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To determine the prevalence and characteristics of urinary catheter blockage in older patients using objective indicators and to characterize obstructive materials and microbiota.
A cross-sectional study.
Patients aged ≥ 65 years with an indwelling catheter for ≥ 24 h were recruited from a long-term care hospital. Blockage was defined using objective indicators including residual urine volume, leakage, reinsertion urine volume and resistance to saline injection. Samples were analysed for composition and microbiota.
Among 77 patients, 29.9% experienced catheter blockage. Blockage was associated with shorter catheterization duration and greater intraluminal narrowing. Proteus mirabilis and Campylobacter ureolyticus were more abundant. Most blockages occurred at the catheter tip (81.0%), with struvite as the predominant material (71.4%). Microbiota varied by material composition.
Catheter blockage occurred in 29.9% of patients, mainly at the catheter tip and associated with struvite. Microbiota differed by blockage status and material composition.
Objective identification of catheter blockage supports early detection and targeted management and provides a basis for research on mechanisms. These findings provide a foundation for future research to develop and evaluate evidence-based nursing interventions for preventing catheter blockage in older adults.
This study addressed the lack of objective criteria and limited understanding of catheter blockage. It showed that about 30% of patients experienced blockage and identified distinct microbiota and material characteristics. These findings may improve catheter management and support future research on mechanisms and prevention.
STROBE checklist.
Patients contributed to data collection by providing information on symptoms related to catheter blockage through structured assessments, while nurses during the study period facilitated data collection and conducted clinical assessments.
Patients undergoing orotracheal intubation (OTI) are prone to oral mucosal pressure injuries (OMPI), yet clinical recognition and prevention remain insufficient. The knowledge, attitudes and practices (KAP) of ICU nurses regarding OMPI prevention are unclear, particularly in multicentre settings.
To assess ICU nurses' KAP on OMPI prevention in Western China, identify gaps, and inform targeted training and practices.
Cross-sectional survey.
A multicentre cross-sectional survey used convenience sampling. ICU nurses completed a 36-item KAP-OMPI questionnaire online. Data were analysed using R 4.3.3 and Zstats 1.0. Cronbach's α assessed internal consistency. Group comparisons used chi-square, Mann–Whitney U or Kruskal–Wallis tests (α = 0.05). Multivariate linear regression and mediation analysis (1000 bootstraps) tested the KAP pathway.
A total of 667 questionnaires were returned from ICU nurses in 48 hospitals. Median total KAP-OMPI score was 136. Knowledge scored 30, attitude 40 and practice 64. Univariate analysis showed that education, professional title, age, years of experience, prior OMPI care, training and active literature learning were significantly associated with all scores (all p < 0.05). Multivariate regression identified lack of training, no prior OMPI care and no active literature learning as independent predictors of lower total, knowledge and practice scores (all p < 0.05). Mediation analysis showed attitude partially mediated the knowledge–practice relationship (indirect effect 0.294), accounting for 31.35% of the total effect.
ICU nurses showed positive attitudes and moderate-to-high practices, but knowledge, assessment and evidence-based learning gaps persist. We recommend targeted training on staging and standardized protocols to improve OMPI prevention and reduce OTI-related complications.
Leveraging these findings, OMPI staging training and standardized protocols should be implemented to bridge the KAP gap and reduce intubation-related OMPI.
No patient or public involvement; data from anonymous nurse surveys only.
Chinese Clinical Trial Registry: ChiCTR2500112798 (Date: November 19, 2025)
To propose an ethical decision-making framework for artificial intelligence (AI) involvement in person-centred fundamental care, organised around the relational dependency of care activities and grounded in the Fundamentals of Care Framework and the Caring Life Course Theory.
Discursive paper integrating care ethics, the Fundamentals of Care Framework, the Caring Life Course Theory, person-centred care theory and technology ethics scholarship.
Peer-reviewed literature (primarily 2006–2026, plus seminal earlier care-ethics works) from nursing, bioethics, technology ethics and health informatics was searched across CINAHL Complete, PubMed, PsycINFO and Scopus. Policy documents from the World Health Organisation (WHO), the International Council of Nurses (ICN) and the European Union (EU) were also reviewed.
