Conectar
To explore nurses' experiences of the adoption, implementation, and use of digital technologies during the Covid-19 pandemic in the UK.
A qualitative descriptive study.
A qualitative study using two data sources: qualitative responses from 55 respondents to an online survey, and data from in-depth interviews with 21 individuals. The NASSS framework was used to guide data collection and analysis. Data were analysed using framework analysis.
Respondents reported using a variety of technologies including video conferencing applications, telemonitoring, systems to support care management and telecommunication systems. The analysis identified a range of reasons why technology had been introduced into services, and a recognition of its value in a situation where otherwise care may not have been able to continue. During the pandemic nurses were expected to change their work practices very rapidly, and we identified situations where organisational infrastructure either supported this effectively or created additional burdens for the nurses' work.
Nurses had to adapt to new ways of working rapidly, with digital technology being one of the primary means through which communication and care were delivered. The Covid-19 pandemic provided a unique set of circumstances where layers of governance and many of the existing barriers to technology introduction were reduced.
It is important to learn from these experiences, to understand how to sustain innovations that have proved to be successful, as well as the factors that enable nurses to work effectively in this new environment.
This study adheres to the guidance for publishing qualitative research in informatics.
A public contributor was involved from the beginning of the study conceptualization. They had input into the study approach, were part of the team that acquired the funding for the study and gave input at various stages into the processes for data collection, analysis and writing up the findings. The public contributor is a co-author on this paper and has been involved in the writing and editing of this report.
This study aims to synthesise evidence on users' experiences of telephone cancer information and support services (CISS) to identify important service features and inform service development.
A qualitative evidence synthesis.
OVID MEDLINE, EMBASE, CINAHL, PsycINFO and SocINDEX databases were searched for peer-reviewed qualitative literature fitting the inclusion criteria from database inception to 30 March 2023. The included articles were double-screened, and quality appraised using the CASP checklist. GRADE-CERQual was used as a tool to assess the confidence of review findings. Content synthesis combined the qualitative data with the Loiselle cancer experience measurement framework guiding analysis. This paper is reported as per the equator network recommended SRQR checklist.
Of the 607 articles screened, seven studies were included. Four main themes and 14 sub-themes about CISS aspects were identified: psychological well-being (managing emotions/coping, hope/reassurance, supporting close others and a reluctance to call the CISS); knowledge is power (information seeking, the burden of knowledge and empowerment); truth and clarity (adjunct support, credible source and improved understanding and confidence); and service adequacy (operators' ability to connect with users, convenience, service provision and awareness, and the cancer journey).
Findings suggest people with cancer and their carers accessing a CISS value emotional support combined with trusted information, topic expertise and a connection with the service operator. future service provision should address the lack of awareness regarding the range of services and the convenience extended operating hours may offer.
The results add to our understanding of CISS service provision. However, knowledge gaps remain regarding preferences among service features and the hierarchy of CISS characteristics to be prioritised to enhance services.
Focused CISS awareness campaigns will inform communities and healthcare professionals of the available resources to improve the lives of those affected by cancer. Ongoing service review will enable resources to be tailored to callers' needs, potentially easing the burden on existing services that are overwhelmed and under-resourced.
This qualitative evidence synthesis did not directly involve patient or public contribution to the manuscript.
Systematic Review Registration Number (PROSPERO): CRD42023413897
To explore the existential lived experiences of emerging adult siblings of children with complex care needs.
A qualitative phenomenological design.
In-depth conversational interviews were conducted between February and June 2022 with nine emerging adult siblings (aged 16–27), who grew up with a brother or sister with complex care needs. Data were analysed using van Manen's phenomenology of practice approach.
Five core themes were identified: Loss of a familiar world: the profound changes and disruptions in siblings' lives. The sibling bond: endured and enduring love. Embracing the load: balancing responsibilities. Being behind the scenes: a lonely childhood. Jigsaw falling into place: siblings finding clarity and forging their own paths.
Early experiences of growing up with a sibling who has complex care needs, may resurface or shift in meaning, impacting long-term existential well-being, particularly when siblings feel overlooked by families, educators, and healthcare professionals. These silenced experiences often persist into emerging adulthood, shaping emotional health, relationships, and life choices.
