Conectar
To examine triggers, responses, and outcomes for patient-related violence and/or aggression events during acute hospitalisation.
This was a descriptive observational study undertaken at two healthcare organisations.
Pre-existing data were extracted from organisational incident reports and individual medical records during a retrospective period (1/1/2023 to 30/6/2023) and a prospective period (7/6/2024 to 16/11/2024). Violence and/or aggression events requiring an organisational response that involved patients hospitalised in general ward areas at a metropolitan (Site A) and a regional (Site B) site were included. Data were analysed using descriptive statistics and content analysis.
The sample included 100 retrospective cases and 42 prospective cases. The most prevalent causes for hospitalisation related to a medical or mental health condition and dementia. Confusion and irritability were the most common forms of behaviour of concern prior to the event. Physical restraint was utilised more frequently in the prospective period compared with the retrospective period. Chemical restraint was used in approximately half of the cases in both study periods. A form of physical violence was the most prevalent behavioural symptom in both periods, followed by verbal aggression and inability to be re-directed.
Patients with a pre-existing medical condition, confusion and/or dementia are frequently involved in violent and/or aggressive events in ward settings. Physical and chemical restraints are commonly used to manage violence and aggression.
Alternative strategies are needed to manage occupational violence and aggression to minimise the need for physical and/or chemical restraint.
This study addresses a gap in evidence regarding triggers, responses and outcomes for patients exhibiting violence and aggression in ward settings during hospitalisation. Patients with dementia, confusion and irritability frequently exhibit behaviours of concern, exposing healthcare workers to potential physical and psychological harm.
STROBE checklist.
This study did not include patient or public involvement in its design, conduct, or reporting.
The study explored patient experiences of the Call for a Kit (CFAK) intervention, a community-based initiative designed to improve bowel cancer screening uptake and examined the mechanisms that may support participation among non-responders.
A convergent parallel mixed-methods design was employed, combining quantitative surveys and qualitative interviews.
The evaluation was conducted in general practices across Lancashire and South Cumbria, Northwest England, where CFAK clinics were delivered by an external health promotion team based within the Community Voluntary Services. These clinics target practices with low screening uptake.
A total of 113 CFAK attendees aged 54 and above, and who had missed their most recent screening invitation, completed a patient experience survey. 12 participants were purposively sampled for follow-up interviews.
Statistical analyses examined associations between patient experience and screening behaviours, including kit ordering and intention to complete the screening kit. Thematic analysis explored barriers and facilitators to participation, as well as experiences of CFAK clinics.
Patient experience scores were significantly higher among women than men and were positively associated with intention to complete the kit, though not with kit ordering. Qualitative findings indicated that CFAK addressed key barriers such as low awareness, confusion and emotional discomfort by providing personalised education, reassurance and culturally sensitive support. Participants particularly valued the relational aspects of the intervention, including the face-to-face delivery and communication in preferred languages.
CFAK clinics appear to enhance psychological capability and motivation for bowel screening by offering tailored, inclusive and supportive care. These findings highlight the value of patient-centred approaches in addressing inequalities in cancer screening and offer insights for the design of future community-based interventions.
While almost half of older adults admitted to hospital are prescribed potentially inappropriate medicines, less than 1% have a medicine proactively deprescribed during admission in the UK. The CompreHensive geriAtRician-led MEdication Review (CHARMER) intervention is designed to address geriatricians’ and pharmacists’ barriers and enablers to deprescribing. The CHARMER definitive trial will evaluate effectiveness, cost-effectiveness and safety.
A stepped-wedge cluster randomised controlled trial will be conducted in 20 hospitals in England, with four hospitals in reserve. All hospitals will collect baseline data. Every 3 months, five hospitals will be randomised to receive the intervention. The intervention, implemented by a local project manager, comprises a hospital action plan to set deprescribing as an organisational goal; workshops for pharmacists and geriatricians to change beliefs about deprescribing; weekly briefings between geriatricians and pharmacists to discuss opportunities for deprescribing; benchmarking reports to compare deprescribing performance across participating hospitals. With an average of 200 patients admitted and discharged during each step, the study will have 89.5% power at 5% significance level and intra-class correlation coefficient of 0.05 to detect a 3% difference in 90-day re-admission rate from 16.7% versus 13.7%. Anonymised routinely collected data, including readmissions, will be obtained for all patients admitted during the study period. Enhanced data collection periods of 1 month during control and intervention periods will be used to recruit patients and data for secondary outcomes and process evaluation.
