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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.
Toxic leadership has become prevalent in nursing; however, the literature provides limited evidence of the different outcomes of toxic leadership behaviours. This research investigated nursing leaders' toxic leadership, nurses' workplace satisfaction, job engagement, and turnover intention in Jordan and whether toxic leadership and sample characteristics predict nurses' workplace satisfaction, job engagement, and turnover intention.
To reach a more diverse and larger population of nurses, data were gathered in 2023 using an online survey and a cross-sectional research design with convenience snowball sampling of 384 nurses from different hospitals. Nurses “agreed” on the presence of nursing leaders' toxic leadership.
Nurses “agreed” on the presence of nursing leaders' toxic leadership. Similar to Sexton et al.'s (2006) scoring, it was still low (Mean = 3.08/5, Standard Error (SE) = 0.043), which applied in the same magnitude for low nurses' workplace satisfaction (Mean = 2.45/5, SE = 0.036), low nurses' job engagement (Mean = 3.57/5, SE = 0.040), and low nurses' turnover intention (Mean = 3.25/5, SE = 0.038). The highest and lowest means for the four variables. As a part of the workplace satisfaction tool, nurses were asked two open ended-questions about the best and the worst things about their jobs; they answered that nursing provides humanitarian care for patients (n = 178, 95.33%), while the worst thing was the poor work environments, especially related to salaries and workload were (n = 85, 27.25%). Perceived nursing leaders' toxic leadership only predicted perceived nurses' workplace satisfaction (t = 5.79, p = 0.001, Adjusted R 2 = 0.066); perceived nurses' job engagement (t = 5.52, p = 0.001, Adjusted R 2 = 0.067); and perceived nurses' turnover intention (t = 11.16, p = 0.001, Adjusted R 2 = 0.249).
The major effect of toxic leadership of nursing leaders was on nurses' intention to leave. Given the high global nurse turnover rates, toxic leadership would result in low job satisfaction, stress and emotional exhaustion, and, in turn, decreased quality of nursing care. Therefore, it is essential to confront toxic leadership immediately. Nursing leaders' toxic leadership, nurses' workplace satisfaction, job engagement, and turnover intention were low in the current study. However, even if it has a low level, it should be diagnosed and eradicated at early stages to avoid its disastrous outcomes; toxic leadership has detrimental consequences.
Low workplace satisfaction and job engagement are dangerous; thus, they warrant immediate managerial interventions, such as establishing training programmes and using effective communication.
This study highlights the urgent need for innovative managerial interventions to overcome low workplace satisfaction and job engagement; they are alarming in such rapidly changing work environments.
Guidelines were followed using the STROBE reporting method.
None.
To explore the perceptions of primary care nurses regarding their skills and the challenges they face in managing paediatric obesity.
Qualitative descriptive study.
Data were collected between May 2022 and March 2024 from focus groups with primary care nurses (n = 25) and analysed using thematic analysis.
Four themes emerged from the data. ‘Nurses’ beliefs, skills and tools to manage pediatric obesity’ highlights the skills and limitations nurses encounter in their practice, their views on the causes of this condition, and how they assess families' motivation. The second theme, ‘Nurse-family-child communication’ describes the communication strategies nurses employ when interacting with motivated and unmotivated families. The third theme, ‘The impact of nursing interventions on family behavior’ highlights the limited results behavioural changes observed in families following interventions. The fourth theme, ‘Nurses' reactions to the treatment of pediatric obesity’ reflects the negative feelings nurses experience in managing paediatric obesity.
This study identifies significant challenges for nurses in addressing paediatric obesity, particularly in communication and engagement with unmotivated families, which might stem from a lack of tools. Furthermore, it recognises the emotional responses of nurses when tackling obesity.
This study highlights the needs related to nurses' communication skills. It is recommended to implement training courses focused on this topic.
Adherence to COREQ guidelines was maintained.
There was 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 pilot and evaluate the implementation of a structured Evidence-Based Rounds (EBR) education model in critical care.
A mixed data type design was used to evaluate Evidence-Based Rounds in a critical care setting. Structured observational data were captured and open-ended survey responses were submitted by attendees. Content analysis and descriptive statistics were used to analyse survey findings.
Seventeen rounds were completed between March 2023 and January 2024 with a total of n = 83 clinical staff members. From these, n = 55 staff completed and submitted evaluation surveys. Rounds were most frequently attended by nurses of all bandings including senior clinical nurses, support workers and student nurses. Evidence-Based Rounds were globally perceived as a positive and useful education strategy and staff were very willing to attend future sessions. Patient outcomes were not directly assessed and rounds specifically facilitated three outcomes: (1) helping staff apply evidence to practice, (2) building staff confidence in presenting clinical information and (3) supporting staff in identifying local improvements to patient care.
