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The multifaceted responsibilities borne by clinical facilitators can impose a significant strain on their mental and emotional health and well-being. Within nursing and other healthcare professions, the responsibilities of clinical facilitators extend beyond conventional clinical duties to encompass supervising, facilitating, assessing, and supporting students as they transition into professional nursing practice. There is a need for insights into the well-being of clinical facilitators in the face of demanding work conditions, limited resources, and the emotional toll of patient care. This article critically reviews the literature to determine the current state of mental well-being among clinical facilitators in undergraduate health professions education and how they should be supported.
A scoping review guided the study using the Population, Context, Concept framework with a search string incorporating associated Boolean operators. 233 records were retrieved from eight databases and reviewed according to the inclusion and exclusion criteria. A total of 13 full-text articles were found to be eligible for extraction and analysis.
Major findings resulted in thematising mental health issue characteristics according to high and low job demands and burnout. Literature outlined the causes of mental health issues, including lack of recognition and appreciation, work performance, teaching and learning practices, student characteristics, support structures, and the environment. Recommendations included training, appropriate support systems, workload, guidelines, monitoring, community of practice, and research-oriented support.
Educational institutions must move beyond ad hoc support and implement integrated, strategic initiatives grounded in the principles of the Job-Demand-Control model. Future research should focus on developing and rigorously evaluating multifaceted intervention programmes that address these systemic factors. By investing in the well-being of clinical facilitators, institutions ultimately invest in the quality of future healthcare providers and the safety of the patients they will serve.
This article sets the tone for factors to consider and provides recommendations for educational institutions to better support the mental well-being of clinical facilitators.
To examine the contexts and mechanisms that enable compassionate mentorship in healthcare, in order to generate evidence-informed insights for fostering healthier, more sustainable work environments.
A rapid realist review.
Systematic searches were conducted in Ovid MEDLINE (1946–December 2024), Embase (1974–December 2024) and CINAHL (1981–December 2024). Additional sources included Google Scholar searches, reference list scanning and grey literature (e.g., practice guidelines, policy briefs, professional reports). The review was conducted between August 2024 and July 2025.
Realist review methods were applied to answer the question: What works, for whom, under what circumstances and why? The review proceeded in four stages: defining scope and research questions with an expert panel; iterative searching and screening; data extraction and synthesis into context–mechanism–outcome configurations (CMOCs); and development of a programme theory.
Twenty-two documents were included, spanning nursing, medicine, allied health and interdisciplinary contexts. Six CMOCs were identified, encompassing the following themes: (1) relationship compatibility; (2) vulnerability and self-exploration; (3) growth through untapped strengths; (4) anti-oppression and equity; (5) mentors' pride and confidence; and (6) culture of mentorship. The resulting programme theory conceptualises compassionate mentorship as a dynamic, multi-level process with cumulative impacts on individual well-being, professional development and organisational culture.
Compassionate mentorship represents not only a relational practice but also a structural intervention for healthier workplaces. Programmes should prioritise compatibility, cultivate psychological safety, invest in mentee growth, embed equity, recognise mentor contributions and institutionalise mentorship culture.
These strategies offer actionable pathways to strengthen workforce resilience, retention and sustainability.
One co-author is a retired nurse, ethicist and person with lived experience in the healthcare system. This co-author was integral to this project, serving on the scientific steering committee from project conceptualisation and funding application through study conduct and publication.
To explore nurse practitioners' attitudes towards medical error perception, approach and cause using the Medical Error Attitude Scale and examine their experiences following a medical error and the support received.
A cross-sectional, descriptive study using an electronic survey.
A convenience sample of nurse practitioners licensed in Utah was invited to participate. The survey included the Medical Error Attitude Scale, demographic items, questions regarding error reporting, experiences after an error and support received or desired.
Nurse practitioners generally have positive attitudes towards medical errors. Higher scores were observed among individuals with doctoral-level education, female respondents and those employed in organisations with formal support programmes. While most nurse practitioners reported their medical errors, many indicated they did not receive institutional support afterwards. Peer support emerged as the most frequently desired form of assistance.
