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Ethnic minoritized women face cultural and systemic barriers in accessing antepartum and intrapartum care. Healthcare providers play a pivotal role in addressing these challenges, but their perspectives and experiences in delivering culturally competent care remain underexplored.
To synthesise healthcare providers' experiences and perspectives on providing culturally competent antepartum and intrapartum care for ethnic minoritised women.
A qualitative meta-synthesis study design was employed. Six electronic databases were searched from their inception date till January 2025. The included studies were assessed using the method of the Critical Appraisal Skills Programme tool, and findings were meta-synthesised using Sandelowski and Barroso's six-step approach. This review was registered via the International Prospective Register of Systematic Reviews.
Overall, 38 studies were included, and three themes emerged. The first theme revealed how providers' biases and professional training distorted their ability to understand and respect cultural practices. The second theme underscored the impact of systemic barriers such as time constraints, resource scarcity and lack of representation among providers. The final theme highlighted healthcare providers' aspirations for improved communication, targeted training and guidance on building trust to enhance care delivery.
Healthcare providers encounter notable challenges in delivering culturally competent antepartum and intrapartum care, but remain hopeful about bridging gaps in communication and understanding. Practical recommendations include implementing mandatory cultural competency training at all levels of healthcare professional education, increasing resources for interpreters and cultural liaisons and fostering diversity within the healthcare workforce. Future research should explore patient-centred interventions and systemic reforms to improve care for ethnic minoritised women. These findings highlight the need for policies and practices that empower providers to deliver equitable, culturally respectful antepartum and intrapartum care.
No patient or public contribution.
To consolidate and synthesise the literature reporting perceptions of nurses and nursing students regarding evidence-based nursing.
Qualitative systematic review.
Seven electronic databases (Cumulative Index to Nursing and Allied Health Literature, Embase, ProQuest Dissertations & Theses Global, PsycInfo, PubMed, Scopus and Web of Science) were searched from their respective inception dates to January 2025.
The Preferred Reporting Items for Systematic reviews and Meta-Analysis guidelines guided this review. The quality of included studies was assessed using the Critical Appraisal Skills Programme tool, and data were synthesised thematically using Sandelowski and Barroso's two-step approach.
Thematic analysis of the 19 included studies, published from 2007 to 2025, identified three key themes: (1) Advancing nursing through evidence, (2) Personal, structural and systemic challenges and (3) Promoting a new evidence-based nursing culture.
Evidence-based nursing can elevate nursing care standards and enhance patient outcomes. Numerous factors that encourage and hinder the implementation of evidence-based nursing among nurses and nursing students were reported.
This review suggests the need to incentivise nurses to champion evidence-based nursing initiatives, provide nurses and nursing students with continuing education, and develop updated evidence-based nursing guidelines. These strategies could help in cultivating a supportive evidence-based nursing workplace culture and improving the implementation of evidence-based nursing.
Valuable insights into the facilitators and barriers associated with the implementation of evidence-based nursing were reported by nurses and nursing students—the key personnel responsible for practising evidence-based nursing. Future research could be undertaken to explore the perceptions of nurses and nursing students across varied cultural settings and in underrepresented regions.
The Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines.
This study did not include patient or public involvement in its design, conduct, or reporting.
To explore the experiences and perceptions of Singaporean parents in managing feeding difficulties among children with developmental disabilities.
A descriptive qualitative study design was used.
Twenty parents were recruited via convenience sampling from a paediatric feeding clinic in a public hospital in Singapore between July and October 2024. One-to-one interviews were conducted using a semi-structured interview guide. Thematic analysis was used to analyse the data.
Four themes were identified: (1) Feeding as a ‘guessing’ game; (2) mutual understanding within the family and community; (3) beliefs regarding developmental disabilities and feeding difficulties; and (4) challenges in accessing adequate support. There were a total of nine subthemes supporting these themes.
This study revealed that parents of children with developmental disabilities faced challenges in adjusting to their child's feeding preferences, dealing with conflicting views on feeding practices among caregivers, and accessing adequate support. Parents also valued instrumental support from grandparents and domestic helpers, as well as emotional support from online peers. Additional research and targeted interventions are needed to better support parents of children with developmental disabilities in managing feeding difficulties.