The underrecognized existential needs of these siblings call for intentional, person-centred care. Our research advocates early, targeted interventions, emphasizing the pivotal role of nurses. A lifeworld-led phenomenological approach equips nurses to more effectively attend to the unmet needs of siblings within family care settings.
The research followed the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist.
Emerging adult siblings with lived experience of growing up alongside a brother or sister with complex care needs contributed important insights into the interpretation of findings, ensuring relevance to clinical nursing.
Around 2 billion people globally were affected by natural disasters between 2008–2018. The World Health Organization requires countries and governments to have disaster plans and emergency health workers ready and prepared at all times.
To conduct an integrative review of literature of emergency healthcare workers’ perceived preparedness for disaster management.
An integrative literature review using the PRISMA checklist guidelines was conducted to explore physicians, nurses, emergency medical services and allied medical professionals’ preparedness for disasters. Literature was searched from 2005, published in the English language and from MEDLINE (PubMed), Google Scholar, EMBASE, PsycINFO, SCOPUS, ProQuest and CINAHL databases. Reviews, case reports, clinical audits, editorials and short communications were excluded. Studies were critically appraised using the Mixed Methods Appraisal Tool.
The initial search yielded 9589 articles. Twenty-seven articles were included following application of the eligibility criteria. Included studies were geographically diverse including North America, the Middle East and the Asia Pacific. Most studies (n = 24) assessed the knowledge of healthcare workers in general disasters. Studies using the Disaster Preparedness Evaluation Tool reported moderate disaster preparedness and knowledge, while studies using other instruments largely reported inadequate disaster preparedness and knowledge. Regional variations were recorded, with high-income countries’ reporting a higher perceived preparedness for disasters than low-income countries.
The majority of the emergency healthcare workers appear to have inadequate disaster preparedness. Previous disaster experience and training improved disaster preparedness. Future research should focus on interventions to improve emergency healthcare workers preparedness for disasters.
To examine the characteristics of the health care needs corresponding to the medical care process and HR-QOL of women with cancer.
A descriptive design was adopted.
The study's participants were 122 women with cancer who completed a survey before and 6 months after treatment initiation. A principal component analysis (PCA) was conducted on a set of 12 health care satisfaction scores at each point. Correlations were examined between the resulting components and HR-QOL indicators, including subjective well-being, symptoms, symptom-related interference, anxiety and depression.
Most participants reported high health care satisfaction in both phases. PCA indicated the presence of 3 distinct domains: satisfaction with health care, health care management and supportive care. In both phases, these domains accounted for about 60% of the variance, while the remaining 40% was unexplained. Only satisfaction with health care was correlated with HR-QOL at both phases, with particularly strong associations observed for subjective well-being and depression at 6 months. Before treatment initiation, the item of ‘nursing care and practice’ received the highest average score, but demonstrated a negative loading on the component of ‘satisfaction with health care management’. The component of ‘satisfaction with supportive care needs’ was retained at both phases.
Health care plays a pivotal role in maintaining patients' quality of life, while supportive care and the integration of nursing practice within health care management remain essential.
High satisfaction scores do not necessarily mean that all health care needs are met. Addressing unmet needs from the perspective of HR-QOL and ensuring continuous supportive care throughout the treatment process is imperative.
Data provided by women with cancer was used.
To examine the associations among diabetes-related stress, treatment adherence, perceived social support, and health-related quality of life (HRQoL) in adults with type 1 diabetes mellitus (DM1), and to explore the mediating roles of support and adherence in this relationship.
A cross-sectional observational study using self-report standardised measures and mediation analysis.
A total of 772 Spanish adults with DM1 completed validated instruments measuring diabetes-related distress, perceived social support, treatment adherence, and HRQoL. Hierarchical multiple regression and serial mediation analysis (PROCESS Model 6, 10,000 bootstraps) were conducted, controlling for age, sex, and time since diagnosis.
Not applicable (primary data collection, not a review).
