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Social Isolation and Loneliness Among Older Asian Immigrants Through the Lens of Sense of Coherence: Systematic Review of Qualitative Studies

ABSTRACT

Aim

To explore the meaning older Asian immigrants attribute to social isolation and loneliness, their management strategies, utilisation of resources and impact on health.

Design

Systematic review of qualitative studies.

Data Sources

AgeLine, CINAHL, MEDLINE, ProQuest, PsycINFO, Scopus, and Web of Science databases were searched in September 2024.

Methods

Inclusion criteria: participants were Asian immigrants to Western countries aged 65 and over, community-living and experiencing social isolation and loneliness. Antonovsky's Sense of Coherence was used to frame the thematic analysis.

Results

Ten papers were included and analysed deductively using elements of the sense of coherence framework: • Comprehensibility: Social isolation and loneliness are viewed as multifaceted, influenced by cultural and environmental dislocation, language barriers, intergenerational conflicts, deteriorating health and mobility, and socioeconomic challenges. • Manageability: included engaging in culture-specific community programs, family and ethnic community support and living within ethnic enclaves mitigated isolation and loneliness. • Meaningfulness: Strong family ties, active community involvement, spirituality, volunteerism, and cultural practices fostered resilience. However, accepting the changing values of their new world, living independently, and carving their own niche provided meaning to their transformed reality.

Conclusion

Older Asian immigrants experience social isolation and loneliness through a cultural lens, shaped by migration experiences, language barriers, and shifting family dynamics. Cultural roots, family ties, spirituality, community, acceptance, and independence enhance sense of coherence. Recognising the dynamic interplay between cultural identity, resilience, and adaptation is key to understanding their lived experience.

Implications for the Profession and Patient Care

This review informs culturally sensitive interventions, guiding healthcare, community services, and policy to support social participation, mitigate loneliness through ethno-specific activities, and improve the quality of life for aging immigrant populations in Western countries.

Reporting Method

The review was undertaken and reported using the PRISMA guidelines.

Patient or Public Involvement

None.

Protocol Registration

PROSPERO (CRD42023425752)

Compassion in Practice: A Realist Review of Mentorship as a Catalyst for Healthy Workplaces

ABSTRACT

Aim

To examine the contexts and mechanisms that enable compassionate mentorship in healthcare, in order to generate evidence-informed insights for fostering healthier, more sustainable work environments.

Design

A rapid realist review.

Data Sources

Systematic searches were conducted in Ovid MEDLINE (1946–December 2024), Embase (1974–December 2024) and CINAHL (1981–December 2024). Additional sources included Google Scholar searches, reference list scanning and grey literature (e.g., practice guidelines, policy briefs, professional reports). The review was conducted between August 2024 and July 2025.

Review Methods

Realist review methods were applied to answer the question: What works, for whom, under what circumstances and why? The review proceeded in four stages: defining scope and research questions with an expert panel; iterative searching and screening; data extraction and synthesis into context–mechanism–outcome configurations (CMOCs); and development of a programme theory.

Results

Twenty-two documents were included, spanning nursing, medicine, allied health and interdisciplinary contexts. Six CMOCs were identified, encompassing the following themes: (1) relationship compatibility; (2) vulnerability and self-exploration; (3) growth through untapped strengths; (4) anti-oppression and equity; (5) mentors' pride and confidence; and (6) culture of mentorship. The resulting programme theory conceptualises compassionate mentorship as a dynamic, multi-level process with cumulative impacts on individual well-being, professional development and organisational culture.

Conclusion

Compassionate mentorship represents not only a relational practice but also a structural intervention for healthier workplaces. Programmes should prioritise compatibility, cultivate psychological safety, invest in mentee growth, embed equity, recognise mentor contributions and institutionalise mentorship culture.

Impact

These strategies offer actionable pathways to strengthen workforce resilience, retention and sustainability.

Patient or Public Contribution

One co-author is a retired nurse, ethicist and person with lived experience in the healthcare system. This co-author was integral to this project, serving on the scientific steering committee from project conceptualisation and funding application through study conduct and publication.

Psychological Safety of Culturally and Linguistically Diverse Nurses in Healthcare Work Environments—Systematic Review of Mixed‐Methodology

ABSTRACT

Background

The international mobility of nurses is a significant component of healthcare systems worldwide, resulting in the global recruitment and adaptation of culturally and linguistically diverse nurses into diverse work environments. CALD nurses face integration challenges, which can potentially compromise their well-being and adjustment to the new setting. Psychological safety is a key component to promoting individual well-being and effective organisational integration.

Objective

This systematic review aimed to identify the current evidence on the psychological safety of culturally and linguistically diverse nurses in healthcare work environments and the factors associated with it.

Methods

This systematic review was conducted using JBI guidelines. PiCo/PEO format was utilised for inclusion and exclusion criteria, including English/Finnish, without time limitations. The screening process was conducted by two independent researchers, with a third researcher resolving the conflicts. The PRISMA checklist was utilised in reporting. Data were analysed using content analysis for qualitative and data synthesis for quantitative.

