Conectar
To synthesise the available evidence related to nurses' pain assessment and management practices for patients with diagnosed mental health conditions.
Mixed-methods systematic review.
Medline, CINAHL, PsycINFO, SPORTDiscus and Psychology and Behavioural Sciences Collection.
Databases search was conducted in March 2024 and updated in June 2025. Methodological quality was assessed using the Mixed Methods Appraisal Tool. Data synthesis followed the Joanna Briggs Institute (JBI) Manual for Evidence Synthesis.
Of the 1318 eligible studies identified, 12 met the inclusion criteria. The included studies were methodologically robust overall but frequently neglected nonresponse bias and were predominantly conducted in high-income countries, potentially limiting generalisability. The synthesis revealed diverse experiences among nurses in assessing and managing pain in patients with diagnosed mental health conditions. Six key themes emerged: Inadequate and Inconsistent Pain Assessments, Seeing is Believing, To Trust or Not to Trust the Patient, A Balancing Act, Diagnostic Overshadowing and Organisational Restraint and Support.
This review highlights the ongoing challenges nurses encounter in assessing and managing pain and the need for enhanced education and institutional support to strengthen nurses' capacity for effective pain assessment and management in patients with diagnosed mental health conditions. Stigma, both structural and interpersonal, continues to shape clinical decision-making, often leading to under-assessment and inadequate treatment of pain. Integrating clinical judgement with validated pain assessment tools will help ensure nurses provide evidence-based pain management for this often-marginalised group.
Enhancing nursing competence in pain assessment and management for patients with diagnosed mental health conditions leads to more accurate and timely pain relief, significantly improving physical and psychological wellbeing. Effective pain control for this vulnerable group can reduce hospital length of stay and minimise complications, ultimately contributing to better health outcomes and quality of life.
No patient contribution.
What problem did the study address?: Pain is a complex sensation affecting people with diagnosed mental health conditions. They are likely to receive inadequate pain assessment and management due to mental health conditions preventing them from accurately self-reporting their pain and advocating for timely treatment. This review explored the pain assessment and management practices among nurses for patients with diagnosed mental health conditions.
What were the main findings?: Significant barriers were identified, including inconsistent use of pain assessment tools, limited knowledge and confidence among nurses, power imbalances in the nurse–patient relationship, diagnostic overshadowing where physical symptoms are presumed to be related to mental illness, and organisational constraints such as staffing shortages, lack of education and restrictive hospital policies. Strategies to mitigate these barriers are essential to improving pain outcomes and promoting person-centred care for this vulnerable population.
Where and on whom will the research have an impact?: This review highlights the need for more robust approaches to the assessment and management of pain experienced by patients with diagnosed mental health conditions. It underscores the importance of integrating pain assessment, mental health and substance use education into nursing curricula and post-registration nursing practice. The findings highlight the need to update clinical guidelines and organisational policies, ensuring that nurses receive the necessary training, resources and support to provide effective pain management for patients with mental health conditions to enhance the quality of care and promote more equitable health outcomes for individuals with mental health conditions.
Joanna Briggs Institute (JBI) Manual for Evidence Synthesis and Preferred Reporting Items for Systematic and Meta-analysis (PRISMA) reporting guideline for systematic reviews.
None.
We conducted a feasibility study to evaluate the feasibility of recruiting patients to examine the effect of near vision glasses in young infants at risk of cerebral visual impairment.
A three-arm, parallel-group, open-label randomised feasibility trial.
Tertiary neonatal intensive care in London, UK.
We included babies born before 29 weeks of gestation or at full term with hypoxic ischaemic encephalopathy. Babies who needed ongoing inpatient care, with established eye anomalies or with very high refractive errors at baseline (±8.00D) were not included. Infants with retinopathy of prematurity were not excluded.
At 8 weeks corrected age, we allocated 18 infants to wear glasses (+3.00D over full cycloplegic refraction) immediately (intervention 1), 18 to wear the same glasses at 16 weeks (intervention 2) and 19 infants were allocated to standard treatment (no glasses).
Recruitment and retention of study participants (primary), compliance wearing glasses, preferential-looking visual acuity (with glasses) and visual function as determined using A Test Battery of Child Development for Examining Functional Vision at 3-month and 6-month age post-term.
