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Hospital falls and associated injuries are a global issue associated with harm and significant costs to individuals and society, especially for older adults. Hospital standards specify the minimum level of care required to optimise patient safety, quality and outcomes. Standards are often used during hospital accreditation. This investigation analysed the content and quality of hospital falls standards across the globe.
Hospital standards were located by searching online databases (PubMed, CINAHL, Google Scholar, MEDLINE), ChatGPT, the grey literature via internet search engines, and websites of accreditation agencies, government agencies, and other relevant organisations. We searched for standards from the 60 largest countries by population plus the 60 countries with the highest gross domestic product (n = 82 after accounting for duplicates). For inclusion, hospital standards had to mention ‘fall/s’. Data were analysed using a deductive framework synthesis and content analysis to identify emergent themes.
Forty-one standards used by at least 72 countries were identified from our search. Sixteen were excluded from detailed analysis because they did not mention falls and 3 could not be retrieved. A total of 22 standards were included in the final detailed analysis. Included standards showed wide variations in content and quality. Seven were assessed as high quality, 12 medium quality, and 3 were deemed to be of low quality. Some lacked details on hospital falls screening, assessment, prevention, and management. Consumer engagement in development, implementation, or evaluation was not mentioned in all standards. Procedures for falls data collection and reporting were seldom documented. Hospital standards infrequently referred readers to contemporary research or clinical practice guidelines.
There are variations in the quality and content of standards on hospital falls. International collaboration is recommended to increase the consistency and validity of hospital falls standards across nations, in order to optimise healthcare outcomes.
The findings of this global analysis of hospital falls standards have the potential to impact falls rates and fall-related injuries in hospital patients by providing data to inform the content, evidence base and use of hospital standards to optimise the safety and quality of care delivery. The findings inform the review, design and implementation of hospital accreditation procedures to improve patient outcomes, patient experiences, and service quality.
To examine whether self-reported thriving at work is associated with biomarkers of stress, inflammation, neuroplasticity and neurodegeneration in nurses.
A cross-sectional study.
An online questionnaire measuring thriving at work was administered to nurses in a teaching hospital in Michigan, U.S. over 5 weeks in 2024. A subsample of 100 questionnaire respondents provided blood samples for biomarker analysis. Multiple regression was used to identify self-reported and biomarker predictors of nurse thriving. Cluster analysis was used to distinguish between nurses with high and low levels of thriving based on a combination of self-report and biomarker data.
Higher self-reports of individual and work-related resources predicted higher thriving. Cortisol, a stress hormone, was significantly and inversely associated with thriving. No blood-based biomarkers of inflammation or neuroplasticity predicted thriving. Neurofilament light chain, a marker of neurodegeneration, was not a direct predictor but modified the effects of interpersonal and work resources on thriving.
Biological markers do play a role in nurses' thriving at work and may contribute important complementary information to that provided by nurse self-reports.
Nurses thrive in a work situation characterised by positive reports of individual, interpersonal and work resources and lower levels of stress. Efforts to enhance thriving could positively impact nurses' well-being and conditions for providing high-quality patient care.
This study addressed the question of whether self-reported thriving at work among nurses is reflected in biomarkers of stress, inflammation, and neurocognitive health. A profile of high self-reported work-related resources and low cortisol distinguished higher levels of nurses' thriving from lower levels. Organisational efforts to enhance nurses' thriving can positively impact nurses' health, their work environment, and patient care.
We followed the STROBE checklist in reporting this study.
No Patient or public contribution.
This article investigates school vaccination for adolescents with intellectual and developmental disability through the lens of person-centred care principles.
This is a theoretical framework analysis in which qualitative interview data were mapped to the principles of a Person-Centred Practice Framework.
Data were drawn from Vax4Health, an empirical study that aims to improve vaccination uptake and experiences for adolescents with disabilities.
Our four-step process included: identifying elements of the school vaccination programme that relate to the Framework domains; mapping programme capacities and challenges by each domain; identifying key factors influencing person-centredness; and synthesising these key influencing factors into three themes.