Data Sources

CINAHL, PubMed, ProQuest, Scopus and Medic. Search period: 24.10.2024–23.1.2025.

Results

The systematic review yielded 15 qualitative, one mixed-methods and one quantitative article. The content analysis produced 270 codes, 67 subcategories, seven categories and two main categories. Professional growth and acceptance captured inclusion, professional competence and support from colleagues and managers in creating job satisfaction. Marginalised disempowerment reflected factors linked to low psychological safety, contributing to reduced job satisfaction in the workplace.

Conclusion

Healthcare organisations should confront existing inequities on psychological safety in culturally diverse healthcare environments that are structured around professional inequalities to create equitable spaces for CALD nurses. More research is needed to understand psychological safety experiences from the CALD nurse perspective, exploring the equitability of facilitating factors amid systemic disadvantages in the healthcare workplace.

Patient or Public Contribution

No patient or public involvement.

Trial Registration

Prospero registration: CRD42024581860

Adverse Outcomes and Associated Factors Among Children and Youths With Diabetes Mellitus in East Africa: A Systematic Review and Meta‐Analysis

ABSTRACT

Aim

To identify adverse outcomes and factors associated with diabetes mellitus among children and youths in East Africa.

Design

This review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Data Sources

No date restrictions were applied to searches of the Ovid MEDLINE, Embase, PubMed, CINAHL, Scopus, Web of Science, Cochrane Library databases and Google Scholar. The review identified and included literature published between 2007 and 2024.

Methods

Independent reviewers conducted study selection, data extraction, and quality assessment. Data were organised in Microsoft Excel, detailing study characteristics, demographics, exposures, and outcomes. Narrative synthesis summarised the data, while meta-analysis yielded pooled proportions.

Results

From 3797 publications, 30 studies involving 6109 children and youths with type 1 diabetes were included. Findings revealed that between 39.3% and 99% did not achieve target glycaemic levels. Diabetic ketoacidosis at diagnosis ranged from 35.8% to 78.7%. Pooled estimates indicated mortality in 6.47%, nephropathy in 15.66%, and retinopathy in 27.49% of the cases. Other complications included decreased health-related quality of life, lipodystrophy, psychiatric disorders, and stunting.

Conclusion

This review highlights the need for context-specific, personalised diabetes care for children and youths in East Africa. It underscores the need for healthcare professionals, particularly nurse diabetes educators, to provide personalised, holistic care and education. Policies that strengthen health systems, expand health insurance, and improve access to care are critical priorities to improve outcomes for these populations.

Impact

This study provides new information on diabetes-related complications and management challenges among children and youths in East Africa. Findings flag the urgent need for integrated care, standardised diagnostic criteria, and improved access to resources, with implications for healthcare providers, policymakers, and researchers to enhance health outcomes and quality of life.

Patient or Public Contribution

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

Beyond Training: A Qualitative Meta‐Synthesis of Healthcare Professionals' Experiences Providing Culturally Competent Antepartum and Intrapartum Care to Ethnic Minoritized Women

ABSTRACT

Background

Ethnic minoritized women face cultural and systemic barriers in accessing antepartum and intrapartum care. Healthcare providers play a pivotal role in addressing these challenges, but their perspectives and experiences in delivering culturally competent care remain underexplored.

Aim

To synthesise healthcare providers' experiences and perspectives on providing culturally competent antepartum and intrapartum care for ethnic minoritised women.

Methods

A qualitative meta-synthesis study design was employed. Six electronic databases were searched from their inception date till January 2025. The included studies were assessed using the method of the Critical Appraisal Skills Programme tool, and findings were meta-synthesised using Sandelowski and Barroso's six-step approach. This review was registered via the International Prospective Register of Systematic Reviews.

Results

Overall, 38 studies were included, and three themes emerged. The first theme revealed how providers' biases and professional training distorted their ability to understand and respect cultural practices. The second theme underscored the impact of systemic barriers such as time constraints, resource scarcity and lack of representation among providers. The final theme highlighted healthcare providers' aspirations for improved communication, targeted training and guidance on building trust to enhance care delivery.

Conclusion

Healthcare providers encounter notable challenges in delivering culturally competent antepartum and intrapartum care, but remain hopeful about bridging gaps in communication and understanding. Practical recommendations include implementing mandatory cultural competency training at all levels of healthcare professional education, increasing resources for interpreters and cultural liaisons and fostering diversity within the healthcare workforce. Future research should explore patient-centred interventions and systemic reforms to improve care for ethnic minoritised women. These findings highlight the need for policies and practices that empower providers to deliver equitable, culturally respectful antepartum and intrapartum care.

Patient or Public Contribution

No patient or public contribution.

Artificial Intelligence Technologies in Nursing Clinical Decision‐Making: An Umbrella Review

ABSTRACT

Aim

To describe contemporary peer-reviewed literature on artificial intelligence in nurses' clinical decision-making.

