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To describe the leadership trajectories of graduates of a Doctor of Philosophy in Nursing Education programme in a single university in the Philippines and examine how the doctoral programme influenced these trajectories.
Qualitative design, specifically thematic narrative analysis.
A total of 10 purposively selected graduates of the programme were interviewed with the aid of videoconferencing and life-calendaring methods.
The emerging central narrative theme is transformative potential. Leadership trajectories are characterised by expanding fields of transformative potential from within to beyond their organisations. Doctoral education shapes these trajectories through curriculum-driven capacity building, beyond-curriculum capacity building and character building.
The evolving leadership trajectories of graduates of the Doctor of Philosophy in Nursing Education programme are characterised by expanding and accumulating transformative potential.
The findings can help nursing academic institutions design and improve postgraduate degrees, which will develop transformational leaders in the profession.
What problem did the study address?
This study aims to map and describe the leadership trajectories of graduates of a Doctor of Philosophy in Nursing Education programme.
What were the main findings?
The leadership trajectories of graduates are characterised by expanding and accumulating transformative potential.
Where and on whom will the research have an impact?
The findings can inform the planning, design and evaluation of doctoral nursing degree programmes in higher education institutions, as well as continuing educational programmes for nursing leaders in academic and clinical settings.
Initial findings were sent to the graduates of Doctor of Philosophy in Nursing Education programme to validate the qualitative insights as part of member checking.
The primary barrier to maximizing the benefits of intermittently scanned continuous glucose monitoring (isCGM) is low scan frequency. Higher daily scan frequency correlates with better glycemic control.
To evaluate the effect of a nurse-led educational intervention on scan frequency and behavioral change in adults with type 1 diabetes (T1D) showing low scanning frequency.
In this 12-week quasi-experimental study, adults with T1D using isCGM and low scan frequency participated in a single, individualized, direct education session led by a diabetes nurse educator. The intervention focused on increasing daily scan frequency and supporting patient engagement in self-management.
Thirty-four patients using isCGM participated. Mean daily scan frequency increased from 3.1 to 6.1 scans/day following the intervention. This rise was associated with an 8.0% improvement in TIR. A positive correlation was observed between scan frequency and TIR, with each additional daily scan associated with a 0.51% increase in TIR.
A single, targeted educational session can significantly improve isCGM adherence and glycemic control in adults with T1D and low adherence, supporting its value as a practical strategy in routine clinical care.
The protocol was publicly registered at ClinicalTrials.gov (NCT05570162)
Commentary on: Price O, Armitage CJ, Bee P, et al. De-escalating aggression in acute inpatient mental health settings: a behaviour change theory-informed, secondary qualitative analysis of staff and patient perspectives. BMC Psychiatry. 2024 Aug 6;24(1):548. doi: 10.1186/s12888-024-05920-y.
Implications for practice and research Successful de-escalation of agitation requires being mindful of the content of verbal and non-verbal interactions and is a skill that may not come naturally. Training will require changing caregiver perceptions and local culture; leadership is essential.
Agitation is an acute behavioural emergency requiring immediate intervention in order to avoid further escalation to aggression/violence. Verbal de-escalation involves engaging the patient and helping him or her become an active partner in their evaluation and treatment in tandem with nonverbal approaches, such as voluntary medication and environment planning.
To examine how family caregivers of deceased nursing home residents scored and justified their ratings for each item on the Quality of Dying in Long-Term Care scale and to identify the consistencies and discrepancies between their perceptions and the scores assigned when assessing the residents' end-of-life experience.
A convergent mixed-methods design, comprising a cross-sectional study and a thematic analysis for quantitative and qualitative phases, respectively.
Quantitative and qualitative data were collected simultaneously between May 2018 and February 2019. The two sets of data were analysed separately. For the quantitative component, family caregivers completed the quality of dying in long-term care scale and a single-item question assessing the final month of the residents' life. Descriptive statistics, Mann–Whitney U-tests for comparative analyses and Spearman's correlations were applied to the quantitative data, while deductive thematic analysis was conducted for the qualitative data obtained through semi-structured interviews.
Sixty-nine family caregivers completed the QoD-LTC, and 11 participated in qualitative interviews. The mean overall QoD-LTC score was 39.29 (SD = 7.58). The highest-rated domain was ‘Personhood’ (M = 4.32; SD = 0.68), while the lowest was ‘Preparatory Tasks’ (M = 2.66; SD = 1.26). Interviewed family caregivers reported effective management of pain and other symptoms, satisfaction with the care provided and respectful and appropriate treatment. However, they identified significant shortcomings in communication concerning end-of-life issues, coping with death and advance care planning. Residents with cognitive impairment had significantly lower scores on the ‘closure’ (p < 0.01) and ‘preparatory tasks’ (p = 0.03) domains as well as on the overall QoD-LTC score (p = 0.01).
