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Parents of adolescents with a mental disorder describe having overwhelming feelings regarding the psychiatric diagnosis, which they respond to with grief. Existing research indicates that these parents face unique challenges, such as self-blame and stigma. Parents are crucial in adolescent care, and healthcare professionals should find interventions that educate parents about the disorder, treatment and symptom management. The aim of this study was to explore and describe parents' experiences in having an adolescent with a mental disorder admitted to the psychiatric unit of a public hospital in Gauteng, South Africa.
The study used Heidegger's interpretive phenomenological design.
A qualitative, exploratory, descriptive and contextual method was used. Data were collected through semi-structured telephonic interviews with 10 parents who had an adolescent with a mental disorder admitted to a public hospital in Gauteng, South Africa. Tesch's thematic coding steps were used for data analysis.
The themes arising from the findings reflected (1) parents experienced that their lives were stuck amid grief for the loss of what their adolescent child used to be, and anxiety about what the future holds, (2) parents experienced that when they reached out for professional help, the healthcare system failed them due to a lack of guidance, information and support, (3) parents experienced that they prayed for divine intervention as a coping strategy, and (4) parents experienced stigma from the community.
The findings illustrate the need for psychiatric nurses to facilitate the mental health of parents of adolescents with a mental disorder. Furthermore, positive attitudes among parents are improved once they are empowered and receive the necessary support, and stigmatization will also be reduced. It is recommended that further research be conducted to explore the effectiveness of emotional and professional support in addressing the challenges parents experience with an adolescent who has a mental disorder.
This paper contributes knowledge to nursing practice by exploring the experiences of parents who have an adolescent with a mental disorder in the South African context.
To describe the latest information on types of psychosocial interventions and their effectiveness on loneliness reduction among older adults in community and residential care settings, and the experience with these interventions.
Umbrella review.
The Joanna Briggs Institute methodology for umbrella reviews.
Cochrane Database of Systematic Reviews; Cumulative Index of Nursing and Allied Health Literature; Medline; Embase; Emcare; PsycINFO; ProQuest Dissertation & Thesis Global; Ovid Nursing Database; MedRxvi.
Twenty-two reviews were included. Seven major types of psychosocial intervention were identified: (1) social facilitation interventions, (2) psychological therapies, (3) health and social care provision, (4) animal-assisted interventions, (5) befriending interventions, (6) leisure and skill development, and (7) other interventions. Social facilitation interventions that provide synchronised interaction, psychological therapies, health and social care provision, and animal (−assisted) interventions demonstrated positive effects while leisure/skill development and befriending interventions warrant more rigorous evidence. Group settings, synchronised interaction and purpose-driven are identified as facilitators, whereas technological issues and safety issues are barriers to participation.
Seven types of psychosocial interventions are currently available for loneliness among community-dwelling older adults, and a positive effect in reducing loneliness was demonstrated in some types. Facilitators and barriers to their participation were synthesised. Two future research directions are suggested: (1) reviews on meaning-centred interventions to provide a comprehensive understanding and (2) implementation studies employing community-based paraprofessionals to promote programme scalability and accessibility.
Health and social care practitioners (e.g., nurses), researchers and policymakers are recommended to employ social facilitation interventions with synchronised interaction, psychological therapies, health and social care provision and animal-assisted interventions to address loneliness among community-dwelling older adults.
This review provided empirical information on available effective interventions to address loneliness among community-dwelling older adults. It also provided information for nurses to implement psychosocial interventions in the community.
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines
This study did not include patient or public involvement in its design, conduct or reporting.
PROSPERO CRD 42023482852, registered 25/11/2023
This study aimed to investigate the relationship between stress, self-compassion, and fertility adjustment in women undergoing infertility treatment in Turkey and to determine whether stress influences fertility adjustment through the mediating effect of self-compassion.
A cross-sectional and descriptive design was used in the study.
The study was conducted with 290 women who applied to the in vitro fertilisation unit in a university hospital in Ankara, Turkey. Descriptive statistics, Pearson correlation, and structural equation analysis were used for statistical analysis.
According to the results of structural equation modelling, self-compassion was found not to affect fertility adjustment, while infertility-related stress directly influenced both self-compassion and fertility adjustment. Additionally, self-compassion was not found to mediate the relationship between stress and fertility adjustment in women undergoing infertility treatment.
The findings suggest that different dynamics may contribute to women's infertility-related stress and fertility adjustment.