Policies should facilitate the provision of feeding-specific resources, treatment, and education for parents. Additionally, healthcare providers should proactively assess feeding-related concerns and address misconceptions to enhance parental awareness of feeding difficulties and how they can improve the feeding practices of their children with developmental disabilities. Future research should obtain a more in-depth understanding of how differing beliefs in feeding difficulties between parents can impact the child's developmental outcomes, as well as the support and resources that may address feeding needs in these children.
This study followed the reporting guidelines outlined by the Consolidated criteria for Reporting Qualitative (COREQ) research checklist.
This study did not include patient or public involvement in its design, conduct, or reporting.
At-risk mothers experience disproportionately higher rates of antenatal depression and anxiety, which can hinder mother–infant bonding and adversely affect infant socioemotional development. Despite growing evidence on postpartum mental health, antenatal risk factors among psychosocially vulnerable mothers remain underexplored, particularly in multi-ethnic Asian settings.
To identify factors associated with antenatal depression, anxiety, and maternal–fetal bonding among at-risk mothers.
This cross-sectional observational study was nested within an ongoing randomised controlled trial. Two hundred at-risk mothers, defined as single, of low socioeconomic status, referred for psychosocial support, at risk of depression, with adverse childhood experiences, or with a fetus with a congenital malformation, were recruited from outpatient obstetric clinics between February and September 2024. Participants completed online self-administered questionnaires assessing antenatal depression, anxiety, perceived stress, social support, parenting self-efficacy, and maternal–fetal bonding. General Linear Models were used to analyse data and identify factors associated with depression, anxiety, and bonding.
Higher perceived stress was associated with increased depression (β = 0.28, p < 0.001) and anxiety (β = 1.28, p < 0.001) and poorer bonding (β = 0.08, p = 0.02), while greater social support predicted lower anxiety (β = −0.31, p < 0.001). Higher parenting self-efficacy was linked to stronger bonding (β = −0.09, p = 0.06). Younger mothers (β = −2.68, p = 0.025) and Indian mothers (β = 7.46, p = 0.017) were particularly vulnerable to anxiety, whereas post-secondary education was protective against depression (β = −1.44, p = 0.02). Model fit ranged from 0.14 to 0.65.
Perceived stress, social support, and parenting self-efficacy significantly influenced antenatal mental health and bonding in at-risk mothers. These findings underscore the need for culturally sensitive, nurse/midwife-led interventions that integrate early screening, stress reduction, and empowerment strategies within routine antenatal care to strengthen maternal mental health and early bonding outcomes.
(1) Nurses and midwives play a critical role in screening for antenatal depression and anxiety in mothers with risk profiles highlighted in this study. (2) Culturally responsive nursing practice that demonstrates sensitivity towards sociocultural pressures is needed to provide individualised care. (3) Integration of digital and community-based antenatal education programs could provide more equitable access to care for at-risk mothers who may face barriers to in-person care.
(1) Despite having a higher susceptibility for antenatal mental health conditions, risk factors for antenatal depression, anxiety, and maternal–infant bonding have been underexplored in at-risk mothers. (2) Antenatal stress and anxiety are universally associated with depression across risk groups, while maternal self-efficacy and perceived social support serve as key protective factors. (3) The findings from this study suggest the need for early screening and nurse-led interventions that support maternal parenting self-efficacy and stress management to improve maternal mental health outcomes among at-risk mothers.
STROBE reporting checklist.
No patient or public contribution.
To examine the perceptions of nurses receiving the Ontological Coaching among Nurses (OCN) intervention in Singapore.
Descriptive qualitative.
Convenience sampling was used to recruit 34 nurses who received OCN intervention and three coaches who provided the intervention. Written informed consent was obtained, and semi-structured, one-on-one interviews were used to collect data, which were then transcribed verbatim. Thematic analysis was used to analyse the data.
Three themes with nine sub-themes were identified. The main themes were: (1) From ‘Outlet to Confide’: Ontological Coaching as an Enhanced Sense of Fulfilment; (2) Mindset Readiness and Openness for Successful Coaching; and (3) Future Endeavours for Sustainable Coaching Practices.
The findings show that nurses benefitted on personal and professional fronts from receiving coaching. Further evaluations are required to see the potential of using coaching intervention for novice nurses.