The findings demonstrate consistency between the quantitative and qualitative data, with high scores reported across most domains of the QoD-LTC scale, with the exception of the ‘Preparatory Tasks’ domain. Cognitive impairment among residents was associated with lower perceived quality of the dying process from the perspective of family members.
Aspects related to closure and preparatory tasks were often overlooked. Strategies to enhance end-of-life communication and advance care planning are needed.
The study adhered to the EQUATOR guidelines. The Mixed Methods Reporting in Rehabilitation & Health Sciences (MMR-RHS) checklist for mixed-methods studies, the STROBE checklist for cross-sectional studies, and the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines for qualitative studies were used for reporting.
No funding was received for the completion of this study.
This paper responds to the recently published article on nurses' turnover intentions and their lived experiences of disempowerment, moral distress and organisational neglect. While the study illuminates important workplace realities, it overlooks the perspectives of nurses who have left not only their institutions but also their countries of origin. From the vantage point of Filipino nurses in the diaspora, the decision to migrate mirrors the dynamic, cumulative processes described in the article. Migration is seldom the result of one critical incident; rather, it arises from entrenched systemic issues—understaffing, lack of respect and persistent undervaluing of nursing contributions—that transcend borders. Diaspora nurses bring with them narratives of resilience, yet their departure reflects health system fragility in their home countries and exposes new challenges in host nations. This commentary highlights the urgent need for global cooperation, stronger leadership and policy innovations that recognise migration as part of the retention equation, not apart from it.
by Sarah Zuern, Bella Romero, Carlos Spichiger, Leandro Ortiz, Alejandro Jerez, Esteban Basoalto, Max Emil Schön, Sigisfredo Garnica
The microsporidium Vairimorpha (Nosema) ceranae is an emerging threat to honey bees (Apis mellifera), known to disrupt gut microbiota and suppress immune responses, potentially contributing to colony losses. Fungal extracts have recently gained interest as sources of bioactive compounds with antimicrobial and immunomodulatory potential. In this study, we explored the effects of different dietary supplements—sugar syrup, HiveAlive™, and a novel Ganoderma australe extract (GanoBee)—on gut bacterial composition and immune-related gene expression in honey bees subjected to experimental exposure to V. ceranae 1 x 104 spores per bee. The GanoBee diet altered the gut microbiota, notably reducing the relative abundance of Rhizobiaceae (Bartonella apis) and increasing Frischella compared to other treatments. While alpha diversity was not significantly affected by diet or exposure to V. ceranae, beta diversity differed significantly in bees fed with GanoBee. Additionally, the expression of the antimicrobial peptide genes abaecin and hymenoptaecin was elevated in both exposed and unexposed bees fed with GanoBee, depending on the sampling day. However, the establishment of V. ceranae infection appeared limited, likely due to low spore viability, and mortality in control bees was higher than expected. The low Vairimorpha ceranae infection levels observed in this study are likely attributable to reduced spore viability caused by storage conditions and/or suboptimal environmental conditions within the laboratory cages. Post hoc analyses indicated that the high viscosity of GanoBee-supplemented diets likely contributed to the elevated bee mortality observed, underscoring a critical limitation of the experimental design related to diet formulation and delivery method. These physical factors complicate the interpretation of treatment efficacy and highlight the importance of optimizing feeding protocols to avoid confounding effects. Despite these constraints, GanoBee demonstrated promising potential as a modulator of gut microbiota composition and immune-related gene expression, supporting the need for further research under improved and carefully controlled experimental conditions.Necrotising soft tissue infection (NSTI) is a progressive disease with a time-dependent prognosis; if not promptly treated, it can lead to significant morbidity as well as mortality. Early and aggressive surgical treatment is mandatory for appropriate management. This study reports the diagnostic and therapeutic pathway, surgical treatment and outcomes in a single-centre series. Data from 40 patients with NSTI treated between 2015 and 2024 were retrospectively analysed for demographic and social information, microbiological results, therapeutic course, clinical outcome and mortality. TC Indication and timing, the role of limb amputation in critical patient survival and reconstruction technique were also reviewed. Fourteen patients (35%) were referred at an advanced stage due to avoidable delay. The mean number of surgical interventions for a single patient was 4. Eight patients (20%) underwent limb amputation. Skin grafts were the most used reconstruction procedure. Seven patients (17.5%) died in the hospitalisation. NSTI is a life-threatening disease requiring prompt diagnosis and treatment within dedicated clinical pathways. Our series highlights the fundamental role of TC in critical patients or unclear diagnosis, and limb amputation as a life-saving procedure even at admission in severe cases.
