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AnteayerInternacionales

Assessing the Impact of Supplemental Oxygen Use on Deterioration Detection in the General Care Setting With Pulse Oximetry‐Based Continuous Monitoring

ABSTRACT

Aims

Continuous pulse oximetry monitoring has been used in patient deterioration recognition systems for decades. For patients on supplemental O2, questions related to the effectiveness of this approach have been raised due to elevation of SpO2 from O2 therapy. We examine this issue in the context of a stable inpatient continuous pulse oximetry-based rescue system with the aim of ascertaining if patients receiving supplemental oxygen are at risk of experiencing clinically meaningful delays in deterioration recognition as compared to patients on room air.

Design

Retrospective observational analysis.

Methods

Clinical markers of deterioration recognition timeliness and impact were compared for patients receiving various levels of supplemental oxygen and those on room air over 6 years. Chart review was conducted to assess cause and likelihood of preventability and improvement in detection with other monitoring modalities for emergent cases.

Results

Analysis adjusted for patient characteristics, and population level supplemental oxygen use showed no difference between patients on supplemental oxygen vs. room air for transfer rate, emergent transfer rate, or death after rescue or transfer. Analysis excluding population supplemental oxygen modeling showed limited increases in event likelihood, but not for emergent transfers. Chart review of emergent transfers revealed no pattern of delay in recognition of deterioration for patients on supplemental oxygen.

Conclusions

This study found no evidence that pulse oximetry-based continuous monitoring significantly degrades or delays detection of severe deterioration episodes for patients receiving supplemental oxygen. These findings challenge arguments suggesting pulse oximetry is not an appropriate continuous monitoring modality for general care patients receiving oxygen.

Implications for the Profession and/or Patient Care

This study provides clinical nurses with information about using continuous monitoring when caring for patients who are receiving supplemental oxygen in the general care setting. The study also assesses patient safety of the practice of using pulse oximetry for monitoring in this patient population.

Impact

This study addresses concerns related to using continuous pulse oximetry monitoring for deterioration detection when patients are receiving supplemental oxygen. This study found no evidence that pulse oximetry-based continuous monitoring significantly degrades or delays detection of severe deterioration episodes for patients receiving supplemental oxygen. The results can be used by the inpatient nursing community to ensure safe practices are in place for patient care.

Reporting Method

This study adheres to the STROBE reporting method.

No Patient or Public Contribution

Patient and/or public contribution was not deemed applicable for the rigorous design and execution of this study.

Defining Life Stages and Mapping Care Trajectories: A Narrative Review of Life‐Course Theories, Models and Frameworks

ABSTRACT

Aims

To review how life-course theories, models and frameworks define and classify life stages and transitions; how they characterise trajectories of care needs and care provision; and to consider how these insights might inform future developments of care-focused life-course frameworks.

Design

Narrative review using a theory synthesis approach.

Methods

The review synthesised 56 theories, models and frameworks, drawn from 90 articles published up to 2024, using a three-stage process: extraction and summarisation of conceptual content; comparison to identify convergence and divergence; and interpretive synthesis to generate an overarching account of how frameworks conceptualise life-course development, care transitions and care trajectories.

Results

Earlier life-course perspectives emphasise normative, age-graded stages, while more recent approaches highlight transitional junctures, relational contexts and structural influences on care trajectories. Life stages were defined variably, encompassing developmental phases, chronological age bands, major life transitions, historical and cultural perspectives and diverse lived experiences. Trajectories of care needs and provision were shaped by social networks, socioeconomic conditions, timing of transitions, transgenerational relationships and interdependencies, and intersectionality. Findings suggest that care needs and care provision fluctuate across time and are best understood as interrelated, dynamic processes influenced by life-course biographies, as well as broader social, economic and policy environments at individual (micro), relational (meso) and structural (macro) levels.

Conclusion

Life-course frameworks are shifting from age-based models towards personalised, context-sensitive perspectives that better capture the complexity and diversity of care trajectories.

