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Authentic leadership holds great potential to impact positive nursing and organizational outcomes. However, authentic leadership's connection to organizational culture, self-efficacy, and work engagement remains underreported.
To investigate the associations of authentic leadership, organizational culture, self-efficacy, and work engagement among nurses.
Cross-sectional and correlational design employing consecutive sampling in recruiting nurses (n = 534) between May and October 2024. Four validated self-report scales were used to collect data. Structural equation modeling analysis was used to examine the study variables' interrelationships.
Organizational culture significantly predicted authentic leadership (β = 0.91, p = 0.004), while authentic leadership significantly influenced both self-efficacy (β = −0.16, p = 0.041) and work engagement (β = 0.57, p = 0.001). Meanwhile, self-efficacy directly and positively influences work engagement (β = 0.24, p = 0.002). Organizational culture had significant indirect effects on both self-efficacy (β = −0.14, p = 0.042) and work engagement (β = 0.48, p = 0.001) through the mediation of authentic leadership. Finally, self-efficacy mediated the association between authentic leadership and work engagement (β = −0.04, p = 0.002).
The study shed light on the complex and interwoven relationships among several essential constructs—specifically, authentic leadership, organizational culture, self-efficacy, and work engagement. These factors collectively contribute to the creation and maintenance of a dynamic and supportive working environment for nurses.
Integrating evidence-based practice (EBP) into nursing is critical for improving clinical outcomes, yet adoption remains limited due to ongoing individual and organizational barriers.
The EBP Scholars Program was developed to overcome barriers and foster a culture of evidence-based nursing practice within a pediatric healthcare system.
Launched in 2007 during the organization's Magnet journey, the program is grounded in scientific, educational, and implementation science principles. Selected through a competitive application process, scholars engage in a seven-month structured curriculum grounded in the 8 A's Model of EBP. Learning outcomes are evaluated using pre- and post-program scores on the Evidence-Based Practice Knowledge Assessment Questionnaire (EBP-KAQ).
The program has enrolled 147 participants and graduated 124. On average, participants increased their EBP knowledge by 15.7%. Scholar-led projects have led to over 40 policy updates, new care guidelines, and measurable quality and safety improvements. Graduates have produced 43 posters, 18 podium presentations, and 9 peer-reviewed publications.
The EBP Scholars Program offers a scalable model for embedding EBP in healthcare. Through strategic leadership, interdisciplinary collaboration, and structured mentorship, it has advanced evidence-based care, professional development, and a culture of continuous improvement.
Stroke survivors frequently experience multiple co-occurring symptoms that cluster together, significantly affecting their quality of life and rehabilitation outcomes. However, previous research has predominantly focused on individual symptoms in isolation, limiting the potential to inform more comprehensive, symptom cluster-based approaches to post-stroke care.
This scoping review aimed to synthesize existing evidence on the assessment tools used to evaluate them, the analytical techniques employed to identify them, and the composition of symptom clusters in people with stroke.
A comprehensive literature search was conducted across seven databases (PubMed, EMBASE, APA PsycInfo, CINAHL, Web of Science, China National Knowledge Infrastructure, and Wanfang) for studies published between 2001 and April 2025. Methodological quality was assessed using the JBI Critical Appraisal Checklists. Data were extracted on study characteristics, measurement instruments, analytical techniques, and symptom cluster composition.
Fourteen studies comprising 6556 stroke patients were included. A total of 11 assessment tools and six analytical techniques were identified, with exploratory factor analysis being the most commonly used. Seven common symptom clusters were synthesized: pain and fatigue, somatic movement dysfunction, cognitive impairment, affective disturbance, mood and sleep dysregulation, psychological distress, and gastrointestinal symptoms. The most frequently reported symptom cluster was pain and fatigue. Considerable heterogeneity was found across studies in terms of measurement instruments, analytical techniques, and symptom cluster composition.
This review highlights the methodological inconsistencies and diversity in symptom cluster research in stroke populations. The findings underscore the need for standardized, culturally adaptable assessment tools and longitudinal designs to capture the dynamic nature of symptom clusters. This comprehensive review summarizes common symptom clusters in stroke patients and provides clinicians and researchers with valuable insights to help them develop more effective symptom management strategies and ultimately improve patient outcomes.
PROSPERO: CRD420251069463
Quality improvement is a well-known and commonly utilized approach to improving care and outcomes that is built on process improvement methods but not practice improvement methods. Because quality care includes both process and practice elements, process improvement alone cannot ensure quality outcomes will be achieved. This calls for a new approach.
To share an innovative, synergistic, and collaborative quality framework: Evidence-based Quality in Practice and Process: The EQUiPP Framework.
The EQUiPP Framework's intent is to provide structure for collaborative efforts to effectively identify best practices/processes, implement and sustain change, and improve outcomes. The framework provides guidance to decrease the frequency of implementing ineffective changes by deriving effective solutions … the first time, every time.