The Relational Care–Artificial Intelligence Alignment (RCAA) framework operates within the three established dimensions of the Fundamentals of Care Framework (relationship, integration of care and context) and classifies fundamental care activities by relational dependency into three zones: Zone 1 (high dependency), where AI serves as background support; Zone 2 (moderate dependency), where collaborative human–AI partnership is appropriate; and Zone 3 (low dependency), where autonomous AI operation under human oversight is acceptable. Five ethical principles guide zone placement: relational autonomy, non-maleficence of depersonalisation, universal access to person-centred fundamental care, transparency and explicability and proportionality. Each is grounded in established care ethics, bioethics or AI governance traditions. Establishing the nurse–patient relationship and eliciting patient preferences sit at the entry point of the framework.
The framework offers a structured approach for determining where AI can participate in fundamental care while preserving the relational essence of nursing. It is offered as a heuristic to facilitate discussion and action across clinical, educational and policy settings.
The framework can inform institutional AI adoption policies, guide nursing curricula and support regulatory standards for technology deployment in care.
What problem did the study address? The absence of a systematic ethical framework, anchored in established person-centred fundamental care theory, for determining appropriate boundaries of artificial intelligence involvement in fundamental nursing care. What were the main findings? A relational dependency-based classification, situated within the Fundamentals of Care Framework, can guide artificial intelligence involvement through three zones of human–machine collaboration while preserving patient choice and the centrality of the nurse–patient relationship. Where and on whom will the research have an impact? Nurses, healthcare organisations, policymakers and technology developers working through artificial intelligence integration into person-centred care.
This study did not include patient or public involvement in its design, conduct or reporting. We acknowledge this as a limitation and discuss it explicitly in the Strengths and Limitations section.
To synthesize evidence on continuous bedside pressure mapping for pressure injury prevention in adult hospital and long-term care settings and its impact on staff and family members.
Mixed-methods systematic review following the Joanna Briggs Institute convergent segregated approach.
Double screening, standardized data extraction and quality appraisal were performed. Quantitative findings were synthesized using meta-analysis where appropriate or summarized without pooling, and qualitative findings were synthesized thematically, followed by integrated synthesis. The review was registered with PROSPERO (CRD42024537519).
PubMed, Web of Science, the Cochrane Library, Embase, CINAHL, CNKI, Wanfang Data and VIP were searched from inception to September 20, 2025. Manual checking of relevant sources, including citation and reference checking, was also conducted.
Eighteen studies were included. Observational cohort studies suggested lower pressure injury incidence in selected high-risk settings, but randomized trials showed no significant overall preventive effect. An exploratory interface pressure meta-analysis showed a borderline reduction with substantial heterogeneity and was not robust to sensitivity analysis. The technology was associated with process improvements in the timeliness of repositioning, staff knowledge, patient awareness and acceptability. Barriers included cost, technical concerns, workflow disruption and limited economic evidence.
Continuous bedside pressure mapping may support pressure injury prevention as a workflow-integrated decision-support tool, but evidence of clinical effectiveness remains limited and context-dependent. Implementation should include staff training, protocolized repositioning, patient and family communication and evaluation of care processes, clinical outcomes, workload and costs. High-quality randomized trials with standardized protocols and economic evaluations are needed.
Nurses should use continuous bedside pressure mapping as an adjunct to clinical judgement and established protocols, rather than as a stand-alone intervention. Adoption should include staff training, agreed repositioning protocols and alert thresholds, patient and family explanation and monitoring of care processes, workload, outcomes and costs.
This systematic review adhered to the PRISMA 2020 reporting guideline.
No patient or public contribution.
To retrieve, evaluate, and summarize the evidence related to nutritional risk screening and assessment in adult critically ill patients, providing an evidence-based decision-making reference for clinical healthcare professionals.
This study was an evidence summary followed by the evidence summary reporting standard of Fudan University Center for Evidence-based Nursing.
According to the ‘6S’ model of evidence resources, evidence on nutritional risk screening and assessment in adult critically ill patients was retrieved, including clinical decision-making, best practices, guidelines, evidence summaries, expert consensus, and systematic evaluations.
Up to date, BMJ Best Practice, Cochrane Library, Joanna Briggs Institute (JBI), Embase, PubMed, WanFang Medical, China Biomedical Literature Database, CNKI, and relevant professional society websites including the National Institute for Health and Care Excellence (NICE), GIlN, the National Guideline Clearinghouse, and Yi Maitong were searched from the establishment of these databases to Dec. 2024.