This study highlights the importance of developing strategies to enhance fertility adjustment in women receiving infertility treatment and underscores the need for nurses working in this field to evaluate women's attitudes toward themselves to provide individualised care aimed at alleviating infertility-related stress.
The findings indicate that self-compassion does not have the expected effect in coping with infertility. Specifically, the lack of a direct effect of self-compassion on fertility adjustment, along with the strong influence of stress on both self-compassion and fertility adjustment, suggests that stress management-focused interventions may take precedence. These results indicate that approaches aimed at stress management during infertility treatment can play a critical role in supporting women's adjustment processes.
STROBE guidelines were followed for this study.
There is no patient or public contribution.
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.
An online, cross-sectional survey study.
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.
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.
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.
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.
Healthcare professionals were part of the study population.
To offer a comprehensive overview of the individual and organisational factors related to inclusive leadership among healthcare professionals.
Systematic review and meta-analysis.
The review was conducted following the Joanna Briggs Institute methodology for systematic reviews of effectiveness. Findings were synthesised using meta-analysis, a random effects model and narrative synthesis.
In January 2025, a systematic search was conducted with no time or geographical limits in the CINAHL, MEDLINE (PubMed), Mednar, ProQuest and Scopus databases. Studies in English, Swedish and Finnish were included.
A total of 34 studies were included. The meta-analysis revealed a statistically significant positive relationship between inclusive leadership and psychological safety among healthcare professionals (n = 10). The narrative synthesis further identified individual and organisational factors related to inclusive leadership. Individual factors consisted of well-being at work, performance and productivity, social behaviour, innovativeness and creativity and psychological capacity. Organisational factors revealed work community cohesion and citizenship, as well as organisational fairness and appreciation.
Inclusive leadership is a promising leadership behaviour, with positive outcomes for healthcare professionals and organisations. By enhancing psychological safety, inclusive leadership offers broader benefits for individuals and organisations. As such, it could improve the retention of professionals and the attractiveness of organisations in the healthcare sector.
To strengthen the functioning of healthcare organisations, leaders should be educated in inclusive leadership and its practical benefits. Training should focus on developing inclusive leadership behaviours that foster belonging, value individual uniqueness and encourage participation across all professional groups, creating an environment where both individuals and organisations can thrive.
The Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines were used to report the results.
No patient or public contribution.
The protocol was registered in the International Prospective Register of Systematic Reviews PROSPERO (ID: CRD42024503861)
To explore how coaching can facilitate the development of an Evidence-Based Quality Improvement (EBQI) learning culture within nursing teams in hospital and community care settings. This study also explores the specific contextual factors that influence effective outcomes.
Action research.
Nine teams, including 254 nurses were selected from four hospitals and two community care organisations to participate in the development of an EBQI-learning culture under the guidance of internal and external coaches. Data were gathered from 27 focus groups with 56 unique participants (of whom 31 participated multiple times) and six individual interviews with three external coaches. Transcripts of all interviews were subjected to abductive thematic analysis.
To promote an EBQI learning culture in nursing teams, it is essential that internal coaches effectively guide their team members. The internal coaches in this study focused on enhancing readiness for EBQI by providing support, encouraging involvement and motivating team members. They deepened innovation competencies including assessing daily care, implementing well-structured changes in care practices and embedding small steps in the change process in daily routines. It was found that barriers and facilitators within the team's context can influence the development of EBQI-learning culture and therefore need to be considered when seeking to make changes. The presence of external coaches served as a valuable resource and a motivator in supporting internal coaches to apply and improve their coaching skills.
To stimulate the development of an EBQI-learning culture, internal coaches need to focus on team readiness to work with EBQI. Priority needs to be given to enhancing the care change competencies of team members. Barriers to change must also be addressed. Internal coaches require external support and motivation to continually develop coaching skills.
The Standards for Reporting Qualitative Research.
No patient or public contribution.
To develop a reflection method for community nurses and certified nursing assistants to support the implementation of the Dutch Informal Care guideline in daily care.
Design-based research.
A design group and four test groups of community nurses and nursing assistants were formed to develop a reflection method that aligns with the needs and preferences of its end-users. The design and test group meetings were video recorded. The video data were iteratively discussed and analysed thematically to adapt and refine the method and to identify its key features.
