Conectar
To integrate the quantitative and qualitative data collected as part of the PEACH (Procalcitonin: Evaluation of Antibiotic use in COVID-19 Hospitalised patients) study, which evaluated whether procalcitonin (PCT) testing should be used to guide antibiotic prescribing and safely reduce antibiotic use among patients admitted to acute UK National Health Service (NHS) hospitals.
Triangulation to integrate quantitative and qualitative data.
Four data sources in 148 NHS hospitals in England and Wales including data from 6089 patients.
A triangulation protocol was used to integrate three quantitative data sources (survey, organisation-level data and patient-level data: data sources 1, 2 and 3) and one qualitative data source (clinician interviews: data source 4) collected as part of the PEACH study. Analysis of data sources initially took place independently, and then, key findings for each data source were added to a matrix. A series of interactive discussion meetings took place with quantitative, qualitative and clinical researchers, together with patient and public involvement (PPI) representatives, to group the key findings and produce seven statements relating to the study objectives. Each statement and the key findings related to that statement were considered alongside an assessment of whether there was agreement, partial agreement, dissonance or silence across all four data sources (convergence coding). The matrix was then interpreted to produce a narrative for each statement.
To explore whether PCT testing safely reduced antibiotic use during the first wave of the COVID-19 pandemic.
Seven statements were produced relating to the PEACH study objective. There was agreement across all four data sources for our first key statement, ‘During the first wave of the pandemic (01/02/2020-30/06/2020), PCT testing reduced antibiotic prescribing’. The second statement was related to this key statement, ‘During the first wave of the pandemic (01/02/2020-30/06/2020), PCT testing safely reduced antibiotic prescribing’. Partial agreement was found between data sources 3 (quantitative patient-level data) and 4 (qualitative clinician interviews). There were no data regarding safety from data sources 1 or 2 (quantitative survey and organisational-level data) to contribute to this statement. For statements three and four, ‘PCT was not used as a central factor influencing antibiotic prescribing’, and ‘PCT testing reduced antibiotic prescribing in the emergency department (ED)/acute medical unit (AMU),’ there was agreement between data source 2 (organisational-level data) and data source 4 (interviews with clinicians). The remaining two data sources (survey and patient-level data) contributed no data on this statement. For statement five, ‘PCT testing reduced antibiotic prescribing in the intensive care unit (ICU)’, there was disagreement between data sources 2 and 3 (organisational-level data and patient-level data) and data source 4 (clinician interviews). Data source 1 (survey) did not provide data on this statement. We therefore assigned dissonance to this statement. For statement six, ‘There were many barriers to implementing PCT testing during the first wave of COVID-19’, there was partial agreement between data source 1 (survey) and data source 4 (clinician interviews) and no data provided by the two remaining data sources (organisational-level data and patient-level data). For statement seven, ‘Local PCT guidelines/protocols were perceived to be valuable’, only data source 4 (clinician interviews) provided data. The clinicians expressed that guidelines were valuable, but as there was no data from the other three data sources, we assigned silence to this statement.
There was agreement between all four data sources on our key finding ‘during the first wave of the pandemic (01/02/2020-30/06/2020), PCT testing reduced antibiotic prescribing’. Data, methodological and investigator triangulation, and a transparent triangulation protocol give validity to this finding.
The purpose of this study was to explore undergraduate nursing students' lived experiences with secondary traumatic stress.
The design was an interpretivist, hermeneutic-phenomenological approach. Data collection took place in the United States from September through November of 2024. Undergraduate nursing students who scored ≥ 38 (moderate, high, or severe) on the Secondary Traumatic Stress Scale were purposively recruited for face-to-face interviews with biometric and audiovisual recordings. Data analysis followed an iterative, inductive approach using principles from Heidegger's hermeneutic approach and Benner's interpretive framework for nursing.
Four main themes emerged from the data, illuminating student lived experiences on (1) How an Event Becomes ‘Traumatic,’ (2) Maladaptive or Ineffective Coping in Response to an Event, (3) Nursing Culture as a Conduit for Secondary Traumatic Stress and (4) The Student Journey Toward Effective Coping.
Findings revealed largely unaddressed secondary traumatic stress in undergraduate nursing students, a hidden driver of burnout and early exit from the profession. During synthesis, a four-step cascade emerged: (1) an emotionally charged event, (2) experiencing distorted thoughts, (3) symptoms of physiological arousal and (4) demonstrated behavioural avoidance, intensified by an underlying professional expectation of stoicism. Although students reported using relational, spiritual, cognitive and physical coping tools, these strategies alone rarely interrupted the cascade.
Three educational imperatives follow: (1) embed explicit secondary traumatic stress literacy in educational modules, (2) normalise brief peer/faculty debriefings and (3) train preceptors to frame vulnerability as a form of competence. Trauma-informed pedagogy built on these steps can foster integrated (rather than sustained) trauma, curb attrition and help secure the future nursing workforce.
Undergraduate nursing students frequently experience secondary traumatic stress during clinical training, yet curricula and clinical cultures provide little explicit preparation or support. This gap accelerates burnout and early departure from the profession, worsening nurse shortages and threatening patient safety.
The study uncovered a four-step STS cascade: a clinical event led to distorted thoughts, which resulted in physiological arousal and produced behavioural avoidance (amplified by the hidden curriculum of stoicism misinterpreted as professional resilience). Students improvised multi-layered coping toolkits, but these alone were perceived as insufficient. Targeted, real-time interventions can interrupt the cascade and transform distress into manageable, integrated memories.
The research will influence educators, clinical mentors, and health-system managers who shape the day-to-day experiences of nursing students and new graduates, with ripple effects for patient safety and workforce sustainability across comparable healthcare contexts worldwide.
SRQR.