We extrapolated three themes: (1) Parents and students expressed strong support for the programme, but there is potential to enhance their participation in vaccination decision-making processes. (2) Nurses bring high levels of motivation, clinical experience, empathy and creativity to vaccinate students, but opportunities remain to enhance disability-specific training and knowledge of individual students' needs. (3) Special schools are committed to supporting families and facilitating the programme, but limited resourcing and unclear responsibilities present challenges that need addressing. We discuss how these themes relate to the five domains of the Framework. Key considerations for vaccination programme improvement towards a more person-centred approach are highlighted.
Applying the Framework to the findings of the Vax4Health study identified a range of opportunities to improve person-centred school-based vaccination for adolescents with IDD. Future research could involve engagement with all stakeholders to co-design interventions aimed at applying person-centred care principles to vaccinating students with IDD.
The findings from this analysis could be used to inform future implementation research into person-centred approaches to school vaccination aiming for positive outcomes for adolescents with IDD, their families and schools and health professionals.
Using advanced forms of medical technology such as extracorporeal organ support to take over organ function in the face of critical illness is a manifestation of the technological expertise to support and prolong life. However, clinician focus on the technical aspects of extracorporeal organ support both in research and clinical practice has the tendency to relegate to the background and disregard multiple, non-technical components such as the meanings, interactions, and experiences of nurses, families and other healthcare professionals.
To understand how experiences and social interactions of critically ill children, families, and healthcare professionals are influenced by the use of extracorporeal organ support.
Hermeneutic review of the literature.
CINAHL, PubMed and Web of Science followed by cross-citations and snowballing.
A total of 24 studies were included in the review, representing four conceptual streams, namely (1) extracorporeal organ support as a biomedical intervention, (2) relationality concerning extracorporeal organ support, (3) performativity in using extracorporeal organ support and (4) the agential role of extracorporeal organ support.
The hermeneutic framework helped foreground perspectives demonstrating that extracorporeal organ support is not merely a piece of medical technology, but is an active fulcrum upon which human and material elements revolve, interact, and integrate to form multiple assemblages that can influence how the huge volume of nurse work can be reframed beyond the perpetuation of the patient-machine connection and affect the ways by which patients and families are cared for.
Understanding extracorporeal organ support as more than a medical device can enable nurses to develop informed plans of care and advocate for the interests of the family and that of the critically ill child who remains a passive recipient of care in an intensive care bed.
No patient or public contribution.
Research indicates various barriers to cervical cancer screening for transgender people, contributing to cancer inequities. Further research is required to better understand how these barriers affect experiences along the screening trajectory, from engaging with information, through invitation and testing, to receiving test results. Research exploring how transgender people navigate these barriers is also required.
To explore the experiences of cervical cancer screening in Sweden among transgender people who were assigned female at birth, and to identify touchpoints in need of improvement along the cervical cancer screening trajectory.
Qualitative interview study inspired by journey mapping.
Semi-structured interviews (n = 18) and interpretive description analysis.
Five phases were identified comprising participants' cervical cancer screening journey, with touchpoints in each phase indicating key experiences, barriers, and strategies to navigate barriers. Experiences of touchpoints were affected by four interrelated dimensions: The embodied person—personal gender identity, relationship with own body, and transition process; System factors—policies, routines, and practices; Gender norms and transphobia; and Prior healthcare experiences. Significant barriers included a lack of trans-specific screening information; an invitation system that does not automatically invite male-registered individuals with a cervix; lack of trans competency among clinics and staff; female-centred clinics; gender dysphoria; anticipation or fear of being mistreated; distrust of healthcare authorities; and participant-staff power dynamics.
To make cervical cancer screening more equitable for transgender people, barriers need to be addressed by considering the four dimensions that affect these barriers.
Findings show that staff involved in policy and clinical practice can improve transgender people's experiences of cervical cancer screening by promoting agency and self-determination in each screening phase. This involves providing inclusive information, continuing invitations for male-registered individuals with a cervix, enhancing trans-competency, and addressing power dynamics in staff-participant interactions.
The Standards of Reporting Qualitative Research (SRQR).
Representatives from the Regional Cancer Centre Stockholm–Gotland were involved in the conceptualisation of this study. Representatives from trans and LGBTQI+ organisations, Regional Cancer Centres, and the National Board of Health and Welfare have provided feedback during the analysis and writing phases.
To explore the experience and practices of clinical research nurses in Victoria, Australia.