Methods

An umbrella review of literature reviews.

Data Sources

Four major databases were searched for reviews published between 2019 and 2024.

Results

Sixteen literature reviews reported on 965 nursing artificial intelligence primary studies. The studies focused on technology development and emerging performance evaluations, whilst real-world testing or implementation in nursing clinical settings was rare. Rigorous comparative analyses were lacking. While artificial intelligence demonstrates promise in decision-making, challenges such as a lack of controlled studies, algorithmic bias, limited reproducibility and insufficient clinical trials hinder its practical impact. Ethical concerns, transparency and patient data privacy issues pose barriers to AI integration in nursing practice. Ethical and legal guidelines for patient privacy are needed and should be taught along with AI literacy training for nurses.

Conclusions

Artificial intelligence has the potential to enhance clinical nursing decision-making, although evidence is limited by too few examples of nurse participation during development. Underutilisation in administrative nursing functions hinders implementation. Nurses should assume a central role in the design and development of AI applications to ensure that these technologies address the realities of nursing practice. With such improvements, artificial intelligence can transform nursing practice, improve nurses' clinical decision-making and ultimately enhance consumer healthcare outcomes.

Patient or Public Involvement

No Patient or Public Involvement.

Reporting Method

While there is no reporting checklist for umbrella reviews, the PRISMA guide for systematic reviews was followed.

Non‐Pharmacological Interventions for Cough in Patients With Lung Cancer: A Systematic Review and Meta‐Analysis

ABSTRACT

Background

Cough, a prevalent and debilitating symptom of lung cancer, remains poorly managed. Accumulating evidence on non-pharmacological interventions for lung cancer cough necessitates systematic evaluation to assess their efficacy.

Aim

To synthesise evidence on non-pharmacological interventions for managing cough in lung cancer patients.

Design

A systematic review and meta-analysis following the Preferred Reporting Items for Systematic reviews and Meta-Analyses reporting guideline.

Methods

Nine databases were searched from inception to December 2024 to identify randomised controlled trials. Study quality was appraised using the Revised Cochrane Risk-of-Bias Tool for Randomised Trials. Meta-analyses were performed for quantitative synthesis, with sources of heterogeneity examined using meta-regression and subgroup analyses.

Results

Thirty-eight studies representing 2995 lung cancer patients were identified. These studies investigated acupuncture therapy, moxibustion, pulmonary rehabilitation, self-management intervention, physical exercises, psychoeducation support, mindfulness, and multicomponent interventions. Non-pharmacological interventions showed positive effects on cough severity and cough-related quality of life. Additional benefits were observed for expectoration, dyspnea, and general quality of life. Pulmonary rehabilitation showed a greater effect on cough severity than other non-pharmacological interventions.

Conclusion

Non-pharmacological interventions are promising in improving cough, expectoration, dyspnea, and general quality of life among lung cancer patients. Pulmonary rehabilitation showed the most promising effect. Future research should adopt objective cough measures in addition to self-reported measures.

Implications for the Profession and/or Patient Care

Non-pharmacological interventions demonstrated potential effects in relieving cough and additional benefits in improving expectoration, dyspnea, and general quality of life among lung cancer patients. Healthcare professionals may adopt pulmonary rehabilitation for cough and related symptoms in lung cancer patients.

Impact

As the first meta-analysis addressing non-pharmacological interventions for lung cancer cough, this study provides evidence supporting their clinical efficacy for improving cough and associated symptoms among patients with lung cancer.

Patient or Public Contribution

No patient or Public contribution.

Registration

PROSPERO CRD42024588729.

Workplace Violence Against Emergency Department Nurses in Low‐ and Middle‐Income Countries: A Systematic Review and Meta‐Analysis

ABSTRACT

Aim

Workplace violence (WPV) against emergency department (ED) nurses is a global concern; however, evidence from low- and middle-income countries (LMICs) remains fragmented despite substantial differences in healthcare infrastructure, staffing and policy capacity compared with high-income settings. This review aimed to synthesise the existing literature to identify the prevalence, risk factors, types and impacts of workplace violence against emergency nurses in low- and middle-income countries.

Design

Systematic review and meta-analysis.

Methods

This review was conducted following PRISMA guidelines. Studies were included if they employed quantitative or mixed-methods designs, focused on emergency nurses in LMICs, and reported WPV prevalence. Quality assessment was conducted using the JBI Critical Appraisal Checklist. A random-effects meta-analysis was performed to examine the prevalence of WPV.

Data Sources

Four databases, CINAHL, PsycINFO, PubMed and Google Scholar, were searched for studies published between 2015 and 2025.