Eleven literature sources were included, comprising 8 guidelines, 2 expert consensuses, and 1 evidence summary. Through rigorous synthesis, 18 best practice recommendations were distilled across eight critical domains: multidisciplinary team formation, screening targets, screening timing, screening instruments, screening frequency, assessment targets, assessment core parameters, and assessment frequency.
This study summarizes the current best evidence regarding nutritional risk screening and assessment in adult critically ill patients, providing optimal evidence support for standardizing nutritional risk screening and assessment in this population. In clinical practice, it is essential to select the best evidence for localized and individualized application while continuously updating the evidence to standardize nursing practice.
Clinical medical staff are encouraged to use evidence-based recommendations for the screening and assessment of nutritional risks in adult critically ill patients. By implementing these best evidence practices, healthcare professionals can enhance patient care and improve clinical outcomes, ensuring that nutritional needs are effectively addressed.
The effective screening and assessment of nutritional risk in critically ill patients are crucial for optimizing patient outcomes. This study summarizes 18 pieces of best evidence concerning nutritional risk screening and assessment, highlighting their importance in clinical practice. Implementing these recommendations can enhance the quality of nutritional care, reduce complications, and ensure that patients receive appropriate nutritional interventions tailored to their needs. By focusing on these best practices, healthcare providers can significantly improve the management of nutrition in critically ill patients.
This research followed the evidence summary reporting specifications of the Fudan University Center for Evidence-based Nursing.
The registration number is ‘ES20221368’
Sleep problems are common among primary care nurses and are closely associated with psychological stress and maladaptive cognitive processing. Understanding the complex interplay among these psychological factors is critical for improving health outcomes and care quality.
This study aimed to examine the relationships between perceived stress, rumination (both positive and negative), and sleep quality in primary care nurses using a network analysis approach.
A cross-sectional study was conducted among 316 primary care nurses in public primary healthcare institutions in Shapingba District, Chongqing, China. Participants completed standardized self-report measures assessing perceived stress, rumination tendencies, and sleep quality. Network analysis was used to model the associations between these variables and to identify the most influential components.
Approximately 64.6% of participants reported poor sleep quality. Network analysis revealed that sleep latency and perceived tension were the most central nodes within the network. Sense of tension and enjoy happiness showed the highest bridge strength, indicating their roles in connecting different psychological domains. Negative rumination—particularly suppression of positive emotions and negative attribution—showed strong links to sleep-related variables, suggesting its importance in the network structure.
Perceived stress and negative rumination were closely related to sleep problems among primary care nurses. The findings suggest that stress reduction and cognitive-emotional interventions targeting maladaptive rumination may be effective strategies to improve sleep quality and overall well-being in this population.
No patient or public contribution.
To assess the prevalence of workplace violence (WPV) against clinical nursing students during internships and quantify the prevalence of different types of violence, such as physical, verbal and sexual.
Systematic review and meta-analysis.
Eligible cross-sectional studies that reported WPV prevalence among clinical nursing students were included. Two researchers independently screened literature and extracted data. The Joanna Briggs Institute tool was used to evaluate bias risk. Pooled prevalence rates, heterogeneity and publication bias were examined.
A comprehensive search was conducted across eight databases, from the inception of each database to 31 March 2025.
A total of 16 cross-sectional studies from eight countries involving 8037 nursing students were included in the analysis, with 11 studies (n = 5550) contributing to the overall pooled estimate. Using a random-effects model, the pooled prevalence of WPV of any type was found to be 40%, with substantial heterogeneity. Verbal violence emerged as the most prevalent subtype (47%), followed by sexual violence (12%) and physical violence (10%). Significant publication bias was detected for both physical and sexual violence, indicating a potential underestimation of the true prevalence.
This systematic review indicated that WPV is a significant occupational hazard encountered by clinical nursing students across diverse international contexts represented during internships.
These findings highlight the urgent need for educational and healthcare institutions and policymakers to implement coordinated measures, such as enhanced preventive training, comprehensive reporting and support systems and a zero tolerance safety culture to protect the future nursing workforce.
This systematic review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
This study did not include patient or public involvement in its design, conduct or reporting.
The research protocol was registered with PROSPERO (CRD420251027354).
To assess caregiver burden and its relationship with health literacy, self-efficacy, stigma, and social support among caregivers of children with tuberculosis in Shanghai, China.
Explanatory sequential mixed-methods design.