Diabetes-related stress was the strongest predictor of lower HRQoL. Perceived social support and treatment adherence also contributed significantly. Mediation analyses indicated that the impact of stress on HRQoL was partially mediated by perceived social support and, in sequence, by treatment adherence. The indirect path through social support alone and the sequential path involving both mediators were significant.
Stress and social support are critical in understanding and improving HRQoL in adults with DM1. Treatment adherence appears to be influenced by perceived support, highlighting an indirect mechanism linking stress to quality of life.
Healthcare professionals should integrate psychosocial assessments and interventions into routine diabetes care. Targeting stress reduction and enhancing social support may improve adherence and overall well-being in adults with DM1.
What problem did the study address? The study addressed the need to understand how psychosocial factors—specifically stress, perceived social support, and treatment adherence—contribute to HRQoL in adults with DM1. While prior research often focused on paediatric or clinical populations and rarely explored mediation models, this study sought to fill those gaps with data from a large community sample of adults.
What were the main findings? The main findings indicate that diabetes-related stress is the most significant predictor of reduced HRQoL. This relationship is partially mediated by perceived social support and, sequentially, by treatment adherence. While stress directly affects HRQoL, its negative impact is also channelled through diminished social support and decreased adherence. The indirect effect through treatment adherence alone was not significant.
Where and on whom will the research have an impact? The research has implications for adults living with DM1, particularly those in community settings outside of clinical supervision. It informs healthcare providers, diabetes educators, and policymakers on the importance of addressing emotional distress and strengthening support networks to improve both treatment adherence and overall quality of life.
This study adhered to the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines for cross-sectional studies. All methods and results are reported in alignment with EQUATOR Network recommendations for transparent and rigorous research reporting.
The study was conducted in collaboration with the Spanish Diabetes Federation (FEDE), which supported participant recruitment and dissemination through its affiliated associations. Patient input was incorporated throughout the study. A person with lived experience of type 1 diabetes contributed to the conceptual development of the research questions and the interpretation of findings. Their perspective helped ensure that the study design, choice of measures, and implications were relevant and meaningful to people living with the condition. This involvement supported a patient-centred approach to both the research and the manuscript preparation. Patients' participation as voluntary contributors was essential to the data collection process.
To describe the implementation determinants for care coordination interventions in a hospital context.
Systematic review.
This review was guided by the Consolidated Framework of Implementation Research (CFIR), assessed for quality using the Mixed Methods Appraisal Tool and reported with the PRISMA guidelines.
CINHAL Complete, EMBASE, MEDLINE Complete, PsychINFO (between January 1, 2013, and December 31, 2022, and updated May 09, 2024) and a manual reference list search of all included studies.
The search returned 5614 articles after duplicates were removed. After title and abstract screening, 264 articles underwent full-text review. Sixteen studies (15 care coordination models) met the inclusion criteria. The CFIR inner setting domain and the implementation process domain were the most prominent domains and ‘Partnerships & Connections’, ‘Work Infrastructure’, ‘Capability’ and ‘Reflecting and Evaluating’ subdomains emerged as important determinants across the included studies.
Inconsistent findings relating to care coordination outcomes are likely to be substantially influenced by the complexity and heterogeneity of the interventions and variations in implementation and contextual factors. Intra- and inter-organisational relationships were important to connect previously disconnected parts of the health system and were facilitated by experienced care coordinators. Continual improvement was also important to increase fit with contextual factors. More high-quality studies are needed to identify commonalities and provide generalisable principles and characteristics associated with high-performance implementation.
Review findings will provide practitioners, policymakers, and researchers with a comprehensive synthesis of evidence underpinning implementation of effective community care coordination from hospital settings.
These review findings will inform the effective implementation of care coordination interventions in a hospital context for patients with complex multimorbidity.
Preferred Reporting Items for Systematic reviews and Meta-Analysis.
PROSPERO Registration: CRD42022376642.
No patient or public Contribution.
To explore the experiences of significant others of patients with severe burn injury in the intensive care unit. Specifically, how severe burn injury impacted the significant other and their role within their loved one's life.
This qualitative study employed a Narrative Inquiry approach.