Results

Eleven cross-sectional studies from Africa, Asia, Europe-Asia and South America were included, involving sample sizes ranging from 80 to over 20,000 ED nurses. The pooled prevalence of any WPV was 79% (95% CI: 69%–86%). Verbal violence was the most common form, affecting 82% of nurses (95% CI: 71%–89%). Physical violence was 40% (95% CI: 22%–63%), with substantial heterogeneity across studies. The main risk factors included long waiting times, overcrowding, inadequate staffing and poor security measures. WPV resulted in significant physical, psychological and professional consequences, including stress, depression, burnout and increased turnover intentions.

Conclusion

WPV against ED nurses in LMICs is widespread and severe, affecting 79% of nurses, with verbal abuse being the most prevalent.

Implications for the Profession and/or Patient Care

The high prevalence rates highlight the urgent need for targeted prevention strategies, improved workplace safety measures and comprehensive support systems for emergency nurses.

Reporting Method

We have adhered to relevant EQUATOR guidelines, particularly the PRISMA checklist.

Patient or Public Contribution

No patient or public contribution.

Ten‐Year Update of Nurse Practitioner Service Impact on Patient and Health Service Outcomes in Emergency Care Settings—A Systematic Review

ABSTRACT

Aims

To provide a 10-year update on the best available evidence evaluating the impact of nurse practitioner services on cost, waiting times, patient satisfaction, representation rates, and length of stay in emergency and urgent care settings.

Design

Systematic review.

Data Sources

The search was completed on January 28, 2025, in Embase (Elsevier), Medline (EBSCOhost), CINAHL (EBSCOhost), Cochrane Library (Wiley), Emcare (Ovid), Web of Science Core Collection (Clarivate) and Scopus (Elsevier). The data range (2014–2024) was used to limit the search.

Methods

The search was conducted with results imported into Covidence. In Covidence, two reviewers conducted screening, data extraction, and quality appraisal of articles, and findings were analysed using a narrative synthesis approach. Eligible studies examined nurse practitioner services in emergency or urgent care settings, reporting outcomes of cost, waiting times, patient satisfaction, representation rates, and length of stay.

Results

Title and abstract screening were performed on 2329 records. Of these, 236 full-text articles were reviewed, and 17 underwent critical appraisal and data extraction. Narrative analysis of outcome measures yielded mixed results, with both favourable and unfavourable findings reported regarding nurse practitioner services.

Conclusions

Global evaluation of nurse practitioner services in emergency care remains inconsistent. Nevertheless, emerging evidence supports their positive impact, particularly in improving patient outcomes. To effectively inform policy, workforce planning and clinical integration, there is a need for professional benchmarks that provide clear frameworks for the evaluation of patient-centred outcomes and operational impacts in emergency departments.

Implications

Evidence related to nurse practitioner services in emergency and urgent care clinics highlights the positive impact of nurse practitioner services on patient wait times and satisfaction; however, there is limited and variable evidence of impact on health care costs and outcomes.

Impact

This paper recommends that evaluating emergency nurse practitioner services requires homogeneous research using consistent professional benchmarks and evaluation frameworks.

Reporting Method

This systematic review follows the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines.

Patient or Public Contribution

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

Trail Registration

PROSPERO 2025 CRD420250645148.

The Role of Artificial Intelligence for Intimate Partner Violence Prevention: A Systematic Review

ABSTRACT

Introduction

Intimate partner violence (IPV), encompassing physical, sexual, emotional and economic abuse, remains a pervasive global health concern. Traditional prevention efforts face obstacles such as underreporting, delayed detection and limited personalised support. Emerging artificial intelligence (AI) approaches offer new opportunities to enhance IPV prevention.

Aim

This systematic review maps and synthesises evidence on AI-driven tools in IPV prevention based on studies published between 2004 and 2024.

Methods

Following PRISMA 2020 guidelines and PROSPERO registration, we searched PubMed, Embase, CINAHL, PsycINFO, IEEE Xplore and Web of Science. Eligible studies explicitly evaluated AI technologies targeting IPV prediction, screening, intervention or support delivery. Study quality was appraised using the Mixed Methods Appraisal Tool (MMAT).

Results

Of 1304 records initially identified, 41 studies met eligibility criteria. AI applications ranged from machine learning (ML) for risk prediction and natural language processing (NLP) for IPV detection in clinical and social media data, to image analysis for forensic evaluation and chatbot-based support. Predictive modelling demonstrated strong discriminative performance, while NLP-based screening detected IPV with notable sensitivity. Chatbots showed feasibility and user acceptability, but evidence of their direct impact on reducing IPV incidence was limited, with one randomised controlled trial showing a modest reduction. Key challenges identified included algorithmic bias, data privacy risks and barriers to integration across health and social care systems.

Discussion

AI-informed interventions show promise for improving IPV detection, risk assessment, and scalable support, but questions remain about long-term effectiveness, ethical fairness, transparency and equitable implementation. Future interdisciplinary research should address these concerns to responsibly deploy AI in IPV prevention.

Relevance to Clinical Practice

The findings highlight the importance of trauma-informed, culturally responsive care and provider training in AI applications. Nurse-led innovation and policy advocacy will be crucial for safe, equitable integration of AI in IPV prevention.

