To assess the level of alarm fatigue among intensive care unit (ICU), cardiac care unit (CCU) and emergency room (ER) nurses, identify associated demographic and occupational factors, determine the most frequent sources of alarms and evaluate nurses’ psychological reactions to alarms.

A cross-sectional, descriptive–analytical study.

ICUs, CCUs and ERs of six public teaching hospitals affiliated with Tehran and Kashan Universities of Medical Sciences in Iran.

Using a multistage stratified random sampling method, 285 nurses were approached, of whom 260 completed and returned the questionnaires (response rate: 91%). Participants were registered nurses with at least a bachelor’s degree or higher and 3 months of experience in ICUs, CCUs or ERs.

The primary outcome was the level of alarm fatigue measured using the validated Nurses’ Alarm Fatigue Questionnaire. Secondary outcomes included factors associated with alarm fatigue and nurses’ reported psychological responses to frequent alarms.

The mean score of alarm fatigue was 26.4±7.9, indicating a moderate level. After adjusting for confounders and hospital-level clustering using multivariable mixed-effects regression, higher monthly income was significantly associated with lower alarm fatigue (β=–0.15, p=0.03), and nurses working rotational shifts reported significantly higher fatigue compared with those with fixed shifts (β=0.18, p=0.02). Other demographic and occupational factors were not significant. Reported psychological reactions to alarms included indifference (14%), irritability (18%) and anxiety/stress (15%).

ICU, CCU and ER nurses experience a moderate level of alarm fatigue, with income and shift type as independent associated factors. The association between income and alarm fatigue may reflect the role of financial stress as an additional job demand that compounds the burden of frequent alarms, particularly in contexts where low base salaries lead nurses to rely on overtime and multiple shifts. These findings underscore the need for targeted managerial and educational interventions, including shift schedule optimisation and attention to workload-related stressors, alongside alarm prioritisation strategies. Due to the cross-sectional design, causal inferences cannot be drawn.

Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are major drivers of hospitalisation, readmission and mortality. Patient delay, the interval between the onset or recognition of exacerbation symptoms and the first contact with a healthcare professional, represents a potentially modifiable part of the overall prehospital delay. Existing evidence on why people with COPD delay seeking care is fragmented, based on heterogeneous definitions of delay and limited sets of predictors, and has not yet been synthesised within a coherent theoretical framework. This protocol describes a systematic review and meta-analysis to identify determinants of delayed care-seeking during AECOPD, structured by Andersen’s Behavioural Model of Health Service Use.

We will include observational analytic studies (prospective or retrospective cohort, case-control and cross-sectional designs) involving adults (≥18 years) with physician-diagnosed COPD who have experienced at least one AECOPD. The primary outcome is delayed care-seeking, defined as the time interval between onset or recognition of exacerbation symptoms and first contact with a healthcare professional or facility; studies must report a clear definition of "delay" and provide effect estimates (or sufficient data to calculate them) for associations between candidate determinants and delayed presentation or delay duration. Determinants of interest will be mapped onto Andersen’s predisposing, enabling and need-related domains. We will search PubMed, Web of Science, CINAHL, Cochrane Library and EMBASE from database inception to the date of the final search, supplemented by grey literature searching, backward reference list screening and forward citation tracking, without restrictions on country or, where feasible, language. Two reviewers will independently perform study selection and data extraction and will assess risk of bias using study design-specific critical appraisal tools appropriate to cohort, case-control and cross-sectional studies. Where at least three studies report comparable effect measures for the same determinant–outcome pair, random-effects meta-analyses will be conducted; otherwise, findings will be synthesised narratively. Certainty of evidence for key associations will be graded using the grading of recommendations assessment, development and evaluation approach adapted for observational and prognostic evidence.

Ethical approval is not required for this systematic review and meta-analysis, as it will use data extracted exclusively from published studies and other publicly available sources, with no involvement of individual participants or identifiable personal data. The findings of this review will be disseminated through publication in a peer-reviewed journal and presentation at relevant academic and clinical conferences. The results are expected to inform clinicians, nurses and policymakers about key determinants of delayed care-seeking during AECOPD, and to support the development of theory-informed, targeted interventions aimed at promoting timely healthcare utilisation.

This study has been registered in the PROSPERO (CRD420251244791).