Nurse practitioners experience medical errors while providing care and require meaningful, accessible support. Despite favourable attitudes, many reported limited institutional support. Additional research is needed to understand their support needs following medical errors better.
We adhered to the STROBE guidelines for the reporting method.
No patient or public contribution.
To discuss how shared decision-making (SDM) is currently practised in hospitals, to highlight the essential—yet often underacknowledged—contribution of nurses to inclusive SDM in life-prolonging treatment decisions, and to propose a five-step implementation plan to strengthen the role of patients in the SDM process.
A position paper on current SDM practices.
To take a position, we drew on knowledge gained from six empirical studies conducted by our research group and evaluated these findings in light of the most recent literature.
A five-step implementation plan to stimulate SDM: (1) Clarify roles, (2) Organisational alignment, (3) Comprehensive training, (4) Tailored implementation plans, and (5) Sustainable integration.
The plan is ambitious, yet it offers a clear and actionable path forward for healthcare organisations and professionals. It provides a concrete opportunity for collaboration to embed SDM in daily clinical practice. Ultimately, our shared objective is to achieve optimal patient outcomes—an aim that unites all stakeholders.
Integrating nurses into SDM processes will enhance the quality of support for treatment decision-making. However, to realise truly inclusive, high-quality, patient-centred care, coordinated action at multiple organisational levels is essential.
The proposed plan is not only relevant to treatment decisions at the end of life in hospital settings, but also presents broader opportunities to advance SDM across healthcare sectors. It offers nurses a clearly defined and meaningful role in SDM and provides a practical blueprint for implementation at all levels of the organisation—transforming long-standing ambitions into tangible practice.
To examine how mixed methods research has been applied in studies of family caregiving for stroke survivors, focusing on key methodological components (rationale, design types, integration strategies, and use of joint displays).
Methodological systematic review.
A systematic search of five databases yielded 17 studies. The extraction focused on mixed methods features (rationale, design, integration, joint displays), and quality was appraised using the Mixed Methods Appraisal Tool.
PubMed, CINAHL, Scopus, Web of Science, and PsycINFO were searched for relevant studies published from 2010 to 2025.
The included studies addressed topics such as caregiver burden, coping, resilience, and intervention outcomes. Convergent and explanatory sequential designs predominated. Complementarity was the most frequent rationale for mixing methods. Integration occurred mainly through merging, with fewer instances of connecting or building. Three studies included joint displays to integrate the results.
Mixed methods research is increasingly applied in family caregiving. To advance the field, researchers should strengthen integration during analysis and results and improve transparency in reporting key design features.
Strengthening methodological rigour in mixed methods studies on stroke caregiving will improve the evidence base for nursing practice. Intentional and meaningful integration of qualitative and quantitative evidence can better inform effective interventions and support programs, ultimately enhancing care for stroke survivors and their families.
This review evaluates how mixed methods research is applied in family caregiving studies. It identifies significant methodological gaps, including unclear reporting of design and limited use of advanced integration techniques. The recommendations provide practical guidance for researchers to improve reporting and integration, yielding richer evidence to inform interventions and policies that support family caregivers.
The review followed the PRISMA 2021 guidelines for transparent reporting of systematic reviews.
No patient or public involvement.
Hypertension remains a critical health disparity among Black older adults, driven by factors such as socioeconomic inequities, chronic stress and barriers to healthcare access. Within this population, family relationships, particularly intergenerational interactions, significantly influence health behaviours and the management of hypertension remain understudied.
To explore intergenerational factors influencing hypertension prevention and management among Black older adults, focusing on how family relationships impact health behaviours, knowledge transfer and treatment adherence.
A discursive paper applying the Transtheoretical Model of Change and Self-Determination Theory as guiding frameworks to examine the role of family dynamics in hypertension management. PubMed, Scopus and Google Scholar were searched for peer-reviewed papers published from 2015 to 2025.
The role of family in health behaviours is examined, including the transmission of health knowledge, caregiving dynamics and emotional support. Both barriers and facilitators to effective hypertension management are identified, including cultural beliefs, community resources and the impact of intergenerational role modelling.
The discussion underscores the need for nurses to adopt family-centred approaches in hypertension management, considering the intergenerational influences on health outcomes. Recommendations for integrating these insights into clinical practice and nursing education are provided.