As frontline key players in our healthcare system, nurses face a unique set of challenges that impact their psychological well-being. The impact is even more significant for early-to mid-career nurses, leading to poorer quality of life and high turnover rates. This paper highlighted the importance of resources made available to novice and mid-career nurses through coaching. The perceptions of nurses who received coaching intervention serve as a foundation for future studies examining the relevance of ontological coaching in the nursing profession. The nurses' recommendations reported in this paper include building awareness of coaching and incorporating flexibility into coaching programmes to help enhance their readiness to receive and engage with coaching for a more fulfilling coaching experience. Incorporating these recommendations can help inform future coaching-related interventional studies.
This study adhered to COREQ guidelines.
None.
To explore peer volunteers' experiences of delivering online support through SMART to at-risk mothers during the perinatal period, to inform future improvements to mobile-health-application (mHealth app) based peer-support interventions.
Descriptive qualitative research.
The study was conducted between February 2024 and June 2025 in a tertiary public healthcare institution in Singapore. Twenty peer volunteers were recruited via convenience and snowball sampling and participated in individual semi-structured interviews. Interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis.
Four themes were identified: (a) Giving and receiving: the inner world of peer volunteers; (b) Navigating relational complexity in digital peer support; (c) Facilitating connection and continuity in digital peer support; and (d) Building better connections through supportive ecosystems.
Peers reported experiencing reciprocal benefits, such as a sense of fulfilment and achievement, while supporting mothers. Shared experiences and psychosocial vulnerabilities enhanced relatability, reassurance and rapport, which sustained supportive relationships. Challenges encountered by peers highlighted the need for strengthening both intervention design and peer training.
Regular check-ins by programme facilitators, alongside clear information, flexible guidelines and reassurance, can improve peer volunteers' motivation and resilience, thereby ensuring consistent and sustainable support for at-risk mothers.
Examined peer volunteers' experiences in providing online perinatal support to mothers with diverse psychosocial vulnerabilities. Peers offered emotional, informational and practical support, while mothers benefited from learning how peers had coped with their psychosocial vulnerabilities. Shared experiences fostered confidence and reassurance among mothers that they, too could overcome similar adversities. Valuable in providing both medically accurate perinatal information and meaningful social support to perinatal mothers.
The reporting of the study adheres to the standards outlined in the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist.
Mothers and peer volunteers contributed valuable insights and suggestions that helped in the design of the intervention.
To examine the perinatal experiences of at-risk mothers and their engagement with mobile-health-based care.
A qualitative descriptive study.
One-to-one semi-structured interviews were conducted with 30 at-risk mothers, defined as those who were single, had low income, were at risk of depression, had adverse childhood experiences, gave birth to a baby with congenital disorders, or had a history of mental health conditions. Participants were purposively sampled at 6 months postpartum from a tertiary public hospital in Singapore between February and September 2024. Interviews continued until data saturation was achieved, were audio-recorded, transcribed verbatim and analysed using thematic analysis.
The study identified four overarching themes: (a) Me and my baby versus the world, (b) navigating vulnerability and strength in motherhood, (c) generational tensions in modern parenting and (d) reimagining perinatal care for every mother. Across the perinatal period, both intervention and control group mothers reported social isolation, emotional and physical strain and challenges balancing traditional family expectations with modern parenting practices. While mothers in the intervention group described receiving holistic support through the SMART program, those in the control group relied on ad hoc sources of support, such as social media platforms.
At-risk mothers experienced significant challenges during the perinatal period, and those who used a mobile-health-based perinatal intervention felt supported through its peer support and multimedia educational resources.
Mobile-health-based interventions can be integral aspects of standard nursing care. Future researchers must ensure that support rendered to at-risk mothers is culturally compatible and specific to the psychosocial vulnerabilities they experience. Increased contact and funding are vital, whereas artificial intelligence, multiple shared access and health monitoring trackers can shape future perinatal interventions.
A mobile-health-based perinatal intervention can have an enormous positive impact on the psychological well-being of vulnerable mothers worldwide.
This study followed the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist.
This study did not include patient or public involvement in its design, conduct or reporting.
ClinicalTrials.gov (Registration ID: NCT06363019). Registered 4/12/23, first recruitment on 26/02/2024.
To explore the experiences of Singaporean parents managing care for children with underlying chronic medical conditions and Paediatric Feeding Disorders.
Descriptive qualitative.
Data were collected via semi-structured interviews from 4 July 2024 to 4 October 2024. Fourteen English-speaking Singaporean parents were recruited via purposive sampling at an outpatient paediatric feeding clinic in a public tertiary hospital in Singapore. Data were thematically analysed using Braun and Clarke's six-step inductive approach.