Knee osteoarthritis (KOA) is a prevalent degenerative joint disorder, often accompanied by comorbidities like type 2 diabetes mellitus (T2DM). These conditions have a significant impact on patients’ sleep quality and metabolic health. Current treatments for KOA primarily focus on symptom management, while innovative approaches targeting interconnected health outcomes remain underexplored. The lumbar knee recovery device, a non-invasive device patented in Iran, offers potential benefits by enhancing lumbar-knee synchronisation, improving blood circulation and optimising cellular metabolism. This randomised controlled trial (RCT) aims to evaluate the device’s effectiveness in improving sleep quality and regulating blood glucose levels in diabetic patients with KOA.

This RCT aims to evaluate the impact of using the lumbar knee recovery device (Kamarasa) on sleep quality, blood glucose levels, HbA1c (blood glucose control level over the past 90 days) and body mass index (BMI) in patients with T2DM and grade 1–3 KOA. The study will be conducted at the Orthopedic Clinic of Imam Khomeini Hospital, Tehran, and the Health and Wellness Clinic. Eligible participants will be randomly allocated into two groups: the intervention group (receiving 10 supervised sessions using the Recovery device over 3 months) and the control group (receiving standard KOA and diabetes care). A total of 37 participants will be included in each group. The primary outcome, sleep quality, will be assessed using the Pittsburgh Sleep Quality Index at baseline and 3 months post intervention. Secondary outcomes will include random blood glucose levels, which will be measured at 10 intervals during the study; BMI, measured at the start and end of the study and HbA1c, assessed at both baseline and post intervention. The Western Ontario and McMaster Universities Arthritis Index will be used to assess pain, stiffness and physical function, also at both baseline and 3 months. Appropriate statistical tests, including two-sample t-tests, ² tests, analysis of covariance or linear regression, will be performed based on the type of variables using SPSS V.23. Additionally, standardised intervention effect sizes will be calculated for each outcome.

Ethical approval for this study was obtained from the Research Ethics Committee of the School of Nursing and Midwifery at Tehran University of Medical Sciences with reference number (IR.TUMS.FNM.REC.1403.145). Additionally, the study protocol was registered with the IRCT under the identifier IRCT20191027045257N7 on 24 November 2024.

Iranian Registry of Clinical Trials (IRCT20191027045257N7). This clinical trial was registered on 24 November 2024.

The clinical practicum is a critical component of nursing education. In Spain, it is currently facing systemic challenges that compromise its quality and sustainability. A persistent nursing shortage, combined with increasing pressure on healthcare systems and a growing number of students intended to address this gap, is adding strain to clinical learning environments, which may compromise the capacity of nurses to provide adequate supervision and meaningful learning experiences for nursing students. This not only diminishes the quality of the training experiences, but also negatively affects the well-being of both students and nurses, further worsening the situation. This protocol outlines a study aimed at conducting an in-depth analysis of the current challenges affecting the clinical practicum and proposing a new model that effectively addresses them, with significant potential for adaptation and implementation across different health education fields and geographical locations.

The study will employ a sequential mixed-methods design comprising two integrated phases. In phase I, quantitative, qualitative and scoping review methodologies will be combined to identify current challenges and opportunities. Quantitative data will be obtained by administering questionnaires to nursing students and clinical mentors (CMs) tutoring them in Catalonia, examining potential barriers and facilitators to their mentoring role. Data will be analysed through descriptive and inferential statistics. Qualitative data will emerge from semistructured interviews with CMs and nurse coordinators, as well as from a visual elicitation technique, the ‘Emojional’ Calendar, conducted with students to understand their clinical practicum experiences. These will be analysed through an inductive thematic analysis approach. The scoping review, following the Arksey and O’Malley framework, will identify best practices in clinical practicums in nursing and other health studies globally. Phase II will involve a three-round qualitative Delphi study in which all preceding results will be presented to stakeholders and decision makers in order to redesign the clinical practicum model.

Ethical approval for this study was obtained from Hospital del Mar Clinical Research Ethics Committee (Ref #2023/11123). Results will be disseminated through peer-reviewed journals and conference presentations, as well as via strategic actions (forums and meetings with healthcare managers, deans and policymakers) and general outreach (talks, social media and websites) targeted at professionals, students and the public.

Pressure injuries (PIs) pose a substantial global healthcare challenge, with their prevalence ranging from 0% to 72.5% across settings.1 In the UK, over 700 000 individuals are affected annually, with community settings prevalence of 0.40–0.70 per 1000 adults in Northern England.2 Early detection of PIs presents unique challenges in individuals with darker skin tones (DST), accentuating a critical gap in nursing education and...