Evidence-Based Rounds are an adaptable effective model of bedside education within critical care. In our setting, staff perceived that this model facilitated the application of evidence in clinical practice and positively influenced feelings of confidence. Importantly, this education strategy empowered nurses to explore and identify improvements locally to patient care. Whilst this model offers a practical education approach to address some of the key critical care workforce issues, such as an expanding curriculum and loss of senior staff, it could also be widely adopted to other clinical areas.
Evidence-Based Rounds are perceived by staff as a successful bedside education model that facilitates nurses to apply evidence in practice. It is feasible that this strategy is a potentially sustainable, low-cost model for continuing professional development centred around routine clinical work.
No patient or public contribution.
To examine older persons' experiences and participation in life-enhancement activities in a long-term care facility.
Convergent mixed-methods design.
Naturalistic observations of 20 life-enhancement activity sessions were conducted in a single long-term care facility that includes 111 older persons in September 2024. Data were collected through guiding questions and fieldnotes for systematic observation. We used Kruskal-Wallis and Mann–Whitney U tests for quantitative analysis. Fieldnotes were analyzed using a six-phase reflexive thematic analysis approach.
Engagement levels (self-initiative, assistance-seeking frequency, and social interaction frequency) significantly differed across 16 different life-enhancement activities. Social interaction frequency also varied by mobility status (wheelchair, walker, independent). Participants displayed significantly more distractions in the TV Room than in the Activity Room. Four themes emerged from thematic analysis: (1) participation barriers, (2) activity contextual factors, (3) facilitator support strategies, and (4) social interactions and emotional well-being.
Structural elements (purposefully designed rooms, activity design and complexity, and the resident-preferred music), relational elements (facilitators' hands-on support, conflict resolution, and positive reinforcement), and individual factors (mobility status) influence older persons' participation in life-enhancement activities. Life-enhancement activities benefit older persons when they are provided with choices and adaptive equipment.
Findings support allocating distraction-free spaces for life-enhancement activities, incorporating resident-preferred music and game-layered physical exercises, and providing facilitator training in adaptive coaching, hands-on support, and conflict resolution.
Life-enhancement programs can promote psychosocial well-being among older persons in long-term care facilities by transforming routine recreational activities into personalized and socially engaging experiences that may reduce feelings of loneliness.
Journal Article Reporting Standards for Mixed Methods Research.
No Patient or Public Contribution.
This study aims to (1) understand the impact of having a child with complex care needs in the family and (2) explore how siblings and parents experience the Sibling Talks intervention.
A qualitative exploratory design.
Semi-structured interviews were conducted with six siblings and 10 parents from seven families after completing the Sibling Talks intervention between January 2023 and April 2023. Data were analysed using Braun and Clarke's reflexive thematic analysis.
The analysis identified four themes, with separate findings for siblings and parents. Siblings described the impact of having a sibling with complex care needs as ‘Struggling to find their role and to understand themselves’ and their experiences with dialogues in Sibling Talks as ‘The importance of support from the school nurse’. Parents described their experience of their family situation as ‘A balancing act of care and other responsibilities’ and noted a shift ‘From scepticism to relief’ regarding the dialogues in Sibling Talks.
Sibling Talks facilitated open communication between siblings and parents, helping parents gain a deeper understanding of their children's perspectives. Sessions with nurses were experienced as respectful and caring, allowing siblings' perspectives to be heard and enhancing family interaction.
This study provides new insights into siblings' needs and how nurses can approach and communicate with siblings and parents, highlighting positive experiences with the Sibling Talks intervention.
The study followed the Consolidated Criteria for Reporting Qualitative Research (COREQ).
There was no patient or public contribution.
The aim of the study was to investigate the impact of the use of baby-friendly community initiative (BFCI) model on various stakeholders in the community.
Quasi-experimental research design.
The study was conducted in public premises and online workshops from April 2019 to September 2022. Participants were followed up for a period of 1 month, except for those employed at public premises. The program involved training based on an accredited BFCI framework to cultivate a breastfeeding-friendly attitude and knowledge. A paired sample t-test was used to examine breastfeeding attitude and knowledge scores before and after BFCI training among staff employed from public premises. An analysis of variance was conducted to examine the breastfeeding self-efficacy and attitude scores, measured repeatedly at different timepoints over 1-month timepoint (T0, T1 and T2) among pregnant and postpartum women.