Implications for the Profession and/or Patient Care

Care planning should incorporate not only developmental stage but also individual, relational and structural factors influencing care needs, care provision and care trajectories over time.

Impact

Applying a personalised, multilevel life-course perspective may improve assessment accuracy, coordination of resources and equity in care delivery.

No Patient or Public Contribution

This narrative review did not involve patients or the public.

Effects of Nursing Leaders' Toxic Leadership on Nurses' Workplace Satisfaction, Job Engagement, and Turnover Intention: An Online Cross‐Sectional Study

ABSTRACT

Aim

Toxic leadership has become prevalent in nursing; however, the literature provides limited evidence of the different outcomes of toxic leadership behaviours. This research investigated nursing leaders' toxic leadership, nurses' workplace satisfaction, job engagement, and turnover intention in Jordan and whether toxic leadership and sample characteristics predict nurses' workplace satisfaction, job engagement, and turnover intention.

Methods

To reach a more diverse and larger population of nurses, data were gathered in 2023 using an online survey and a cross-sectional research design with convenience snowball sampling of 384 nurses from different hospitals. Nurses “agreed” on the presence of nursing leaders' toxic leadership.

Results

Nurses “agreed” on the presence of nursing leaders' toxic leadership. Similar to Sexton et al.'s (2006) scoring, it was still low (Mean = 3.08/5, Standard Error (SE) = 0.043), which applied in the same magnitude for low nurses' workplace satisfaction (Mean = 2.45/5, SE = 0.036), low nurses' job engagement (Mean = 3.57/5, SE = 0.040), and low nurses' turnover intention (Mean = 3.25/5, SE = 0.038). The highest and lowest means for the four variables. As a part of the workplace satisfaction tool, nurses were asked two open ended-questions about the best and the worst things about their jobs; they answered that nursing provides humanitarian care for patients (n = 178, 95.33%), while the worst thing was the poor work environments, especially related to salaries and workload were (n = 85, 27.25%). Perceived nursing leaders' toxic leadership only predicted perceived nurses' workplace satisfaction (t = 5.79, p = 0.001, Adjusted R 2 = 0.066); perceived nurses' job engagement (t = 5.52, p = 0.001, Adjusted R 2 = 0.067); and perceived nurses' turnover intention (t = 11.16, p = 0.001, Adjusted R 2 = 0.249).

Conclusions

The major effect of toxic leadership of nursing leaders was on nurses' intention to leave. Given the high global nurse turnover rates, toxic leadership would result in low job satisfaction, stress and emotional exhaustion, and, in turn, decreased quality of nursing care. Therefore, it is essential to confront toxic leadership immediately. Nursing leaders' toxic leadership, nurses' workplace satisfaction, job engagement, and turnover intention were low in the current study. However, even if it has a low level, it should be diagnosed and eradicated at early stages to avoid its disastrous outcomes; toxic leadership has detrimental consequences.

Implications for the Profession

Low workplace satisfaction and job engagement are dangerous; thus, they warrant immediate managerial interventions, such as establishing training programmes and using effective communication.

Impact

This study highlights the urgent need for innovative managerial interventions to overcome low workplace satisfaction and job engagement; they are alarming in such rapidly changing work environments.

Reporting Method

Guidelines were followed using the STROBE reporting method.

Patient or Public Contribution

None.

Challenges, Skills and Training Needs of Nurses in Managing Paediatric Obesity in Primary Care Settings

ABSTRACT

Aim

To explore the perceptions of primary care nurses regarding their skills and the challenges they face in managing paediatric obesity.

Design

Qualitative descriptive study.

Methods

Data were collected between May 2022 and March 2024 from focus groups with primary care nurses (n = 25) and analysed using thematic analysis.

