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To report on the unique perspectives of senior nursing leaders on the value proposition of the Clinical Nurse Specialist (CNS) role, their organisational experience and the barriers and facilitators to optimise and promote the long-term sustainability.
A qualitative sub-study of a larger multi-method study focused on informing policy recommendations to optimise the CNS workforce, informed by integrated knowledge translation.
Chief Nursing Officers (CNOs) and other senior leaders in all health authorities in British Columbia, Canada, were invited to participate in semi-structured interviews via video call between August–December 2023. We recruited 13 participants from diverse health regions, including 5 CNOs.
Leaders collectively conveyed a renewed interest in the CNS role to support nursing and multidisciplinary teams to better meet patient and system needs, and a sense of urgency to optimise the role in diverse settings. The overarching theme of “success by design” was supported by three thematic priorities: (1) understanding the CNS role, (2) a role that needs protection and connections and (3) moving forward together. Views were aligned to co-construct implementation-ready policy recommendations to guide provincial strategies.
Senior leaders reported a common understanding of the value-add of the CNS workforce and had a shared experience of barriers to optimisation. Contemporary policy guidance is needed to equip health systems to address this gap.
Across international regions, the role of CNSs is not fully optimised. This is a wasted opportunity to address the pressing need for nursing practice leaders to transform health systems and improve outcomes. This study provides new knowledge about the perspectives of Chief Nursing Officers and other nursing leaders to shape comprehensive and targeted policy recommendations and address enduring and new challenges to realise the full impact of the CNS workforce.
We have adhered to COREQ reporting guidelines (See supplemental file).
This study did not include patient or public involvement in its design, conduct, or reporting.
The Cancer Behaviour Inventory–Brief Version was designed to assess cancer-coping self-efficacy in clinical and research settings where minimising patient burden is essential. However, there is no evidence of its longitudinal validity. Although widely used in cancer research, the lack of evidence for longitudinal invariance significantly undermines its validity in studies spanning multiple time points. Establishing longitudinal invariance enables valid comparisons over time, enhancing our confidence in applying it in longitudinal research.
To examine the factor structure of the measurement and test its longitudinal invariance across four time points in cancer patients experiencing moderate-to-high symptoms during curative cancer treatment.
A longitudinal psychometric evaluation.
This is a secondary data analysis of a randomised controlled trial in patients with moderate-to-high symptoms undergoing cancer treatment (N = 534). We conducted longitudinal invariance tests for the measurement using four time points. Other psychometric tests included confirmatory factor analysis, reliability analyses and correlations.
Our confirmatory factor analysis supported the four-factor, 12-item structure for the Cancer Behaviour Inventory–Brief Version. Items 1 and 6 were found to be moderately correlated. The resulting 12-item measure demonstrated good internal consistency, with convergent and divergent validity supported by correlations with selected instruments. Finally, longitudinal invariance was tested, which revealed strict measurement invariance across four time points (CFI = 0.930, RMSEA = 0.045, SRMA = 0.056).
We found that the factor structure of the Cancer Behaviour Inventory–Brief Version remained stable over four time points in a sample of patients having moderate to high symptoms under cancer treatment. This supports its accountability for examining the changes in cancer-coping self-efficacy among cancer patients over time in longitudinal studies.
This study confirms that Cancer Behaviour Inventory–Brief Version has adequate internal consistency and demonstrated evidence of construct validity. Our conclusion of strict longitudinal invariance supports its credibility for continuous assessment of cancer-coping self-efficacy to evaluate patient outcomes and intervention processes over time in clinical and research settings.
No patient or public contribution.
To review how life-course theories, models and frameworks define and classify life stages and transitions; how they characterise trajectories of care needs and care provision; and to consider how these insights might inform future developments of care-focused life-course frameworks.
Narrative review using a theory synthesis approach.
The review synthesised 56 theories, models and frameworks, drawn from 90 articles published up to 2024, using a three-stage process: extraction and summarisation of conceptual content; comparison to identify convergence and divergence; and interpretive synthesis to generate an overarching account of how frameworks conceptualise life-course development, care transitions and care trajectories.
Earlier life-course perspectives emphasise normative, age-graded stages, while more recent approaches highlight transitional junctures, relational contexts and structural influences on care trajectories. Life stages were defined variably, encompassing developmental phases, chronological age bands, major life transitions, historical and cultural perspectives and diverse lived experiences. Trajectories of care needs and provision were shaped by social networks, socioeconomic conditions, timing of transitions, transgenerational relationships and interdependencies, and intersectionality. Findings suggest that care needs and care provision fluctuate across time and are best understood as interrelated, dynamic processes influenced by life-course biographies, as well as broader social, economic and policy environments at individual (micro), relational (meso) and structural (macro) levels.
Life-course frameworks are shifting from age-based models towards personalised, context-sensitive perspectives that better capture the complexity and diversity of care trajectories.
