024572542

As of 2024, paid paternity leave was available in 102 countries worldwide. However, the accessibility and methods of taking paternity leave are influenced by cultural background and individual values, leading to variations in uptake rate. Both positive and negative effects of paternity leave have been reported on the health of fathers, partners and children. A comprehensive understanding of this topic is essential for medical professionals supporting fathers undertaking childcare. The aim of this review is to identify and provide an overview of research related to the impact of paternity leave on the health of fathers, their partners and their children.

PubMed, CINAHL, Web of Science and Ichushi-Web (Japan’s medical literature database) will be searched for published studies, and Google Scholar, ProQuest and CiNii Research (a database used to search for academic information in Japan) will be searched for grey literature. Screening will be performed by two independent reviewers. In this scoping review, we will include studies that focus on fathers taking paternity leave, their partners and their children, regardless of ethnicity or geographic location. This review will focus only on studies related to effects within 3 years after childbirth. We will not restrict study inclusion by whether paternity leave is paid or unpaid, the length of the leave or whether it was taken solely by the father. Furthermore, we will include both English and Japanese literature. The findings of this scoping review will be presented in tabular form and summarised in a way that aligns with the review questions.

This paper does not involve human participants, so approval by an ethics committee is not required. The results of this scoping review will be presented in academic conferences and disseminated in peer-reviewed journals.

https://osf.io/jsc89.

Chronic obstructive pulmonary disease (COPD) is frequently accompanied by anxiety, depression and impaired health-related quality of life (HRQoL). Psychological comorbidities worsen symptom burden, daily functioning and self-management and are associated with more frequent exacerbations and higher mortality. Digital cognitive behavioural therapy (dCBT), in which core cognitive behavioural therapy (CBT) content is delivered predominantly via web-based or app-based platforms, offers a potentially scalable approach to addressing these needs. However, no systematic review and meta-analysis has yet synthesised randomised controlled trial (RCT) evidence on the effects of dCBT on patient-reported outcomes (PROs) in adults with COPD. This protocol describes the planned methods for such a review.

We will include RCTs enrolling adults (≥18 years) with COPD that compare dCBT with usual care, wait-list, attention control, non-CBT psychological or educational interventions, or other non-CBT digital interventions. For this review, dCBT will be defined as an intervention that explicitly states a CBT framework or CBT techniques, delivers most therapeutic content through digital platforms and uses digital CBT as the principal active component. Blended or multicomponent programmes will be eligible only when the dCBT component is clearly identifiable and central to the intervention. The primary outcomes will be PROs assessed by validated PRO measures, including disease-specific or generic HRQoL and psychological symptoms (anxiety and depression). Secondary outcomes will include other PROs such as disease-specific symptom burden, psychological distress or well-being, and self-efficacy where reported. We will search PubMed, Embase, the Cochrane Library, Web of Science, PsycINFO, CNKI, Wanfang Data and SinoMed from inception to 30 November 2025, without language restrictions. Two reviewers will independently screen studies, extract data and assess risk of bias using the Cochrane Risk-of-Bias 2 tool. Where appropriate, we will conduct random-effects meta-analyses, with subgroup, sensitivity and (if feasible) meta-regression analyses to explore heterogeneity. The certainty of evidence for key outcomes will be graded using the Grading of Recommendations Assessment, Development and Evaluation approach.

This systematic review and meta-analysis will use data extracted exclusively from published randomised controlled trials and other publicly available sources. No new data will be collected directly from individual participants, and no identifiable personal information will be obtained; therefore, formal approval from a research ethics committee and informed consent are not required. The review will be carried out in accordance with established methodological guidance for systematic reviews and meta-analyses. The findings will be disseminated through peer-reviewed publication and conference presentations, and review-related data will be curated and made available as appropriate in the final report.

CRD420251246582.

The COVID-19 pandemic had significant physical and psychosocial impacts on nurses. While the initial phases of the pandemic presented considerable challenges, these appear to have diminished over time. This study aimed to explore the lived experiences of Iranian nurses working in clinical settings during the post-pandemic period of COVID-19.

This is a qualitative study conducted using the conventional content analysis approach proposed by Granheim and Lundman (2004).

This study was conducted at secondary care hospitals in northwest Iran that served as referral centres for multiple provinces during the COVID-19 pandemic.