Interviews were undertaken during 2021–2022 with 17 participants who were the significant others of a patient with severe burn injury in the Intensive Care Unit. Recruitment occurred in New South Wales, Australia, from two tertiary hospitals providing care for people with major burns. A narrative inquiry approach was utilised, capturing stories through semi-structured interviews.
Significant others experienced necessary changes in their life in response to the catastrophe. These included advocating, being present and ensuring their loved one's needs were met, while often neglecting themselves. Significant others contemplated their future as a carer to their loved one with severe burn injury, and adjusting their own career, finances and lifestyle, often as a long-term measure. The shifting of their role to carer ultimately transformed and redefined their relationships and lives.
Significant others endure immense trauma when a loved one sustains a severe burn injury. They require support but prioritise the patient by virtue of their critical illness. The life of the significant other is changed as they take on the role of carer and provide support. It is, therefore, imperative that the support needs of significant others are recognised, understood and addressed to ensure their well-being while processing the trauma.
With increased understanding of the significant others' experiences, healthcare providers can adopt a consultative approach, where roles and boundaries can be clearly identified. Through this process, healthcare providers can strengthen rapport and provide targeted support for significant others, as they navigate this traumatic life-altering event.
No patient or public contribution.
To examine the relationship between weight loss and problems with oral intake in institutionalised older adults.
A 1-year longitudinal observational study.
Data were obtained from a prospective study conducted in three nursing homes and two long-term care facilities in Japan. Participants' problems with oral intake were assessed using items published in 2021 by the Japanese Ministry of Health, Labour and Welfare. Baseline and follow-up factors were compared between individuals who experienced a weight loss of 5% or more and those who did not. Separate multivariable logistic regression models were constructed for each oral intake assessment item to examine its independent association with weight loss of 5% or more, accounting for transitions in each item between baseline and the 1-year follow-up.
In total, 172 institutionalised older adults were included in the analysis. Among them, 57 (33.1%) participants experienced a weight decrease of 5% or more. The emergence of somnolence or clouding of consciousness during meals at the 1-year follow-up in participants without these signs at baseline was independently associated with a weight loss of 5% or more, after adjustment for baseline characteristics.
Recognising signs of somnolence or clouding of consciousness during meals may be useful for the early detection and prevention of weight loss in institutionalised older adults.
Early detection of individuals at risk is essential to prevent significant weight loss and its associated adverse outcomes. Recognising somnolence or clouding of consciousness during meals may enable earlier detection and intervention to prevent weight loss and improve the quality of care for older adults.
Strengthening the Reporting of Observational Studies in Epidemiology.
No patient or public contribution.
To investigate the effects of active involvement of family caregivers in adult in-hospital care on patients' readmissions, complications, mortality, length of hospital stay, quality of life, psychological distress and activities of daily living, as well as on the satisfaction of patients, HCPs and family caregivers.
Systematic review.
Ovid Medline, Ovid Embase, EBSCO CINAHL, Cochrane Library (from inception to February 2024).
The PRISMA 2020 statement was followed. Prospective controlled studies focusing on active involvement of family caregivers in adult in-hospital care were included. Two independent teams of authors conducted study selection, quality assessment and data extraction.
Thirteen studies were included, comprising 11 randomised controlled trials. The clinical and methodological heterogeneity precluded a meta-analysis. Six of these studies were performed in stroke patients. Some studies reported statistically significant benefits of active family involvement on readmission rates, hospital LOS, ADL, psychological distress for patients and family members, QoL and satisfaction of family caregivers. However, others did not observe differences in these outcomes. For complication rates, mortality and satisfaction of patients and HCPs, no studies demonstrated significant differences between groups.
Further research is needed to provide a conclusive answer as to whether active family caregiver involvement improves outcomes of adult hospitalised patients.
Despite the inconclusive findings of this review, advocating for active involvement of family caregivers in adult in-hospital care fits the perspective of patient- and family-centred care.
As the care of hospitalised adults is shifting to a more family-centric approach, investigating the effects of an active role of family caregivers in adult in-hospital care is necessary. However, the small number of studies available and heterogeneity between studies included in this review hamper firm conclusions. Further evaluations through well-designed studies are required.