A final reflection method was developed. Five main themes were identified from the analysis: the group, reflective triggers, knowledge about the guidelines, the coach and preconditions. The themes are linked to nine key features representing the building blocks of the reflection method. The key features are group size, participants with different (educational) backgrounds, pairs of participants, expressing thoughts, video feedback, reflection game, making the connection with the guideline, coaching as a process facilitator and meeting organizational and contextual conditions for implementation.
An evidence- and practice-based reflection method for community nurses and certified nursing assistants is developed to support the implementation. By involving community nurses and certified nursing assistants, the method closely matches their needs and preferences. Critical elements of the reflection method are a game element, video feedback and working in pairs in a group of participants from different (educational) backgrounds. Guidance is needed to make the transfer from theory to practice.
A reflection method for community nurses and certified nursing assistants was developed to enhance care work according to guideline recommendations, aiming to improve the care provided by informal caregivers.
The COREQ guideline was used.
This reflection method was developed in close collaboration with all stakeholders during the entire study.
To develop a reflection method for community nurses and certified nursing assistants to support the implementation of a professional reporting guideline for nurses and certified nursing assistants in daily care and to identify its key features.
Design-based research.
This study was conducted in the Netherlands from February 2021 to April 2022. The reflection method was developed by a design group (community nurses, certified nursing assistants and a patient representative) and four test groups of nurses. Experiences of participants were explored with video recordings and observational notes from test group meetings. The data were thematically analysed to refine the reflection method and identify key features.
A final reflection method was developed. We identified three main themes: (1) Impact on behaviour change, (2) group learning and (3) conditional factors for critical reflection. Seven key features emerged as essential, forming the building blocks of the reflection method: focus on critical reflection, allocate time to formulate themes, include participants from various backgrounds and organisations, ensure the group is appropriately sized, allow for sufficient time, keep it simple and attractive and stimulate the group to make the transfer of learning to their clinical practice.
The final method included two 2 h meetings with up to six participants and a coach. Participants learned from critical reflection and feedback to improve the reporting quality and critical assessment of daily practices, especially from colleagues with varying team affiliations and educational backgrounds.
This reflection method enables community nurses and certified nursing assistants to learn collaboratively, aligning with the ‘Nursing and Caring Reporting’ guideline and bridging the gap between research and clinical practice.
The COREQ guideline was used.
The study design facilitated close collaboration among researchers, community nurses, certified nursing assistants and clients.
Alarm fatigue has the potential to have significant consequences for patient safety, and the critical role of intensive care nurses in alarm management is an important component of this process.
This study aimed to investigate the alarm management practices of intensive care nurses.
This study utilised an observational design.
The study was conducted in the intensive care unit of a university hospital in western Türkiye with 21 nurses. To avoid influencing their behaviour, the primary purpose of the observation was not disclosed to the nurses. Two observers used an observation form to record alarms, nurse interventions and intervention times. Environmental noise levels were also measured and recorded during the observation periods.
Over 118 h of observation, 460 alarms were recorded. Most alarms (80.4%) were generated by monitors, and 36.3% were due to deviations in the patient's clinical status. It was found that 53.3% of alarms were not responded to, and 73.7% were controlled. Environmental noise levels ranged from 41.90 to 83.10 dB.
The control, intervention and response times to alarms by intensive care nurses varied based on the alarm cause and their workload at the time. High environmental noise levels were also observed, which may impact alarm response.
The centralised location of the nurses' station, preparation of treatments at the bedside and proximity to patients contribute positively to alarm management. Recommendations to reduce technical alarms include appropriate device calibration; secure technical connections; and appropriate use of ECG electrodes, sensors and medical supplies. Setting appropriate alarm limits by primary nurses and evaluating ICU noise levels for necessary adjustments are crucial.
The study was reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklists.
No patient or public contribution.
To identify and characterise the approaches and instruments used in recent literature to measure the prevalence of restrictive care practices in adult mental health inpatient units. Additionally, it sought to summarise the reported psychometric properties, including reliability and validity of these measures.
A systematic review of recent litratures was conducted using Scopus, MEDLINE, CINAHL, PsycINFO, Web of Science and Embase databases to identify studies published from 1 January 2010 to 11 October 2023. A total of 128 studies measuring the use of restrictive care practices were included. Data on measurement methods were extracted from each study and summarised to compare how consistently these practices have been measured across studies and how authors consistently reported the reliability and validity of these measurment approaches. All findings were reported following the PRISMA 2020 checklist.
