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To examine practical, ethical, and organisational implications of the use of a key technology deployed in the care of hospitalised people with dementia—visual identifiers—through a comparative analysis with parallel interventions in other spheres of healthcare and social activity.
Discursive paper.
We contrast visual identification systems used for hospitalised patients with dementia with other, ostensibly similar, systems to understand how they differ in key characteristics: what they disclose, to whom and with what intended consequence.
Certain distinctive features of the ways identifier systems are used to improve dementia care appear particularly consequential for their impact. Given how much is expected of such identifiers, they are likely to fail at least a proportion of patients.
We argue that it is important to critically evaluate the interests served by visual identifiers, identifying the dimensions of quality they can enhance and those that may be negatively impacted.
Visual identifiers for people with dementia can contribute to the ‘taskification’ of nursing care, implying that achieving person-centred care is a matter of following defined protocols rather than an emergent, relational, time-consuming process. Staff may end up prioritising risk avoidance and hospital routines (tasks that are measurable and auditable) rather than embracing the unpredictability of developing relationships with patients.
Visual identifiers are a part of well-established strategies to improve hospital care for those with cognitive impairment. While these identifiers aim to prompt healthcare professionals to deliver individually tailored care, research suggests that they are unable to consistently ensure the desirable quality of care. Understanding influences on how they are deployed can help reshape the expectations placed on such low-tech interventions and inform more reflective use.
Patients and public were not directly involved in the development of this discursive paper.
To explore the conceptualisation of social frailty and discuss its role in shaping the disease trajectory of heart failure. Based on the discussion, recommendations on how to prevent and manage social frailty in this clinical cohort are delineated.
A discursive paper.
This paper searched two databases, PubMed and Google Scholar, for a narrative review of the literature related to social frailty and heart failure from 2008 to 2024.
By integrating the conceptualisation of social frailty from different theoretical paradigms, social frailty is a multi-domain construct that relies on a balance between the availability of environmental resources, social interactions and an individual's ability to maintain and acquire these resources to enhance their well-being. Substantial evidence showed the prognostic impact of social frailty on patient-reported, functional and clinical outcomes of patients with heart failure. The underlying mechanism is still under-investigated, but heart failure-related self-care may mediate its impact. Based on this evidence, improving social frailty may rely on a diagnostic protocol to enhance the person-centred care planning on ways to optimise the social resources to support complex self-care.
Social frailty poses a greater risk to health outcomes in patients with heart failure. Further research is needed to explore determinants and interventions for social frailty in this population.
This paper increases the awareness of social frailty in heart failure patients and provides important insights on how to combat this social determinant of poor health outcomes among this clinical cohort. A dual-purpose approach of improving social resources and self-care behaviours may have great promise in reducing their social frailty, and this postulation will need to be investigated in future research.
There is no involvement of patients or the public in the design or writing of this discursive paper.
To propose a conceptual model of dignity-centred care for hospitalised older adults using Levine's Conservation Model as a theoretical framework.
A discursive approach.
Data were obtained from an extensive search of five databases and grey literature without date restrictions for information on patient dignity, dignified care for hospitalised older adults and the Levine Conservation Model.
Dignity is a multifaceted concept encompassing an inherent self-worth and self-worth acquired through personal accomplishments and associations. Hospitalised older adults are at risk of dignity erosion due to complex health conditions, poor healthcare professional- patient communication, inadequate health information, loss of autonomy, inadequate privacy, and infrastructural and systemic barriers. Key components of dignified care include respect, autonomy, privacy, effective symptom management, effective communication and active patient involvement in decision-making. The proposed conceptual model integrates Levine's principles of conservation into a dignity-centred care framework. This model identifies threats to dignity in hospitalised older adults and outlines practical interventions to mitigate these threats in order to maintain or restore dignity.
The proposed conceptual model of dignity in care for hospitalised older adults, underpinned by the Levine Conservation Model, offers a practical framework to guide healthcare professionals in providing care that upholds the dignity and well-being of older adults. The model can serve as a foundation for developing institutional policies and training programmes that reflect the multidimensional nature of dignity in care for older adults.