To examine the association between perceived quality of care and the level of coercion experienced by individuals hospitalised in acute mental health units.
National cross-sectional study.
Data were collected from 255 patients admitted to 12 acute mental health units across Spain. Standardised instruments assessed perceived quality of care and levels of coercion, humiliation and fear at discharge. Multiple linear regression analyses were used to explore associations between care quality dimensions and patients' experiences.
Perceived quality of care was significantly associated with lower levels of perceived coercion and humiliation. All dimensions of care quality showed inverse associations, with the “secluded” dimension showing the strongest association. The association between care quality and perceived fear was less consistent. These findings are particularly relevant for mental health nurses, who play a central role in delivering relational care and ensuring patients' emotional safety.
Higher perceived quality of care is associated with lower levels of coercion, humiliation, and fear during hospitalisation in acute mental health settings.
For mental health nursing, these results underscore the critical role of nurses in creating therapeutic environments that reduce coercive experiences. By fostering trust, promoting patient autonomy, and ensuring emotional and physical safety, nurses can significantly influence the quality of care and patient outcomes.
The study addresses the lack of evidence on how perceived quality of care influences experiences of coercion in acute mental health settings. Better perceived care quality is linked to reduced feelings of coercion, humiliation and fear. The research has direct implications for mental health nurses, clinical educators and healthcare managers aiming to improve patient experiences and reduce coercive practices in psychiatric care.
STROBE reporting guideline.
No patient or public contribution.
To critically assess the impact of theory-guided positive psychological interventions on the quality of life of breast cancer patients and survivors.
Systematic review and meta-analysis.
A comprehensive literature search was conducted across seven electronic databases from inception to August 2024. Randomised controlled trials that examined the effects of theory-guided positive psychological interventions on adult breast cancer patients or survivors and reported quality of life outcomes were included. Screening, data extraction and critical appraisal were independently performed by the reviewers using the revised Cochrane risk-of-bias tool (RoB2). A meta-analysis was conducted using RevMan Web. The study was reported following the PRISMA 2020 Statement.
Five randomised controlled trials were included. Only two of these studies showed a low risk of bias across all quality measures. The meta-analysis demonstrated a significant improvement in quality of life following theory-guided positive psychological interventions, with low heterogeneity. Subgroup analyses revealed that interventions lasting either less than or longer than 3 weeks, and both group-based and individual-based formats, had positive effects on quality of life. Additional psychological benefits were observed including reductions in depressive symptoms, anxiety, perceived stress and improvements in post-traumatic growth, resilience, hope and perceived benefits. One study also reported improvements in sleep quality.
The findings demonstrate that theory-guided positive psychological interventions can potentially significantly improve quality of life in breast cancer patients. However, the limited number of studies underscores the need for further high-quality research to validate these findings and identify the most effective intervention characteristics.
Our systematic review highlights that theory-guided positive psychological interventions show promise as an effective strategy for improving the quality of life in breast cancer patients. These interventions can enhance psychosocial support strategies, paving the way for better-informed approaches that lead to improved patient outcomes.
No patient or public contribution.
The systematic review and meta-analysis had been registered with the International Prospective Register of Systematic Reviews (PROSPERO) under the registration ID number: CRD42024581382
To determine the treatment effectiveness associated with mobile health-delivered cognitive behavioural therapy for insomnia (mCBT-I) interventions for adults with insomnia and to identify the potential characteristics associated with better treatment outcomes.
A systematic review and meta-analysis was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) guidelines.
Seven English- and two Chinese-language databases were searched, without restrictions on publication dates, up to July 2024. Reference lists of relevant reviews and grey literature were included in the search. Randomised controlled trials evaluating mCBT-I in adults with insomnia and published in either English or Chinese were included in this meta-analysis. A random-effects model was used for data analysis, accompanied by additional subgroup analyses and meta-regression.