In the quantitative phase, 132 caregivers were recruited from a Shanghai Hospital, and 21 participated in the qualitative interviews. Data were collected (April 2023–April 2025) using the Zarit Burden Interview scale, Chinese Health Literacy Scale for Tuberculosis, General Self-Efficacy Scale, Tuberculosis-related Stigma Scale, Multidimensional Scale of Perceived Social Support, and semi-structured interviews. Quantitative data were analysed using descriptive statistics and multiple regression analyses, and qualitative data were analysed using content analysis.
Most caregivers were mothers (72.7%). Burden levels were classified as mild (58.3%), moderate (27.3%), or severe (2.3%). The quantitative analysis identified lower health literacy, limited social support, reduced self-efficacy, and being a female caregiver as significant predictors. Social support partially mediated and self-efficacy mediated the effect of perceived stigma and health literacy on caregiver burden, respectively. Qualitative themes revealed psychological and physical effects, impact on social life, and coping strategies.
Caregiver burden in paediatric tuberculosis is multidimensional and influenced by complex mechanisms. Interventions should address health literacy gaps, enhance self-efficacy, strengthen social support systems, and implement targeted stigma-reduction strategies while considering developmental-stage-specific needs.
Healthcare systems should routinely assess caregiver burden, and multidisciplinary teams should be trained to provide integrated targeted support.
This study demonstrates distinct stigma pathways and comprehensively shows that caregiver burden is significantly associated with modifiable psychosocial factors. Consequently, healthcare providers should develop targeted support interventions that address both psychological and practical caregiving challenges, ultimately contributing to improved patient care outcomes and caregiver well-being in tuberculosis management.
This study adheres to the Good Reporting of A Mixed Methods Study checklist.
None.
The rising prevalence of cognitive impairment has made it a critical public health priority. Nurses are central to chronic disease management, yet the efficacy of the interventions in older adults with cognitive disorders remains uncertain.
To evaluate the efficacy of nurse-led interventions in older adults with cognitive disorders.
A comprehensive search was conducted across seven electronic databases from their inception to August 2025. This meta-analysis focused on nurse-led interventions. The primary outcome was cognitive function, and secondary outcomes included depressive symptoms and quality of life. Due to the heterogeneity of the studies, we employed a random effects model for the meta-analysis.
The results indicated that nurse-led interventions significantly improved cognition (SMD = 0.64; 95% CI, 0.39–0.88; p < 0.05), substantially alleviated depressive symptoms (SMD = −0.32; 95% CI, −0.53–0.11; p < 0.05) and enhanced quality of life (QoL) (SMD = 0.40; 95% CI, 0.17–0.64; p < 0.05).
The results of this study indicate that nurse-led interventions are highly beneficial for elderly individuals with mild cognitive impairment (MCI) or dementia. In future research, it is necessary to comprehensively consider the roles that nurses undertake. They should play an active role in the recovery from chronic diseases. These findings provide an important basis for policymakers and clinicians.
PROSPERO Registration number: CRD42024619016
To explore the illness coping experiences of patients with moderate-to-severe burns and provide a reference for healthcare professionals to formulate coping strategies.
Qualitative study using a descriptive phenomenological approach.
From 1 June to 30 September 2024, semi-structured interviews were conducted with 19 patients with moderate-to-severe burns. Colaizzi's seven-step method was used for data analysis.
Seven subthemes and three higher order themes were identified: (1) perception of illness experience; (2) coping with disease threats; and (3) benefits of coping with illness. Most of the participants faced multiple difficulties in their disease experiences, such as increased financial pressure, higher pressure on family caregiving, deformed physical conditions and negative emotions. Positive psychological qualities, family and social support played significant roles in coping with these challenges.
Patients with moderate-to-severe burns experience multiple difficulties during their recovery. Effective coping resources can help them overcome these challenges.
Healthcare professionals should work with patients with moderate-to-severe burns and their families to establish an effective support system that enhances patients' coping abilities and promotes their overall recovery.
Patients with moderate-to-severe burns face diverse challenges. However, their experiences and coping processes during recovery remain unclear. This study provided valuable insights into their illness experiences and coping strategies. The findings highlighted multiple difficulties, such as a significant increase in financial pressure and dependence on family caregiving, painful and deforming physical conditions and various negative emotions. Positive psychological qualities, family and social support play an important role in coping with these challenges. Healthcare professionals should work with patients and their families to establish effective support systems to promote overall recovery.
No patient or public involvement.
To systematically review published studies on the post stroke delirium risk prediction models; and to provide the evidence for developing and updating the clinically available prediction models.