A total of 2340 perinatal women and 1339 staff from public premises were recruited. For staff, there was an increase in the mean score of breastfeeding knowledge and attitude by 5.8 and 6.1, respectively, at T1. Similarly, for perinatal women, there was an increase in the mean score of breastfeeding self-efficacy and attitude by 6.6 and 3.3, respectively, at T1.
In summary, a BFCI model, with active community participation, accreditation and an award system, has been effective in promoting breastfeeding. Adapting the baby-friendly hospital initiative to local contexts and employing a social theory model can enhance breastfeeding promotion and improve infant health outcomes. Prioritizing culturally sensitive breastfeeding education is crucial for successful BFCI implementation.
Healthcare professionals should consider clients' culture and socio-economic backgrounds when providing breastfeeding education to maximize effectiveness. The target audience for breastfeeding education should be expanded to include various community stakeholders beyond families.
What problem did the study address? This study addressed the problem of knowledge gaps among stakeholders in building a breastfeeding-friendly community, particularly in implementing a baby-friendly community initiative (BFCI) as part of a baby-friendly hospital initiative (BFHI). The research filled a service gap by providing effective interventions targeting community stakeholders and assessing the impact of a BFCI program on their knowledge and attitudes towards breastfeeding.
What were the main findings? The findings highlighted the effectiveness of a BFCI program in enhancing breastfeeding knowledge and attitudes among frontline staff and increasing breastfeeding confidence among mothers. These findings contribute to the understanding of the program's impact on different stakeholders in the community.
Where and on whom will the research have an impact? It impacts on global policymakers by providing insights for developing comprehensive guidelines for future BFCI implementations. It also contributes to the creation of a more baby-friendly community, benefiting breastfeeding families and their infants by promoting and supporting breastfeeding families.
This study has adhered to relevant EQUATOR guidelines using the TREND reporting guideline.
No patient or public contribution.
This study provides an overview of the establishment of a localized BFCI program. It also opens up a new direction for the community to investigate BFCI strategies for community stakeholders. It also provides evidence to support other countries in following a similar process, as each country approaches becoming breastfeeding-friendly in its own unique way.
No protocol.
This study reports on the implementation of a registered advanced nurse practitioner intervention. Aims include improving access, service user outcomes and integration between primary and secondary care.
This paper reports the quantitative results of a mixed methods implementation study. Qualitative data are reported separately. The PARiHS framework informs the implementation process itself, with considerations for nurses and other healthcare professionals explored.
The CORE-OM 34 item rating scale was administered both pre- and post-intervention. Service user attendances in secondary care was monitored.
Findings suggest that the intervention was associated with clinically significant improvements in global or generic distress, reported by service users, as evidenced by changes in the CORE-OM scores. Access to care was recorded at an average of 3.6 days. Implementation science supported effective and safe implementation with clear governance structures.
Registered advanced nurse practice in mental health clinics which provide full episodes of care results in improved integration and may be associated with positive patient outcomes. Implementation science is taught on Irish nursing programmes and this is important if innovative services are to be embedded in the healthcare system.
The development of a model of care for mental health Registered Advanced Nurse Practitioners at the interface of primary and secondary care settings may be merited. Positive Advanced Recovery Connections may be associated with improving mental health outcomes and bolstering integration of primary and secondary care services. The utilisation of implementation science highlights the need for collaboration with all stakeholders to overcome barriers and recognise facilitators to attain the necessary model of integrated care.
Peer recovery input was provided by members of the service Recovery College, with participation evident in all stages of the project. The psychosocial assessment template was also co-designed.
To describe the co-creation of the ‘Desired Dementia Care Towards End of Life’ (DEDICATED) approach to improve person-centred palliative care for individuals with dementia and to describe the experiences of healthcare professionals during the approach's implementation.
A needs assessment, comprising both qualitative and quantitative studies, informed palliative care needs of healthcare professionals, family caregivers and individuals with dementia. The approach was co-created with healthcare and education professionals, guided by the findings. Then, healthcare professionals were trained to implement the approach in their organizations. From April to June 2022, semi-structured interviews with actively engaged professionals were analysed using Conventional Content Analysis.
The needs assessment yielded six key themes: (1) raising palliative care awareness, (2) familiarization with a person with dementia, (3) communication about future care preferences, (4) managing pain and responsive behaviour, (5) enhancing interprofessional collaboration in advance care planning and (6) improving interprofessional collaboration during transitions to nursing homes. Interviews with 17 healthcare professionals revealed that active involvement in co-creating or providing feedback facilitated implementation. Overall, the DEDICATED approach was perceived as a valuable toolkit for optimizing palliative care for people with dementia and their loved ones.
