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Barriers to Women's Leadership in Nursing: A Rapid Evidence Assessment and Proposal for an Integrated Theoretical Framework

ABSTRACT

Aim(s)

This review analyses and synthesises the available evidence on the barriers limiting women's career advancement in nursing. It aims to identify effective interventions to promote gender equity in healthcare leadership through an integrated framework informed by Social Role Theory, Ambivalent Sexism Theory and Theory of Planned Behaviour.

Design

Rapid Evidence Assessment.

Data Sources

The search was conducted on the databases: PubMed, CINAHL Complete, MEDLINE, ApaPsycArticles, ApaPsycInfo between March and May 2025.

Methods

The Population–Exposure–Outcome framework guided the formulation of the research question. Two reviewers independently conducted screening, quality appraisal and data extraction.

Results

Eight studies with heterogeneous research designs were included: four literature reviews, three quantitative studies and one qualitative study. The analysis identified four themes: (1) gender pay gap; (2) gender stereotypes and cultural expectations; (3) systemic barriers: organisational structures and institutional culture; (4) organisational strategies for gender equity and female leadership.

Conclusion

Career advancement for female nurses is limited by systemic and internalised constraints that reinforce vertical segregation. Multilevel interventions are needed to dismantle structural inequalities and reshape gender norms within nursing leadership.

Implications for the Profession and/or Patient Care

Targeted reforms, including transparent promotion criteria, structured mentoring, bias awareness training and inclusive organisational policies, are essential to promote leadership equity, improve workplace justice and foster a sustainable health system.

Impact

This study addresses the persistent gender gap in nursing leadership, identifying systemic, cultural and individual barriers to women's career progression. Through a Rapid Evidence Assessment, it proposes a new multilevel theoretical framework. The results support policies and interventions to promote gender equity in nursing leadership.

Reporting Methods

This review adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for reporting.

Patient or Public Contribution

None.

Profiling Healthcare Professionals' Digital Health Competence and Associated Factors: A Cross‐Sectional Study

ABSTRACT

Aim

To assess healthcare professionals' digital health competence and its associated factors.

Design

Cross-sectional study.

Methods

The study was conducted from October 2023 to April 2024 among healthcare professionals in Italy, using convenience and snowball sampling. The questionnaire included four sections assessing: (i) socio-demographic and work-related characteristics; (ii) use of digital solutions as part of work and in free time, and communication channels to counsel clients in work; and DigiHealthCom and DigiComInf instruments including measurements of (iii) digital health competence and (iv) managerial, organisational and collegiality factors. K-means cluster analysis was employed to identify clusters of digital health competence; descriptive statistics to summarise characteristics and ANOVA and Chi-square tests to assess cluster differences.

Results

Among 301 healthcare professionals, the majority were nurses (n = 287, 95.3%). Three clusters were identified: cluster 1 showing the lowest, cluster 2 moderate and cluster 3 the highest digital health competence. Most participants (n = 193, 64.1%) belonged to cluster 3. Despite their proficiency, clusters 2 and 3 scored significantly lower on ethical competence. Least digitally competent professionals had significantly higher work experience, while the most competent reported stronger support from management, organisation, and colleagues. Communication channels for counselling clients and digital device use, both at work and during free time, were predominantly traditional technologies.

Conclusion

Educational programmes and organisational policies prioritising digital health competence development are needed to advance digital transition and equity in the healthcare workforce.

Implications for the Profession

Greater emphasis should be placed on the ethical aspects, with interventions tailored to healthcare professionals' digital health competence. Training and policies involving managers and colleagues, such as mentoring and distributed leadership, could help bridge the digital divide. Alongside traditional devices, the adoption of advanced technologies should be promoted.

Reporting Method

This study adheres to the STROBE checklist.

Patient or Public Contribution

None.

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