A total of 18 nurses with at least 1 year of clinical experience in COVID-19 wards were recruited using purposive sampling. Participants were diverse in terms of gender, age and educational background. Nurses temporarily transferred from other wards were excluded.

‘Return to Normalcy’ emerged as the overarching theme, encompassing five main categories: Expansion of Knowledge, Changing Attitudes Toward the Disease, Improved Disease Management, Changing Nature of the Disease and Expansion of Facilities.

The findings suggest that, like other crises, the COVID-19 pandemic represents a temporary disruption. However, certain factors can expedite the transition back to normalcy. These include enhanced awareness of the disease, effective crisis management and improved access to diagnostic, therapeutic and protective resources.

This study aimed to explore, in depth, the challenges nursing students encounter during clinical practice, the emotions they experience and coping strategies they use to manage these challenges.

Clinical practice is a critical component of nursing education, enabling students to integrate theoretical knowledge into practice. However, factors such as limited instructor support, inadequate laboratory preparation and the demands of clinical environments may negatively affect students’ learning experiences.

A qualitative study using reflexive thematic analysis.

The study was conducted at Ağrı Ibrahim Cecen University between April and July 2025. 18 nursing students with clinical practice experience participated in semi-structured, face-to-face interviews. Data were analysed using Braun and Clarke’s reflexive thematic analysis, supported by MAXQDA qualitative data analysis software. Data collection and analysis proceeded iteratively until sufficient depth and richness of data were achieved. Reflexive discussions were conducted throughout the analysis process to enhance analytical rigour.

Two main themes and five subthemes were identified, including challenges and emotional experiences, causes of difficulties, coping strategies and recommendations. Students reported issues such as insufficient instructor support, large clinical groups, limited psychomotor skills and perceived ‘intern bias’. Emotional responses included feelings of inadequacy, low motivation and fear of making mistakes. Coping strategies involved peer support, self-affirmation and seeking guidance from clinical nurses. Participants recommended increasing instructor availability, expanding simulation-based training and strengthening mentoring systems.

The findings suggest that strengthening supportive instructional approaches, structured clinical environments and enhanced simulation opportunities may be important in nursing education. These findings may inform educators and clinical mentors in developing more supportive and effective clinical learning environments.

This study aims to translate, culturally adapt, and validate the Chinese version of the King’s Stool Chart among patients receiving enteral nutrition for use in nursing practice.

This is a descriptive, cross-sectional study.

This study was conducted in the intensive care unit (ICU) of a tertiary hospital in Henan Province, China.

A total of 144 patients receiving enteral nutrition were included.

This study was conducted in two phases. Phase I involved the translation and cultural adaptation of the King’s Stool Chart using established methodologies, including forward translation, synthesis, back-translation and expert review. Phase II comprised psychometric evaluation with 144 patients receiving enteral nutrition. The Chinese version of the King’s Stool Chart was used to assess stool frequency, consistency, weight and the daily total score. Validity was tested through content, construct and concurrent validity, while inter-rater reliability was assessed using the kappa coefficient.

The Chinese version of the King’s Stool Chart demonstrated excellent content validity, with item-level indices ranging from 0.95 to 1.00. Construct validity was supported by the ability of the Chinese version of the King’s Stool Chart to differentiate between clinical subgroups with varying stool characteristics. Sensitivity rates for stool weight categorisation were above 89%, and substantial inter-rater reliability (kappa=0.735) was observed. The daily total score was effective in identifying patients at risk for diarrhoea, with significant differences observed among clinical subgroups. Diarrhoea classification, using a threshold of ≥15 points, showed strong construct validity.

Within the scope of this single-centre sample, the Chinese version of the King’s Stool Chart demonstrates acceptable validity and substantial to excellent inter-rater reliability for assessing stool frequency, consistency, weight and diarrhoea classification in enterally fed ICU patients in China. These psychometric properties provide preliminary support for its use in routine nursing practice for gastrointestinal function monitoring in ICU settings. Further multicentre and large-sample studies are required to verify its external validity and generalisability to broader Chinese-speaking populations and non-ICU clinical settings.

To investigate coping strategies and associated factors among clinical nurses in Iran in 2023.

Cross-sectional study.

Hospitals in Kashan, Iran.

A total of 400 nurses were selected through stratified random sampling from different hospital departments.