A stepped-wedge design enabled a smaller number of hospitals and patients to be included than a traditional cluster-randomised design. The complexity of intervention implementation necessitated a project manager in addition to the principal investigator responsible for trial conduct. Using routinely collected data for the primary outcome measure should ensure that the trial has sufficient power on completion. Planned enhanced data collection for short periods of time improves trial efficiency.
The experiences of people from ethnic minority backgrounds living in care homes—A qualitative systematic review.
Despite the increasing need for older people from ethnic minority backgrounds to be able to access good quality, culturally competent care home provision, globally, there is an absence of literature exploring care home residents' perspectives. This study conducted a systematic review, identifying and synthesising qualitative evidence, which explored the experiences of residents', and their families, from ethnic minority backgrounds, who live in care home settings.
A qualitative systematic review.
Nine electronic databases, MEDLINE, Nursing and Allied Health, CINAHL, ASSIA, AMED, Sociological Abstracts, PsycINFO, Web of Science, SCOPUS, were systematically searched for research published after 2005 until 2025.
This systematic review of qualitative studies was conducted in accordance with The PRISMA 2020 (Preferred Reporting Items for Systematic Reviews and Meta-analyses) statement. Studies were appraised for quality based upon validated critical appraisal tools from the Joanna Briggs Institute. Qualitative data were extracted and synthesised using reflexive thematic analysis.
Sixteen studies were identified from the international literature that explored care home experiences from the resident's and families' perspectives. Three key themes were extrapolated: Patter, which includes how cross-cultural communication skills and language affect care experiences; Place, which includes the care home environment, the multi-ethnic environment, and quality of care; and Person, which encompasses the individual's culture, values, beliefs, food, and family.
There is limited literature from the UK and low-to-middle income countries exploring care home residents' perspectives on care provision. Key components of culturally competent care include culturally sensitive communication, adaptable environments that support residents' chosen lifestyles, and inclusive, family-centred approaches to living well.
For nurses within the adult social care sector, to recognise the need for further research, education, and policy initiatives aimed at enhancing the care home provision for people from ethnic minority groups.
There was no patient or public contribution.
To measure patients' views of nurses' communication and interpersonal skills during acute hospitalisation.
This was a descriptive cross-sectional study.
From January to June 2024, a convenience sampling approach was used to recruit patients hospitalised in acute care wards across two healthcare organisations in regional Victoria, Australia. A self-report survey, the Communication Assessment Tool for Nurses, included 15 items that measured patients' opinions about the quality of nurses' communication using a 5-point scale. Data were analysed by descriptive and univariate statistics and logistic regression.
The sample included 204 participants. Higher ratings were found for respectful care: ‘Treated me with respect’ and ‘Showed care and concern’. Lower ratings largely related to shared decision-making: ‘Encouraged me to ask questions’, ‘Informed me about my plan of care’, ‘Involved me in decisions as much as I wanted’ and ‘Showed interest in my ideas about my health’. Logistic regression revealed lower ratings for the quality of nurses' communication based on longer hospital stay for items related to greetings and shared decision-making.
Whilst this study found that patients perceive a high quality of respectful nursing care, the findings underscore the need for communication skills training to enhance shared decision-making by nurses. Consideration is needed regarding how nurses are prepared to engage in shared decision-making with patients during acute hospitalisation, particularly for longer hospital stays.
This study addresses a gap in evidence regarding patients' perceptions about the quality of nurses' communication during acute hospitalisation in the Australian context. Whilst they perceive that nurses communicate in a respectful and caring manner, opportunities for shared decision-making may not be capitalised on. Hospital managers and nurse academics should develop interventions to address essential communication skills.
This study did not include patient or public involvement in its design, conduct or reporting.