The study addressed both the conceptual ambiguity and skills gap surrounding dignity-centred care for older adults by offering a practical guide for integrating dignity-centred principles into routine clinical practice. The findings hold substantial relevance for healthcare practice, providing a structured, theory-informed model to advance dignity-centred care and protect the dignity of hospitalised older adults.
Not applicable.
To establish the suitability of self-determination theory as a theoretical framework to inform research and design of digital applications for nurses' well-being.
This discursive paper describes the background and core premises of self-determination theory and explains its relevance as a theoretical framework to support research and the design of digital applications to promote nurses' well-being.
Increasing numbers of digital applications are being used by nurses, but few are supported by clearly explicated theoretical frameworks. Self-determination theory focuses on how people's innate psychological needs interact and are influenced by the social environments where they live and work. Given the influence the social environment can have on well-being, self-determination theory is well suited as a theoretical framework to inform research and design of digital applications promoting nurses' well-being.
Stress and burnout impact nurses worldwide, to the detriment of staff well-being, their retention in health services, and provision of patient care. The rapid development and ubiquitous use of digital applications by nurses make researching their effectiveness vitally important if nurses' well being is to be supported. Self-determination theory provides a theoretical framework useful for these applications.
Through the lens of self-determination theory, researchers, digital application designers, and organisations can garner further insights to support digital application development and implementation for the well-being of nurses.
This paper has international relevance and can assist researchers, application designers, and organisations interested in promoting nurses' well-being through understanding the applicability and usefulness of self-determination theory as a theoretical framework for the design of digital applications for nurses' well-being.
No Patient or Public Contribution.
To characterise and analyse doctoral programmes in nursing in Latin America through an exhaustive review of the official websites of the universities.
Descriptive and multiple correspondence analysis. Existing programmes were mapped out, identifying their geographic distribution and curricular characteristics.
A review of 59 doctoral programmes in nursing was conducted through the official web portals of universities in Latin America that were currently available (as of 2025) and that provided the required information. Thereafter, a matrix was built in Excel to consolidate the data.
The study identified an increase in the number of doctoral programmes in nursing offered in Latin America. Furthermore, these programmes were found to be more strongly concentrated in countries such as Brazil, Peru and Mexico, while other countries, including Guatemala and Uruguay, have recently incorporated such training.
Doctoral education in nursing in Latin America has experienced significant growth in recent years, consolidating itself as a fundamental pillar for the development of the discipline and the generation of knowledge in health. However, structural challenges persist, including limited funding for research, a lack of cooperation between universities, and the absence of programmes focused on Advanced Nursing Practice.
This contribution helps identify trends in the offering of doctoral programmes and inequalities in their geographic distribution, allowing for an understanding of how training varies across countries in the region while also consolidating Nursing as an academic and professional discipline.
To critically reflect on a transnational, clinically embedded doctoral journey undertaken during and after the COVID-19 pandemic, and to draw conceptual and systemic lessons for doctoral education and clinical academic nursing pathways.
Reflective accounts of doctoral study exist, yet few examine practice-based PhDs conducted across different countries and health systems during a global crisis. This paper analyses one such pathway—enrolment at an Australian university with research embedded within the UK National Health Service—to explore resilience, identity formation, mentorship ecologies and organisational conditions that support or hinder clinical academic development.
Using analytic autoethnography and reflective case study logic, experiential data (field notes, supervisory records, ethics correspondence, project artefacts and publication trajectories) were synthesised with relevant scholarship. A conceptual framework, the TCAD lens, was developed to structure analysis across contexts, constraints, mechanisms and outcomes.
Four phases are outlined: starting in crisis as a senior ICU nurse, transitioning to lead educator, serving as surgical matron while implementing changes, and moving into academia to complete the thesis by publication. Dual ethics and governance procedures, contractual arrangements and GDPR-compliant data stewardship imposed significant administrative burdens but fostered global literacy and networks. Mentorship functioned as an ecology—supportive, critical, pragmatic and strategic—evolving towards independence. COVID-19 served as a stress test, narrowing scope while improving the feasibility and sustainability of the family member's voice reorientation intervention. Personal adversity intersected with identity development, with compassionate supervision enabling timely completion (3.7 years) and five peer-reviewed publications.
Transnational, clinically embedded doctoral pathways can enhance nursing research capacity but require deliberate institutional design: genuine protected time, cross-jurisdictional support and mentorship ecosystems. The TCAD lens provides a transferable framework for educators, supervisors and health systems.