Qualitative descriptive design with reflexive thematic analysis.
Semi-structured interviews were conducted with ten clinical research nurses between October and December 2023 in Victoria, Australia.
Three phases (overarching themes) were generated: (1) Becoming a clinical research nurse, occurred by chance with a stressful and unsupportive transition period; (2) Being a clinical research nurse, was described as an ongoing development of confidence, specialised skills and knowledge; and (3) Building a clinical research nurse role, was described as challenging due to limited educational and career opportunities.
Clinical research nurses experienced a limited number of clear educational and career pathways that they could use to plan and grow in the nursing profession.
Addressing support and career development needs may ease clinical research nurses' transition and improve career planning.
This study addresses a gap by highlighting the limited structured career pathways, formal mentorship and ongoing educational planning for clinical research nurses. Findings illustrate that clinical research nurses often begin unprepared, gradually develop confidence and skills, but continue to struggle with unclear career development plans. The findings can inform nursing leadership, educators and policymakers to better support clinical research nurses.
The Consolidated Criteria for Reporting Qualitative Research Checklist (COREQ).
No patient or public contribution.
The aim of this study was to understand student perspectives regarding an interprofessional education (IPE) innovation using a single standardised patient (SP) in a large-group setting for a pain management and substance use simulation.
A qualitative descriptive design was used.
Students representing eight health science programs from four universities were invited to participate in a simulation-based IPE program blending asynchronous and synchronous learning. DNP students were one of the largest professions represented (n = 92, 30%) along with students enrolled in Doctor of Pharmacy (n = 111) and Doctor of Medicine (n = 69) programs. Students were invited to complete a post-activity survey asking what parts of the IPE activity were most valued and what could be improved. Student responses were themed using a qualitative descriptive approach with inductive coding and constant comparison.
Of 304 participating students, 155 (51%) responded to one or both open-ended questions. Respondents highly valued interprofessional team diversity. Responses highlighted the importance of: (1) using simulation with student teams to foster active learning, (2) student preparation using relevant curricular resources and (3) grounding interprofessional collaboration activities in student engagement and professional respect.
Findings confirmed that a cost-effective IPE activity using one SP within deliberately planned interprofessional activities can be engaging and meaningful. Students valued team-based collaboration across the disciplines of nursing, pharmacy and medicine.
Educators gathered evidence on the merits of a replicable, cost-effective IPE structure intended to expand team-based simulation learning opportunities. High-priority public health topics such as pain and substance use require multidisciplinary, integrative care to maximise health outcomes. To better prepare nurses and their health science collaborators, novel pedagogy in IPE may optimise student learning experiences.
We followed the Standards for Reporting Qualitative Research (SRQR).
Health sciences faculty served as facilitators in the IPE sessions. Facilitators were provided 1 h of training and observed student team breakout rooms to ensure that students were engaged and understood the assigned task. They provided feedback to session leaders after the sessions.
To explore the experiences of and reasons for midwives leaving practice.
A qualitative approach applying a social constructivism interpretative framework.
Twenty participants were selected for interviews based on reasons for leaving midwifery practice between October 2022 and April 2023. Thematic analysis was used to identify themes, and results were checked for trustworthiness through a third coder, community engagement and member checking with two participants.
One overarching theme with six subthemes characterised the experience of leaving midwifery practice. All participants reported the overarching theme: Caring for myself and my close community became incompatible with the work of midwifery. Five subthemes reflected negative aspects of midwifery work: value incongruence; racism in midwifery; not feeling respected/valued (+compensation); high workload leading to low quality of care; negative practice climate and psychosocial safety climate. The theme of strong professional commitment and identity weighed into their decision to leave. Negative experiences working in birth centres were prominent across themes.
Participants reported leaving the profession of midwifery when they reached an unsustainable balance between the demands of work life and personal life. The decision to leave midwifery was emotional; participants maintained a strong connection to midwifery. The leaving process supports a theoretical premise for midwifery turnover behaviour. The work life of midwives is a complex composite of challenges that are reflective of identified problems with maternity care in the United States.
Midwives are not leaving practice because they want to leave midwifery but because they are unable to meet non-work-related caring demands. Family-friendly policies, such as flexible schedules and leave policies, could help retain the midwifery workforce.