Of 70 eligible families, 55 consented and 34 attended baseline assessments, and 28 completed the study. Non-attendance was due mainly to prolonged inpatient stay, infant health and scheduling conflicts. Glasses were worn for similar periods in each group (Intervention 1: median 2 hours/day (95% CI 1 hour to 4 hours); Intervention 2: median 2 hours/day (95% CI 1.5 hours to 3 hours)). Visual acuity improved from baseline to 6 months. Mean (SE) LogMAR (Minimum Angle of Resolution) improvements were standard care: 0.47 (0.45); intervention 1: 0.66 (0.44); intervention 2: 0.37 (0.36). Among the 29 very preterm infants, there were similar findings: standard care: 0.35 (0.35); Intervention 1: 0.67 (0.47); Intervention 2: 0.34 (0.40). As a functional measure, object permanence was present at the following rates by randomised arm: standard care: 29%; whereas intervention 1: 56%; and intervention 2: 44% (OR intervention 1 vs standard care: 3.13 (95% CI 0.38 to 25.57), ie, not statistically significant).
We demonstrate feasibility for a definitive RCT (randomized controlled trial) with good recruitment and retention and observed potential benefits for vision and development following the dispensing of glasses at 8 weeks post-term age compared with untreated controls. We identified methodological modifications to further improve recruitment processes for a future larger study.
Most patients with health conditions necessitating time off work consult in primary care. Offering vocational advice (VA) early within this setting may help them to return to work and reduce sickness absence. Previous research shows the benefits of VA interventions for musculoskeletal pain in primary care, but an intervention for a much broader primary care patient population has yet to be tested. The Work And Vocational advicE feasibility study tested patient identification and recruitment methods, explored participants’ experiences of being invited to the study and their experiences of receiving VA.
A mixed method, single arm feasibility study comprising both quantitative and qualitative analysis of recruitment and participation in the study.
Primary care.
The study included participant follow-up by fortnightly Short Message Service text and 6-week questionnaire. Stop/go criteria focus on recruitment and intervention engagement. The semistructured interviews explored participants’ experiences of recruitment and receipt and engagement with the intervention.
19 participants were recruited (4.3% response rate). Identification of participants via retrospective fit-note searches was reasonably successful (13/19 (68%) identified), recruitment stop/go criteria were met with ≥50% of those eligible and expressing an interest recruited. The stop/go criterion for intervention engagement was met with 16/19 (86%) participants having at least one contact with a vocational support worker. Five participants were interviewed; they reported positive experiences of recruitment and felt the VA intervention was acceptable.
This study demonstrates that delivering VA in primary care is feasible and acceptable. To ensure a future trial is feasible, recruitment strategies and data collection methods require additional refinement.
Self-care plays a pivotal role in the management of heart failure (HF). Health literacy and empowerment are considered the prerequisites of effective self-care. This project aims to improve self-management in people with HF by describing, analysing and enhancing the communication practices of clinicians and patients to support people with HF to increase their health literacy skills and participate in shared decision-making.
A multimethod research design incorporating an interview component, a concurrent mixed-methods component and a pilot intervention study is used. The study is currently being conducted at two Australian hospitals in metropolitan areas (one public and one private). The interview component involves semistructured interviews with healthcare providers and hospital executives and managers at the participating sites to explore perceived barriers and facilitators to HF self-management and understand the institutional context of HF care. The concurrent mixed-methods components include: (a) tracking and audio recording the clinical interactions of patients with HF (n=30) during their hospitalisation and up to 6 months after discharge and semistructured interviews with the patient (and the carer) and the participating clinician after each clinical interaction and (b) collecting longitudinal survey data (n=180, patients) to track patients’ health literacy, empowerment and self-management over 6 months. The pilot feasibility study includes developing a complex intervention for clinicians and patients and evaluating its acceptability and potential in improving health literacy and reducing readmissions, length of stay and costs.
This study was approved by the Australian Capital Territory Health (2023.ETH.00007) and Edith Cowan University (023–04314-SAUNDERS) Human Research Ethics Committees. Informed consent was obtained and will continue to be sought from all participants. Study results will be disseminated in peer-reviewed journals.