Care planning should incorporate not only developmental stage but also individual, relational and structural factors influencing care needs, care provision and care trajectories over time.
Applying a personalised, multilevel life-course perspective may improve assessment accuracy, coordination of resources and equity in care delivery.
This narrative review did not involve patients or the public.
To examine the American Cancer Society's HPV vaccination guidelines through a nursing policy analysis framework, assessing justice and equity outcomes in cancer prevention policy implementation.
Human papillomavirus vaccination remains critical for cancer prevention, yet persistent health disparities undermine equity goals despite evidence-based policy recommendations. Limited research has systematically applied nursing conceptual frameworks to analyse vaccination policy through an explicit equity lens.
Policy Analysis Using the Russell and Fawcett Conceptual Model for Nursing and Health Policy, Focusing on Level 4 Outcomes Addressing Justice, Social Changes and Market Interventions.
Systematic analysis of policy sources (public, organisational, professional), components (personnel, services, expenditures) and outcomes across quality, cost and access dimensions. Data sources included primary policy documents, implementation reports and peer-reviewed literature from 2015 to 2024. Thematic analysis examined policy effectiveness through distributive and procedural justice lenses.
Critical policy fragmentation creates systematic equity barriers, with only five jurisdictions (Virginia, District of Columbia, Rhode Island, Puerto Rico, Hawaii) achieving > 70% vaccination coverage through school-entry mandates and 46 states and territories demonstrating substantially lower rates. Rural adolescents experience 15%–20% lower vaccination rates, while Black adolescents show 10 percentage points lower coverage than white adolescents despite federal Vaccines for Children (VFC) program investment of $4.2 billion annually. Provider training gaps and cultural competency limitations disproportionately affect communities of colour. Healthcare system transformation remains concentrated in well-resourced organisations, creating two-tiered implementation that reinforces existing disparities.
Achieving cancer prevention equity requires coordinated interventions across multiple policy levels, enhanced provider training emphasising cultural competency, community-based service expansion and equity-focused resource allocation. Federal leadership establishing minimum vaccination requirements linked to education funding, respecting state constitutional authority, sustainable funding models and nursing leadership represent essential actions for advancing health equity.
Demonstrates nursing frameworks' utility for rigorous health policy analysis while providing evidence-based recommendations for strengthening vaccination policy to achieve cancer prevention equity across diverse populations.
This study did not include patient or public involvement in its design, conduct or reporting.
To understand the current evidence base regarding holistic nursing assessments performed by registered nurses in residential aged care homes in Australia, and identify the gaps in knowledge and potential areas for future research.
A scoping review informed by JBI guidelines and the PRISMA extension for Scoping Reviews.
The electronic databases Medline, EMBASE, CINAHL, Scopus and ProQuest Central were searched, alongside citation chaining and manual journal searches. Limits of English language and publication after the year 2000 were applied. Studies were screened against pre-defined eligibility criteria. Data were extracted and analysed using descriptive statistics and a narrative synthesis.
A total of 3987 studies were identified, of which 28 were categorised as comprehensive or multimodal assessment programmes, standalone assessment tools or assessment infrastructure papers. Key outcomes described included staff factors and resident emergency department transfers or hospitalisations. The key feature of existing nursing assessments across studies was education, which was generally associated with improved staff knowledge, confidence and efficiency. Apart from this, there was large heterogeneity among assessment interventions with inconsistent effects. Few studies focused on residents with dementia or palliative care needs.
There is currently no standardised, systematic approach to the holistic assessment of residents by registered nurses in Australia. This gap in assessment is especially evident for residents with dementia or palliative care needs.
This research highlights the need to develop standardised holistic nursing assessments to bridge this gap in practice.
No Patient or Public Contribution.
(1) Explore the role of core abdominal exercise in people living with a stoma in Australia; (2) determine whether the presence of a parastomal hernia influenced participant symptoms and complications, health status, experiences with different types of exercise, recall advice given by healthcare professionals; (3) determine whether there is an appetite for supervised/supported exercise programs.
A cross-sectional, anonymous survey.
Between August and September 2022. The survey included Likert scales and a single free text response. Logistic regression and Cramer's V were used to explore relationships between variables.
Approximately half (45.5%) of 105 participants reported a parastomal hernia. Those with a parastomal hernia were less likely to recall having received advice (15.20%) or demonstration (9.40%) pertaining to exercise. Less than a quarter of all participants completed strengthening (23.80%) or vigorous (22.90%) exercise. Fear of vigorous exercise, abdominal exercise and heavy lifting were high in both groups. Relationships between healthcare advice, exercise-related fears and avoidance of heavy lifting were observed.
Many Australians living with a stoma are not achieving physical activity recommendations. While exercise behaviours did not differ between people with and without a parastomal hernia, recall of healthcare advice around exercise did. Fear-avoidance relationships were observed.