Systematic review.
Systematically searched studies on 10 databases, which were conducted from inception to 9 January 2025. The studies of post-stroke delirium risk prediction models were included.
Extracted the data from the selected studies. The Prediction Model Risk of Bias Assessment Tool checklist was used to evaluate the risk of bias of the models. The meta-analysis of model performance and common predictors was performed by Revman 5.4 and Medcalc.
A total of 12 studies were included, and 21 risk prediction models for post-stroke delirium were constructed. The combined effect size of area under the receiver operating characteristic curve was 0.84. All studies were found to have a high risk of bias and good applicability. Meta-analysis showed: National Institutes of Health Stroke Scale score, age, neutrophil-to-lymphocyte ratio, neglect, visual impairment and atrial fibrillation were independent predictors of post-stroke delirium.
The included studies all found to have a high risk of bias; future studies should focus on adopting more scientifically rigorous study designs and following the standardised reporting guidelines to enhance extrapolation and facilitate its clinical application.
This review may promote clinical healthcare workers to develop and update clinically available prediction models, thereby establishing risk prediction models with strong clinical utility.
This study presents the first systematic evaluation of delirium risk prediction models in stroke patients, thereby facilitating the choice, use and develop of the clinical usable post stroke delirium risk prediction models.
This review adhered to the PRISMA guidelines.
No patient or public contribution.
RD42024620360 (PROSPERO According to JAN Guidelines).
To explore the factors influencing nurses' attitudes towards seeking professional psychological help using network analysis.
A cross-sectional study design was employed.
In Shapingba District, Chongqing, China, a two-stage sampling method was used to select 717 nurses from primary healthcare institutions and secondary public hospitals. Data were collected through anonymous online self-report surveys from November to December 2023. Multiple validated scales were used to measure mental health literacy, social support, mental illness stigma and attitudes towards seeking professional psychological help. Network analysis was conducted in R software.
The ‘Confidence in Mental Health Practitioner’ was identified as a key node in the network. Social support was positively associated with the attitude of seeking help, while mental illness stigma had a negative effect.
Confidence in mental health practitioners plays a key role in shaping nurses' help-seeking attitudes. Enhancing professional credibility, reducing stigma and fostering supportive environments may promote psychological help-seeking, especially in primary and secondary care settings.
For the profession, it provides insights for developing targeted training to improve nurses' mental health. For patient care, a mentally healthy nursing workforce can enhance the quality of care.
Addressed the problem of low rates of nurses seeking professional psychological help and the complex factors involved. Main findings: Key factors influencing nurses' attitudes towards seeking help and the role of confidence in mental health practitioners. The research will impact healthcare institutions, nurses and ultimately patients, as it can guide the creation of a better working environment for nurses.
No patient or public contribution.
To explore the prescribing practices and behaviours of Advanced Practice Nurses (APN) and pharmacist prescribers in Singapore, assess their confidence in key prescribing competencies, examine their use of information sources, and understand their views on the consequences of prescribing errors.
Cross-sectional national survey.
A census survey of all registered APN and pharmacist prescribers in Singapore was conducted from February to May 2024 using a validated 96-item instrument. The survey assessed prescribing practices, confidence in prescribing competencies, use of information sources, and prescribing safety. Descriptive statistics were used for analysis.
Ninety-one prescribers (54 APNs, 37 pharmacists) responded (32% response rate), most of whom worked in public medical/surgical settings. Prescribing comprised a median of 75% of their practice. Most time was spent prescribing continued medications, with less on initiating new medicines. Participants reported high confidence in communication, therapeutic partnerships, and working within professional standards. Greatest confidence was seen in educating patients, legal prescribing, and monitoring treatment response. Lower confidence was noted in complementary medicine-related tasks. Professional literature and colleagues were the most valued information sources. Most participants acknowledged the serious consequences of prescribing errors, though many believed such errors would likely be intercepted.
APNs and pharmacists demonstrate strong competencies in safe, holistic prescribing. However, cultural factors may limit patient engagement, highlighting the need to strengthen shared decision-making and collaborative practice.
Refining governance structures, adopting tiered prescriber autonomy, and enhancing training in complex prescribing are essential. Standardising deprescribing, improving access to decision-support tools, and promoting interprofessional collaboration and patient involvement can strengthen care quality and team-based delivery.