To propose a normative framework that guides nursing professional organisations to act as human rights intermediaries in the governance of artificial intelligence in healthcare.
Discursive paper.
The paper presents a triaxial framework that conceptualises the role of nursing professional organisations in artificial intelligence governance. The framework consists of a domain axis, which identifies key areas of engagement; a modality axis, which aligns actions with the specific functions of these organisations; and a human rights axis, which defines their role towards rights claimants and duty bearers.
The proposed framework provides a practical tool for nursing professional organisations to strategically plan and implement initiatives to influence the advancement and regulation of artificial intelligence. Its application can help ensure that healthcare innovation is equitable and rights-based.
This paper provides a blueprint for nursing leaders and policymakers to engage proactively with the ethical dimensions of artificial intelligence. It emphasises the salient roles of nursing professional organisations in advocating for the human right to health in a technologically driven healthcare landscape.
This paper addresses the gap in how the nursing profession can systematically engage with artificial intelligence governance. The main finding is a novel framework that provides a structured way for nursing professional organisations to act as human rights intermediaries. This research will have a significant impact on nursing leadership, patient advocacy groups, and policymakers involved in healthcare technology and ethics.
Initial parts of this paper were presented to allied health practitioners via a webinar, providing early feedback and dialogue that informed its development.
Transgender and gender-diverse individuals often face significant barriers to accessing gender-affirming care, such as hormones and/or surgery, leading to poorer mental health, lower quality of life, and higher rates of substance use and suicidal ideation. Vaginoplasty, the most commonly sought genital gender-affirming surgery (GGAS), is desired by over half of all trans women but has been performed in only a minority. This is due largely to limited surgeon availability and long wait times. Peer support has been shown to improve health outcomes and reduce stigma in marginalised populations, including trans communities, but has never been studied for efficacy during the perioperative period of GGAS. Building on priorities identified by multi-stakeholder engagement from the Transgender & Non-Binary Surgery Allied Research Collective, the Support for Transgender and Nonbinary Individuals Seeking Vaginoplasty (STRIVE) study aims to evaluate the efficacy of a centralised peer support and education intervention for patients seeking vaginoplasty, addressing a critical gap in perioperative care.
The STRIVE Study is a pragmatic, multi-site randomised controlled trial enrolling trans adults seeking full depth vaginoplasty. Participants are randomised to one of two arms; enhanced usual care, or a facilitated group intervention. The primary outcome is coping self-efficacy at 6 months, with a secondary outcome of surgical readiness. Primary analysis uses an intention-to-treat approach with linear mixed effects modelling, adjusting for selected baseline values and site. The feasibility evaluation data collected via qualitative interviews will be analysed thematically.
Approvals were granted by the primary site’s Institutional Review Board on 10 May 2024 (STUDY00026957). The trial was registered on 24 May 2024. Results will be published in open access journals and made available to community members in plain language formats.
Low physical functioning and frailty are prevalent in non-geriatric vulnerable populations such as people experiencing homelessness, addiction and mental health challenges. The objective of this study was to explore the feasibility and impact of a targeted exercise intervention with protein supplementation for women experiencing homelessness, addiction and mental health challenges.
Mixed-methods feasibility study.
A women’s-only day service for people with homelessness and addiction issues, in Dublin, Ireland.
Women experiencing homelessness, addiction and mental health challenges.
The intervention was a 10-week low-threshold exercise and protein supplementation pre-post programme (LEAP-W). Qualitative interviews were conducted following the intervention with programme participants and key stakeholders.
The primary outcome was feasibility measured by recruitment, retention, adherence, safety and acceptability, and secondary outcomes measured pre-post intervention change in physical function, pain, nutritional and frailty status, and overall health status.
Overall, 33 participants were recruited. Data generated demonstrated that LEAP-W was feasible by its safety, acceptability and high retention in certain subgroups, and high adherence to the exercise and protein supplement; its impact was demonstrated by pre-post intervention improvement in multiple domains (strength (chair stand test), balance (the single leg stance test), pain and quality of life/mental health (mental component summary of the Short Form-12; 95% CI, p
Targeted exercise interventions with trauma-sensitive, flexible design can be successfully delivered and yield impact in women with complex needs who experience homelessness, addiction and mental health challenges. Service design should be considered when delivering interventions to this population. Further higher-powered longitudinal studies are warranted.