Most people living with a stoma do not recall advice about core abdominal exercises. Healthcare practitioners need to be aware of fear-avoidance related to lifting among people living with a stoma. This was the first study in Australia, exploring perspectives and experiences regarding exercise; providing foundations for future research particularly exercise programs.
This study adhered to relevant EQUATOR guidelines and the reporting of survey studies (CROSS).
This study did not include patient or public involvement in its design, conduct, or reporting.
To explore levers and barriers to providing culturally responsive care for general practice nurses (GPNs) using normalization process theory.
A self-administered online cross-sectional survey.
A participatory co-designed adapted version of the normalization of complex interventions measure (NoMAD) validated tool was distributed to a convenience sample of GPNs between December 2022 and February 2023. The sample comprised of GPNs working in general practice services in Ireland (n = 122). Data were analysed using descriptive and analytical statistics (Pearson correlations) and principles of content analysis. This study was conducted and reported in line with the Consensus-Based Checklist for Reporting of Survey Studies (CROSS).
GPNs in this study indicated their familiarity with, acknowledged the importance of and were committed to, providing culturally responsive care. However, implementing culturally responsive care in daily practice was problematic due to insufficient education and training, scarcity of resources and supports and a lack of organizational leadership. Subsequently, GPNs experience difficulties adapting everyday practices to respond appropriately to the care needs of culturally and linguistically diverse (CaLD) patients.
This analysis highlights the necessity of exploring the intricacies of factors that influence capabilities and capacity for providing culturally responsive care. Despite demonstrating awareness of the importance of providing nursing care that responds to the needs of CaLD patients, GPNs do not have full confidence or capacity to integrate culturally responsive care into their daily work practices.
Using normalization process theory, this study elucidates for the first time how GPNs in Ireland make sense of, legitimize, enact and sustain culturally responsive care as a routine way of working. It illuminates the multitude of micro-level (individual), meso-level (organizational) and macro-level (structural) factors that require attention for normalizing culturally responsive care in general practice services.
The study question was identified in a participatory research prioritization for Irish research about migrant health that involved migrants in the process.
Many frontline essential working mothers returned to work outside of the home after maternity leave during the COVID-19 pandemic. The purpose of this study is to describe the changes in breastfeeding relationships.
A longitudinal descriptive qualitative design was used.
Four open-ended questions were asked to explore breastfeeding experiences at home, mothers' thoughts and feelings during direct breastfeeding, strategies to solve their breastfeeding problems, and workplace breastfeeding support. Data were collected by an online survey at 1, 3, 5 and 6 months between June 2022 and August 2023. Data were analysed using inductive content analysis from 21 mothers in the United States who were directly breastfeeding at least once a day for the first 6 months. The trustworthiness of study results involved coding by consensus, peer debriefing, and maintenance of an audit trial.
The core construct, “Changes in Breastfeeding Relationships When Frontline Essential Working Mothers Return to Work Outside of the Home” explained mothers' experience in four domains: (1) Breastfeeding changes, (2) Changes in sleep arrangements, (3) Social support to continue breastfeeding, and (4) Physical and emotional distress of mothers and infants.
Unrestricted direct breastfeeding upon reunion through the night along with co-sleeping was the strategy mothers used to restore breastfeeding relationships with their infants and continue direct breastfeeding. Scheduled feeding and solitary sleep resulted in less direct breastfeeding, had negative consequences such as low milk supply, slow infant weight gain, and maternal distress.
Even though frontline essential working mothers persevered with the complexities of their work during the COVID-19 pandemic, findings highlight challenges mothers faced with their breastfeeding experience. Nurses need to discuss with mothers expected challenges of less frequent direct breastfeeding along with emotional tolls while being separated from their infant and strategies to develop sustainable breastfeeding relationships and continuation of direct breastfeeding.
None.
To explore oncology nursing advance care planning practices and understand how to better support nurses in conducting advance care planning with patients and their families.
Qualitative interpretive descriptive methodology.
Semi-structured, individual telephone or Zoom interviews with 19 oncology nurses in a Western province of Canada between May and August 2022. Interviews were audio-recorded, transcribed, de-identified, and analysed using inductive, thematic, and constant comparative techniques.
Oncology nurses highlighted several factors affecting their ability to engage in advance care planning, including (1) uncertainties related to the nursing role in advance care planning, such as how and when a nurse ought to engage; (2) the educational, experiential, and training environment; and (3) structural barriers, such as a lack of time, space, and privacy; models of care that inhibit nurses from developing longitudinal relationships with their patients; and team dynamics that affect advance care planning interdisciplinary collaboration.