Three themes and nine sub-themes were identified. The three themes were: (1) Caregiver's Compass: From Survival to Stability, (2) Navigating Emotional Terrain in Caregiving, (3) Feeding Suck-cess: Systemic, Medical, and Societal Challenges.
The findings reflected the experiences of parents managing Paediatric Feeding Disorders. Parents transitioned from survival-focused to development-focused care, balancing medical guidance with parental instinct while navigating emotional strain, gendered caregiving roles, fragmented healthcare, and cultural conflicts.
Nurses are vital in supporting parents by recognising their lived experiences and caregiving challenges. By incorporating family-centered interventions, nurses can foster shared-decision making and provide culturally sensitive care. Providing tailored education and collaboration with multidisciplinary teams will enable nurses to empower caregivers with essential knowledge and resources, such as accessible and culturally attuned digital health solutions.
This study contributes to the limited body of qualitative research on parents of chronically ill children with Paediatric Feeding Disorders in Singapore and underscores the need for culturally sensitive, multidisciplinary support models to address the manifold responsibilities parents face in managing feeding issues. These insights may have broader implications for diverse populations managing similar caregiving complexities, informing family-centered interventions and healthcare policies that better support parents managing chronically ill children.
COREQ checklist.
This study did not include patient or public involvement in its design, conduct, or reporting.
To explore the perceptions and experiences of parents caring for children with paediatric feeding disorders requiring feeding tubes (PFD-T).
A descriptive qualitative approach was adopted in this study.
Using purposive sampling, 12 parents were recruited from paediatric inpatient wards and the outpatient paediatric feeding clinic at a tertiary public hospital in Singapore. Data collection was done from July to December 2024. Semi-structured one-on-one interviews were conducted with the parents (fathers or mothers) until data saturation. Thematic analysis was used to identify themes from the interview content.
A total of three themes and six subthemes were identified, encapsulating the challenges experienced by parents with caregiving and feeding tube management, as well as the sources of support they had. The themes are: (1) A sense of community, (2) Grieving over the loss of normalcy and (3) Facing the unknown.
Parents in this study felt supported being in a community of other parents with children who have PFD-T. It enabled them to gain valuable information and offered them a space where they felt understood. At the same time, they expressed feelings of guilt and isolation, as the caregiving demands led to limited capacity to cater to or interact with other loved ones. Additional challenges parents faced included transitioning between types of feeding tubes and insufficient support from healthcare professionals.
Ethical approval was obtained from the National Health Group Domain Specific Review Board (DSRB 2024/00064) on 8 May 2024.
This study followed the reporting guidelines outlined by the COnsolidated criteria for REporting Qualitative (COREQ) research checklist.
This study did not include patient or public involvement in its design, conduct, or reporting.
To critically reflect on the 50-year evolution of nursing in Singapore, identify pivotal milestones that have shaped the profession, and discuss strategies to address emerging challenges over the next five decades.
Nursing in Singapore has evolved from a vocational, subordinate role into a respected profession grounded in higher education, evidence-based practice and leadership in clinical and policy domains. Reforms in education, professional identity, workforce development and technology have paved the way for addressing future challenges, including ageing populations, workforce sustainability, technological disruption, leadership equity and global health threats.
Discursive commentary informed by historical analysis, policy developments and published literature, focusing on nursing education, workforce, leadership and digital integration in Singapore.
Strategic investments in education, research and leadership have elevated nursing's status and scope, with milestones such as tertiary education, advanced practice roles and doctoral pathways enabling nurses to serve as autonomous clinicians, researchers and policy leaders. Sustaining progress will require preparing nurses for multimorbidity and healthy ageing, embedding digital competencies while preserving human connection, ensuring inclusive leadership and enhancing global research translation.
Singapore's unique blend of innovation and tradition positions it to lead in shaping the future of nursing. By adopting a systems-level approach that integrates education reform, workforce wellbeing, ethical technology adoption and global collaboration, nursing can transform emerging challenges into opportunities for national progress and international impact.
This commentary offers insights for policymakers, educators and healthcare leaders on how a mid-sized nation can strategically position its nursing workforce for future readiness. Lessons from Singapore's trajectory, particularly in education reform, leadership cultivation and technology integration, apply to other countries seeking to enhance nursing's role in achieving health equity and system resilience.
None.
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