This study investigates the association between healthcare staff turnover and quality of care in nursing homes.1 2 In recent years, the healthcare industry has faced serious challenges regarding workforce shortages. Particularly in long-term care facilities such as nursing homes, staff shortages and high turnover rates are considered major problems.1 2 This situation has not only negatively impacted patient care quality, but has also placed considerable pressure on healthcare systems...

Elderly patients, defined as adults aged 65 years and above, represent a growing segment of the surgical population.1 Despite numerous advances in surgical techniques and postoperative care, elderly patients face unique physical and psychological challenges that can exacerbate their risk of poor clinical outcomes.2 The recent study by Kata et al explores...

Haemodynamic management, and particularly the management of blood pressure (BP), is critical to reduce mortality and preserve the functional capacity of people with cardiovascular disease.1 However, there is insufficient evidence to justify lower BP targets (≤135/85 mm Hg) in people with hypertension and established cardiovascular disease.1 Wang et al have undertaken a multicentre clinical trial in 26 hospitals across China to explore both...

Central venous catheters (CVCs) are widely used for the administration of medications, fluids and parenteral nutrition. It has been estimated that annually 5 million CVCs are inserted in the USA and 27 million worldwide. However, the use of CVC is associated with several risks. This systematic review and meta-analysis by Teja et al provides important findings about some CVC complications globally and at the venous site.1

The...

Management of heart failure (HF) is a challenge, with less than one-third of patients meeting physical activity recommendations.1 Existing cardiac rehabilitation programmes are designed to meet class 1A American Heart Association recommendations for physical activity.1 Benefits, facilitators and barriers to these programmes are described...

While there is minimal literature regarding the lived experience of fathers with infants in the neonatal intensive care unit (NICU), paternal involvement is associated with reduced length of hospitalisation and improved weight gain.1 Alternatively, negative fathering behaviours are associated with behavioural problems at 1 year of age.1 Perceived exclusion from having an...

The integration of artificial intelligence (AI) in intensive care units (ICUs) marks a significant advancement in critical care, offering automated task management and enhanced data analysis. Historically, critical care has relied on high-acuity clinical decision-making, where nurses’ judgement and expertise are paramount. The rapid evolution of AI promises efficiency but raises concerns about ethical implications, role changes and trust. While AI tools improve clinical outcomes, their black-box nature and potential for...

Music intervention is a complementary treatment that aims to ameliorate symptoms related to a medical condition. Music intervention is distinct from music therapy in that it is a solo listening experience rather than an active or therapist-guided session. Music intervention is thought to be a low-risk and convenient treatment with potentially positive effects on patients with breast cancer as measured by self-assessed symptom or quality of life scores or pain treatment...

Carpal tunnel syndrome (CTS) has become one of the most prevalent occupational health problems1 and represents a major burden for individuals, employers1 2 and healthcare systems.1 The need to consider psychosocial factors such as stress and coping strategies is increasingly recognised...

Today’s world is increasingly augmented by AI, and use and application of natural language process-based translation services could enhance clinical communications. They have the potential to support confidential and cost-effective communication mechanisms for non-native language patients. This study1 evaluates quality, cultural sensitivity, terminology, context, consistency and risks associated with use of AI translators for Spanish, Portuguese and Haitian paediatric patients, illustrating shortcomings in quality, accuracy and patient...

To analyse the trajectory of sleep quality changes and identify influencing factors among patients undergoing maintenance haemodialysis (MHD).

Longitudinal study design.

The study was conducted in the nephrology departments of two tertiary hospitals in Urumqi, Xinjiang, China.

This study employed convenience sampling and completed follow-up assessments for 282 patients with MHD between December 2024 and August 2025.

Data collection used a general information questionnaire, the Pittsburgh Sleep Quality Index and the Self-Rating Depression Scale. Sleep quality assessment timepoints included baseline (T1), 3 months (T2) and 6 months (T3). Latent class growth models were used to identify heterogeneous trajectories of sleep quality. Univariable and multivariable logistic regression analyses were used to determine independent predictors of sleep disorders trajectory categories.