This study did not include patient or public involvement in its design, conduct, or reporting.
by Alan Reubenson, Leo Ng, Vidya Lawton, Irmina Nahon, Rebecca Terry, Claire Baldwin, Julia Blackford, Alex Bond, Rosemary Corrigan, Megan Dalton, Amabile Borges Dario, Michael Donovan, Ruth Dunwoodie, Genevieve M. Dwyer, Roma Forbes, Alison Francis-Cracknell, Janelle Gill, Andrea Hams, Anne Jones, Taryn Jones, Belinda Judd, Ewan Kennedy, Prue Morgan, Tanya Palmer, Casey Peiris, Carolyn Taylor, Debra Virtue, Cherie Zischke, Daniel F. Gucciardi, on behalf of the Physiotherapy Clinical Education Research Collaborative (PCERC)
The Assessment of Physiotherapy Practice (APP) is a 20-item assessment instrument used to assess entry-level physiotherapy practice in Australia, New Zealand and other international locations. Initial APP reliability and validity evidence supported a unidimensional or single latent factor as the best representation of entry-level physiotherapy practice performance. However, there remains inconsistency in how the APP is interpreted and operationalised across Australian and New Zealand universities offering entry-level physiotherapy programs. In essence, the presumption that the psychometric integrity of the APP generalises across people, time, and contexts remains largely untested. This multi-site, archival replication study utilised APP assessment data from 8,979 clinical placement assessments, across 19 Australian and New Zealand universities, graduating entry-level physiotherapy students (n=1865) in 2019. Structural representation of APP scores were examined via confirmatory factor analysis and penalised structural equation models. Factor analyses indicated a 2-factor representation, with four items (1–4) for the professional dimension and 16 items (5–20) for the clinical dimension, is the best approximation of entry-level physiotherapy performance. Measurement invariance analyses supported the robustness of this 2-factor representation over time and across diverse practice areas in both penultimate and final years of study. The findings provide strong evidence for the psychometric integrity of the APP, and the 2-factor alternative interpretation and operationalisation is recommended. To meet entry-level standards students should be assessed as competent across both professional and clinical dimensions of physiotherapy practice.To identify and synthesise recommendations and guidelines for mental health chatbot conversational design.
Integrative review.
Suitable publications presenting recommendations or guidelines for mental health conversational design were included. The quality of included publications was assessed using Joanna Briggs Institute Critical Appraisal Tools. Thematic analysis was conducted.
Primary searches limited to last 10 years were conducted in PubMed, Scopus, ACM Digital Library and EBSCO databases including APA PsycINFO, CINAHL, APA PsycArticles and MEDLINE in February 2023 and updated in October 2023. A secondary search was conducted in Google Scholar in May 2023.
Of 1684 articles screened, 16 publications were selected. Three overarching themes were developed: (1) explicit knowledge about chatbot design and domain, (2) knowing your audience and (3) creating a safe space to engage. Results highlight that creating pleasant and effective conversations with a mental health chatbot requires careful and professional planning in advance, defining the target group and working together with it to address its needs and preferences. It is essential to emphasise the pleasant user experience and safety from both technical and psychological perspectives.
Recommendations for mental health chatbot conversational design have evolved and become more specific in recent years. Recommendations set high standards for mental health chatbots. To meet that, co-design, explicit knowledge of the user needs, domain and conversational design is needed.
Mental health professionals participating in chatbot development can utilise this review. The results can also inform technical development teams not involving healthcare professionals directly.
Knowledge of developing mental health chatbot conversations appears scattered. In mental health chatbots, features that enhance the chatbot's ability to meet users' needs and increase safety should be considered. This review is useful for developers of mental health chatbots and other health applications used independently.
This integrative review was reported according to PRISMA guidelines, as applicable.
No patient or public contribution.
To highlight the use of corpus linguistics for analysing language data and to provide a worked example of this approach in nursing research.
Methodology discussion paper.
This paper introduces corpus linguistics as a distinct approach to undertaking qualitative research in nursing. Examples are provided to illustrate how corpus linguistics can be applied to explore contemporary concepts in healthcare.
Corpus linguistics offers a structured, robust alternative to traditional qualitative analysis. When combined with critical social theory, it is ideal for exploring power dynamics and discourse, making it a valuable approach for nursing and healthcare related research.
Nurse researchers often work with large amounts of textual data. Corpus linguistics provides a rigorous framework for analysing such data sets, which can be used for various studies.
Corpus linguistics analytics can enhance nursing research by uncovering language use patterns that can help generate knowledge to inform nursing practice and policy development.
None.
To review the application of telehealth guidelines developed by Bondini et al for clinicians to determine patient suitability for telehealth in an outpatient Chronic Wound Service, including the proportion of patients suitable for telehealth, type and mode of telehealth encounters. Retrospective, random convenience sample of patients attending the Chronic Wound Service in 2021. Fifty-six patients were included, most with leg/foot wounds (93%), median age 74 [54–84], 64% male. Four patients at admission and 19 patients at review met criteria for telehealth. Six percent of encounters were telehealth; phone-only (82%), unscheduled nursing reviews (77%) in patients with healing wounds. Thirty patients (54%) received at least one telehealth encounter. Telehealth occurred 35.6 days later in the admission than face-to-face encounters (p < 0.05, 95% CI 14.9–56.3). There was a significant relationship between patients receiving telehealth and meeting telehealth suitability criteria on reviews (X 2 (1) = 19.6*, p < 0.001). Eighteen percent of patients required wound-related hospitalisation during their outpatient admission. Telehealth guidelines identified patients suitable for telehealth, although the proportion of patients was small. Telehealth was mostly utilised for nurse-led telephone calls in patients with improving wounds. Future research into use of telephone review for clinical standards of wound care is warranted.
FreshRSS 