Pressure injuries present significant challenges in clinical care, leading to severe complications such as infection, pain and delayed wound healing. They are a common chronic wound that contribute to increased morbidity, prolonged hospital stays and substantial healthcare costs. Despite national efforts to enhance chronic wound management, development of optimal treatment strategies remains a priority. The Pressure Injury Treatment Advisory (PITA) Quick Guide was developed to provide an evidence-based guide to support clinicians in pressure injury management. A survey was conducted to evaluate clinician perspectives on the usability and practicality of the Guide in acute care, residential aged care and community settings. A post-test survey was conducted on a convenience sample of healthcare professionals from three healthcare settings across metropolitan, regional and rural Australia. The survey included 5-point Likert-scale items assessing ease of use, effectiveness and integration with workflows. Three hundred and two responses were received (66.7% response rate). Clinicians expressed overwhelmingly positive perceptions, with over 95% agreeing or strongly agreeing on the guide's utility and effectiveness. No respondents strongly disagreed with any item. Residential aged care and rural clinicians rated the tool slightly higher than acute care and medical clinicians. The PITA Quick Guide was well-received across all settings, demonstrating strong potential to enhance evidence-based pressure injury management.
Identify and describe patient engagement interventions used to improve medication management in older adults during transitions of care.
A mixed-methods systematic review.
A comprehensive search of all study designs was conducted. Studies were categorised using the ladder of patient and family engagement, a framework that positions engagement from low (passive) to high (active partnership) patient engagement.
Six databases were searched from inception to April 2024.
The search yielded 29 reports, with 25 classified as studies. Most interventions (n = 19, 76%) were low-level interventions that comprised informing patients in a passive manner. Interventions that facilitated high-level engagement (n = 6, 24%) where patients were integrated in the decision-making process were associated with consistently improved patient and healthcare long-term outcomes.
While low and high-level engagement interventions were associated with significantly decreased hospital readmission rates, high-level interventions consistently demonstrated positive patient outcomes. Interventions supporting older adults beyond discharge achieved meaningful and lasting patient and healthcare outcomes for older adults.
Findings provide clinical reference for designing engagement interventions, highlighting long-term benefits of partnership-based approaches and continuity beyond discharge.
Engagement in medication management during transitions of care varied significantly. High-level engagement was consistently linked to improved patient and healthcare outcomes but was often resource intensive. This review identifies the need to design balanced interventions that align with the preferences of older adults and real-world contextual healthcare settings.
PRISMA guidelines.
No patient or public contribution.
PROSPERO (registration number CRD42024557385).
To propose a conceptual model of dignity-centred care for hospitalised older adults using Levine's Conservation Model as a theoretical framework.
A discursive approach.
Data were obtained from an extensive search of five databases and grey literature without date restrictions for information on patient dignity, dignified care for hospitalised older adults and the Levine Conservation Model.
Dignity is a multifaceted concept encompassing an inherent self-worth and self-worth acquired through personal accomplishments and associations. Hospitalised older adults are at risk of dignity erosion due to complex health conditions, poor healthcare professional- patient communication, inadequate health information, loss of autonomy, inadequate privacy, and infrastructural and systemic barriers. Key components of dignified care include respect, autonomy, privacy, effective symptom management, effective communication and active patient involvement in decision-making. The proposed conceptual model integrates Levine's principles of conservation into a dignity-centred care framework. This model identifies threats to dignity in hospitalised older adults and outlines practical interventions to mitigate these threats in order to maintain or restore dignity.
The proposed conceptual model of dignity in care for hospitalised older adults, underpinned by the Levine Conservation Model, offers a practical framework to guide healthcare professionals in providing care that upholds the dignity and well-being of older adults. The model can serve as a foundation for developing institutional policies and training programmes that reflect the multidimensional nature of dignity in care for older adults.
The study addressed both the conceptual ambiguity and skills gap surrounding dignity-centred care for older adults by offering a practical guide for integrating dignity-centred principles into routine clinical practice. The findings hold substantial relevance for healthcare practice, providing a structured, theory-informed model to advance dignity-centred care and protect the dignity of hospitalised older adults.
Not applicable.
Type 2 diabetes mellitus (T2D) and metabolic syndrome (MetS) have reached epidemic proportions for Indigenous populations globally. In Australia, disproportionate rates of T2D and MetS are inextricably tied to the experience of colonisation. As part of a growing shift towards strengths-based, Aboriginal-led initiatives, this project sought to co-design and assess the feasibility of a metabolic remission initiative, whereby Aboriginal people living on Ngarrindjeri Ruwe (Country) are supported to adopt a low-carbohydrate diet.