A team of experts used a consensus approach to develop the framework.
A precursor to this framework, the Practice and Process Improvement = Quality (PPQ) Model, was evaluated by individual expert review and a two-day beta test workshop. Feedback was obtained during the workshop when participants applied the model in activities reflecting real-world healthcare scenarios. When used in both DNP student work and real-world health systems, fundamental flaws were identified which resulted in the necessity to develop a different conceptualization. The framework described here is a new approach to improving quality care.
The EQUiPP Framework is a tool that provides the synergistic integration of both practice improvement (EBP) and process improvement methodologies to successfully implement and sustain best practices to achieve and sustain quality outcomes.
The EQUiPP Framework aligns EBP and process improvement, allowing clinicians and students to work collaboratively to identify and effectively, as well as efficiently, implement and sustain best practices to deliver quality outcomes.
Nursing students are the primary reserve force for hospital nurses. With the shrinking of nurse human resources and the increase in turnover rates, understanding the job preferences of nursing students is crucial for attracting nursing students.
To systematically review published studies on discrete choice experiments involving nursing students.
Ten databases were systematically searched from their inception to January 15, 2025. Two researchers independently used the International Society for Pharmacoeconomics and Outcomes Research checklist to evaluate the quality of the included studies. Thematic analysis was used to classify the attributes into broad categories and corresponding subcategories. The frequency, significance, relative importance, and willingness-to-pay of each attribute in the included studies were analyzed.
Fifteen studies spanning 12 countries were included, with a total of 102 individual attributes extracted and divided into two broad categories and six subcategories. Non-financial attributes were the most frequently reported broad category. The subgroup analyses indicated that nursing students from high-income countries valued income and were highly concerned about the working atmosphere.
Linking Evidence to Action:
The results of this systematic review provide important evidence for developing incentive policies to attract nursing students to the nursing profession.
Ample evidence has shown the benefit of high-fidelity simulation (HFS) in promoting learning in pre-licensure nursing students, but the evidence for practising registered nurses has not been synthesised.
To evaluate the effects of HFS training on learning outcomes and satisfaction in practising registered nurses.
In this systematic review and meta-analysis, we searched PubMed, CINAHL, ERIC, Cochrane Library, Web of Science and China National Knowledge Infrastructure (CNKI) for studies published in English or Chinese from database inception to 31 May 2023 (updated on 20 April 2025). All randomised controlled trials (RCT) or quasi-experiments that compared HFS training with traditional methods (e.g., lecture) for practising registered nurses and reported learning outcomes and satisfaction were included. Risk of bias was assessed by the Cochrane risk-of-bias tool for randomised trials (RoB 2) and non-randomised trials (ROBINS-I). Inverse-variance random-effect models were used to calculate standardised mean differences (SMDs) with 95% confidence interval (CI). We followed the PRISMA 2020 guideline.
Of 1404 records, eight eligible studies (five RCTs and three quasi-experiments) involving 275 practising nurses were identified. Two RCTs had high risk of bias, while others showed some concerns or moderate risk of bias. Meta-analyses showed that HFS could promote knowledge acquisition (SMD = 0.65, 95% CI, [0.35, 0.95], p < 0.01, I2 = 0%), professional skills (SMD = 0.72, 95% CI, [0.41, 1.04], p < 0.01, I2 = 0%) and learning satisfaction (SMD = 1.24, 95% CI, [0.35, 2.13], p < 0.01; I2 = 67%), compared with traditional methods. The pooled effect on self-confidence was marginally insignificant (SMD = 0.59, 95% CI, [−0.04, 1.22], p = 0.07; I2 = 67%).
Compared with traditional training methods, HFS is effective in promoting knowledge acquisition, professional skills and learning satisfaction and may enhance self-confidence among practising nurses. To strengthen the evidence base, more rigorous RCTs with larger sample sizes, adequate reporting of HFS design, and standardised outcome measures are warranted.
PROSPERO (CRD42022358717). No Patient or Public Contribution.
This retrospective cohort study evaluated the relationship between patient falls, Morse Fall Scale (MFS) items, patient demographics, length of stay and hospital site.
Data were acquired from 72 hospitals in a health system. Logistic regression models were conducted including MFS items, demographics, length of stay, and interaction terms. The final mixed effects logistic regression model included significant patient-level covariates as fixed effects and hospital site as a random effect.
6531 of 978,920 total admissions included a patient fall. Four MFS items (fall history, secondary diagnosis, gait weak/impaired, mental status—overestimates/forgets limitations) and three demographic items (male gender, increased age, longer length of stay) were associated with increased likelihood of falling. Two MFS items (ambulatory aids, intravenous therapy/lock) and Hispanic ethnicity were associated with decreased risk of falling. An interaction effect was present between male gender and mental status. Males who overestimate/forget limitations had 3.16 times higher odds of falling than females oriented to their own ability. The proportion of variance in falls between hospitals was 0.23 and the median odds ratio (MOR) 1.57.