Fostering Healthy Work Environments Through Interprofessional Simulation: Teamwork, Communication, Psychological Safety—Systematic Review of Randomised Controlled and Quasi‐Experimental Studies

ABSTRACT

Aim

To evaluate the effectiveness of simulation-based interprofessional education (IPSE) interventions on teamwork, communication and psychological safety outcomes among healthcare professionals and students.

Design

A systematic review.

Data Sources

Searches were conducted across PubMed, CINAHL, Scopus, Web of Science and Cochrane CENTRAL, supplemented by manual reference and citation tracking.

Review Methods

The search strategy was developed with an academic librarian to ensure thoroughness and relevance. The review included randomised controlled trials (RCTs) and quasi-experimental studies published between 2010 and 2025. Eligible studies reported quantitative outcomes of IPSE interventions involving at least two healthcare professions. Risk of bias was assessed using RoB 2 for RCTs and ROBINS-I for quasi-experimental studies.

Results

Thirty studies (14 RCTs, 16 quasi-experimental) from 16 countries were included. Most studies reported positive effects on teamwork, including improved coordination, role clarity and adherence to structured protocols. Communication outcomes showed enhanced information exchange, clarity and structured behaviours, such as SBAR and closed-loop communication, although some studies noted inconsistent safety practices. Psychological safety outcomes demonstrated gains in self-confidence, self-efficacy, leadership and safety climate, with several studies also reporting reduced anxiety. However, findings on stress, workload and attitudinal change were mixed. Overall, RCTs were judged methodologically robust, and quasi-experimental studies were largely low risk with some moderate concerns.

Conclusion

Simulation-based interprofessional training enhances teamwork, communication and psychological safety in fostering a healthy work environment, though effects vary by context and population.

Impact

This review synthesises evidence from 30 trials, offering guidance for educators and policymakers on advancing interprofessional collaboration. Integrating IPSE into health curricula and clinical training can strengthen collaboration and contribute to safer patient care.

Patient or Public Contribution

No patient or public contribution.

Reporting Methods

The review adhered to PRISMA 2020 guidelines, and the protocol was registered in the PROSPERO international prospective register of systematic reviews (ID: CRD420251039410).

Mixed Methods Research on Family Caregiving for Stroke Survivors: A Methodological Systematic Review

ABSTRACT

Aim

To examine how mixed methods research has been applied in studies of family caregiving for stroke survivors, focusing on key methodological components (rationale, design types, integration strategies, and use of joint displays).

Design

Methodological systematic review.

Methods

A systematic search of five databases yielded 17 studies. The extraction focused on mixed methods features (rationale, design, integration, joint displays), and quality was appraised using the Mixed Methods Appraisal Tool.

Data Sources

PubMed, CINAHL, Scopus, Web of Science, and PsycINFO were searched for relevant studies published from 2010 to 2025.

Results

The included studies addressed topics such as caregiver burden, coping, resilience, and intervention outcomes. Convergent and explanatory sequential designs predominated. Complementarity was the most frequent rationale for mixing methods. Integration occurred mainly through merging, with fewer instances of connecting or building. Three studies included joint displays to integrate the results.

Conclusion

Mixed methods research is increasingly applied in family caregiving. To advance the field, researchers should strengthen integration during analysis and results and improve transparency in reporting key design features.

Implications for the Profession and/or Patient Care

Strengthening methodological rigour in mixed methods studies on stroke caregiving will improve the evidence base for nursing practice. Intentional and meaningful integration of qualitative and quantitative evidence can better inform effective interventions and support programs, ultimately enhancing care for stroke survivors and their families.

Impact

This review evaluates how mixed methods research is applied in family caregiving studies. It identifies significant methodological gaps, including unclear reporting of design and limited use of advanced integration techniques. The recommendations provide practical guidance for researchers to improve reporting and integration, yielding richer evidence to inform interventions and policies that support family caregivers.

Reporting Method

The review followed the PRISMA 2021 guidelines for transparent reporting of systematic reviews.

Patient or Public Contribution

No patient or public involvement.

Nurses' Perceptions of Reasons for Missed Nursing Care in Hospitals: A Qualitative Systematic Review

ABSTRACT

Aim

To identify and synthesise qualitative evidence on nurses' perceptions of reasons for missed nursing care in hospitals.

Design

Systematic review of qualitative evidence.

Methods

An extensive search of all relevant databases was conducted. Study selection, quality assessment, data extraction and meta-aggregation were performed independently by two reviewers according to the JBI guidelines for systematic reviews of qualitative evidence. Confidence in the findings was assessed using the ConQual approach.

Data Sources

The electronic databases CINAHL, PubMed, Embase, PsychInfo, and Scopus were searched in January 2024 and repeated in May 2025.