Coping strategies were measured via the Potential Factors Related to Coping Strategies Questionnaire, the Work-Family Conflict Scale and the Ways of Coping Questionnaire. Coping strategies were quantified with scores ranging from 0 to 198. Associations with potential influencing factors were assessed.

The coping strategies score was 94.22±25.49 (95% CLM 91.72 to 96.72). Notably, 83.5% of the variation in coping strategy scores could be attributed to emotion-focused coping. The simultaneous inclusion of work-family conflict and spouse participation in household affairs was found to be significant (F=9.85, p

Nurses in Kashan hospitals used moderate levels of coping strategies, which were mainly emotion-focused. It is recommended that hospitals provide guidance on these strategies, especially during pandemic crises.

To explore nurses’ experiences of central venous catheter (CVC) management in a resource-limited tertiary hospital.

A qualitative exploratory-descriptive study using in-depth, semistructured interviews.

A low-resource tertiary care facility in Ghana, West Africa.

13 registered nurses working in intensive and critical care units.

Individual semistructured interviews were conducted and analysed using reflexive thematic analysis.

Four (4) main themes and 14 related subthemes were identified. The main themes included (1) system constraints shaping CVC care (supplies, infrastructure and workload); (2) practice and protocol feasibility (infection prevention and workarounds); (3) capability building and support (knowledge/skills, practical training, supervision and mentoring and nurses’ voice) and (4) psychosocial impact (burnout, fear of complications and limited emotional support). Nurses described confidence in routine tasks but reported limited support for managing complications and sustaining protocol adherence.

In resource-limited settings, effective CVC management extends beyond individual clinical competence and requires robust institutional support, adequate staffing, ongoing professional development and responsive organisational systems. Addressing these structural and psychosocial factors is essential to improving nursing practice, enhancing patient safety and supporting global infection prevention priorities.

To investigate the association between staffing levels, particularly the number and combination of nurses and medical social workers (MSWs) in the discharge planning department, and the average length of stay (LOS) at the ward level in acute care hospitals in Japan.

Cross-sectional study.

We used nationwide administrative hospital-level and ward-level data from fiscal year 2021, encompassing 4989 acute care wards in 923 hospitals across 216 secondary medical areas.

A total of 1036 wards in designated special function hospitals, 3398 general acute care wards with a 7:1 patient-to-nurse ratio (7:1 acute care wards) and 555 general acute care wards with a 10:1 patient-to-nurse ratio (10:1 acute care wards) were included in the analysis.

Average LOS per ward.

Two-level multilevel linear regression models with random intercepts were stratified by ward type. The analysis was adjusted for ward-level, hospital-level and region-level covariates. We examined both the total staffing level (the total number of nurses and MSWs per 100 hospital beds) and the staffing combinations (high/low numbers of nurses and MSWs) in the discharge planning department.

In multilevel models, no statistically significant associations were observed between discharge planning department staffing and ward-level average LOS across any ward type. In special function wards, wards with high nurse/low MSW staffing (coefficient: –1.07; 95% CI –2.39 to 0.25; p=0.11) and high nurse/high MSW staffing (coefficient: –1.16; 95% CI –2.45 to 0.13; p=0.08) tended to have shorter LOS than did those with low nurse/low MSW staffing. In 7:1 acute care wards, higher total staffing was not significantly associated with LOS (coefficient: –0.14; 95% CI –0.30 to 0.03; p=0.10). No clear associations were observed for 10:1 acute care wards.

This nationwide cross-sectional study found no statistically significant association between discharge planning department staffing levels and ward-level LOS in Japanese acute care hospitals. While LOS alone may not adequately capture the discharge planning relationship, the findings may inform staffing policies in healthcare systems facing population ageing.

To investigate the risk factors for primary non-central malposition of peripherally inserted central catheter (PICC) tip in neonates admitted to the neonatal surgical department, compare the malposition rates across different insertion sites in disease types, and explore whether different diseases affect PICC tip malposition.

A retrospective case–control study conducted in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement.

A 3A women’s and children’s hospital in South China (Guangdong Province).

A total of 558 neonates aged ≤28 days who underwent PICC insertion between January 2019 and November 2024 were enrolled. Neonates with congenital circulatory system malformations, incomplete clinical data and death or treatment withdrawal before tip positioning were excluded.