Recommendations cover programme development, cross-border oversight, NHS–university collaborations, funding arrangements in different currencies and resilience infrastructure for clinician–researchers.
To demonstrate and reflect upon the methodological lessons by which healthcare organizations can address questions of environmental sustainability related to single-use healthcare materials.
A cross-sectional multi-centre study in hospitals was performed, followed by an exploratory analysis of the sustainability of commonly used healthcare materials.
A hospital survey was conducted to collect the procurement data for single-use medical materials. Based on consumption and cost, five single-use medical materials with sustainable alternatives were selected using different reuse strategies. Single-use and reusable materials were assessed through an exploratory literature review and document study based on four parameters: environmental sustainability, safety, cost and efficiency.
A pragmatic method emerged from this study, providing healthcare facilities with tools to select environmentally sustainable alternatives to replace single-use options. First, an inventory of single-use medical materials consumed was collected. Next, single-use materials were prioritized for further study based on criteria such as cost, volume of the material, feasibility and input of stakeholders. We then analysed the prioritized single-use materials and their alternatives based on life cycle assessments or available information on their different life stages. Finally, we assessed safety, costs and efficiency related to the process following the use of the medical material.
This pragmatic method can guide healthcare institutions in making the most sustainable choices of medical materials and achieving sustainability goals within their institutions and nationwide.
Patient care involves a large consumption of single-use medical materials with considerable environmental impact. A pragmatic method was developed to guide healthcare institutions in making the most sustainable choices regarding the use of single-use healthcare materials. Healthcare institutions, ideally represented by a green team including nurses and other relevant professionals, can use this method to reduce the use of single-use medical materials, thereby yielding positive outcomes for the entire population.
No patient or public contribution.
This discussion paper explores the group experience of a cohort of eight nurses completing our university's first professional nursing doctorate programme.
This paper aims to make sense of our shared experience and to contribute to what is known about doctoral study by sharing our insights.
Discursive paper.
Through individual and group reflections on our experience, we address the questions ‘why did we stay’? and ‘how do we make sense of the fact that we all, as a group, successfully completed the programme’? We drew on principles of collaborative and collective auto-ethnography to guide our group reflexivity in response to these questions.
The main reasons we gave for staying were: (i) commitment, which had three strands - ‘proving’, ‘obligation’ and ‘self-determination’ - and (ii) shared-identity and common humanity. The two further elements that helped us make sense of our cohort's completion were (i) the joy of learning together and (ii) professional friendship and Socratic inquiry.
As the first programme cohort for the nursing doctorate in our area, we became a close and supportive group, which we argue contributed to our success. We ascribed this to our characteristics as doctoral students and the creation of a sisterhood reminiscent of a community of practice. We also acknowledged the importance of the WhatsApp platform in facilitating group cohesion, and the sense of reflexive closure brought by the process of reflection at the end of our programme.
We recommend that doctoral cohorts, supervisors, and teaching teams systematically plan opportunities into programmes for organic relationship development and consider how the literature on communities of practice and academic persistence might support academic development. Academic staff could also encourage students to set up an online communication channel such as WhatsApp or similar at an early stage in their programmes and give particular consideration to closure and transition to post-doctoral practice on completion of professional doctorates.
The purpose of this manuscript is to offer an overview of knowledge regarding Evidence-Based Practice and implementation science. It addresses the question: What are the EBP implementation models used in nursing settings?
Discursive paper.
The databases were searched with the following keywords: ‘Nursing Faculty’, ‘Nurse educator’, ‘Academic’, ‘clinic’, ‘Evidence-based implementation’, ‘evidence-based practice’, ‘implementation’, ‘implementation science’, ‘undergraduate’, ‘nurse’. The search strategy aims to identify published studies. Eight databases were searched.
There are specific implementation models for implementing EBP: the IOWA Model, the Stetler Model, the Johns Hopkins Nursing Evidence-Based Practice Model, the Stevens Star Model, the Promoting Action on Research Implementation in Health Services (PARIHS), the Advancing Research and Clinical practice through close collaboration (ARCC) model. They were analysed according to the Nilsen classification. An evidence-based implementation project must be structured. First, it is necessary to choose an implementation model, then identify one or more implementation strategies, and finally, plan evaluation for implementation outcome. The use of implementation science ensures successful implementation or at least highlights barriers that need adjustment. Effective utilisation of implementation science facilitates the transfer of obtained results to similar contexts.