This study offers the first national insight into Singapore's Collaborative Prescribing Framework and informs training, policy, and workforce development for non-physician prescribers locally and in similar international contexts.
STROBE checklist.
This study did not include patient or public involvement in its design, conduct, or reporting.
To examine the relationship between ethical conflicts and ethical decision-making ability, ethical sensitivity and demographic factors as mediator/moderator roles.
A cross-sectional survey was conducted from June to December 2024.
This study involved 503 intensive care unit nurses from eight tertiary hospitals across Zhejiang, Guangdong and Guangxi provinces. Participants completed validated instruments including the Ethical Conflict Nursing Questionnaire-Critical Care Version, the Chinese Moral Sensitivity Questionnaire-Revised version and the Chinese Version of Judgement About Nursing Decision. SPSS 27.0 was used for descriptive statistics and Pearson correlation analysis, while PROCESS macro handled mediation and moderation analysis.
The relationship between ethical conflict and decision-making ability was significantly mediated by both moral responsibility/strength and burden, with the latter demonstrating a stronger indirect effect. Furthermore, exploratory moderated mediation analysis showed that this mediation model varied significantly across different levels of work experience and types of intensive care unit. Given the exploratory nature of these findings, they require verification in future confirmatory studies.
The association between ethical conflict and decision-making ability was mediated by ethical sensitivity. This pathway was moderated by work environment and qualifications, indicating the need for tailored interventions.
Developing nurses' ethical sensitivity is a key strategy for managers aiming to improve ethical decision-making when nurses face ethical conflicts.
This study addressed ambiguous findings regarding the relationship between ethical conflict and nurses' decision-making ability. For nurse managers, fostering ethical sensitivity among staff represents a key strategy for mitigating the ethical conflicts that are negatively associated with decision-making ability.
The strengthening the reporting of observational studies in epidemiology statement (STROBE) was followed.
No patient or public contribution.
Chinese Clinical Trial Registry (ChiCTR): MR-33-24-032956
To examine the relationship between frailty status, family functioning, and quality of life in adolescents with congenital heart disease (CHD).
Frailty is a rarely assessed health outcome in adolescents. Despite advances in paediatric CHD treatment, potential complications may cause frailty, affecting family dynamics and quality of life. Family support and early screening are vital to managing the symptoms of frailty associated with CHD.
Cross-sectional study.
During the period from July 2022 to August 2023, 302 adolescents aged between 12 and 18 who had received a diagnosis of CHD were assessed for frailty using criteria that included slowness, weakness, exhaustion, shrinkage/body composition, and diminished physical activity. Data were collected from assessments of grip strength, the 6-min walk test, body mass index, triceps skinfold thickness, the PedsQL Multidimensional Fatigue Scale Adolescent, Physical Activity Questionnaire for Adolescents, the Family Adaptability, Partnership, Growth, Affection, and Resolve scale, and the PedsQL 3.0 Cardiac Module. All data were subjected to multiple linear regression analysis.
Frailty, as measured by exhaustion and diminished physical activity, was significantly more prevalent in adolescents with severe symptoms of CHD than in those without symptoms. Of the participants, 56.6% were prefrail, and 8.3% were frail. Adolescents who were frail and lived in dysfunctional families experienced a worse quality of life than participants with robust health and those with positive family functioning.
Frailty and family dysfunction negatively affect the quality of life in adolescents with CHD.
Developing programmes that detect frailty early and improve family functioning for adolescents with CHD is critical. Establishing guidelines for identifying frailty in this population can minimise adverse health effects and enhance familial relationships.
No patient or public involvement.
Delirium is a common complication following cardiac surgery and significantly affects patient prognosis and quality of life. Recently, the application of artificial intelligence (AI) has gained prominence in predicting and assessing the risk of postoperative delirium, showing considerable potential in clinical settings.
This scoping review summarises existing research on AI-based prediction models for post-cardiac surgery delirium and provides insights and recommendations for clinical practice and future research.
Following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines, eight databases were searched: China National Knowledge Infrastructure, Wanfang Database, China Biomedical Literature Database, Virtual Information Platform, PubMed, Web of Science, Medline, and Embase. Studies meeting the inclusion criteria were screened, and data were extracted on surgery type, delirium assessment tools, predictive factors, and AI-based prediction models. The search covered database inception through January 12, 2025. Two researchers independently conducted the literature review and data analysis.