This study uniquely assessed fall risk at the level of the patient and hospital, using data from nearly 1 million admissions at 72 hospitals. Controlling for patient characteristics, results demonstrate variability in fall risk among hospitals. Research informing hospital differences as well as gender and racial/ethnic differences in falls is needed to identify appropriate interventions.
As hospitals increasingly adopt risk-directed fall prevention, assessment tools should be re-evaluated for clinical utility and corresponding prevention practices. The MFS may be enhanced by removing intravenous lock as a risk and screening for additional risks such as medications and medical equipment. Quality improvement efforts must also consider the hospital's environment and processes that may further contribute to fall risk.
Authors adhered to STROBE guidelines for reporting.
No Patient or Public Contribution.
To explore community dwelling adults' lived experiences of participating in death café in Singapore.
A descriptive phenomenological study with Photovoice.
A purposive sample of community dwelling adults who participated in a community-based death café was recruited for this study. Data was collected through online individual semi-structured interviews. The Colaizzi's six-step descriptive phenomenological analysis was conducted for data analysis.
Twenty community dwelling adults who participated in a death café were recruited. Participants' experiences of the death café were expounded in four themes: appeals of attending death cafés, enabling features of death café, engaging in die-logues, and perceived impacts of death café on everyday lives. The participants were attracted to death cafés for various reasons including curiosity and grief. A comfortable environment, accompanied by open dialogues and refreshments, was credited as enablers for death conversations. Through these ‘die-logues’, the participants had a deeper understanding of death and began engaging in advance planning.
Death cafés provide a supportive environment for individuals to engage in death-related conversations that may not easily occur in daily life. By engaging in conversations about mortality within death cafés, participants are encouraged to take proactive steps towards advance planning.
Findings from this study can guide the development of community-based interventions by highlighting the essential components required for a death café tailored to the Asian context.
This study describes the community dwelling adults' lived experiences of participating in a death café. The findings from this study underscore the role of informal conversations about death as a tool to promote population health based palliative care initiatives such as overcoming death taboos and stimulating advance care planning among community dwelling adults.
The Consolidated Criteria for Reporting Qualitative Studies was used.
Community-dwelling adults participated in the interviews.
Managing patients' mental state deterioration in acute hospital settings is a critical challenge, requiring prompt specialised intervention to mitigate adverse outcomes. Current responses vary widely across health systems. Integrating rapid response systems that incorporate mental health expertise offers a promising approach to reduce risks and adverse outcomes.
To evaluate how a response system manages patient mental state deterioration in acute hospital settings, focusing on the mechanisms driving system effectiveness, for whom it works and under what circumstances, using a realist-informed theory-testing approach with field observation.
We conducted non-participant field observations in one trauma and one surgical unit over 4 months to examine the contexts, mechanisms and outcomes shaping a mental state deterioration response system. Observations captured multidisciplinary interactions, escalation processes and decision-making. Structured field notes were thematically coded using a realist framework to refine program theories and identify key factors influencing timely intervention.
Twenty responses were observed, most in the trauma unit. The system worked best when bedside nurses escalated early signs of deterioration, prompting timely intervention. Multidisciplinary collaboration involving nurse unit managers, liaison psychiatry, doctors and allied health professionals activated mechanisms of integrated assessment and coordinated care, enabling both medical and mental health needs to be addressed. Competing medical acuity demands at times reduced system availability. Teleconferencing supported specialist input when in-person attendance was not possible, ensuring person-centred care.
System functioning depended on early risk communication by bedside nurses and proactive multidisciplinary collaboration. Organisational support and staff training are essential to address operational challenges. Findings provide evidence for strengthening response systems to deliver timely, comprehensive interventions that improve physical and mental health outcomes.
DIvERT (De-escalation, Intervention, Early, Response, Team) is a proactive rapid response model of care piloted to improve the management and outcomes of patients experiencing mental state deterioration in acute hospital settings. The model achieves this through structured escalation pathways, proactive interventions and coordinated multidisciplinary collaboration to integrate medical and mental health care. Strengthening organisational support and staff training further reduces reliance on restrictive practices and promotes safer, person-centred care.
What problem did the study address? Acute hospitals face persistent challenges in responding to patient mental state deterioration alongside medical acuity, with existing rapid response systems often insufficiently integrated with mental health expertise. What were the main findings? Field observations of the DIvERT model demonstrated that proactive integration of mental health expertise, supported by organisational investment in training, clear escalation protocols and multidisciplinary collaboration, enabled earlier intervention and more coordinated responses. Where and on whom will the research have an impact? These findings have implications for acute hospital services, informing system-level improvements to rapid response models that support patient safety, reduce adverse events and improve staff wellbeing.