Falls represent the most frequent reason older people are admitted to hospital and significantly increase the likelihood of functional decline, healthcare utilisation and early mortality. The aim of this study is to comprehensively delineate the burden of falls amongst community-dwelling older people in Ireland.
Population-representative analysis of Wave 6 of the Irish Longitudinal Study on Ageing (TILDA) estimating incidence of falls requiring medical attention and emergency department (ED) attendance, fractures and fear of falling over 12 months. Additional data detailing falls-risk increasing drugs (FRIDs) and prior falls were also analysed.
Using Central Statistics Office Census 2022, the population of older people in Ireland was multiplied by the proportion of TILDA participants with each outcome of interest to yield population-level estimates.
Population-representative sample of 2299 (55% female) community-dwelling people in Ireland aged ≥70 years.
Almost 12% (proportion 0.12 (95% CI 0.10 to 0.13)) of participants, corresponding to almost 62 000 older people in Ireland, reported a fall requiring medical attention in 12 months, with 6% (proportion 0.06 (95% CI 0.05 to 0.07)), or over 32 000 people, attending ED due to a fall. Over 3% (proportion 0.03 (95% CI 0.03 to 0.04)) reported sustaining a fracture. Almost half of participants reporting a fall requiring medical attention were prescribed FRIDs, and over half had also reported a fall when assessed at the prior wave of the study (ie, 2 years ago).
The burden of falls amongst community-dwelling older people is considerable; 1 in 8 required medical attention for a fall and 1 in 16 attended the ED with falls over 12 months.
Currently, there is no national falls strategy in Ireland. These findings, alongside our ageing population, underscore the need for strengthened falls-prevention strategies to reduce avoidable morbidity and healthcare utilisation.
This study aims to evaluate a structured nurse-led follow-up programme coordinated by an advanced practice nurse (APN) as an alternative to conventional postdischarge care for patients with heart failure (HF). The main objective is to assess the clinical effectiveness and economic efficiency of the programme using quality-adjusted life years and healthcare costs related to resource use as outcome measures.
A quasiexperimental multicentre study will be conducted including an intervention group and a comparison group of patients discharged with HF from three public hospitals in the province of Málaga, Spain. The intervention group will be followed by an APN using a structured follow-up model, while the comparison group will receive standard care. Sociodemographic, clinical, quality of life, self-care, therapeutic adherence and healthcare resource utilisation data will be collected. The economic evaluation will be conducted from the perspective of the public healthcare system through a cost-utility analysis.
The study protocol has been approved by the corresponding Research Ethics Committee. All participants will provide written informed consent prior to inclusion. The results will be disseminated through peer-reviewed publications and presentations at national and international scientific conferences.
Case reports (CRs) are essential in physiotherapy, yet reporting remains heterogeneous and insufficiently standardised. The 2013 CAse REport (CARE) guideline improves transparency but lacks physiotherapy-specific detail. This study aimed to develop a consensus-driven extension of the CARE reporting guideline to support structured reporting of physiotherapy CRs, encompassing physiotherapy-specific assessments and interventions.
An e-Delphi consensus process study following the ACcurate COnsensus Reporting Document (ACCORD) guidelines.
Online.
Forty-four international experts in physiotherapy practice, research and education, along with six core committee members.
Experts objectively scored items for relevance (5-point Likert scale) and provided open-ended responses for each item of the drafts. Scores and responses were analysed to facilitate iterative refinement of the Physiotherapy CAse REport (PhyCARE) reporting guidelines. Consensus was predetermined at over 70% agreement.
Round 1 had the majority of items achieving ≥70% agreement, except two items that did not meet the threshold were revised and replaced with an alternative. Five new items addressing physiotherapy-specific reporting needs were added, and 10 items were relocated. In round 2, all 35 items across 13 domains achieved 84%–100% agreement. The nomenclature of one domain was revised to ‘Outcomes and Follow-up’. Following two e-Delphi rounds, consensus was achieved, and suggestions from online meeting, piloting led to item rephrasing, after which the PhyCARE guidelines were finalised.
The PhyCARE guidelines have the potential to provide a physiotherapy-specific extension of CARE to support structured, transparent and reproducible reporting of physiotherapy CRs.
Self-harm represents a significant public health concern and is a common reason for contact with urgent and emergency care (UEC) services among young people. Although young people frequently interact with multiple components of the urgent care system following self-harm, there is limited system-level evidence describing patterns of service use, transitions between services and repeat emergency department (ED) attendance. An improved understanding of how young people use UEC services after self-harm is needed to inform the design of more effective and appropriate care pathways.