Implementation science complements the EBP process perfectly and ensures the proper implementation of evidence.
EBP mentors now have the entire structure of implementation science to succeed in implementing evidence-based data in both academic and clinical settings.
The discursive paper addresses the difficulties of implementing evidence in academic or clinical settings. Implementation science is the bridge between evidence and practice. Nurses now have everything they need to implement evidence-based practice successfully.
There was no patient or public involvement in the design or writing of this discursive article.
The longitudinal programme of research described in this paper seeks to generate knowledge about factors influencing the implementation of a system-level intervention, the clinical nurse leader care model, involving nurses as leaders at the frontlines of care and the outcomes achievable with successful implementation. The research programme has the following aims, (a) to clarify clinical nurse leader practice, (b) develop and empirically validate a translational model of frontline care delivery that includes clinical nurse leader practice and (c) delineate the patterns of and critical outcomes of successful implementation of the clinical nurse leader care model.
This programme of research follows a knowledge-building trajectory involving multiple study designs in both qualitative (grounded theory, case study) and quantitative (descriptive, correlational and quasi-experimental) traditions.
Multiple mixed methods within a system-based participatory framework were used to conduct this programme of implementation–effectiveness research.
Findings are demonstrating how the clinical nurse leader care model, as a complex system-level intervention, can be implemented in diverse healthcare contexts to make a difference to patient care quality and safety. Findings also contribute to implementation science, helping to better understand the dynamic interdependencies between implementation, the interventions implemented and the contexts in which they are implemented.
Findings translate into sets of evidence-informed implementation ‘recipes’ that health systems can match to their specific contexts and needs. This allows health systems to take on strategies that both maximize resource impact within their existing structures and support achieving intended outcomes.
This programme of research is producing actionable implementation and outcome evidence about ways to organize nursing knowledge and practice into care models that can be successfully adopted within real-world healthcare settings to achieve safer and higher quality patient care.
This paper outlines key developments, innovations, and milestones in the field of spirituality and spiritual care in nursing.
A discursive paper.
Nursing scholars have significantly influenced the profession and contributed to the development of nursing knowledge, particularly in the field of spirituality and spiritual care. Key research has focused on nurses' perceptions and attitudes toward spirituality, clarifying foundational spiritual concepts, and establishing a framework of core spiritual care competencies for the profession.
Despite these advancements, significant gaps remain in nurses' knowledge, understanding, and experience in providing spiritual care. The development of agreed-upon spiritual care competencies at the European level offers important guidance for the profession, and educational initiatives are underway to support their integration. However, the field remains in an early stage of development, and further research is needed to embed spiritual care competencies into national and international nursing policy and practice. Moreover, continued research is also essential to inform and evaluate current educational programmes and nursing interventions, and to support the translation of evidence-based knowledge into effective spiritual care delivery.
Spiritual support is proven to be an important consideration for many patients and families globally. Imbedding spiritual care education into both undergraduate and postgraduate nursing curricula is essential to prepare nurses to address the spiritual needs of patients in healthcare settings. Structured curricula that provide clear instructions on how to recognise, assess, and respond to spiritual concerns in clinical practice can enhance nurses' competence and confidence. Embedding spiritual care into education and training helps normalise spiritual care as a component of holistic nursing, supporting its inclusion in everyday care rather than treating it as an optional or marginal practice. Such educational integration has the potential to improve the consistency and quality of spiritual care across healthcare settings.
Internationally there are evident gaps in the consistent provision of spiritual care to patients and their families. These are being addressed through conceptual clarity, the agreed-upon competencies, and enhanced educational initiatives. It is essential to continue to increase awareness among the nursing profession on the necessity of addressing spiritual care needs, within the context of cultural perspectives to ensure that value is placed on the significance of these issues on a global scale.
There was no patient or publication contribution in this specific commentary.
To explore the potential axiological shift in nursing, drawing upon a critical reading of the new definition of ‘nursing’ published by the International Council of Nurses (ICN) in June 2025, and to articulate its implications for research and doctoral education.