This study adhered to the relevant EQUATOR guidelines. Specifically, reporting followed the RAMESES II (Realist And Meta-narrative Evidence Syntheses: Evolving Standards II) reporting standards, which provide criteria for transparent and rigorous reporting of realist evaluation methodology.
No patient or public contribution.
In clinical oncology nursing practice, the preservation of quality of life is an essential component. E-health interventions have been proven effective in improving quality of life in patients with cancer, but the optimal content and delivery format remain undetermined.
To compare the efficacy of e-health interventions with varying contents and delivery formats in improving quality of life in patients with cancer.
Network meta-analysis of randomized controlled trials.
Six databases, including Medline, Web of Science, Embase, CINAHL, the Cochrane Central Register of Controlled Trials, and PsycINFO, were searched from inception to October 25, 2025.
Two reviewers independently screened studies and extracted data. A pairwise meta-analysis and a network meta-analysis were performed sequentially to determine the efficacy of different contents and delivery formats of e-health interventions in improving quality of life in patients with cancer.
A total of 50 studies included e-health interventions with eight contents and five delivery formats. The results identified health education (SUCRA = 82.2%), symptom management (SUCRA = 72.2%), and rehabilitation interventions (SUCRA = 71.1%) as the three most effective e-health intervention contents for improving quality of life in patients with cancer. Among delivery formats, app-based (SUCRA = 82.1%), internet/web-based (SUCRA = 71.5%), and telephone-based e-health interventions (SUCRA = 53.3%) ranked among the top three.
This study explored the efficacy of different contents and delivery formats of e-health interventions in improving quality of life in patients with cancer. These results are expected to provide an evidence-based basis for clinical oncology nursing practice.
PROSPERO number: CRD42025638829
Nurse-led self-care interventions represent a promising approach for chronic pain management. However, a comprehensive synthesis of their efficacy is lacking.
This systematic review and meta-analysis assessed the impact of the interventions on four key outcomes in chronic pain patients: pain intensity, quality of life, anxiety levels, and depression severity.
The study was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. An electronic search for relevant articles spanning from inception to November 2024 was carried out across multiple databases, including EMBASE, PubMed, CENTRAL, Web of Science (Core Collection), CINAHL, Scopus, and PsycINFO. The Cochrane Risk of Bias Tool was used to assess the quality of the included studies. The meta-analysis was conducted using Stata 18 and Review Manager 5.4, and a GRADE evidence profile was subsequently generated.
The systematic review and meta-analysis involved 30 studies in total. The results of the data analysis indicated that the interventions alleviated pain intensity (SMD = −0.30, 95% CI: −0.41 to −0.20, Z = 5.57, p < 0.001). They also enhanced quality of life (SMD = 0.28, 95% CI: 0.14 to 0.42, Z = 3.83, p < 0.001), while reducing anxiety (SMD = −0.15, 95% CI: −0.29 to −0.01, Z = 2.11, p = 0.03) and depression symptoms (SMD = −0.27, 95% CI: −0.45 to −0.09, Z = 2.88, p = 0.004).
This systematic review demonstrated that nurse-led self-care interventions benefit chronic pain patients. Future research should conduct more rigorous randomized controlled trials to strengthen the evidence base for using such interventions in chronic pain management.
Globally, doctorally-prepared nurses have pursued career paths centered on research and academic leadership. In the United States, alongside the PhD in nursing, there exists a distinct educational pathway, the Doctor of Nursing Practice (DNP), which emphasizes clinical practice. However, the actual career trajectories of individuals from both groups often diverge from these traditional expectations, prompting questions about how their roles are integrated within academic and clinical environments.
This systematic review aims to critically examine the career pathways of nurses with doctoral degrees, with a focus on the intersection of research and clinical practice.
Following the PRISMA guidelines, a systematic search of five databases (PROQUEST Nursing, Scopus, EBSCO, EMBASE, and PubMed) was conducted on October 14, 2024. We identified 6003 references, with 23 studies ultimately meeting inclusion criteria. Thematic analysis was used to synthesize findings.
PhD and DNP nurses in the US exhibit overlapping yet nontraditional career paths, with PhDs taking on clinical leadership and DNPs entering academia. Globally, PhD nurses often hold hybrid roles in research, education, and limited clinical practice. Across contexts, both groups face role misalignment and identity challenges, including marginalization and limited institutional support.
The findings highlight the blurring of traditional boundaries between PhD and DNP career paths, underscoring the need for flexible career models that combine academic and clinical practice as a viable option to address these challenges.
The review was registered in PROSPERO (Registration Number)
FreshRSS 