Results

Four themes emerged from the data. ‘Nurses’ beliefs, skills and tools to manage pediatric obesity’ highlights the skills and limitations nurses encounter in their practice, their views on the causes of this condition, and how they assess families' motivation. The second theme, ‘Nurse-family-child communication’ describes the communication strategies nurses employ when interacting with motivated and unmotivated families. The third theme, ‘The impact of nursing interventions on family behavior’ highlights the limited results behavioural changes observed in families following interventions. The fourth theme, ‘Nurses' reactions to the treatment of pediatric obesity’ reflects the negative feelings nurses experience in managing paediatric obesity.

Conclusion

This study identifies significant challenges for nurses in addressing paediatric obesity, particularly in communication and engagement with unmotivated families, which might stem from a lack of tools. Furthermore, it recognises the emotional responses of nurses when tackling obesity.

Implications for the Profession

This study highlights the needs related to nurses' communication skills. It is recommended to implement training courses focused on this topic.

Reporting Method

Adherence to COREQ guidelines was maintained.

Patient or Public Contribution

There was no patient or public contribution.

How Government Policies and Organisational and Sectoral Circumstances Influence Nurse Practitioner and Physician Assistant Employment and Training: A Realist Analysis Using Surveys

ABSTRACT

Aims

To explain how government policies affected decision-making on Nurse Practitioner and Physician Assistant employment and training within Dutch healthcare organisations, and how organisational and sectoral circumstances were influential.

Design

An online, cross-sectional survey study.

Methods

A literature- and interview-based program theory was tested using surveys. Respondents from hospital care, (nursing) home care, primary care, and intellectual disability services were recruited using convenience sampling. Data analysis used descriptive statistics and inferential tests. Open-ended responses were analysed using thematic synthesis techniques. Survey results were clustered to assess verification, falsification, or refinement of program theory elements.

Results

A total of 568 experts in hiring and training healthcare professionals participated. Respondents indicated that most government policies promoted employment and training. Organisational and sectoral circumstances caused significant variations in Nurse Practitioner and Physician Assistant deployment across healthcare sectors, shaping how decision-makers interpreted and acted on government policies. Specific circumstances within primary care hampered deployment.

Conclusion

Government policies stimulated training and employment by: (1) removing practice restrictions (scope of practice expansion, legal acknowledgment), (2) facilitating cost-effective training and deployment (training grants, billing options), (3) providing sectoral knowledge on deployment, training, and healthcare outcomes (funding research and a sectoral knowledge center), and (4) establishing sectoral agreements (on apprenticeships). Organisational and sectoral circumstances significantly influenced outcomes. Key circumstances included flanking policies, stakeholder support, labor market capacity, healthcare demand, organisational resources and aims, and type of decision-makers (medical doctor or manager/director). Familiarity with the professions stimulated deployment.

Impact and Implications

The refined and verified program theory supports designing effective skill-mix policies and facilitating Nurse Practitioner and Physician Assistant employment and training. Tailoring skill-mix policies can optimise outcomes. This offers opportunities for governments, healthcare funders, organisations, and professionals to contribute to healthcare quality, cost efficiency, and patient satisfaction.

Patient or Public Contribution

Healthcare professionals were part of the study population.

Impact of missed insulin doses on glycaemic parameters in people with diabetes using smart insulin pens

Por: Varma · M. · Campbell · D. J. T.

Commentary on: Danne et al. Association Between Treatment Adherence and Continuous Glucose Monitoring Outcomes in People With Diabetes Using Smart Insulin Pens in a Real-World Setting. Diabetes Care. 2024.47 (6),:995-10031

Implications for practice and research

  • Healthcare providers should emphasise consistent insulin adherence for people with diabetes, as even a few missed doses can worsen overall glycaemia.

  • Future research should identify barriers to consistent usage of insulin and develop strategies to enable patients’ adherence, such as increasing patient engagement with smart insulin pens and continuous glucose monitoring systems.

  • Context

    Diabetes is a widespread chronic disease, with steadily rising prevalence in most countries. In 2019, the global prevalence of diabetes was estimated at 9.3%, affecting 463 million people. This figure is projected to rise to 10.2% by 2030 and 10.9% by 2045.2 All people with type 1 diabetes and many people...