The primary outcome was the incidence of primary non-central PICC tip malposition confirmed by X-ray or ultrasound within 24 h after insertion. Secondary outcomes included comparison of primary non-central PICC tip malposition rates across different insertion sites and comparison of primary PICC tip malposition rates by insertion sites across different disease groups.

558 neonates were included in this study, including 460 cases with PICC tip in place and 98 with PICC tip malposition. In binary logistic regression analysis, the PICC insertion site was considered an independent risk factor (OR 2.908, 95% CI 1.748, 4.840, p

Medical staff can choose appropriate upper or lower limb veins for PICC insertion without worrying about the impact of abdominal diseases or thoracic diseases on non-central PICC tip malposition. PICC insertion via the head and neck veins should be performed with caution in neonates, as these sites carry a high risk of primary non-central tip malposition compared with other insertion sites.

Prolonged sedentary behaviour (SB) is an independent risk factor for adverse health outcomes, with current WHO guidelines emphasising both increased physical activity (PA) and reduced sitting time. While electronic health (eHealth) interventions offer scalable solutions, the comparative effectiveness of two dominant strategies: sedentary break interventions (frequent interruptions of sitting) versus PA promotion (structured activity sessions) remains unclear. This systematic review and meta-analysis protocol aims to compare the effectiveness of interventions targeting breaks in SB versus increased PA in reducing sedentary time through meta-analysis of randomised controlled trials (RCTs) comparing either intervention to a control condition, while exploring key moderating factors including participant characteristics, intervention type, duration, eHealth delivery mode, theoretical basis, use of behaviour change techniques (BCTs), PA intensity and SB frequency.

This protocol follows the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guidelines. A comprehensive search will be conducted in PubMed, Embase, Web of Science and the Cochrane Library from inception to 31 July 2025, with language restrictions limited to English and Chinese publications. RCTs comparing eHealth-delivered interventions promoting sedentary breaks with those increasing PA in adults will be included. The primary outcome is sedentary time (objectively measured or self-reported), and secondary outcomes include health outcomes such as cardiometabolic markers, fatigue and well-being. Two reviewers (SC and XN) will independently screen studies, extract data and assess risk of bias using validated tools. Meta-analyses will be performed if sufficient homogeneous data are available, comparing changes in sedentary time. Subgroup analyses will explore effects by participant characteristics including gender (male vs female), age groups (3 to

Ethical approval is not required as this study involves secondary analysis of published data. Findings will be disseminated through peer-reviewed publication and conference presentations.

CRD420251042994.

Concept analysis is widely used in nursing to clarify key concepts, support theory development and improve conceptual consistency in research and practice. Although concept analysis studies have increased substantially, concerns remain regarding methodological heterogeneity and incomplete reporting. Based on preliminary scoping of the literature, no dedicated scoping review has yet mapped the broad landscape of concept analysis studies in nursing while also examining reporting completeness. This protocol describes a scoping review that will characterise methodological trends, identify recurrent reporting omissions and generate an evidence map to support future methodological work in this field.

This scoping review will follow established scoping review guidance and will be reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. Guided by the Population-Concept-Context framework, we will search major English-language and Chinese-language databases for nursing-related concept analysis studies. All concept analysis approaches will be considered eligible, provided the study explicitly reports analysing a nursing-related phenomenon. Two reviewers will independently screen records, assess full texts and chart data using a standardised extraction form. In parallel, reporting completeness will be examined using an author-developed, evidence-informed audit checklist. Findings will be synthesised using descriptive statistics and qualitative thematic analysis.

Ethical approval is not required because this review will synthesise data from publicly available sources. Findings will be disseminated through peer-reviewed publication and conference presentation. The review is expected to provide a structured overview of current concept analysis practices in nursing and to identify priority areas for improving reporting transparency in future methodological work.

To determine burnout prevalence, associated factors and coping strategies used by nursing professionals.

Cross-sectional analytical study.

Public and private healthcare institutions in Kerala, India.

Nursing professionals in Kerala (n=349).

Burnout levels (assessed with the Burnout Assessment Tool (BAT)) and coping strategies. Log-binomial regression was performed to identify factors associated with burnout.