Understanding the intergenerational context of hypertension management can enhance patient care by improving adherence and prevention strategies. Future research should further explore the role of family in managing hypertension among Black older adults.
To advance the understanding of chronic illness self-management among Chinese immigrants in Western countries by synthesising evidence and through the lens of the Middle Range Theory of Self- and Family Management of Chronic Illness.
Integrative review following Whittemore and Knafl.
Two reviewers used Covidence software to screen potential articles. After identifying the sample, reviewers extracted data into a matrix and appraised study quality using Critical Appraisal Skills Programme checklists. Reviewers used the constant comparative method to categorise data into categories: (1) facilitators/barriers, (2) processes and (3) outcomes. Findings were then synthesised and mapped to the theory domains.
MEDLINE, CINAHL, Web of Science, Embase, PsycINFO and ProQuest Central (database inception—August 2025).
Of 3205 records screened, 20 studies met the inclusion criteria with acceptable quality. Personal characteristics/health status, resources/environment, Chinese-Western cross-cultural experiences, family and healthcare systems, and linguistic barriers shaped the processes of Focusing on Illness Needs (developing illness insights, taking ownership of health needs, and health promotion); Activating Resources (Western health care, traditional Chinese practices, community and family support, and blended spiritual resources); and Living with a Chronic Illness (processing emotions, adjusting, integrating, and meaning-making). These processes lead to outcomes including improved disease control, psychological/cognitive well-being, and healthcare utilisation and unintended negative consequences such as emotional burden and delayed care-seeking.
While Chinese immigrants share certain aspects of self-management with Western populations, their approaches are shaped by culturally grounded, family-centred values, traditional health practices, and immigrant experiences, which underscore the need for culturally and contextually sensitive self-management support. The findings also expand the applicability of the guiding theory by identifying new cultural elements.
Nurses can support self-management among Chinese immigrants by developing culturally and linguistically tailored interventions, engaging family members in health education and treatment planning, enhancing accessible digital, community and navigational resources, providing language assistance and strengthening staff training.
We used the PRISMA 2020 checklist for adherence to review protocols.
This study did not include patient or public involvement in its design, conduct or reporting.
To explore current evidence regarding the provision of palliative care for individuals with very severe to extreme behavioural and psychological symptoms of dementia (BPSD) in a hospital setting.
Scoping review.
The PRISMA-ScR reporting guideline.
The JBI guidelines for scoping reviews were followed. A data extraction form assisted in the identification of key findings via a process of content analysis.
Studies were obtained from bibliographic databases of PubMed, CINAHL, and PsycINFO.
This review included six articles, and nine categories emerged from the findings. Symptom assessment and management, pain assessment challenges, atypical presentation of end-stage dementia, complex prescribing and treatment practices, principles of person-centred care, collaboration; training for health care professionals; emotional impact on staff; and family and caregivers.
This scoping review highlighted a significant gap in the literature regarding palliative care for people living with very severe to extreme BPSD in hospital settings. This review highlighted key differences in the presentation of people with BPSD needing palliative care. There is a need for tailored models of care, specialised training and education for health professionals, families, and carers, and recognition of dementia as a terminal illness.
The results of this review provide valuable insights into the level of understanding about the unique palliative care needs for people experiencing very severe to extreme BPSD, making an important contribution to the planning and development of future models of care.
Mapping the available literature highlights a paucity of research in palliative care for people with very severe to extreme BPSD in hospital settings. There is a need for rigorous research studies and models of care developed and informed by the evidence for this small population necessitating unique care needs.
No patient or public contribution.
To explore the utility of a quantitative person-centred approach to identify subgroups of commencing first-year rural nurses and examine their work attitudes and intentions.
Exploratory cross-sectional survey.
A survey of commencing first-year nurses was conducted in two Australian rural health districts in 2019 and 2020, with a 91% response rate. A two-step latent class analysis of 159 responses was undertaken with two indicators of perceived professional opportunity and three indicators of local connection and rural training. Three outcomes assessing work intention and attitudes were compared across subtypes.