    Role of intrapartum epidural analgesia in severe maternal morbidity: are there benefits beyond pain relief?

    Por: Ferguson · B. · Capper · T.

    Commentary on: Kearns, RJ, Kyzayeva, A, Halliday, LO, et al. Epidural analgesia during labour and severe maternal morbidity: population based study. BMJ 2024;385.

    Implications for practice and research

  • Health research, policy and information should emphasise the advantages of intrapartum epidurals beyond pain relief, especially for women with pre-existing conditions and preterm labour.

  • Health services must provide access to a 24-hour epidural service within their maternity care.

  • Context

    The use of intrapartum epidurals to manage pain during labour and birth has been globally accepted for decades.1 Kearns et al’s study included all Scottish National Health Service hospitals with birthing units that provide intrapartum care for women between 24 and 42+6 weeks gestation, having either a vaginal or an unplanned caesarean birth.2 Their research highlights the impact of epidural analgesia on 21 indicative conditions identified by the US Centers for Disease Control...

    Fostering inclusive and democratised research through empowered involvement of marginalised communities in research process

    Por: Farzaneh · V. · Turin · T. C.

    Commentary on: Reason M, Acton K, Foulds D. Working it out together: Lessons and insights into inclusive research in an arts context. British Journal of Learning Disabilities 2024:1–11.

    Implications for practice and research

  • Inclusive research places a strong emphasis on the active empowered participation, particularly in decision-making and agenda-setting, of marginalised/disadvantaged community members in every step of the research process.

  • Implementation research needs to focus on how research methodologies can be democratised through a continuous commitment to allyship with marginalised/disadvantaged populations towards empowered involvement.

  • Context

    Research in the field of learning disabilities has been influenced by ableist practices, often excluding individuals with learning disabilities and autism from the research process. This exclusionary tradition, which also has been observed in research with other marginalised/disadvantaged groups, has diminished their capacity to drive change within their communities.1 In contrast to this exclusionary history, the...

    A Descriptive Evaluation of Evidence‐Based Rounds in Critical Care Using Mixed Data Types

    ABSTRACT

    Objectives

    To pilot and evaluate the implementation of a structured Evidence-Based Rounds (EBR) education model in critical care.

    Design

    A mixed data type design was used to evaluate Evidence-Based Rounds in a critical care setting. Structured observational data were captured and open-ended survey responses were submitted by attendees. Content analysis and descriptive statistics were used to analyse survey findings.

    Results

    Seventeen rounds were completed between March 2023 and January 2024 with a total of n = 83 clinical staff members. From these, n = 55 staff completed and submitted evaluation surveys. Rounds were most frequently attended by nurses of all bandings including senior clinical nurses, support workers and student nurses. Evidence-Based Rounds were globally perceived as a positive and useful education strategy and staff were very willing to attend future sessions. Patient outcomes were not directly assessed and rounds specifically facilitated three outcomes: (1) helping staff apply evidence to practice, (2) building staff confidence in presenting clinical information and (3) supporting staff in identifying local improvements to patient care.

    Conclusion

    Evidence-Based Rounds are an adaptable effective model of bedside education within critical care. In our setting, staff perceived that this model facilitated the application of evidence in clinical practice and positively influenced feelings of confidence. Importantly, this education strategy empowered nurses to explore and identify improvements locally to patient care. Whilst this model offers a practical education approach to address some of the key critical care workforce issues, such as an expanding curriculum and loss of senior staff, it could also be widely adopted to other clinical areas.

    Implications for the Profession

    Evidence-Based Rounds are perceived by staff as a successful bedside education model that facilitates nurses to apply evidence in practice. It is feasible that this strategy is a potentially sustainable, low-cost model for continuing professional development centred around routine clinical work.

    Patient and Public Contribution

    No patient or public contribution.

    Older Persons' Participation in Life‐Enhancement Activities in a Long‐Term Care Facility: A Mixed‐Methods Observational Study

    ABSTRACT

    Aim

    To examine older persons' experiences and participation in life-enhancement activities in a long-term care facility.