High burnout was reported by 36.1% of participants (126/349; 95% CI 31.1 to 41.4). Burnout prevalence was higher among nurses with an MSc (Master of Science) or higher educational qualification (adjusted prevalence ratio (APR)=1.46; 95% CI 1.04 to 2.03); those working in urban settings (APR=1.41; 95% CI 1.04 to 1.90); those who were single, divorced or separated (APR=1.58; 95% CI 1.18 to 2.12); those with travel time ≥30 min (APR=1.36; 95% CI 1.03 to 1.79); and those engaged in clinical/direct patient care duties (APR=1.75; 95% CI 1.18 to 2.59). Commonly reported coping strategies included active coping (59.6%), seeking instrumental social support (58.7%) and venting (54.4%), whereas negative strategies, such as substance use, were less frequent (22.9%).

Over one-third of the nurses in our study reported high burnout. Efforts to reduce burnout should focus on nurses with higher qualifications, those working in urban settings, those with higher travel time, those who are single/divorced/separated and those involved in clinical duties to enhance healthcare quality.

Breastfeeding provides well-documented benefits for both mothers and infants, yet global exclusive breastfeeding rates remain below target levels. Current research on lactation outcomes and challenges tends to focus on isolated factors, creating a fragmented evidence base. This scoping review aims to systematically map the existing literature on factors affecting lactation during the first 6 months post partum. We will develop and apply a Bio-Psycho-Social-Ecological (BPSE) integrative framework to organise the findings and identify gaps for future research.

We will conduct this scoping review following the updated Joanna Briggs Institute (JBI) methodology and report findings according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. Systematic searches will be performed in PubMed, Cochrane Library, Scopus, Web of Science, CNKI, Wanfang and VIP databases. We will include systematic reviews, meta-analyses and randomised controlled trials published between January 2020 and October 2025. Two reviewers will independently screen articles and extract data. The extracted data will include study characteristics, trial registration status, examined factors or interventions and relevant lactation outcomes. Findings will be synthesised narratively and mapped within the BPSE framework.

Ethical approval is not required as this scoping review will synthesise data from publicly available publications. The findings will be disseminated through publication in a peer-reviewed journal and presentations at relevant academic conferences.

Open Science Framework https://doi.org/10.17605/OSF.IO/NXCRF.

Seamless collaboration in the operating room is the critical foundation for patient safety and successful outcomes. This synergy enhances efficiency, minimises errors and is a key determinant of the final surgical quality. The objective of this study is to synthesise qualitative studies on facilitators of and barriers to teamwork between operating room nurses (ORNs) and other practitioners.

Systematic review and meta-synthesis of qualitative studies.

A systematic search was conducted across nine electronic databases: PubMed, Embase, Scopus, Web of Science (Core Collection), CINAHL, PsycINFO, CNKI, WanFang and Vip. The search covered the period from 1 January 2014 to 30 September 2025. The search strategy used both medical subject headings and free-text terms, supplemented by the snowball method and grey literature.

Qualitative studies exploring teamwork involving ORNs were included. Of 4839 initially retrieved records, 29 studies finally met the inclusion criteria.

Two researchers independently extracted data, including the author, year of publication, country, study design, study objective, interview location, number of participants, age, methods of data collection and analysis and duration of interviews. The key findings were synthesised into two overarching themes: facilitators (eg, professional skills, role awareness, team familiarity, patient-centred culture, effective leadership) of and barriers (eg, individualistic behaviour, hierarchical culture, insufficient resources, punitive management, environmental constraints) to teamwork between ORNs and other practitioners. A meta-synthesis was conducted to synthesise study results from different groups and countries. NVivo 15 was used for data management.

A total of 29 qualitative studies (published between 2014 and 2025) were included in this study. Key facilitators of teamwork included professional skills, role awareness, team familiarity, patient-centred culture and effective leadership. Major barriers encompassed individualistic behaviours, punitive management, hierarchical culture, environmental constraints and insufficient resources. These factors worked across individual, interpersonal and systemic levels to shape OR teamwork.

Optimising OR teamwork requires a multifaceted approach simultaneously addressing these facilitators and barriers. Interventions should simultaneously cultivate individual competencies (eg, skills, role awareness), foster positive team dynamics (eg, familiarity, psychological safety, inclusive leadership), and rectify systemic issues (eg, hierarchical culture, resource constraints, punitive management). In this way, teamwork between ORNs and other practitioners can be enhanced, thereby contributing to improved perioperative safety and outcomes.

CRD42024506414.