Based on recommendations from representatives of historically marginalised groups within the midwifery community, we offered participants to be interviewed by a midwife of colour.
To explore the lived experience of young people aged 16–24 years diagnosed with melanoma and that of their significant other in England.
Interpretive phenomenological analysis.
Data were collected between August 2023 and January 2024 from one specialist cancer centre in England. Thirteen young people were approached, and 10 took part. Each young person was asked to nominate a significant other. Five nominated a significant other, and five nominated no one. Although interviews were offered face-to-face, virtual was the preferred method. In-depth semi-structured interviews were audio-recorded with the participant's consent. Interview data were transcribed verbatim and analysed.
The core conceptual thread woven throughout the findings was ‘It's like being on a rollercoaster,’ which is representative of the ups and downs of the treatment trajectory, often without the support of age-appropriate specialist care. Four superordinate themes were identified: ‘Is something wrong?’, ‘Suddenly it's serious’, ‘Out on a limb’ and ‘Finding our place’.
Although most young people were treated in a primary treatment centre for adults with cancer, their experience was challenging from route to diagnosis through their treatment and beyond. Few received age-appropriate care to support their physical, emotional, and social wellbeing to help them navigate the experience.
There is limited evidence exploring the experiences of teenagers and young adults living with melanoma or that of their significant other. This enriched understanding supports improvement of the care pathway and service delivery for these young people and their families.
One young person with lived experience was paid as a consultant to be part of the research team. He helped develop the grant application and research questions, data analysis, and writing this paper.
To develop and evaluate a questionnaire for measuring factors that contribute to thriving at work among nurses.
A cross-sectional study.
An online questionnaire was administered in March 2024 to nurses in a community teaching hospital in Michigan, US. Questionnaire content was based on a literature search and was pilot tested among nursing professionals within the hospital system. Questionnaire factor structure was examined with exploratory and confirmatory factor analyses with split-half sample validation.
Based on exploratory and confirmatory factor analysis, a three-factor solution presented the best model, with factors comprised of 15 items measuring individual resources (3 items), work resources (6 items) and interpersonal aspects of the nursing work environment (6 items). Reliability estimates for all three factors exceeded 0.80, indicating good internal homogeneity. The questionnaire also demonstrated acceptable split-half validity and reliability.
The questionnaire presented here provides a potentially useful tool for measuring and evaluating thriving at work among nurses.
A better understanding of factors that enhance nurse thriving would lay the foundation for targeted interventions aimed at improving the nursing work environment and nurse well-being. Enhancing nurse thriving could have a potentially positive impact on patient care.
This study addressed the need to understand factors that contribute to thriving in nursing work. The questionnaire that was developed revealed a three-factor solution measuring individual nurse resources, work environment resources and work interpersonal resources. By measuring thriving among nurses, hospitals and other healthcare organisations are taking an important first step in identifying interventions to enhance the nursing work environment, nurse well-being and potentially the quality of patient care.
We followed the STROBE checklist in reporting this study.
No patient or public contribution.
Stroke is a global health concern. A timely response to a stroke can help reduce morbidity and mortality. However, barriers to timely response include poor recognition of stroke symptoms. Stroke symptom messages are designed to increase stroke recognition and encourage individuals to seek urgent medical assistance. The Face, Arm, Speech, Time (FAST) and Balance, Eyes, Face, Arm, Speech, Time (BE FAST) are commonly used stroke symptom messages shown to improve stroke symptom recognition and response. However, cultural factors and language differences may limit the effectiveness of stroke symptom messages and their acceptability in different countries and contexts. There has not been a comprehensive examination of the stroke symptom messages used worldwide and how these messages have been adapted in various settings.
We explored what stroke response messages are being used globally, and the contextual factors that influence the adoption of a stroke response mnemonic in different settings.
A 14-item survey was disseminated by the World Stroke Organization to its networks. The survey contained open- and closed-ended questions and allowed uploading relevant stroke symptom campaign materials. The survey was analyzed using descriptive statistics and a content analysis.