In Australia, aligned to safety and quality standards, the health system implements standardised practices that include patient involvement in nursing bedside handover. Despite this mandate, it remains unclear whether patients are genuinely participating in nursing bedside handovers and whether their perspectives are being considered.
To explore patient perceptions of their involvement in nursing bedside handovers.
A cross-sectional survey study was conducted in two acute metropolitan hospitals in Western Australia from July 2021 to March 2022. The survey administered to patients, comprised three sections: demographic information; involvement in bedside handover; and perceptions of bedside handovers; utilising close-ended and Likert scale questions. Open-ended questions further explored participation in bedside handovers. Descriptive statistics and comparative analyses were performed and responses to open-ended questions underwent summative deductive content analysis.
Of the 390 participants, over half reported five or more bedside handovers (n = 197, 50.7%). Most perceived the importance of (n = 334, 79.0%), and expressed their satisfaction with (n = 327, 89.6%), involvement in bedside handover. Perceptions of handover were mostly positive. There were a few significant differences throughout based on type of hospital, gender and age-group. Open ended responses shared perceptions on the perceived benefits, challenges and barriers and ways to enhance involvement in bedside handover. Patients expressed several challenges, including lack of awareness of their right to participate, the approach of nurses and the timing of handovers as hindering their participation in bedside handovers.
Patients perceived the importance of, were mostly satisfied with, and had positive perceptions of bedside handover. However, several challenges hindered effective patient participation. Further research is needed into bedside handover as it is essential to enhance patient-centred quality care that aligns with national safety and quality healthcare standards.
Understanding the significance of patient involvement in bedside handovers motivates patients to actively share information about their care, leading to increased patient satisfaction and the promotion of patient-centred care. Addressing challenges through targeted strategies can enhance patient participation, communication, increased patient satisfaction and foster a more patient-centred approach to care.
The conduct of this study was supported by the consumer advisory group in the participating hospitals who also reviewed the survey questionnaires and conducted face validity of the survey.
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.
There is a need for early, non-invasive and inexpensive biomarkers for Alzheimer’s disease (AD), which could serve as a proxy measure in prevention and intervention trials that might eventually be suitable for mass screening. People with Down syndrome (DS) are the largest patient group whose condition is associated with a genetically determined increased risk of AD. The REVEAL study aims to examine changes in the structure and function of the eye in individuals with DS compared with those with mild cognitive impairment (MCI) and cognitively healthy control (HC) individuals. REVEAL will also explore whether these changes are connected to inflammatory markers previously associated with AD.
The protocol describes a cross-sectional, non-interventional, single-centre study recruiting three cohorts, including (1) participants with DS (target n=50; age range, 6–60 years), (2) participants with MCI (target n=50; age range, 50–80 years) and (3) HC participants (target n=50; age range, 50–80 years). The primary research objective is to profile retinal, choroidal and lenticular status using a variety of eye imaging modalities and retinal functional testing to determine potential associations with cognitive status. The REVEAL study will also measure and compare established blood markers for AD and proteomic and transcriptomic marker profiles between DS, MCI and HC groups. Between-group differences will be assessed with an independent sample t-test and 2 tests for normally distributed or binary measures, respectively. Multivariate regression analysis will be used to analyse parameters across all three cohorts. Data collection began in October 2023 and is expected to end in October 2025.
The study gained a favourable opinion from Health and Social Care Research Ethics Committee A (REC reference 22/NI/0158; approved on 2 December 2022; Amendment 22/0064 Amend 1, 5 April 2023; Amendment 22/0064 Amend 2; 23 May 2024; Amendment 22/0064 Amend 3; 25 June 2024; Amendment 22/0064 Amend 4; 16 January 2025; Amendment 22.0064 Amend 5; 9 May 2025; Amendment 22.0064 Amend 6; 9 June 2025). The study has also been reviewed and approved by the School of Biomedical Sciences Research Ethics Filter Committee within Ulster University. Findings from the REVEAL study will be presented to academic audiences at international conferences and peer-reviewed publications in targeted high-impact journals after data collection and analysis are complete. Dissemination activities will also include presentations at public events.
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