    Design

    Convergent mixed-methods design.

    Methods

    Naturalistic observations of 20 life-enhancement activity sessions were conducted in a single long-term care facility that includes 111 older persons in September 2024. Data were collected through guiding questions and fieldnotes for systematic observation. We used Kruskal-Wallis and Mann–Whitney U tests for quantitative analysis. Fieldnotes were analyzed using a six-phase reflexive thematic analysis approach.

    Results

    Engagement levels (self-initiative, assistance-seeking frequency, and social interaction frequency) significantly differed across 16 different life-enhancement activities. Social interaction frequency also varied by mobility status (wheelchair, walker, independent). Participants displayed significantly more distractions in the TV Room than in the Activity Room. Four themes emerged from thematic analysis: (1) participation barriers, (2) activity contextual factors, (3) facilitator support strategies, and (4) social interactions and emotional well-being.

    Conclusion

    Structural elements (purposefully designed rooms, activity design and complexity, and the resident-preferred music), relational elements (facilitators' hands-on support, conflict resolution, and positive reinforcement), and individual factors (mobility status) influence older persons' participation in life-enhancement activities. Life-enhancement activities benefit older persons when they are provided with choices and adaptive equipment.

    Implication

    Findings support allocating distraction-free spaces for life-enhancement activities, incorporating resident-preferred music and game-layered physical exercises, and providing facilitator training in adaptive coaching, hands-on support, and conflict resolution.

    Impact

    Life-enhancement programs can promote psychosocial well-being among older persons in long-term care facilities by transforming routine recreational activities into personalized and socially engaging experiences that may reduce feelings of loneliness.

    Reporting Method

    Journal Article Reporting Standards for Mixed Methods Research.

    Patient or Public Contribution

    No Patient or Public Contribution.

    Siblings' and Parents' Experiences With the ‘Sibling Talks’ Intervention: A Qualitative Interview Study in a Primary School Nursing Context

    ABSTRACT

    Aims

    This study aims to (1) understand the impact of having a child with complex care needs in the family and (2) explore how siblings and parents experience the Sibling Talks intervention.

    Design

    A qualitative exploratory design.

    Methods

    Semi-structured interviews were conducted with six siblings and 10 parents from seven families after completing the Sibling Talks intervention between January 2023 and April 2023. Data were analysed using Braun and Clarke's reflexive thematic analysis.

    Results

    The analysis identified four themes, with separate findings for siblings and parents. Siblings described the impact of having a sibling with complex care needs as ‘Struggling to find their role and to understand themselves’ and their experiences with dialogues in Sibling Talks as ‘The importance of support from the school nurse’. Parents described their experience of their family situation as ‘A balancing act of care and other responsibilities’ and noted a shift ‘From scepticism to relief’ regarding the dialogues in Sibling Talks.

    Conclusion

    Sibling Talks facilitated open communication between siblings and parents, helping parents gain a deeper understanding of their children's perspectives. Sessions with nurses were experienced as respectful and caring, allowing siblings' perspectives to be heard and enhancing family interaction.

    Impact

    This study provides new insights into siblings' needs and how nurses can approach and communicate with siblings and parents, highlighting positive experiences with the Sibling Talks intervention.

    Reporting Method

    The study followed the Consolidated Criteria for Reporting Qualitative Research (COREQ).

    Patient or Public Contribution

    There was no patient or public contribution.

    Building a baby‐friendly community: Development, strategy, implementation and evaluation of a BFCI program

    Abstract

    Aim

    The aim of the study was to investigate the impact of the use of baby-friendly community initiative (BFCI) model on various stakeholders in the community.

    Design

    Quasi-experimental research design.