Four subgroups (‘classes’) were identified. There were significant differences in the outcomes between the two classes interpreted as ‘rural-locals’. Rural-locals with the highest perceptions of available professional opportunities had the most positive outcomes of all four classes. Of the two ‘non-local’ classes, the class with high perceptions of professional opportunities was significantly happier than the rural-local and non-local classes with lower perceptions; however, class differences in future rural work intentions and attitudes were mixed.
The research found subtypes of rural first-year nurses which differed in terms of occupational happiness and future rural work attitudes. Early career nurses who were rural-locals with highest perceptions of professional opportunities had the highest intention to remain working rurally. This exploratory research demonstrates the relevance of person-centred and theory-informed approaches to rural health workforce recruitment and retention strategies.
The findings show that ‘rural background’ or ‘local’ are useful but insufficient classifiers to distinguish among commencing rural nurse health workforce, given rural work attitudes and future work intentions. Further attention at organisational and policy levels should be given to rural professional development opportunities for early career nurses to support retention.
This research has demonstrated how a quantitative person-centred approach can illuminate heterogeneous subgroups within a rural health workforce to inform more targeted recruitment and retention strategies. Researchers should look to larger datasets and methodological resources from psychological theories of work to realise this potential for informing organisational and governmental policy approaches.
The authors have adhered to the EQUATOR STROBE statement guidelines for reporting observational (cross-sectional) studies.
No patient or public contribution.
To determine the proportion of postpartum depression (PPD), explore associated risk factors with PPD, and examine changes in PPD, social support and quality of life (QOL) among adolescent and adult mothers in the first 6 months postpartum during the COVID-19 pandemic.
A longitudinal comparative study was conducted using an online questionnaire from January to August 2021.
The study recruited 65 adolescent and 65 adult mothers who attended postpartum checkups at 6 weeks postpartum in primary hospitals across Ayutthaya, Chachoengsao and Phetchaburi provinces in Thailand. Data were collected by the Edinburgh Postnatal Depression Scale, Postpartum Support Questionnaire, and the World Health Organisation Quality of Life Brief at 6 weeks, 4 months and 6 months postpartum.
Finally, 60 adolescent and 60 adult mothers were included for analysis. Adolescent mothers experienced lower social support and QOL compared to adult mothers over the 6-month postpartum period. Notably, both adolescent and adult mothers had significantly increased PPD proportions from 6 weeks to 6 months postpartum (31.7%–48.3% and 23.3%–43.3%, respectively). However, there was no significant difference in the PPD proportions between groups. In adjusted models, significant risk factors for PPD during the first 6 months postpartum included educational level, unintended pregnancy, mode of delivery and social support.
Significant changes in PPD, social support and QOL were observed in both adolescent and adult mothers during the first 6 months postpartum. Adolescent mothers consistently demonstrated lower levels of social support and QOL at 6 weeks, 4 months and 6 months postpartum compared to adult mothers. Additionally, mothers with lower educational attainment, unintended pregnancies, caesarean deliveries and low social support were more likely to experience PPD.
Midwives/nurses should provide routine PPD screenings throughout the first six months postpartum for all mothers, particularly for at-risk mothers such as adolescent mothers or those with lower education, unintended pregnancies, caesarean deliveries and limited social support.
We have followed the STROBE guidelines.
No patient or public contribution.
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.
Stroke nurses must perform dysphagia screening on all suspected stroke patients, adhering to best practice guidelines. While comprehensive training is essential for safe and competent screening, the variability in dysphagia screening tools leads to significant differences in education.
This scoping review aims to collate and report what education is provided to stroke nurses on the use of dysphagia screening tools.
A scoping review guided by the PRISMA-ScR checklist.
A systematic review of three electronic databases identified 318 peer-reviewed studies. After screening and eligibility assessment in COVIDENCE, 10 studies were included. Data from these studies was analysed using Arksey and O'Malley's thematic framework.
MEDLINE, CINHAL, Scopus.
Ten studies were included in this review which yielded the following major themes: (1) comprehensive and structured training; (2) diversity of training methods; (3) ongoing education and competency assessment; and (4) standardised protocols and tools.