There were significant variations in how the prevalence of restrictive care practices was measured, and the reliability and validity of these measurements were unclear for most studies. Only 11 studies reported inter/intra-rater reliability. Key variations were observed in data sources utilised, how and by whom the data were collected, the timing and total duration of data collection during patient admission, how and by whom data were extracted from secondary sources, measurement instruments and the reported reliability and validity of measures.
Methodological inconsistencies about the measurements approaches of restricitve care practices would introduduce potential random and/or systematic biases on the reported data which may obscure the the true prevalance these practices. This hinder the ability to acurately assess the effectiveness of reduction strategies and understand the naturally occuring practices. Establishing a standardised set of reliable measures is crucial for enabling valid comparisons for the rates of restricitve car epractice use across settings and countries, which could enhance the ongoing monitoring and reduction of these practices.
The absence of standardised defintions and measurement approaches for restrictive care practices challenges the global effort to reduce their use. Without reliable and common measures, clinicians and researchers often face challenges in documening RCP incidents accurately, compromising efforts to improve care quality and support a recovery-oriented approach. Such measurment errors would mislead decission-maker which would furhter contribute to the inconsistency the the implementation of these practices.
No patient or public contribution.
PROSPERO: CRD:42022335167; https://www.crd.york.ac.uk/prospero/export_details_pdf.php
To compare contextual factors influencing discharge practices in three intensive care units (ICUs).
A prospective observational study.
Data were collected using a discharge process report form (DPRF) between May and September 2023. Descriptive statistics were performed to analyse demographic and clinical data. One-way analysis of variance (ANOVA) was used to test the time interval differences among the three sites.
Overall, 69 patients' discharge processes were observed. Among them, 41 (59%) experienced discharge delay, and 1 in 5 patients experienced after-hours discharge. There were statistically significant differences in mean hours in various time intervals during the discharge processes among the three sites. Patients in Hospital C waited the longest time (mean = 31.9 h) for the ward bed to be ready after the bed was requested and for being eventually discharged after ICU nurses to get them ready for discharge (mean = 26.7 h) compared to Hospital A and Hospital B.
We found that discharge delay and after-hours discharge were common and there were significant differences in mean hours of various time intervals during the discharge processes occurred among the three sites. The influence of contextual factors in different hospitals/ICU needs to be considered to improve the ICU discharge process.
Researchers and clinicians should consider targeted context-specific interventions and strategies to optimise patient discharge process from ICUs.
The study findings will inform the development of tailored interventions to reduce the discharge delay and after-hours discharge and, in turn, improve the quality and safety of patient care and health service efficiency.
The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines.
Patients' discharge processes were observed, and consumer representatives were involved in the study design.
There is a growing consensus to reduce the use of restrictive care practices in mental health settings to minimise the physical and psychological complications for patients. However, data regarding restrictive care practice use and factors contributing to variations in the proportion estimates has not previously been synthesised.
This study aimed to synthesise evidence on (1) the pooled proportions of physical restraint, seclusion or chemical restraint in adult mental health inpatients and (2) sources of variability in these proportion estimates.
Studies were identified from Scopus, MEDLINE, PsycINFO, Web of Science, Embase and CINAHL databases following the PRISMA 2020 guidelines. We conducted a meta-analysis of studies published in English language from 1 January 2010 to 15 August 2022. Binomial data were pooled using a random effect model, with 95% confidence intervals. Meta-regression was also computed to identify factors that may contribute to variations in the proportion estimates.
A total of 77 studies were included in this meta-analysis. The pooled prevalence of physical restraint, seclusion and chemical restraint was 14.4%, 15.8% and 25.7%, respectively. Data were heterogeneous across studies (I 2 > 99%). Reporting practices and geographical locations contributed to the variability in the reported estimates of restrictive care practices, with studies from Asian countries reporting higher proportions.
There appear differences between geographical locations in the proportion of restrictive practices in mental health inpatients; however, this is complicated by how these prevalence data have been measured and defined. Consistency in the reporting of restrictive care practices in mental health is required to make valid comparisons between geographical regions, policy settings and practice innovations.
Efforts are needed to develop training programmes and policy changes to ensure consistency in defining and reporting of restrictive care practices in mental health facilities.
This is a systematic review that analysed data from previously published studies, and there was no patient/public contribution in this study.
The protocol for this review has been registered to PROSPERO: CRD42022335167.
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