    Method

    The study was conducted in public premises and online workshops from April 2019 to September 2022. Participants were followed up for a period of 1 month, except for those employed at public premises. The program involved training based on an accredited BFCI framework to cultivate a breastfeeding-friendly attitude and knowledge. A paired sample t-test was used to examine breastfeeding attitude and knowledge scores before and after BFCI training among staff employed from public premises. An analysis of variance was conducted to examine the breastfeeding self-efficacy and attitude scores, measured repeatedly at different timepoints over 1-month timepoint (T0, T1 and T2) among pregnant and postpartum women.

    Results

    A total of 2340 perinatal women and 1339 staff from public premises were recruited. For staff, there was an increase in the mean score of breastfeeding knowledge and attitude by 5.8 and 6.1, respectively, at T1. Similarly, for perinatal women, there was an increase in the mean score of breastfeeding self-efficacy and attitude by 6.6 and 3.3, respectively, at T1.

    Conclusion

    In summary, a BFCI model, with active community participation, accreditation and an award system, has been effective in promoting breastfeeding. Adapting the baby-friendly hospital initiative to local contexts and employing a social theory model can enhance breastfeeding promotion and improve infant health outcomes. Prioritizing culturally sensitive breastfeeding education is crucial for successful BFCI implementation.

    Implications for the profession and/or patient care

    Healthcare professionals should consider clients' culture and socio-economic backgrounds when providing breastfeeding education to maximize effectiveness. The target audience for breastfeeding education should be expanded to include various community stakeholders beyond families.

    Impact

    What problem did the study address? This study addressed the problem of knowledge gaps among stakeholders in building a breastfeeding-friendly community, particularly in implementing a baby-friendly community initiative (BFCI) as part of a baby-friendly hospital initiative (BFHI). The research filled a service gap by providing effective interventions targeting community stakeholders and assessing the impact of a BFCI program on their knowledge and attitudes towards breastfeeding.

    What were the main findings? The findings highlighted the effectiveness of a BFCI program in enhancing breastfeeding knowledge and attitudes among frontline staff and increasing breastfeeding confidence among mothers. These findings contribute to the understanding of the program's impact on different stakeholders in the community.

    Where and on whom will the research have an impact? It impacts on global policymakers by providing insights for developing comprehensive guidelines for future BFCI implementations. It also contributes to the creation of a more baby-friendly community, benefiting breastfeeding families and their infants by promoting and supporting breastfeeding families.

    Reporting Method

    This study has adhered to relevant EQUATOR guidelines using the TREND reporting guideline.

    Patient or Public Contribution

    No patient or public contribution.

    What Does This Paper Contribute to the Wider Global Clinical Community?

    This study provides an overview of the establishment of a localized BFCI program. It also opens up a new direction for the community to investigate BFCI strategies for community stakeholders. It also provides evidence to support other countries in following a similar process, as each country approaches becoming breastfeeding-friendly in its own unique way.

    Trial and Protocol Registration

    No protocol.

    Implementation of Positive Advanced Recovery Connections in Primary and Secondary Mental Health Care—A Registered Advanced Nurse Practitioner‐Led Initiative

    ABSTRACT

    Aim(s)

    This study reports on the implementation of a registered advanced nurse practitioner intervention. Aims include improving access, service user outcomes and integration between primary and secondary care.

    Design

    This paper reports the quantitative results of a mixed methods implementation study. Qualitative data are reported separately. The PARiHS framework informs the implementation process itself, with considerations for nurses and other healthcare professionals explored.

    Methods

    The CORE-OM 34 item rating scale was administered both pre- and post-intervention. Service user attendances in secondary care was monitored.

    Results

    Findings suggest that the intervention was associated with clinically significant improvements in global or generic distress, reported by service users, as evidenced by changes in the CORE-OM scores. Access to care was recorded at an average of 3.6 days. Implementation science supported effective and safe implementation with clear governance structures.

    Conclusion

    Registered advanced nurse practice in mental health clinics which provide full episodes of care results in improved integration and may be associated with positive patient outcomes. Implementation science is taught on Irish nursing programmes and this is important if innovative services are to be embedded in the healthcare system.