Critical discussion paper.
Guided by critical inquiry and emancipatory nursing knowledge development approaches, this paper deploys retroductive analysis to interrogate the axiological commitments that inform and are generated by the 2025 ICN definition and how it relates to nursing research. Consequently, it utilises the Vitae Researcher Development Framework (RDF) to map strategies for doctoral programmes responding to this axiological shift.
A comprehensive axiological analysis of the 2025 ICN definition reveals a shift towards valuing human rights, relationality and care, planetary health and transformative leadership. However, an axiological analysis of prevailing nursing research definitions indicates a gap, particularly an explicit commitment to these expanded values beyond upholding scientific rigour. In response, an Axiologically-Driven Research Development Strategy Framework (ADRDSF) is proposed, integrating ICN's new axiologies across doctoral programmes in nursing.
This axiological shift signals the reorientation of nursing research to be explicitly value-driven, ethical and focused on social justice, relationality and planetary health. Doctoral programmes must cultivate scholars and leaders who are not only competent but also axiologically aligned, capable of driving this transformative research agenda for a more just and sustainable future.
The aim of this discussion paper is to explore whether recontextualisation theory deepens our understanding of learning across multiple sites when introducing simulation-based education (SBE) into nurse education.
The requirement for students to learn in clinical placements remains an aspiration as well as a regulatory requirement internationally. Yet, the increasing complexity of healthcare and the numbers of vacancies in the healthcare workforce globally have led to poor learning environments. In the context of faster internet speeds, rapid development in virtual technologies, affordability of hardware, and the move to online educational provision after the COVID-19 pandemic, SBE has emerged as a key teaching method in health professional preparation programmes globally.
Critical discussion paper.
This discussion paper is based on current literature on SBE and recontextualisation theory.
Evaluations of SBE often show positive outcomes for learning in nurse education. Weaknesses and gaps in the evidence on SBE, such as the scarcity of control groups or longitudinal studies, have been identified. Using recontextualization theory, we argue that SBE may also increase the theory-practice split for students across multiple sites of learning.
The introduction of SBE offers supplementary positive learning opportunities to those in clinical practice while at the same time creating multiple sites of learning which are not always aligned. More needs to be done to teach from a curriculum which relies on students being motivated and able to learn across multiple sites of learning.
To support student nurses in UG professional preparation programmes which rely on SBE as well as clinical practice and universities, shared values between nurse educators and clinical nurses need to be enacted collaboratively. This could be achieved by reframing how students and nurses learn and rework knowledge across sites of learning.
To demonstrate, through an integrative theoretical synthesis, how fully paid parental leave functions as a boundary-management strategy that enhances nurse well-being and retention; thereby supporting sustainable workforce capacity.
Discursive paper.
Directed literature synthesis (2010–2025) across nursing, organisational psychology, labour economics and health-policy databases; thematic mapping of findings to organisational support theory, ethics-of-care theory and role theory; cross-case comparison of four national leave frameworks.
Paid, discretionary leave raises perceived organisational support and predicts lower turnover intention. Leave is framed as moral reciprocity and restores both relational energy and capacity for job satisfaction. Extended, clearly sign-posted leave reduces time- and strain-based work–family conflict, enabling role enrichment on return. Implementation rests on four structural interventions: leadership endorsement, streamlined processes, guaranteed staffing back-fill and phased return-to-work options.
Paid parental leave is a strategic, theory-grounded intervention that safeguards nurses' dual identities, amplifies organisational commitment and ultimately fortifies patient care quality.
Embedding usable, fully paid leave normalises caregiving, reduces burnout triggers and stabilises staffing to promote nurse retention, continuity of care and positive patient outcomes.
What problem did the study address? Global nurse turnover driven by unmanageable work–family conflict and inadequate leave usability.
What were the main findings? Generous, well-implemented leave improves perceived support, relational energy and retention; four structural interventions maximize the benefits of paid parental leave for nurse-parents, patients, organizations, and the nursing workforce.
Where and on whom will the research have an impact? Onurse leaders, HR policymakers and health-system executives striving to stem workforce attrition and on patient populations reliant on stable, experienced nursing teams.
None (discursive).
This study did not include patient or public involvement in its design, conduct or reporting.
FreshRSS 