All except one survey respondent used a stroke symptom message. Fifteen respondents (27%) reported they did not translate their stroke awareness messaging. Of these 15 respondents, they used the English versions of FAST (n = 8), BE FAST (n = 4), and both FAST and BE FAST (n = 3). Forty respondents (71%) reported that they/their organization used an acronym to raise public awareness of the signs/symptoms of stroke that was different from FAST or BE FAST (English), many of which were direct or indirect translations or influenced by FAST and BE FAST. Survey responses shared insights and recommendations related to the content, tailoring and dissemination of stroke symptom messages.
Study findings highlight the global use of stroke symptom messages and their contextual adaptations to fit diverse settings and contexts. The challenges in applying universal or commonly used stroke symptom messages to different contexts were highlighted.
Nurses could have a key role in raising awareness of stroke symptoms and the development of locally adapted stroke symptom messages.
Commentary on: Halstead S, Cao C, Høgnason Mohr G, et al. Prevalence of multimorbidity in people with and without severe mental illness: a systematic review and meta-analysis. Lancet Psychiatry. 2024;11(6):431–42.
Implications for practice and research Multimorbidity is highly prevalent in adults with severe mental illness and should be a key consideration when assessing these patients. Future research should explore key moderating factors for the prevalence of physical multimorbidity in adults with severe mental illness.
The term severe mental illness (SMI) refers to individuals with psychological conditions so profound that they significantly hinder their capacity to perform functional and occupational activities, with schizophrenia and bipolar disorder often being classified as SMIs.
As discussed in the accompanying editorial Nursing on the front foot,
People living with Long Covid often find the complexity of navigating health services difficult. The nurse’s role is to support patients in this context. This includes ensuring they are sufficiently informed about what Long Covid is. The specialist nurses recommended the British Heart Foundation’s online resource - Long Covid: Symptoms, tests and treatments: https://www.bhf.org.uk/informationsupport/heart-matters-magazine/news/coronavirus-and-your-health/long-covid%23whatdoesfatiguefeel.
Information about Long Covid is also available via Long Covid Physio:
Every person...
Commentary on: Lee IO, Wolstencroft J, Housby H, et al. The inequity of education, health and care plan provision for children and young people with intellectual and developmental disabilities. J Intellect Disabil Res. Published online 22 May 2024.
Implications for practice and research Children and young people with intellectual and developmental disabilities (IDD) living in deprived areas are less likely to receive education, health and care plans in the UK. Future research should aim to identify interventions that have the potential to reduce such inequities for individuals with IDD.
The findings from this study by Lee et al
For many decades, nurses have been expected to base their practice on up-to-date, research-derived evidence, melded with knowledge from nursing theory, experience—our own and others—and innovating in practice. This composite, complex evidence base is passed on through generations of nurses both formally, through educational opportunities and our own readings, and informally through the stories we tell of our practice. These nursing narratives encompass and connect the multiple levels at which nurses work—alongside a person and their families and carers, within the structures of healthcare and social-care organisations and in policymaking settings. Essentially, narratives enable compelling and memorable links to be drawn between research, theory and experience, creating the certainty and confidence we need to work effectively within our very different practice environments. Any turbulence in practice, deficiency in the evidence base or challenge to our ability to pass on our narratives is likely to cause ambiguity and anxiety and...
Commentary on: Szymczak JE, Hayes AA, Labellarte P, et al. Parent and clinician views on not using antibiotics for mild community-acquired pneumonia. Pediatrics. 2024 Jan 1;153(2):e2023063782.
Implications for practice and research Awareness of the possibility to abstain from antibiotic treatment in mild community-acquired pneumonia in young children has to increase. Not only is research needed on improvement of diagnostics and safety of the ‘no antibiotic’ strategy, but also on how to address social, emotional and logistical barriers.
Mild community-acquired pneumonia (CAP) in children under 5 years is often viral in origin. Because of this, routine antibiotic treatment of mild CAP is discouraged in the 2011 Pediatric Infectious Diseases Society (PIDS)/Infectious Diseases Society of America (IDSA) guideline.
Commentary on: Goto R, Pinchuk I, Kolodezhny O, et al (2024). Mental health of adolescents exposed to the war in Ukraine. JAMA Pediatrics, 178 (5), 480-488. doi: 10.1001/jamapediatrics.2024.0295.
Implications for practice and research Individuals screening positive require diagnostic evaluation to inform psychiatric treatment decisions and mental health interventions. Future research should expand these findings with objective measures of war/trauma exposure and full diagnostic assessment.