    Impact

    The development of a model of care for mental health Registered Advanced Nurse Practitioners at the interface of primary and secondary care settings may be merited. Positive Advanced Recovery Connections may be associated with improving mental health outcomes and bolstering integration of primary and secondary care services. The utilisation of implementation science highlights the need for collaboration with all stakeholders to overcome barriers and recognise facilitators to attain the necessary model of integrated care.

    Patient and Public Contribution

    Peer recovery input was provided by members of the service Recovery College, with participation evident in all stages of the project. The psychosocial assessment template was also co-designed.

    Desired dementia care towards end of life: Development and experiences of implementing a new approach to improve person‐centred dementia care

    Abstract

    Aims

    To describe the co-creation of the ‘Desired Dementia Care Towards End of Life’ (DEDICATED) approach to improve person-centred palliative care for individuals with dementia and to describe the experiences of healthcare professionals during the approach's implementation.

    Methods

    A needs assessment, comprising both qualitative and quantitative studies, informed palliative care needs of healthcare professionals, family caregivers and individuals with dementia. The approach was co-created with healthcare and education professionals, guided by the findings. Then, healthcare professionals were trained to implement the approach in their organizations. From April to June 2022, semi-structured interviews with actively engaged professionals were analysed using Conventional Content Analysis.

    Results

    The needs assessment yielded six key themes: (1) raising palliative care awareness, (2) familiarization with a person with dementia, (3) communication about future care preferences, (4) managing pain and responsive behaviour, (5) enhancing interprofessional collaboration in advance care planning and (6) improving interprofessional collaboration during transitions to nursing homes. Interviews with 17 healthcare professionals revealed that active involvement in co-creating or providing feedback facilitated implementation. Overall, the DEDICATED approach was perceived as a valuable toolkit for optimizing palliative care for people with dementia and their loved ones.

    Conclusion

    Co-creating the DEDICATED approach with healthcare professionals facilitated implementation in daily practice. The approach was considered helpful in enhancing person-centred palliative dementia care.

    Impact Statement

    This study underscores the importance of active involvement of healthcare professionals in the research and development of new interventions or tools for palliative care, which can influence the successful implementation, dissemination and sustained usage of the developed tools.

    Implications for the Profession and Patient Care

    The developed approach can improve person-centred palliative care for individuals with dementia, ultimately improving their quality of life and that of their loved ones.

    Reporting Method

    This study used the Consolidated Criteria for Reporting Qualitative Research.

    Patient of Public Contribution

    No patient or public contribution.

    The Association Between Caregiving Context and the Health and Well‐Being of Carers and Their Care Recipients Living With Dementia: A Cross‐Sectional Study

    ABSTRACT

    Aim(s)

    To examine the association between caregiving context and the health and well-being of community-dwelling people with dementia (functional ability, physical function, depression, quality of life and health-related quality of life) and their informal carers (health-related quality of life) at the pre-rehabilitation stage and the potential mediating role of caregiving context variables.

    Design

    Cross-sectional study.

    Methods

    Secondary analysis of baseline data from a randomised controlled trial of 130 dementia care dyads—the Interdisciplinary Home-based Reablement Programme (2018–2022). Bivariate analyses were applied to identify key caregiving context variables—co-residence, sole carer status, additional caring responsibilities, client-carer relationship and subjective carer burden (carer burden hereafter)—associated with health outcomes. Subsequently, multivariable linear regression models were developed. To examine carer burden, two models were run for each outcome: one with caregiving context variables and covariates, and the other adding carer burden. The mediating effects of the identified caregiving context variable were examined using post hoc mediation analysis.

    Results

    Spouse/partner carer relationship was significantly associated with better client well-being, including lower depressive symptoms and higher quality of life scores compared to adult child and other relationships. Higher carer burden was strongly associated with lower functional ability, more depressive symptoms, lower quality of life for clients and lower health-related quality of life for both clients and carers. Including carer burden in regression models explained the greatest variance across most models. Carer burden fully mediated the association between additional caring responsibilities and client functional ability, and partially mediated the association between other carers and client depression.