This 28-week pilot takes the form of a non-randomised stepped-wedge design. Aboriginal adults (≥18 years) living on Ngarrindjeri Ruwe with T2D or MetS will be recruited to two sites in rural South Australia. Participants will transition through three phases (control phase, remission phase and maintenance phase) with repeated measures taken across five key time points (T1–T5). While centring on the adoption of a low-carbohydrate diet, participants will be equipped with continuous glucose and ketone monitors and meal boxes and offered ongoing support through weekly to fortnightly check-ins. The primary outcome is to assess the feasibility of Nra:gi Ya:yun in preparation for a large-scale clinical trial of similar design. Feasibility will be assessed through recruitment, retention and adherence rates. Self-reported dietary recall, out-of-pocket food costs and national pharmaceutical and medical benefits scheme data will also be examined. Qualitative data obtained using the Aboriginal research method of yarning will aid analysis and interpretation of results. Clinical measures (such as blood pressure, weight, waist circumference, capillary ketones and capillary glucose) and venous blood draws will assist in the evaluation of our secondary outcome, namely the initiatives’ preliminary effect on participant metabolic health.
Findings will be disseminated to Community, participants and policymakers in the form of digital posters, manuals, infographics and peer-reviewed publications. Lessons from this study have the potential to provide insights and benefits to Australian public health policy and research, as well as Indigenous populations globally who face similar metabolic challenges. Findings will be used to advise on an implementation strategy for a large-scale clinical trial. Pilot trial approved by the Aboriginal Health Research Ethics Committee (HREC), Flinders University HREC and Southern Adelaide Local Health Network HREC.
Pilot prospectively registered with the Australian and New Zealand Clinical Trials Registry ACTRN12624001019594.
This study engaged key stakeholders—older adults, family caregivers, home care support workers, nurses, and home healthcare leaders—to explore perspectives on essential components and integration into home care models, and to explore the role of their technology readiness for health smart homes adoption.
A qualitative methodology with a quantitative component, early-phase exploratory design.
Semi-structured interviews underwent qualitative thematic analysis, with cross-case analysis comparing stakeholder perspectives to identify convergences and divergences. Descriptive statistics were used to analyse Technology Readiness Index (TRI 2.0) survey data to provide background and context to the qualitative findings.
Among 18 participants—older adults (n = 6), family caregivers (n = 2), nurses (n = 7), and support workers/healthcare leaders (n = 3)—findings reflected optimism for health smart home adoption and its potential to support ageing in place. Nurses and care workers saw health smart home as a tool for improving care coordination and quality of life. Key adoption considerations included education, data visualisation, privacy, and security. Technology readiness scores were moderate, with nurses scoring highest (3.52), followed by caregivers (3.41), support workers (3.13), and older adults (3.10).
While stakeholders were open to integrating health smart home into home care, concerns around usability, security, and training must be addressed to facilitate adoption.
Findings suggest that while health smart home technology holds promise for enhancing ageing in place, varying levels of technology readiness across stakeholders highlight the need for tailored education and support strategies to ensure successful implementation.
Despite a strong preference for ageing in place among older adults, integrating health smart home technologies into home care remains challenging. Key issues include ensuring intuitive functionality, protecting privacy, and clarifying the roles of caregivers and healthcare professionals in a technology-enhanced care model. This study addresses the critical gap in understanding how health smart home solutions can be effectively tailored to support the diverse needs of older adults, family caregivers, and home care nurses and support workers.
Stakeholders were generally optimistic about health smart home technologies supporting ageing in place and improving quality of life. Nurses and support workers highlighted the need for tailored data visualisations, alert parameters, and clear role guidelines. A novel finding was that older adults and family caregivers viewed health smart home as a way to reduce intrusive monitoring, promote independence, and maintain a familiar living environment. Family caregivers valued the ability to stay involved remotely through activity data, offering reassurance and peace of mind. Across all groups, privacy safeguards were seen as essential, with strong concerns about data security, transparent usage policies, and user control over data sharing.
Findings have implications for community-dwelling older adults, family caregivers, home care professionals, researchers, and technology developers. Insights from this study can inform the design of user-friendly health smart home technologies, shape future research, and guide tailored implementation strategies in home care settings.