Sixteen studies involving 2146 participants were included in this meta-analysis. mCBT-I interventions were associated with significantly reduced insomnia symptoms and improved sleep quality at post intervention, at 1–3-month follow-up, and at 4–6-month follow-up. Interventions that included five components of CBT-I, were delivered for 6 weeks or longer, and were conducted in a group format were linked to better treatment outcomes; the differences in other subgroup categories were not statistically significant. Studies involving participants with comorbid conditions showed a greater effect in reducing insomnia symptoms than those without such participants. In addition, mCBT-I interventions delivered by healthcare professionals resulted in statistically larger effect sizes for improving sleep quality than self-help regimens.
The systematic review and meta-analysis identified the effectiveness of mCBT-I in reducing insomnia symptoms and improving sleep quality and offered practical implications for the development of effective mCBT-I interventions in clinical practice. However, future robust studies are needed to explore the long-term effects of mCBT-I interventions.
No patient or public contribution.
PROSPERO CRD: 42023454647
To examine the feasibility of using a large language model (LLM) as a screening tool during structured literature reviews to facilitate evidence-based practice.
A proof-of-concept study.
This paper outlines an innovative method of abstract screening using ChatGPT and computer coding for large scale, effective and efficient abstract screening. The authors, new to ChatGPT and computer coding, used online education and ChatGPT to upskill. The method was empirically tested using 400 abstracts relating to public involvement in nursing education from four different databases (CINAHL, Scopus, ERIC and MEDLINE), using four versions of ChatGPT. Results were compared with a human nursing researcher and reported using the CONSORT 2010 extension for pilot and feasibility trials checklist.
ChatGPT-3.5 Turbo was most effective for rapid screening and had a broad inclusionary approach with a false-negative rate lower than the human researcher. More recent versions of ChatGPT-4, 4 Turbo, and 4 omni were less effective and had a higher number of false negatives compared to ChatGPT-3.5 Turbo and the human researcher. These more recent versions of ChatGPT did not appear to appreciate the nuance and complexities of concepts that underpin nursing practice.
LLMs can be useful in reducing the time nurses spend screening research abstracts without compromising on literature review quality, indicating the potential for expedited synthesis of research evidence to bridge the research–practice gap. However, the benefits of using LLMs can only be realised if nurses actively engage with LLMs, explore LLMs' capabilities to address complex nursing issues, and report on their findings.
Nurses need to engage with LLMs to explore their capabilities and suitability for nursing purposes.
No patient or public contribution.
To assess the validity of a modified Neonatal Skin Risk Assessment scale (Dev-NSARS) for neonatal pressure injuries (PIs) in the neonatal intensive care unit (NICU) and neonatal sub-intensive care unit (NICU-Sub) environment.
Medical devices are the leading cause of pressure injuries (PIs) in neonates, a key cause of morbidity in neonatology, significantly impacting the length of stay (LOS) and public hospital resources.
The Dev-NSRAS scale, considering the presence of medical devices, was tested on a national multicenter prospective study on newborns. The discrimination power of the Dev-NSRAS scale was compared to that of the more commonly used Glamorgan scale.
Nine newborns (6.6%) developed PIs, with a total of 16 injuries, 75% (12 out of 16) of which were device related. Newborns with postconceptional age ≤ 30.8 weeks were at higher risk of developing PIs. First 24-h total Dev-NSRAS scores were compared with first 24-h Glamorgan scores, to obtain and compare respective sensitivity and specificity. During the first 24 h from admission, a very good discriminative performance was evidenced for Dev-NSRAS ≤ 11 (AUC 0.921, 95% CI: 0.899–0.940, p < 0.0001; 81.6% sensitivity and 93.6% specificity) as compared to a moderate discriminative performance shown by a Glamorgan score > 28 (AUC 0.752, 95% CI: 0.634–0.660, p < 0.0001; 92.1% sensitivity and 65.5% specificity).
Early application (i.e., in the first day from hospital admission) of Dev-NSRAS by the nursing personnel shows excellent accuracy in predicting the risk of developing PUs in newborns admitted to NICU and NICU-Sub, as compared to the Glamorgan scale.
The STROBE statement for cohort observational studies was used as the reference reporting method.