    Conclusion

    Carer burden needs to be carefully considered in supporting the health and well-being of dementia carer dyads.

    Implications

    Addressing carer burden and tailoring support to carers are essential for optimising health impacts for dementia carer dyads.

    Reporting Method

    STROBE checklist.

    Patient or Public Contribution

    None.

    Trial Registration

    ClinicalTrials.gov identifier: ACTRN12618000600246

    Fostering career interest in community nursing: early strategic approaches in education, clinical placements, and mentorship for nursing students are crucial

    Por: Mack · A. · Turin · T. C.

    Commentary on: Chee, JMP, Rusli KDB, Tan ZYA, Tan AJQ, Ang SGM, Lau ST, Seah B, Liaw SY. Perceptions of community care among nursing students: A cross-sectional study with implications to the nursing workforce. Nurse Education Today. 2024; 137:106162. 10.1016/j.nedt.2024.106162

    Implications for education and research

  • With the shift towards delivering healthcare services in homes, communities and primary healthcare settings, nursing curricula should integrate community nursing early in the program and provide diverse placements with mentorship opportunities to highlight career paths in this specialty.

  • Future research should explore effective implementation strategies to enhance student perceptions of community care and address workforce challenges in this field.

  • Context

    The increasing demand for postacute and home-based care programmes creates an urgent need to expand the community nursing workforce.1 However, a gap in attracting graduates into community care contributes to a problematic shortage of community nurses.

    The Impact of Perceived Clinical Nurse Managers' Despotic Leadership on Nurse Turnover Intention: A Cross‐Sectional Study

    ABSTRACT

    Background

    Nurses play vital roles in healthcare systems, especially in competitive environments that must meet diverse stakeholder expectations, improve quality and foster innovation. However, these efforts are often challenged by workforce issues such as nurse turnover intention, which is a critical concern requiring effective leadership and management. Despotic leadership is harmful and may lead to negative nurse behaviours, including intentions to leave their positions.

    Aim

    This study explored the correlations and differences in the clinical nurse managers' despotic leadership and nurse turnover intention based on the sample characteristics as perceived by registered nurses (RNs) working in the selected hospitals in Jordan.

    Methods

    This study employed a quantitative cross-sectional correlational comparative design to measure the relationships and differences between the perceived despotic leadership of nurse managers and nurse turnover intention. In 2024, a paper-format survey was distributed to nurses working in various hospitals. Five governmental and private hospitals in Jordan were purposively chosen to recruit 301 nurses using non-probability convenience snowball sampling techniques. Sample size was collected using G* power, and data were collected using a highly psychometric instrument of the Toxic Leadership Behaviours of Nurse Managers Scale (The ToxBH-NM Scale) and the Turnover Intention Scale (TIS-6 Items).

    Results

    The overall score for clinical nurse managers' despotic indicated a moderate level of despotic leadership among nurse managers. Among the nurses surveyed, 53 (17.60%) expressed an intention to stay in their positions, while 248 (82.30%) indicated they intended to leave those positions. There was a statistically significant weak positive correlation between the total score of perceived clinical nurse managers' despotic leadership and the total score of perceived nurse turnover intention (r = 0.215, p = 0.01). This correlation suggests a small effect size (Cohen's guidelines: small = 0.10, medium = 0.30, large = 0.50), indicating that while the relationship was statistically significant, the practical impact was at a small level. No significant differences were found in the perceived despotic leadership of nurse managers or nurse turnover intention.

    Conclusions

    The findings highlighted the critical roles of leaders, policymakers and organisations in reducing the perceived despotic leadership of nurse managers. These roles are crucial in decreasing nurses' intentions to leave their jobs.

    Impact

    Accurately identifying despotic management behaviours is crucial. To improve nurse retention, healthcare organisations should implement evidence-based interventions targeting job satisfaction, workload management and ongoing professional development.

    Patient or Public Contribution

    This study did not include patient or public involvement in its design, conduct or reporting.

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