Results

Thirty-one studies from hospital settings worldwide were included following critical appraisal, with overall quality rated moderate to high. The studies contributed 168 findings, which were organised into 10 categories and three synthesised findings: Organisational and system-level factors influencing missed nursing care, Teamwork and cultural factors influencing missed nursing care, and Individual nurse- and patient-related factors influencing missed nursing care.

Conclusions

Reasons for missed nursing care represent an interplay of systemic, organisational, and individual factors within complex resource-constrained contexts.

Implications for the Profession and/or Patient Care

Healthcare organisations are recommended to implement system-level interventions, rather than relying solely on behaviour-focused solutions. Healthcare leaders should ensure flexible staffing, strong managerial support, and adequate resources to enable fundamental care. Building collaborative, interprofessional cultures that value relational and fundamental care as well as technical tasks is essential, together with education and mentorship that support nurses' decision-making, resilience, and clinical competence.

Impact

Hospital leaders, policymakers, and nurse managers can use the recommendations to reduce missed nursing care and promote a safe person-centred practice. Implementing systemic changes will improve nurses' working conditions and capacity to deliver comprehensive care, ultimately enhancing patient satisfaction and outcomes.

Reporting Method

The ‘enhancing transparency in reporting the synthesis of qualitative research statement’.

Patient or Public Contribution

No patient or public involvement.

Trial and Protocol Registration

The review is registered in the International Prospective Register of Systematic Reviews. PROSPERO CRD42023438198 (https://www.crd.york.ac.uk/PROSPERO/search)

Views and Experiences of People With Dementia, Informal Caregivers and Professionals on Eating and Drinking Difficulties: A Qualitative Systematic Review

ABSTRACT

Aim

This study aims to explore the views and experiences of people with dementia, informal caregivers and professionals regarding eating and drinking difficulties.

Design

A qualitative systematic review was conducted.

Methods

The Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines were used to conduct this systematic review. The quality of the included studies was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research, and the data were thematically synthesised using Thomas and Harden's three-stage method.

Data Sources

Six electronic databases (PubMed, EMBASE, Cochrane Library, Web of Science, CINAHL and PsycINFO) were searched from their respective inception dates to August 2025 to identify relevant studies.

Results

Thematic analysis of the 16 included studies identified four key themes: (1) Physiological and psychological changes in people with dementia and caregivers; (2) factors influencing eating and drinking in people with dementia; (3) needs and recommendations for people with dementia, informal caregivers and professionals; (4) selection of eating methods for end-stage people with dementia.

Conclusions

Eating and drinking difficulties affect the well-being of both patients and caregivers. A good dining environment improves mealtime pleasure but demands caregivers' time and energy. All parties emphasised the importance of effective communication. In end-stage dementia, professional assistance is crucial for enteral nutrition decisions.

Implications for the Profession and/or Patient Care

Collaboration among patients, caregivers and professionals is vital for creating tailored nutritional plans and improving mealtime environments, thereby enhancing nutritional intake. In advanced dementia, providers must provide balanced information on comfort feeding versus enteral nutrition to aid decision-making.

Impact

What problems were addressed in this study? This study addressed the lack of a consolidated, tri-perspective understanding of eating and drinking difficulties in dementia care settings. What are the main findings? Four key themes were identified: physiological and psychological changes, influencing factors, stakeholder needs and end-of-life decision-making. Where and on whom will the research have an impact? This will impact care practices for people with dementia and inform the training and support of informal caregivers and healthcare professionals.

Leadership of Nurses' Interprofessional Collaboration: A Mixed‐Methods Systematic Review

ABSTRACT

Aim

To identify and synthesise qualitative and quantitative evidence of nurse managers' qualities, practices and styles related to leading nurses' interprofessional collaboration.

Design

Mixed-methods systematic review.

Methods

Two authors independently selected studies based on predefined inclusion criteria, assessed quality and extracted data. A thematic synthesis with a convergent qualitative design was used.

Data Sources

CINAHL, PubMed and Scopus were searched from January 1, 2010, to September 7, 2025. Citations of relevant articles were screened.

Results

A total of 32 articles were included. The analysis revealed two leadership core qualities, five core practices, and three core styles of nurse managers that promote nurses' interprofessional collaboration. Core qualities were proficiency and mindset. Core practices comprised empowering, communicating and informing, commitment to interprofessional collaboration, creating possibilities, and establishing an enhancing atmosphere. Core styles included authentic, transformational, and transactional leadership styles.

Conclusion

The results reflect the situational nature of nursing leadership related to interprofessional collaboration. Successful leadership requires managers to adopt primarily a transformational leadership style, yet more traditional leadership is required occasionally. Results indicate that nursing leadership is foremost a process that evolves within its context.

Implications for the Profession and/or Patient Care

Greater clarity on how leadership influences nurses' interprofessional collaboration supports leaders, organisations, and educational institutions in developing and sustaining effective leadership.

Impact

This review demonstrates that the quality of nursing leadership is a central factor for successful interprofessional collaboration.

Reporting Method

The PRISMA guidelines for Systematic Reviews and Meta-Analysis were used.