The study addressed the lack of a risk assessment scale for pressure injuries in neonates. Development and testing of a scale that demonstrated high sensitivity and specificity in the early prediction of pressure injury risk in neonates within the first 24 h. The research will have an impact in NICUs and NICU-Sub units, enabling nurses to plan personalised care to prevent pressure injuries in neonates, thereby reducing the length of hospital stays and overall healthcare costs.
Introduce a validated scale for improving neonatal pressure injury prevention worldwide. Enhance early detection tools, reduce hospital stays and global costs.
The study protocol has been approved by the Paediatric Tuscany Region Ethical Committee (date: 18 January 2021; protocol code 18/2021).
Evaluate the relationship between hospital nursing resources and outcomes among patients with chronic wounds.
Cross-sectional observational.
Hospital-level predictors included the nurse work environment, proportion of Bachelor of Science (BSN)-prepared nurses, and skill mix (i.e., registered nurses [RN] as proportion of nursing personnel). Outcomes included in-hospital and 30-day mortality, discharging to a higher level of care and length of stay. Individual-level nurse data were aggregated to create hospital-level measures of nursing resources. We utilised multi-level modelling with nurses nested within hospitals and outcomes at the patient level.
Three datasets from 2021: RN4CAST-New York/Illinois survey, Medicare Provider Analysis and Review claims and American Hospital Association Annual Survey.
The sample included 34,113 patients with chronic wounds in 215 hospitals in New York and Illinois. In adjusted models, a 1 standard deviation improvement in the work environment was associated with 12% lower odds of in-hospital mortality, 8% lower odds of discharging to a higher level of care and a shorter length of stay by a factor of 0.96. A 10% increase in BSN composition was associated with 8% reduced odds of in-hospital mortality and 6% reduced odds of 30-day mortality. A 10% increase in skill mix was associated with 12% lower odds of in-hospital mortality and a shorter length of stay by a factor of 0.91.
Improved nursing resources are associated with better outcomes among patients with chronic wounds.
Nurses manage the care of patients with chronic wounds; thus, hospital investment in nursing resources is imperative for good outcomes.
Modifiable hospital nursing resources are associated with outcomes among patients with chronic wounds, a complex population.
STROBE.
To identify whether cognitive appraisal and coping style have moderating and mediating effects on the relationship between family resilience and quality of life (QoL) in patients with acute leukaemia (AL).
AL is a clonal and aggressive haematological malignancy that requires long-term and continuous therapy, which may negatively influence QoL. Family resilience can be used as a psychosocial resource that may enhance patients' coping processes and QoL.
This cross-sectional descriptive study was conducted among hospitalised patients with AL from June 2022 to June 2023.
A cross-sectional study was performed following the STROBE Statement. Convenience sampling was used in the present study, and 286 patients were recruited from five tertiary Grade A hospitals in Xi'an, China. The questionnaires included the Functional Assessment of Cancer Therapy-Leukemia (FACT-Leu), the Cognitive Appraisal of Health Scale (CAHS), the Trait Coping Style Questionnaire (TCSQ) and the Family Hardiness Index (FHI). We used SPSS 26.0 and Hayes' PROCESS macro for data analyses and path coefficients.
The QoL of patients with AL was significantly positively correlated with family resilience and positive coping, and negatively correlated with cognitive appraisal. Cognitive appraisal partially mediated the relationship between family resilience and QoL. Positive coping moderated the relationships between family resilience and cognitive appraisal, and between cognitive appraisal and QoL.
The results revealed that the association between family resilience and QoL was partially mediated by cognitive appraisal and that positive coping moderated this relationship. These findings are meaningful for early interventions that reduce the risk of psychosocial distress and improve QoL in this population.
Nurses should focus on the cognitive appraisal and coping style of AL patients and provide family support and respect to improve their QoL.
This cross-sectional descriptive study was conducted on patients with AL undergoing clinical chemotherapy in Chinese medical facilities.
To evaluate the impact of a multilevel intervention in a surgical department on the segregation of non-hazardous healthcare waste (plastic and paper) during the perioperative period as well as its effect on the carbon footprint of the healthcare organisation.