Ten studies from China, Canada, and Germany involving 11,702 participants were included. The reported incidence of postoperative delirium ranged from 5.56% to 34%. The most commonly used assessment tools were Confusion Assessment Method for the Intensive Care Unit, Diagnostic and Statistical Manual of Mental Disorders-5, and Intensive Care Delirium Screening Checklist. Key predictive factors included age, cardiopulmonary bypass time, cerebrovascular disease, and pain scores. AI-based prediction models were primarily developed using R (6/10, 60%) and Python (4/10, 40%). Model performance, as measured by the area under the curve, ranged from 0.544 to 0.92. Among these models, Random Forest (RF) was the most effective (5/10, 50%), followed by XGBoost (3/10, 30%) and Artificial Neural Networks (2/10, 20%).
AI-based models show promise for predicting postoperative delirium in cardiac surgery patients. Future studies should prioritise integrating these models into clinical workflows, conducting rigorous multicenter external validation, and incorporating dynamic, time-varying perioperative variables to enhance generalizability and clinical utility.
This review followed the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines.
This study did not include patient or public involvement in its design, conduct, or reporting.
This study aims to assess the extent of organisational silence among new nurses, analyse how structural empowerment and role ambiguity influence this silence, and determine whether role ambiguity mediates the relationship between structural empowerment and organisational silence. The findings intend to offer practical guidance for nursing managers in supporting new nurses by minimising role ambiguity and fostering open communication during the transition into clinical practice.
New nurses commonly exhibit organisational silence during their transition process. Although research indicates that structural empowerment, role ambiguity and organisational silence are interrelated, the underlying mechanisms among these three factors remain unclear.
A cross-sectional design.
A convenience sampling approach was adopted between September 2024 and March 2025. The study recruited 680 new nurses from 15 tertiary A-level hospitals located in Guangzhou, Changsha and Hangzhou. Data collection instruments included a demographic information form, the Chinese version of the Nursing Role Conflict and Role Ambiguity Scale, the Employee Silence Behaviour Questionnaire and the Job Efficiency Conditions Scale. To examine the mediating role of role ambiguity in the relationship between structural empowerment and organisational silence, structural equation modelling (SEM) was applied.
A total of 628 new nurses participated in the survey. Structural empowerment was negatively correlated with role ambiguity (p < 0.01) and organisational silence (p < 0.01). The mediation analysis indicated that role ambiguity partially mediated the relationship between structural empowerment and organisational silence. Specifically, the mediating effect of role ambiguity was –0.14, accounting for 31.11% of the total effect.
This research indicated that new nurses exhibited a below-average level of structural empowerment, while their levels of role ambiguity and organisational silence were above average. Specifically, structural empowerment had a negative impact on both role ambiguity and organisational silence; role ambiguity positively predicted organisational silence. Furthermore, role ambiguity played a significant mediating role in the relationship between structural empowerment and organisational silence.
The findings indicate that nursing managers should not only focus on enhancing the structural empowerment of new nurses but also strengthen their role awareness, ensuring it plays a key role in reducing levels of organisational silence.
This study did not involve patients, service users, caregivers, or members of the public.
To synthesise evidence on the self-perceived consequences of workplace violence (WPV) among male nurses in hospital care settings.
Mixed-methods systematic review (PROSPERO: CRD420251041864).
Systematic searches were performed in PubMed, Web of Science, Embase, Cochrane Library, China National Knowledge Infrastructure, and China Biomedical Database. Quantitative, qualitative, and mixed-methods studies on registered male nurses were included. Methodological quality was assessed using the Mixed Methods Assessment Tool 2018. Data synthesis followed the Joanna Briggs Institute convergent integrated approach.
Six databases were searched from their inception to April 30, 2025.
Twenty six studies (18 quantitative, 6 qualitative, and 2 mixed-methods) from 12 countries (n = 2354 male nurses; 7 in psychiatric departments, 4 in emergency departments, 2 in psychiatric hospitals, 1 in an ICU, 1 in an operating room, and 11 unspecified department studies in hospital nursing settings) were included. Six themes emerged: (1) Physical health damage; (2) Mental health trauma; (3) Impediments to Career Advancement; (4) Deterioration of working environment and social relations; (5) Impaired Quality of Patient Care; and (6) Deficiencies in Violence Coping Mechanisms and Potential Risks.
WPV inflicts multidimensional harm on male nurses, spanning their health, career, social well-being, and care quality, compounded by systemic underreporting.