This protocol describes a prospective cohort study using an extract from the Centre for URgent and Emergency care research database (CUREd+) research database, which comprises routinely collected, linked healthcare data from the National Health Service 111 (NHS 111), ambulance services, urgent care centres, walk-in centres and EDs across Yorkshire and the Humber, England. The study population will include young people aged ≤25 years presenting to UEC services between April 2019 and March 2022 with self-harm coded as the reason for attendance. Analyses will describe the prevalence of self-harm presentations across UEC settings, quantify the proportion of NHS 111 and ambulance contacts resulting in ED attendance within 24 hours and examine factors associated with ED reattendance at 3 and 12 months. Mixed-effects logistic regression models will be used to account for repeated attendances, confounding variables and temporal variation, including changes related to the COVID-19 pandemic. Anticipated analysis period: January 2026–January 2027.
Ethical approval has been granted by the University of Leeds (MREC 22-079 Amd1) and the University of Sheffield (Ref 068194). The CUREd+ research database operates under Research Ethics Committee approval (23/YH/0079) and Confidentiality Advisory Group approval (18/CAG/0126). Individual consent is not required as all data are pseudonymised at source. Findings will be disseminated through peer-reviewed publications, conference presentations and public-facing outputs coproduced with patient and public involvement groups.
The aim of this study was to assess the relationship between nursing workload at the time of intensive care unit discharge and the likelihood of intensive care unit readmission.
This single-center prospective cohort study was conducted at a Belgian academic hospital and included all intensive care unit admissions from June 1, 2021 to May 31, 2022.
The Nursing Activities Score was documented by the nurse responsible for each patient during every shift. Adult patients (≥ 18 years) with intensive care unit stay exceeding 24 h during the study period were eligible for inclusion. Those discharged to another hospital, a nursing home, or their own home were excluded due to the inability to ensure follow-up.
Among the 1293 eligible admissions recorded during the study period, 133 patients (10.3%) experienced readmission. Readmitted patients exhibited a higher prevalence of medical reasons for intensive care unit admission, significantly increased mortality rates, and longer hospital length of stay compared to non-readmitted patients. The average daily Nursing Activities Score did not differ significantly between the two groups. The Nursing Activities Score at intensive care unit discharge was notably higher in readmitted patients, and those with a score above the median at discharge demonstrated an increased risk of readmission within 30 days. In multivariable analysis, a high Nursing Activities Score at intensive care unit discharge was an independent predictor of readmission.
An elevated nursing workload, as indicated by the Nursing Activities Score recorded at intensive care unit discharge, was significantly associated with a higher risk of readmission.
The study examines the relationship between nursing workload at the time of ICU discharge and the likelihood of unplanned readmission. The results highlight the critical role of nursing workload assessment at ICU discharge in capturing the complexity of care requirements patients face at discharge. The results emphasise the importance of revising discharge planning processes, identifying nursing workload as a critical factor in unplanned readmissions.
STROBE guidelines were used for this study.
Not applicable.
by María-Angélica Calderón-Peláez, Myriam L. Velandia-Romero, Jaime E. Castellanos
Zika virus (ZIKV) poses a significant threat to neural tissue, causing substantial damage to unborn children exposed to the virus in utero, with consequences that can manifest even after birth, despite being born with a normal head circumference. Regardless of the extensive research, the interactions between ZIKV and the nervous system cells remain insufficiently understood, particularly regarding how neuronal responses influence broader inflammatory and viral dynamics especially in postnatal stages of development. This study evaluated the susceptibility to ZIKV infection, viral replication, immune response, and survival of neurons, astrocytes and microglial cells during postnatal developmental stages, using both in vivo and in vitro mice models. In vivo, a non-lethal but extensive infection of neurons and microglia was shown. The infection caused a robust but controlled immune response with elevated levels of MCP-1, TNF-α, and IL-6, that prevented severe neuronal damage. In vitro, neurons exhibited high susceptibility to ZIKV, with elevated levels of pro-inflammatory cytokines and IFN-β, indicating a strong inflammatory response. In contrast, astrocytes and microglia displayed varied responses, contributing to a pro-inflammatory feedback loop. These findings offer critical insights into the cellular dynamics of ZIKV infection, enhancing our understanding of its effects during postnatal nervous system development. By clarifying the interactions between ZIKV and neuronal cell types, this study deepens the comprehension of the virus’s pathophysiology and its broader implications for neurodevelopmental outcomes, extending beyond the well-documented association with microcephaly.
FreshRSS 