Among 282 MHD patients, latent class growth modelling identified four distinct sleep trajectories: ‘High-Slightly Increasing’ (C1, 24.5%), ‘Low-Slightly Increasing’ (C2, 29.4%), ‘High-Declining’ (C3, 27.7%) and ‘Moderate-Increasing’ (C4, 18.4%). Multivariable analysis showed that, compared with C2, baseline depression significantly increased the odds of belonging to C1 (OR=8.53, p

This study reveals four heterogeneous sleep trajectories in MHD patients, underscoring a dynamic view of sleep quality. Depression is an overarching risk factor for unfavourable trajectories, while pruritus and inflammation specifically predict persistent poor sleep. Early screening and targeted interventions against these factors are crucial to improve sleep quality in MHD care.

The incidence of malnutrition is high in enterostomy patients, which impacts their nutritional status and requires targeted dietary management strategies to improve outcomes. This study evaluated the knowledge, attitude and practice (KAP) of dietary management among enterostomy patients, identified influencing factors and provided recommendations for comprehensive nutritional care.

Cross-sectional study.

43 hospitals in Hubei Province.

A convenience sample of 643 enterostomy patients was surveyed between November 2024 and April 2025. The inclusion criteria were as follows: (1) age of 18 years or older; (2) at least 4 weeks post-enterostomy surgery with recovery at home and (3) provision of informed consent and voluntary participation in the study. The exclusion criteria included: (1) inability to eat normally due to illness or other reasons and (2) presence of consciousness, cognitive or communication disorders.

KAP questionnaire score, social alienation scale score and general information.

Of 621 valid responses (96.58% valid questionnaires), the average KAP score was 185, with 79.07% achieving a passing score (≥111). Moderate social isolation was observed with a mean score of 40.04±13.98. Regression analysis revealed that social isolation (β=–0.393, p

Enterostomy patients showed moderate to high knowledge, positive attitudes and good practices in dietary management, but experienced moderate social isolation. A multidisciplinary nutrition team should assess patients’ nutritional, physiological, psychological and social support needs. Personalised dietary plans based on education level and diverse educational methods can enhance intervention effectiveness. Encouraging self-care and leveraging the ‘Internet Plus’ platform for regular progress monitoring can improve self-management capabilities. Continuous monitoring of nutrition and quality of life is essential to support enterostomy patients. These findings may have implications for enterostomy care in resource-limited settings, including low-income and middle-income countries, where multidisciplinary nutrition teams and patient education resources may be limited.

This study aims to explore the latent profiles and influencing factors of engagement in medication safety among elderly patients with cardiometabolic multimorbidity.

A cross-sectional study.

The study was conducted at a class III hospital in Jiangsu, China.

The study included a sample of 316 older adult inpatients with cardiometabolic multimorbidity.

Participants completed the Inpatients’ Involvement in Medication Safety Scale and the Multimorbidity Treatment Burden Questionnaire. Latent profile and multivariate regression analyses were used to identify subgroups and their associated factors.

Latent profile analysis identified three distinct profiles: ‘passive participation’ (22.47%), ‘moderate participation’ (52.53%) and ‘active participation’ (25.0%). Multivariate logistic regression revealed that occupational status, marital status, medical payment method, daily medication type and treatment burden were significant independent factors distinguishing among these profiles (p

The study confirms significant heterogeneity in medication safety engagement among older adults with cardiometabolic multimorbidity. The identified profiles and their specific influencing factors provide a basis for clinicians to stratify patients and develop targeted interventions, particularly for the vulnerable ‘passive participation’ group, to improve medication safety outcomes.

This study aimed to systematically synthesise and analyse nurses’ experiences in implementing clinical nursing research (CNR) to inform administrators and researchers involved in CNR.

Qualitative meta-synthesis.

The following six databases were searched: PubMed, Cochrane Library, Web of Science, CINAHL (EBSCO), PsycINFO (EBSCO) and Embase. The search period included material published up to December 2024.

We included qualitative studies exploring perspectives, experiences and other similar factors. JBI Critical Appraisal Tool (2024 edition) was used to evaluate the quality of included studies.

Two reviewers independently conducted the literature search, study selection and data coding. Using principles of similarity and integration, findings from the included studies were grouped into general categories. A final synthesis was produced through analysis of the relationship between categories.

11 studies were included, from which four themes were identified: feelings and motivations prior to participation in CNR; understanding the role of the clinical nursing researcher; factors hindering CNR implementation; and expectations for CNR development. These themes comprised 12 sub-themes.

This review highlights nurses’ experience in implementing CNR. Strengthening motivation and clarifying the roles and responsibilities associated with CNR may facilitate the translation of research findings into clinical practice. In parallel, healthcare administrators should foster a supportive CNR culture and provide resources to address barriers to implementation.

CRD42025631159.