The study by Goto et al screened adolescents across Ukraine for mental health consequences of war.
Commentary to: Woodward A, Nimmons D, Davies N, et al. A qualitative exploration of the barriers and facilitators to self-managing multiple long-term conditions amongst people experiencing socioeconomic deprivation. Health Expect 2024;27(2):e14046. doi: 10.1111/hex.14046.
Implications for practice and research Addressing socioeconomic barriers is crucial to develop patient-centred care models to help self-managing multiple long-term conditions (MLTCs). Managing MLTCs is not solely an individual responsibility, and community-based interventions should aim to strengthen social support networks and reduce social isolation. The extent of the beneficial effects of social support networks on health outcomes and MLTCs self-management should also be addressed in research.
Worldwide, one in three adults lives with multiple long-term conditions (MLTCs) and requires ongoing management and self-management. Socioeconomic deprivation exacerbates health inequalities due to limited resources and opportunities. In England, people living in deprived areas tend to develop MLTCs earlier and have a...
The purpose of this scoping review is to map and summarise the current peer-reviewed literature on inequities in doctoral nursing education, with a specific focus on populations affected, barriers, facilitators and strategies to support equity in doctoral nursing education.
This scoping review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR).
A comprehensive search for empirical evidence was completed using four databases: CINAHL, Scopus, ERIC and Google Scholar. A systematic screening process was applied, and data were extracted and charted guided by the Population, Concept, Context (PCC) framework.
Databases were searched for peer-reviewed articles published between 2000 and 2025.
A total of 13 studies met the inclusion criteria. Most studies focused on racial/ethnic minoritized populations, and one focused on first-generation doctoral students. Common barriers included experiences of microaggression, systemic racism, lack of funding and feelings of isolation. Common facilitators were faculty mentorship, financial support, peer networks and targeted recruitment programs.
Inequities remain in doctoral nursing education, particularly for racial/ethnic minoritized populations. Although some effective interventions were identified, significant gaps exist in understanding how to support diverse doctoral nursing students, especially for those with intersecting identities.
Addressing inequities in doctoral nursing education can enhance the diversity of the nursing workforce and faculty, promote inclusive academic environments and contribute to health equity.
Persistent inequities in access and experience among underrepresented groups in doctoral nursing education. Main findings: Key structural and social barriers persist, though several promising strategies have emerged. Impact area: Academic institutions, doctoral program designers and nurse leaders.
This study adheres to the PRISMA-ScR reporting guidelines. This study did not involve patients or the public in its design, conduct or reporting.
To explore the associations of (1) shift-to-shift Nurse Perceived Adequacy of Staffing Scale (NPASS) scores and (2) the relative contribution of individual NPASS items to nurse-perceived quality of care (NPQoC) and job enjoyment.
Multihospital prospective observational study.
The study was conducted across 15 medical, surgical or acute admission hospital wards in three teaching hospitals in the Netherlands. Vocationally and bachelor-trained nurses conducted 1550 measurements of perceived adequacy of staffing using the NPASS, NPQoC and job enjoyment in 797 shifts. Multilevel models were used to assess associations between NPASS scores and NPASS items and the outcome variables.
Higher NPASS scores were significantly associated with improved NPQoC and job enjoyment. An increase in 1.0 point NPASS score leads to an increase of 0.97 points in NPQoC and 1.04 points in job enjoyment. Of the NPASS items, energy level, adherence to protocols and the opportunity for adequate breaks had the most positive effect on both outcomes.
Perceived adequacy of staffing as measured by the NPASS is highly relevant for improvements in both NPQoC and job enjoyment.
Decision-makers on nurse staffing should incorporate the NPASS in staffing methods to ensure adequate staffing and the associated benefits. Policies that ensure adequate breaks, adherence to protocols and maintenance of nurses' energy levels during the shift should be implemented with special attention.
This study provides supportive evidence for incorporating nurses' perceived adequacy of staffing, as measured by the NPASS, to ensure adequate staffing. This is crucial for nurse retention, and therefore vital to maintaining accessible healthcare given the global nursing shortages.
The STROBE checklist was used to conduct and describe the study.
This study did not include patient or public involvement in its design, conduct or reporting.
FreshRSS 