Patient or Public Contribution

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

Exploring the Role of Nurse Leadership Through a Systems Thinking Lens: A Systematic Review of Conceptual and Empirical Evidence

ABSTRACT

Aims

To explore the impact of systems thinking in nursing leadership on healthcare quality, decision-making and resource management.

Design

A systematic review.

Data Sources

A comprehensive literature search was conducted in PubMed, CINAHL, Scopus and Web of Science for studies published in English and Italian up to 2024.

Review Methods

Studies were selected based on predefined eligibility criteria, focusing on nursing leadership integrating systems thinking. The Joanna Briggs Institute (JBI) checklist was used to assess methodological quality. A narrative synthesis was conducted to identify key themes and patterns.

Results

Fifteen studies met the inclusion criteria. Findings suggest that systems thinking enhances resource management, decision-making and patient safety, while also reducing errors and improving staff collaboration. Adopting a systems approach allows nursing leaders to navigate complex healthcare environments effectively. However, variability in study designs and implementation strategies limits the generalizability of findings.

Conclusion

Integrating systems thinking into nursing leadership promotes a proactive, holistic approach to problem-solving, optimising healthcare outcomes. While evidence supports its benefits, further empirical studies are needed to confirm its effectiveness across diverse healthcare settings.

Impact

What problem did the study address? The need for structured systems thinking in nursing leadership. What were the main findings? Improved decision-making, resource optimisation and patient safety through systems-oriented leadership. Where and on whom will the research have an impact? Nurse leaders, healthcare administrators and policymakers in diverse healthcare settings.

Patient or Public Contribution

Although patients and the public were not directly involved, this study has implications for enhancing patient safety and healthcare efficiency.

Relationship Between Sleep and Cognitive Frailty in Older Adults: A Systematic Review and Meta‐Analysis

ABSTRACT

Aim

To explore the relationship between sleep and cognitive frailty in older adults.

Design

A systematic review and meta-analysis.

Data Sources

The Web of Science, Cochrane Library, CINAHL, Embase, PsycINFO and PubMed databases were searched from inception to October 28, 2024.

Methods

Two investigators independently conducted literature screening, data extraction and quality assessment. The Joanna Briggs Institute Critical Appraisal Tool and Newcastle–Ottawa Scale were used to evaluate methodological quality. This review followed PRISMA guidelines.

Results

This review included 13 articles involving 14,223 individuals, and 10 studies included in the meta-analysis. Across 13 studies, the overall prevalence of cognitive frailty was 25%. Sleep problems were categorised into four categories; the results reported that poor sleep quality, long sleep time and insomnia were correlated with the presence of cognitive frailty. However, the relationship between short sleep time and cognitive frailty was not significant.

Conclusions

This review quantitatively suggested that sleep parameters such as long sleep time, insomnia and poor sleep quality were correlated with the presence of cognitive frailty. Future research should adopt longitudinal designs and use validated instruments to measure both quantitative and qualitative aspects of sleep, thereby facilitating a thorough examination of the strength of the relationship between sleep and cognitive frailty, as well as the direction of causality.

Impact

The review highlights the need to integrate comprehensive sleep assessments and targeted interventions into nursing care plans for older adults to enhance their sleep health. The findings will provide support for the development of effective interventions to prevent and manage cognitive frailty in the older population.

Patient or Public Contribution

No patient or public contribution.

Prediction Models for Falls Risk Among Inpatients: A Systematic Review and Meta‐Analysis

ABSTRACT

Aim

To systematically review published studies on fall risk prediction models for inpatients.

Design

A systematic review and meta-analysis of prognostic model studies.

Data Sources

A literature search was carried out in Web of Science, the Cochrane Library, PubMed, Embase, CINAHL, SinoMed, VIP Database, CNKI and Wanfang Database. The search covered studies on risk prediction models for falls in inpatients from inception to March 9, 2024.

Methods

The research question was formulated using the PICOTS framework. Data extraction was performed following the Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies (CHARMS). The quality of studies related to risk prediction models was evaluated with the Prediction Model Risk of Bias Assessment Tool (PROBAST). Meta-analysis was conducted using STATA 18.0 software.

Results

A total of 15 studies were included, with 13 eligible for meta-analysis. Only 2 of these 15 studies had external validation. The reported AUC values ranged from 0.681 to 0.900. The overall risk of bias was high, mainly attributed to inappropriate data sources and improper processing in the analysis domain. The pooled AUC from the meta-analysis was 0.799. After reviewing the predictors included in various models, FRIDs, fall history, age, gait, mental status, gender and incontinence were relatively common.

Conclusion

The fall risk prediction model for inpatients performs well overall, but it has a high risk of bias. Future development of risk prediction models should strictly adhere to the PROBAST, combine clinical reality, optimise study design and improve methodological quality.

Impact

This study provides medical professionals with a clear overview of constructing fall risk prediction models for inpatients. The fall-related predictors in these models help healthcare providers identify high-risk patients and implement preventive strategies. It also offers valuable insights for the development of future prediction models.