Urgent interventions are needed, including gender-sensitive training, improved reporting systems, mental health support, and safe workplaces. Addressing WPV is vital for nurse retention and patient safety.
This review highlights under-studied WPV toward male nurses, revealing profound personal and professional impacts. It informs healthcare policymakers, administrators, and clinicians, urging gender-inclusive prevention strategies to protect nurses and enhance global care quality.
This review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines.
No patient or public contribution was involved in this systematic review.
To explore how, why and under what circumstances transitional care can be normalised as a routine care practice for adult patients with enterostomy after discharge from hospitals.
Realist review.
This review was conducted in three iterative phases: (1) constructing an initial programme theory to identify the scope of the study; (2) retrieving and evaluating the evidence, extracting data and integrating the evidence; and (3) analysing and integrating the evidence to refine the programme theory.
Five bibliographic databases and the grey literature were searched from 1947 to 2024 to identify the studies of two core concepts: enterostomy and transitional care.
A total of 36 papers were included, identifying nine context-mechanism-outcome configurations that explain how, why and under what circumstances transitional care can be normalised as routine care for adult patients with enterostomy after discharge: (1) Responsibilities of individual roles; (2) Interdisciplinary team collaboration; (3) Support from upper management; (4) Communication and interaction; (5) Multiple linkage; (6) Professional training; (7) External support and policy formulation; (8) Personalised measures; and (9) Evaluation and feedback.
The normalised implementation of transitional care is essential to help enterostomal patients better adapt to stoma life and improve their quality of life. An effective transitional care model not only relies on the support of professional caregivers, but requires the close cooperation of patients, family members, communities and healthcare organisations.
Reporting was adhered to the RAMESES publication standards: realist syntheses.
Patients and members of the public were involved in study design. Their contributions were participating in advisory groups, ensuring the research was addressed.
This study provides theoretical guidance for clinical stoma transitional care, translating the research findings into routine healthcare practices, constantly optimising and improving the stoma care system, and offering patients higher-quality and more efficient services.
This research, through the realist review approach in combination with the Normalisation Process Theory (NPT) and the Consolidated Framework for Implementation Research (CFIR), systematically elucidates for the first time how, why and under what circumstances transitional care can be regularised as a routine post-discharge care measure for adult enterostomy patients. The research findings will: Improve the quality of life of patients: Through personalised care plans and multidisciplinary team cooperation, help patients better adapt to life with an ostomy, reduce complications and improve self-management ability. Optimise clinical practice: Provide theoretical guidance for medical staff, promote the regular implementation of transitional care and improve the quality and efficiency of care. Promote education and training: Emphasise the importance of professional training and communication skills, and provide new ideas for nursing education. Support policy formulation: Call on the government and medical institutions to improve relevant policies, provide more resources and support and promote the rational allocation of medical resources.
The study aims to investigate patients' perceptions of recurrence risk associated with atrial fibrillation, with the goal of establishing a theoretical foundation for developing future measurement scale and intervention strategies.
A qualitative interview study.
Seventeen patients diagnosed with atrial fibrillation at a Grade-A tertiary hospital participated in semi-structured, in-depth interviews conducted between October and December 2024. Participants were selected via purposive sampling. The data were analysed employing thematic analysis in accordance with Colaizzi's method. The study adhered to the Consolidated Criteria for Reporting Qualitative Research checklist.
The perceptions of recurrence risk among patients with atrial fibrillation can be summarised into five themes: (1) perceived likelihood of recurrence, (2) perceived severity of recurrence, (3) perceived triggers of recurrence, (4) emotional reaction to recurrence, and (5) efficacy perception of managing recurrence risk.
Perceptions of recurrence risk among patients with atrial fibrillation are diverse and often underestimated due to limited knowledge and subjective symptom interpretation, affecting health behaviours. Understanding patients' subjective appraisals, emotions, and perceived efficacy is essential. Validated assessment tools and tailored risk communication may enhance self-management and support targeted interventions.
This study provides critical insights into how atrial fibrillation patients perceive their risk of recurrence. It also provides a theoretical foundation for creating validated assessment tools and tailoring individualised health education and intervention programmes.
Patients were involved in the study design, data collection, and interpretation of findings. Their contributions included providing feedback on the initial interview guide to ensure relevance and clarity, participating in in-depth interviews to share their lived experiences with atrial fibrillation recurrence, and offering reflections on key themes emerging from the data.
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