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To explore current evidence regarding the provision of palliative care for individuals with very severe to extreme behavioural and psychological symptoms of dementia (BPSD) in a hospital setting.
Scoping review.
The PRISMA-ScR reporting guideline.
The JBI guidelines for scoping reviews were followed. A data extraction form assisted in the identification of key findings via a process of content analysis.
Studies were obtained from bibliographic databases of PubMed, CINAHL, and PsycINFO.
This review included six articles, and nine categories emerged from the findings. Symptom assessment and management, pain assessment challenges, atypical presentation of end-stage dementia, complex prescribing and treatment practices, principles of person-centred care, collaboration; training for health care professionals; emotional impact on staff; and family and caregivers.
This scoping review highlighted a significant gap in the literature regarding palliative care for people living with very severe to extreme BPSD in hospital settings. This review highlighted key differences in the presentation of people with BPSD needing palliative care. There is a need for tailored models of care, specialised training and education for health professionals, families, and carers, and recognition of dementia as a terminal illness.
The results of this review provide valuable insights into the level of understanding about the unique palliative care needs for people experiencing very severe to extreme BPSD, making an important contribution to the planning and development of future models of care.
Mapping the available literature highlights a paucity of research in palliative care for people with very severe to extreme BPSD in hospital settings. There is a need for rigorous research studies and models of care developed and informed by the evidence for this small population necessitating unique care needs.
No patient or public contribution.
To 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 describe a sample of healthcare professionals' responses to the valid and reliable Climate and Health Tool and compare participant characteristics relating to Climate and Health Tool subscales.
Observational, cross-sectional, multi-site study.
An electronic survey containing the Climate and Health Tool was administered to healthcare professionals across a large, multi-state health system in the Western United States with a committed effort to reducing carbon emissions.
One thousand three hundred and sixty-three participants reported moderately elevated levels of awareness and concern around climate impacts on health and motivation to participate in climate protective actions. Respondents reported moderate levels of climate-protecting behaviours at home and low levels at work. Females were more concerned and motivated. Medical staff and respondents reporting familiarity with system environmental initiatives reported more awareness and behaviours at home to preserve climate health.
Healthcare professionals are concerned and motivated to decrease climate impacts on health yet take little action at work to preserve the climate. Because of the intersection of climate change, health, and healthcare, healthcare organizations should prioritize and support meaningful action for healthcare professionals to meet community climate health needs.
Healthcare organizations committed to contributing to climate solutions can use this research to increase healthcare professionals' education, engagement, and impact to preserve the climate and health of communities.
Healthcare is a major contributor to carbon emissions, yet healthcare professionals' awareness, motivation, concern, and behaviours related to climate change and health were not clear. Our research showed healthcare professionals are aware and concerned about climate impacts on health but reported low levels of workplace behaviours to protect the climate. The findings of our research will impact healthcare professionals and healthcare organizations to focus efforts on climate-preserving behaviours.
This manuscript followed the STROBE guidelines.
None.
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