No Patient or Public Contribution

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

Factors Associated With Newly Graduated Nurses' Work Engagement: Systematic Review of Quantitative Studies

ABSTRACT

Aim

To describe the factors associated with work engagement in newly graduated nurses.

Design

Systematic review of original quantitative studies according to Joanna Briggs Institute guidelines.

Methods

The systematic review utilised PEO inclusion criteria. Original peer-reviewed quantitative studies were identified. Two researchers independently conducted a screening of study eligibility based on title, abstract, and full text. The JBI critical appraisal tool for analytical cross-sectional studies was employed to perform a rigorous methodological quality assessment. The data was extracted, tabulated, and then analysed narratively.

Data Sources

The literature search was conducted in November 2023 by screening four databases: Scopus, CINAHL (Ebsco), ProQuest, and Ovid Medline.

Results

The review included 19 articles, presenting an overview of factors associated with newly graduated nurses' work engagement. Factors were classified into seven categories explaining supportive workplace, transition and orientation to workplace, competence and career development in nursing practice, personal and psychological characteristics, work environment characteristics, stress and challenges in a work environment, and satisfaction with work.

Conclusions

To support newly graduated nurses' work engagement, nurse leaders should provide a supportive working environment and focus on new nurses' effective support systems in the workplace. Their abilities to develop and educate themselves need to be prioritised to enhance their knowledge and skills in nursing. Additionally, organisations should have policies and procedures to ensure quality orientation, and units need to implement transition and mentorship programmes.

Implications for the Profession and/or Patient Care

This research could be valuable to health care when wanting to develop and improve work engagement, especially among newly graduated nurses. The economic significance of nurses' work engagement is evident, as the cost of nurse turnover is considerable. Reducing nurse turnover and improving retention relies on understanding the factors influencing nurses' decisions to leave the organisation and the profession.

Impact

What problem did the study address? The global shortage of nurses, worsened by newly qualified nurses leaving the health sector, necessitates understanding factors influencing their work engagement; The factors associated with newly graduated nurses' work engagement were supportive work environment, transition and orientation to work, success and career development in nursing, personal and psychological characteristics, characteristics of the work environment, stress and challenges in the work environment, and job satisfaction. Where and on whom will the research have an impact? The results can be used by health care organisations to plan the preceptorship/mentoring programmes of new nurses. Identifying and understanding the factors associated with the retention of newly qualified nurses can help to attract and retain nurses and to promote the adaptation and integration of new nurses into healthcare organisations.

Reporting Method

The YNEPR author checklist has been completed and implemented during this systematic review process. Also, the Prisma 2020 checklist has been used.

Patient or Public Contribution

No patient or public contribution: systematic review.

Trial Registration

PROSPERO number: CRD42023408705 (https://www.crd.york.ac.uk/PROSPERO/)

Diverse Parental Experiences of Kangaroo Care in Neonatal Units Across Healthcare Systems: A Meta‐Synthesis

ABSTRACT

Background

Kangaroo Care is an effective practice recommended by WHO for newborns, especially preterm infants, to reduce mortality and morbidity and improve health outcomes. Understanding parents' experiences with Kangaroo Care is vital as it can significantly influence uptake and sustained practice; however, experiences may vary across healthcare systems.

Aim

To explore parents' experiences of Kangaroo Care in neonatal units and to examine differences across international health systems.

Design

A qualitative meta-synthesis.

Review Methods

A systematic search of the literature was carried out over seven databases, including CINAHL, MEDLINE ALL, EMBASE, PsycINFO, Maternity & Infant Care, Scopus and Cochrane Library. Qualitative studies published in English from 2010 to January 2024 were included. Data extraction and quality appraisal, using the CASP Qualitative Checklist, were undertaken. Meta-synthesis of the included qualitative findings was carried out. The findings were reported following the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) guideline. The protocol was registered on PROSPERO (CRD42023483347).

Results

Twenty-five studies were included and four themes were identified: parental fulfilment from Kangaroo Care, Hardship in Kangaroo Care practice, Roadblocks and difficulties in adopting and Building bridges to encourage and support Kangaroo Care.

Conclusion

This review underscores the multifaceted nature of parental experiences, including positive and challenging aspects, as well as significant barriers and facilitators that influenced Kangaroo Care implementation. By understanding these experiences and factors that hinder and enable, healthcare systems and professionals can better support and empower parents to improve the effectiveness of Kangaroo Care.

Impact and Implications

Kangaroo Care is lifesaving, particularly in low-income countries, but can be a challenge for parents providing it. By addressing deficiencies in infrastructure and resources, barriers can be minimised, thereby encouraging the practice of Kangaroo Care. This is especially important in lower-middle- and low-income countries where the practice is most effective and the practice is lowest.

Patient or Public Contribution

This project is a meta-synthesis; therefore, no patient or public contribution was deemed necessary.

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