A prospective before–after interventional study without a control group was carried out in the operating room of the Universitary Hospital Mútua Terrassa in Catalonia (Spain). A multilevel programme to improve the segregation process during the surgical interventions was implemented in several phases from May 2023 to December 2024. Data collection was conducted in each phase of the study through questionnaires addressed to the professionals along with calculations of the carbon footprint and the volume of waste segregation. The study is framed within the socio-ecological model and employs a collaborative design. The study population included all professionals working in the operating room (n = 320).
A multidisciplinary team was formed with consideration for all stakeholders. The project phases were implemented consecutively. A total of 141 professionals (44.4%) completed the baseline questionnaire. As a result of the project's development, the carbon footprint has been reduced to 79.1 kg CO2 eq/week, representing an 85% reduction in emissions.
The implementation of the recycling project has led to significant reductions in the amount of waste generated and it has been positively evaluated by the professionals.
The benefits of fostering a behavioural change among the professionals, coupled with the implementation of a well-designed segregation and recycling system, lead to significant benefits for the institution in carbon footprint.
Nurses can lead this type of project with a clear impact on both the institution and the environment.
Reduction of the carbon footprint in the operating room increased satisfaction among professionals for contributing to environmental improvement.
The reporting of intervention evaluation studies using nonrandomized designs: the TREND statement Des Jarlais et al. (2004) was used to evaluate the quality of the study.
N/A. Only professionals are involved in this study.
The aim of this study was to (i) identify barriers and enablers and (ii) inform mitigating or strengthening strategies for implementing nurse-initiated care protocols at scale in emergency departments (EDs).
Embedded mixed methods.
The study included four clusters with a total 29 EDs in NSW, Australia. Concurrent quantitative and qualitative data were collected via electronic nursing and medical staff surveys and analysed. Barriers and enablers to implementation were identified and mapped to the domains of the Theoretical Domains Framework (TDF). Selection of intervention functions and behaviour change techniques (BCTs) enabled development of implementation strategies.
In total, 847 responses from nursing and medical staff (43%) reported four enablers for use and implementation: (i) knowing or being able to learn to use simple nurse-initiated care; (ii) protocols help staff remember care; (iii) carefully considered education programme with protected time to attend training; and (iv) benefits of nurse-initiated care. Nine barriers were identified: (i) lack of knowledge; (ii) lack of skills to initiate complex care (paediatric patients, high-risk medications and imaging); (iii) risk for inappropriate care from influence of cognitive bias on decision-making; (iv) punitive re-enforcement; (v) protocols that are too limited, complex or lack clarity; (vi) perceived lack of support from medical or management; (vii) perception that tasks are outside nursing role; (viii) concern nurse-initiated care may increase the already high workload of medical and nursing staff; and (ix) context. The barriers and enablers were mapped to nine TDF domains, five intervention functions and 18 BCTs informing implementation using strategies, including an education programme, pre-existing videos, audit and feedback, clinical champions and an implementation plan.
A rigorous, systematic process generated a multifaceted implementation strategy for optimising nurse-initiated care in rural, regional and metropolitan EDs.
Staff wanted safe interventions that did not lead to increased workload. Staff also wanted support from management and medical teams. Common barriers included a lack of knowledge and skill in advanced practice. Clinicians and policymakers can consider these barriers and enablers globally when implementing in the ED and other high-acuity areas. Successful strategies targeting barriers to advanced practice by emergency nurses can be addressed at the local, state and national levels.
Implementation of new clinical practices in the ED is complex and presents challenges. Key barriers and enablers, including those related to initiating care and workloads in the ED were identified in this study. This research broadly impacts ED staff and policymakers globally.
Mixed Methods Reporting in Rehabilitation & Health Sciences (MMR-RHS).
Site senior nurse researchers for each cluster worked closely with site stakeholders, including local consumer groups. Consumer councils were engaged at all the sites. Site visits by the research nurses have been an important strategy for discussing the study with key stakeholders.
Australian and New Zealand Clinical Trial: ACTRN12622001480774p
FreshRSS 