Offering comprehensive training programs to stroke nurses on dysphagia screening tools is associated with more timely interventions and improved outcomes; however inconsistent approaches to training make it difficult to benchmark outcomes of the education provided. Future research should explore stroke nurses' experiences with current training to guide future training program development.
This review highlights the importance of training stroke nurses to use dysphagia screening tools to improve patient outcomes.
No patient or public contribution.
To examine residential aged care staff's experience of death and grief, and their support needs.
A mixed-methods sequential explanatory design, using an online cross-sectional survey that included the Texas Revised Inventory of Grief and the Grief Support in Health Care Scale. Followed by semi-structured interviews with direct care workers and managers working in residential aged care homes were conducted.
Over 60% of participants experienced five or more resident deaths in the previous 12 months. Although, different levels of grief were experienced among different roles, the importance of open communication and opportunities for farewells after resident death was highlighted. Participants suggested support and education to normalise grief and promote self-care.
Recognising staff grief following the resident death is important. Providing support and education may help improve staff wellbeing and contribute to the delivery of high-quality care for both residents and their families.
Staff grief after a resident death needs to be recognised, and continuing education and support are required for their wellbeing.
The STROBE and SRQR checklists were applied.
No Patient or Public contribution.
Delirium, a common, serious and often preventable complication in older hospitalised adults, contributes to significant health and social care costs. Carers are uniquely positioned to identify early signs and support delirium prevention. The Prevention & Early Delirium Identification Carer Toolkit (PREDICT), a novel model of care designed to educate carers about delirium management and prevention strategies, enables them to actively participate in the care and recovery of their person. Developed through a comprehensive literature review, a co-designed eDelphi and pilot study, PREDICT demonstrated acceptability and feasibility.
To evaluate the effectiveness, implementation and cost-benefit of a PREDICT in hospital settings.
A stepped-wedge cluster randomised controlled trial (SW-cRCT), consisting of a cohort study, healthcare service evaluation, and process evaluation. The study will assess carer and staff knowledge of delirium, carer care giving stress, health service outcomes (e.g., incidence, length of stay, readmissions) and cost-benefit.
PREDICT is a scalable, person-centred approach that supports both patients and carers, with the potential to embed best-practice delirium management into routine healthcare.
This study was developed in consultation with older adults, carers and healthcare staff. Two consumer representatives joined the project steering committee and contributed to shaping the research question, refining the study protocol and selecting outcome measures relevant to families and healthcare staff. Carers were involved in reviewing participant information sheets and the PREDICT website, providing feedback to ensure clarity and accessibility. Results will be shared with participants and the wider community through plain-language summaries and public presentations.
Australian and New Zealand Clinical trial: ACTRN12625000705482 registered on the 3rd of July 2025
To clarify the concept of quiet quitting in nursing practice.
Concept analysis using Walker and Avant's concept analysis methodology.
The eight-step method by Walker and Avant guided the concept analysis.
A systematic literature search was conducted in CINAHL, PsycINFO, Scopus and MEDLINE without date restrictions, identifying 36 empirical and theoretical articles published in English.
Quiet quitting in nursing is defined by four key attributes: minimal compliance with job expectations, psychological and emotional detachment, withdrawal of discretionary effort and lingering in role despite dissatisfaction. Antecedents include unhealthy work environments, psychosocial strain (e.g., burnout, moral distress) and individual/demographic influences (e.g., age, coping strategies). Consequences include impaired team dynamics, reduced care quality and organisational decline and increased turnover intentions. Twenty-five studies used validated measurement tools, notably the Quiet Quitting Scale.
Quiet quitting is a subtle form of disengagement distinct from burnout and turnover. It reflects an adaptive coping response to sustained dissatisfaction and unmet expectations. It is both widespread and underrecognized, with implications for healthcare sustainability.
Understanding and addressing quiet quitting is essential for safeguarding professional standards, promoting nurse engagement and ensuring high-quality patient care. Early identification and systemic reforms are critical to mitigating its impact.
This study addresses the emerging challenge of nurse quit quitting. Findings can inform leadership, education and policy development globally, particularly in healthcare settings facing workforce strain, moral distress and retention challenges.
This article adheres to the PRISMA-ScR reporting guidelines.
This study did not include patient or public involvement in its design, conduct, or reporting.
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