Co-creating the DEDICATED approach with healthcare professionals facilitated implementation in daily practice. The approach was considered helpful in enhancing person-centred palliative dementia care.
This study underscores the importance of active involvement of healthcare professionals in the research and development of new interventions or tools for palliative care, which can influence the successful implementation, dissemination and sustained usage of the developed tools.
The developed approach can improve person-centred palliative care for individuals with dementia, ultimately improving their quality of life and that of their loved ones.
This study used the Consolidated Criteria for Reporting Qualitative Research.
No patient or public contribution.
To examine the association between caregiving context and the health and well-being of community-dwelling people with dementia (functional ability, physical function, depression, quality of life and health-related quality of life) and their informal carers (health-related quality of life) at the pre-rehabilitation stage and the potential mediating role of caregiving context variables.
Cross-sectional study.
Secondary analysis of baseline data from a randomised controlled trial of 130 dementia care dyads—the Interdisciplinary Home-based Reablement Programme (2018–2022). Bivariate analyses were applied to identify key caregiving context variables—co-residence, sole carer status, additional caring responsibilities, client-carer relationship and subjective carer burden (carer burden hereafter)—associated with health outcomes. Subsequently, multivariable linear regression models were developed. To examine carer burden, two models were run for each outcome: one with caregiving context variables and covariates, and the other adding carer burden. The mediating effects of the identified caregiving context variable were examined using post hoc mediation analysis.
Spouse/partner carer relationship was significantly associated with better client well-being, including lower depressive symptoms and higher quality of life scores compared to adult child and other relationships. Higher carer burden was strongly associated with lower functional ability, more depressive symptoms, lower quality of life for clients and lower health-related quality of life for both clients and carers. Including carer burden in regression models explained the greatest variance across most models. Carer burden fully mediated the association between additional caring responsibilities and client functional ability, and partially mediated the association between other carers and client depression.
Carer burden needs to be carefully considered in supporting the health and well-being of dementia carer dyads.
Addressing carer burden and tailoring support to carers are essential for optimising health impacts for dementia carer dyads.
STROBE checklist.
None.
ClinicalTrials.gov identifier: ACTRN12618000600246
Nurses play vital roles in healthcare systems, especially in competitive environments that must meet diverse stakeholder expectations, improve quality and foster innovation. However, these efforts are often challenged by workforce issues such as nurse turnover intention, which is a critical concern requiring effective leadership and management. Despotic leadership is harmful and may lead to negative nurse behaviours, including intentions to leave their positions.
This study explored the correlations and differences in the clinical nurse managers' despotic leadership and nurse turnover intention based on the sample characteristics as perceived by registered nurses (RNs) working in the selected hospitals in Jordan.
This study employed a quantitative cross-sectional correlational comparative design to measure the relationships and differences between the perceived despotic leadership of nurse managers and nurse turnover intention. In 2024, a paper-format survey was distributed to nurses working in various hospitals. Five governmental and private hospitals in Jordan were purposively chosen to recruit 301 nurses using non-probability convenience snowball sampling techniques. Sample size was collected using G* power, and data were collected using a highly psychometric instrument of the Toxic Leadership Behaviours of Nurse Managers Scale (The ToxBH-NM Scale) and the Turnover Intention Scale (TIS-6 Items).
The overall score for clinical nurse managers' despotic indicated a moderate level of despotic leadership among nurse managers. Among the nurses surveyed, 53 (17.60%) expressed an intention to stay in their positions, while 248 (82.30%) indicated they intended to leave those positions. There was a statistically significant weak positive correlation between the total score of perceived clinical nurse managers' despotic leadership and the total score of perceived nurse turnover intention (r = 0.215, p = 0.01). This correlation suggests a small effect size (Cohen's guidelines: small = 0.10, medium = 0.30, large = 0.50), indicating that while the relationship was statistically significant, the practical impact was at a small level. No significant differences were found in the perceived despotic leadership of nurse managers or nurse turnover intention.
The findings highlighted the critical roles of leaders, policymakers and organisations in reducing the perceived despotic leadership of nurse managers. These roles are crucial in decreasing nurses' intentions to leave their jobs.
Accurately identifying despotic management behaviours is crucial. To improve nurse retention, healthcare organisations should implement evidence-based interventions targeting job satisfaction, workload management and ongoing professional development.
This study did not include patient or public involvement in its design, conduct or reporting.
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.
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.
FreshRSS 