An advisory group of community-dwelling older adults in Western Australia provided input on study design and methodology. Their recommendations led to the use of one-on-one interviews to ensure accessibility and relevance for older adults when exploring technology readiness and smart home integration. While the advisory group did not contribute to the data itself or its analysis, their feedback shaped the method of engagement to ensure its relevance and accessibility to potential participants.
This work aimed to explore barriers to pessary self-management and co-create strategies to address these.
Participatory Action Research.
In October 2024, eight pessary-using women living in the United Kingdom participated in cooperative inquiry, discussion and co-creation of strategies in two virtual workshops.
Pessary using women who participated in this research identified challenges affecting willingness to self-manage a pessary and proposed solutions to address these and better support women. Pessary practitioners should assess physical capabilities, consider softer, more malleable pessaries, and explore the possibility of a pessary applicator. Peer support was seen as empowering, enabling self-advocacy and improved care; therefore, establishing peer networks was prioritised. Major barriers included difficulty navigating services and limited access to a full range of pessaries, leading some women to buy devices online without medical oversight, creating a two-tier system based on ability to pay. The group called for improved, standardised pessary care, and for self-management to be reframed to avoid women feeling ‘fobbed off’ through better follow-up, positive language, and compassionate care.
The group identified strategies to address barriers to pessary self-management which require further exploration. Pessary practitioners have a responsibility to listen to these voices and take steps to improve care for women in the future.
To support women's willingness to self-manage their pessary, pessary practitioners should consider and support women to overcome physical and emotional barriers; improve information provision; maximise social support; boost women's perceived self-efficacy; reframe pessary self-management and ensure robust, accessible follow-up is in place. This will ensure pessary-using women are supported to make an informed decision about pessary self-management. This research offers pessary practitioners insight into barriers women perceive to pessary self-management and guidance as to how women can be supported to self-manage their pessary.
Only 21% of women are willing to self-manage their pessary. Therefore, this research aimed to co-create strategies to better support women to self-manage their pessary and overcome barriers to willingness. Women reported individual, societal and service factors which affect willingness to self-manage a pessary. These research findings should be translated into clinical practice and care delivery for pessary using women in both a community and hospital setting.
COREQ (COnsolidated criteria for REporting Qualitative research) Checklist.
Patients and members of the public were involved in research prioritization, study design, data analysis, interpretation of findings and dissemination.
Study not registered.
Limited literature has focused on people with cancers' preference for care providers in scenarios where trade-offs may have to be made.
To report the results of a comprehensive search and synthesis of discrete choice experiments or best-worst scaling studies (± willingness to pay estimates) in scenarios involving cancer nurses, with a focus on: (1) preferred care provider; and (2) relative importance of attributes of care provision for people with cancer.
A search was conducted across: CINAHL, Cochrane Central Register of Controlled Trials, EconLit, Medline, PsycINFO, Scopus, Web of Science Core Collection, and Google Scholar for discrete choice experiments published between January and July 2025. Data were extracted and appraised by two authors. Results were narratively synthesised.
Of 461 studies screened, 11 were included, published in Australia (n = 3), UK (n = 3), and China (n = 5) including people with breast (n = 4), gastric (n = 4), prostate (n = 1), or mixed cancers (n = 2). In six studies exploring scenarios of follow-up care (i.e., survivorship/surveillance), cancer medical specialists were the preferred care provider, followed by cancer nurses, and then general practitioners. In four of the five studies of supportive care scenarios (i.e., diet and exercise advice, anxiety and depression screening), cancer nurses were the preferred care provider, followed by allied health professionals, then cancer medical specialists. The highest WTP estimate was $US226.15 for a medical specialist to provide follow-up care. For supportive care, the highest WTP was $US137.52 for a cancer nurse to provide diet-based lifestyle advice post-treatment for breast cancer.
Cancer nurses are highly valued by people with cancer, particularly for supportive care provision. Opportunities exist for an increase in cancer nurse specialists with expanded scope of practice, to support the preference of people with cancer to have cancer medical specialists, or cancer nurse specialists provide expert cancer follow-up care.
Employees of a cancer patient advocacy group were involved in the design of the study, interpretation of the data, and the preparation of the manuscript. No patients were involved in this work. However, this systematic review prioritized patient voices by including studies that reported on the preferences of people with cancer.