To create environments that support oncology nurses to conduct advance care planning, the findings suggest uncertainties be addressed through a clear and cohesive organisational approach to advance care planning and ongoing, integrated educational opportunities. Further, service delivery models may need to be restructured such that nurses have dedicated time and space for nurse-led advance care planning and opportunities to develop trusting relationships with both patients and their interdisciplinary colleagues.
Oncology nurses recognised the value of advance care planning in supporting patient-centred care and shared decision making, yet they reported limited engagement in advance care planning in their practice. To support oncology nurses in conducting advance care planning, healthcare leaders may address (1) advance care planning-related uncertainties and (2) structural barriers that prevent nurses from engaging in advance care planning with patients and their families. Findings may guide modifications to care models, enhancing support for oncology nurses in conducting advance care planning.
We selected and adhered to the Consolidated Criteria for Reporting Qualitative Research (COREQ) as the most applicable guideline.
No patient or public contribution.
This study explored perceptions of older adults racialised as Black on structural resilience across the life course.
A qualitative descriptive study.
Using purposive sampling, we recruited 15 Black adults aged 50 and older residing in Baltimore, Maryland, including individuals possessing historical or current knowledge of the community. Semi-structured interviews were conducted to elicit participants' experiences with structural resources during childhood, adulthood and late adulthood. Interviews were audio-recorded, transcribed verbatim and analysed using content analysis.
Of the 15 participants, three identified as male (20.0%) and 12 as female (80.0%), with an average age of 70.9 ± 8.2 years. The analysis identified nine categories of structural resilience, confirming its multifaceted and dynamic nature. Common categories present across all life stages included: Built environment, civic engagement, food and housing, healthcare, and social capital and cohesion. Life stage–specific categories included child and family services, educational supports, and workforce development supports during childhood and adulthood, and financial support during adulthood and late adulthood.
These categories were interdependent and spanned across life stages, illustrating the dynamic, cumulative and relational qualities of structural resilience. Furthermore, structural resources were identified as key to safeguarding, empowering and restorative responses to adversity.
These findings contribute to the development of a nuanced, life course–informed framework of structural resilience and highlight the need for ecological strategies that address structural forces shaping health and well-being, particularly among older adults racialised as Black.
This study was reported in accordance with the Consolidated Criteria for Reporting Qualitative Research checklist.
No patient or public contribution.
The aim of this study was to understand the needs of children and young people of a parent with young-onset dementia, to inform the development of a nursing model.
Children and young people of a parent diagnosed with young onset dementia have a range of needs that are subject to change and aligned to their stage of development and growth.
Systematic review.
Searches were conducted in PsycInfo (1806–Jan 2025), Medline (1996–Jan 2025) and CINAHL (1961–Jan 2025); search terms were developed in consultation with an academic librarian.
The Preferred Reporting Items for Systematic reviews and Meta-Analyses was used to assess the trustworthiness and applicability of the findings and the Mixed Methods Assessment Tool to assess quality. The review protocol was registered on PROSPERO (CRD42024534104). Needs identified from the literature were matched with the activities and interventions of a specialist nursing model.
Searches yielded 223 records of which 17 met the inclusion/exclusion criteria, the majority of which used qualitative methods (N = 16). A thematic synthesis approach was used to analyse data to reveal four emergent themes: (1) finding a way, (2) social connection and peer support, (3) preserving childhood and adolescence and (4) practical support, including the needs relating to education. Identified needs: knowledge and information, emotional support, consistency in education and development, maintaining social connections, physical and psychological well-being, and grief and loss were mapped against a specialist nurse role.
Children and young people with a parent diagnosed with young-onset dementia face unique challenges compared to older carers. Despite growing awareness of their needs, this population is often overlooked in national dementia strategies. Developing a specialist nurse role is a positive step, but broader systemic support is essential to safeguard their well-being and future opportunities.
This study adheres to the PRISMA reporting guidelines.
A bespoke Research Advisory Group, consisting of people with young onset dementia, young family carers, clinicians and academics, guided the review.
To canvas the contemporary contextual forces within the Australian residential aged care sector and argue for new research and innovation. There is a pressing need to provide systematised, high-quality and person-centred care to our ageing populations, especially for those who rely on residential care. This paper advances a warrant for establishing a new systematic framework for assessment and management that serves as a foundation for effective person-centred care delivery.
Position paper.
This paper promulgates the current dialogue among key stakeholders of quality residential aged care in Australia, including clinicians, regulatory agencies, researchers and consumers. A desktop review gathered relevant literature spanning research, standards and guidelines regarding current and future challenges in aged care in Australia.
This position paper explores the issues of improving the quality and safety of residential aged care in Australia, including the lingering impact of COVID-19 and incoming reforms. It calls for nurse-led research and innovation to deliver tools to address these challenges.
The paper proposes an appropriate holistic, evidence-based nursing framework to optimise the quality and safety of residential aged care in Australia.
This study did not include patient or public involvement in its design, conduct, or reporting.
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