The aim of this scoping review was to identify factors associated with delayed initiation of end-of-life care for adult patients with cardiovascular disease in critical care settings.
Scoping review.
This scoping review was designed according to the Joanna Briggs Institute methodology. Included articles were uploaded and examined in Covidence.
A systematic search of bibliographic databases (CINAHL, Medline and Embase) and Google Scholar was performed to identify relevant literature between January 2003 and April 2025. Key search concepts included ‘end of life’, ‘cardiac’ and ‘critical care’.
A total of 9430 articles were initially identified. After removing 7750 irrelevant articles, 207 full-text articles were assessed for eligibility. A total of 34 articles were included in the final review. Four major themes were identified: (1) confidence in communication regarding end of life; (2) transition from active therapies to end-of-life care; (3) role clarity in the initiation and provision of end-of-life care; and (4) breakdown in the shared decision-making process.
Delayed initiation of end-of-life care for patients with cardiovascular disease in critical care settings could be mitigated through training to improve confidence when discussing end of life with patients and families, and utilisation of prognostic prediction assessment tools. Increased focus on inter-professional collaboration and shared decision-making in family meetings may reduce indecision at end of life.
The results were reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews.
This study did not include patient or public involvement in its design, conduct or reporting.
The aim of this systematic review was to assess and synthesize the global evidence on existing general dementia training and education for the social care workforce.
Mixed-methods systematic review.
Systematic searches on five databases (PubMed, APA PsychINFO, CINAHL Plus, Scopus, Web of Science) were conducted for articles published between 2010 and July 2024.
Each abstract and full text was screened by two research team members, with conflicts of inclusion dissolved by a third team member. Data were extracted and studies narratively synthesized by the group into comparisons of content, delivery mode, workforce and outcomes/impact.
Twenty-seven studies from 13 mainly high-income countries were included in this review. Most studies provided training to care home staff, with studies using remote, in-person and blended training delivery modes. While the focus was on generic dementia education, various interventions have been evidenced in the social care workforce, to different effects. Most changes in outcomes were reported for staff knowledge and confidence, while evidence on impacts on people with dementia is limited and mixed.
There are various types of in-person and remote dementia training available for the social care workforce, with overall positive impacts on knowledge and change in care delivery. Evidenced interventions need to be implemented across countries and have the potential to improve dementia knowledge, particularly in lower- and middle-income countries where evidence and the social care workforce are limited.
Findings provide clear recommendations on the value and benefit of diverse dementia training on the social care workforce, care delivery and limited but emerging evidence on service user outcomes. Nurses are key parts of the staff working in social care settings, including care homes and would thus benefit from the identified dementia training.
Two former unpaid carers and three voluntary sector staff helped interpret the findings and reviewed drafts of the manuscript. They are co-authors.
To explore the key factors influencing nurses' capability, opportunity and motivation to offer the choice for self-collection for cervical screening within rural primary care services, following a national policy change in Australia.
A qualitative study informed by implementation and behavioural change frameworks.
Primary health nurses working in Victoria were invited to participate in semi-structured interviews via video or telephone between December 2022 and March 2023. Eighteen nurses from 18 clinics participated. Interview data were analysed following a Framework analysis approach, and themes were mapped to the COM-B model.
Nurses were highly motivated to offer the choice for self-collection due to perceived advantages for their patients and potential opportunities for reaching people hesitant to screen. There was variation in how nurses offered this choice, and to whom. Some nurses were concerned about lost opportunities to visualise the vulval area or cervix, or to have broader health and wellbeing conversations with patients. Views were mixed about how self-collection would impact nurse roles, and several external factors were impacting their opportunities as cervical screening providers.
Appropriately trained nurses have the capability and motivation to incorporate the choice for self-collection within their screening practice; however, their opportunity to maximise equity and increase participation is impacted by funding models and structures that limit their autonomy.
People living outside major cities experience greater healthcare inequities. Australia introduced access to the choice for self-collection for all eligible individuals in 2022, in part to achieve greater equity in the national screening program. Nurses can play a key role in program delivery. Understanding how they incorporate self-collection into their practice, and the key factors influencing implementation in rural primary care settings, can inform future program implementation and improve outcomes for patients.
We have adhered to COREQ reporting guidelines.
This study did not include patient or public involvement in its design, conduct or reporting.
FreshRSS 