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This systematic review explored the barriers and facilitators to the implementation of clinical practice guidelines (CPGs) among nurses in emergency departments (EDs) and critical care units (CCUs).
Systematic review.
A systematic review was performed using both qualitative and quantitative studies from five databases (CINAHL, Web of Science, Embase, Scopus and PubMed). The literature search was conducted in May 2024. The PRISMA framework was used to guide the review process. Findings were subject to a narrative, thematic analysis and critical appraisal.
Eighteen studies were identified that met the inclusion criteria, yielding three themes related to barriers and facilitators of guideline implementation: individual-level, guideline-level and organisational-level. Key barriers included lack of awareness of guidelines, lack of knowledge and skills, attitudes towards guidelines, resource limitations, lack of perceived support, complexity of guidelines and lack of training. Facilitators to guideline use included colleague support, adequate training, effective leadership and refinement of guidelines to ensure relevance, local adaptation and user-friendly content.
Numerous barriers to nurse implementation of CPGs exist in ED and CCU settings, reflecting a complex interplay of individual, CPG-related and organisational factors. To facilitate CPG implementation, it is important for staff to be educated and trained in their use, supported to implement (including resource allocation) and that CPGs are designed to be easily implemented in practice.
This systematic review highlights risk factors for poor CPG implementation and highlights the importance of addressing awareness, knowledge, resources and support for CPG use through targeted training, leadership and CPG design.
An analysis of barriers and facilitators to CPG implementation among nurses in ED and CCU settings provides an important opportunity to address a gap in the literature, facilitating the development of strategies to promote CPG use and enhance care quality among nurses in these specific contexts.
To investigate international evidence on home visits and parenting interventions delivered by nurses and midwives and to identify core components, such as intervention content, programme characteristics, contextual factors and implementation elements shared by effective interventions.
Scoping Review.
Nine academic databases and grey literature were searched between June and August 2024 for studies published between 2020 and 2024.
Screening and data extraction were independently conducted by two reviewers using covidence. The intervention characteristics were described using the TIDieR framework, and the content was analysed thematically.
Of the 3217 screened studies, 23 met the inclusion criteria. The studies employed various designs, including RCTs, quasi-experimental, cohort, cross-sectional, register-based and single-case experimental studies. Interventions were typically guided by theories of human ecology, attachment and self-efficacy. Most used structured materials and were delivered via face-to-face home visits by trained nurses, starting during pregnancy and continuing for up to 2 years. Visits ranged from weekly to monthly, mainly to family homes. Interventions were often tailored to family needs and cultural contexts. Five core themes emerged: (1) parenting education, (2) maternal and infant health, (3) mental health and psychosocial support, (4) community connections and (5) cultural sensitivity.
Effective interventions should be early, structured and tailored. Integrating parenting education, health, mental well-being and cultural sensitivity improves outcomes and scalable family care practices.
Findings highlight the need for structured training and support for nurses and midwives. Integrating these interventions into routine services, with attention paid to equity and proportionate universalism, can enhance family outcomes.
This review addressed the lack of clarity regarding what makes nurse- or midwife-led interventions effective. It identified key components that support child and family well-being and offers guidance for designing scalable, evidence-based interventions in maternal and child health services.
The EQUATOR guidelines for PRISMA were met.
No patient or public contributions.
by Sarah L. Brown, Barry J. McDonnell, David McRae, Paul Angel, Imtiaz Khan, Rhiannon Phillips, Britt Hallingberg, Delyth H. James
Using visualisation to conceptualise a chronic condition can encourage accurate illness beliefs and support treatment adherence. Hi-BP is a digital visual intervention to support adherence to antihypertensive medication, co-produced with patients. The aim of this study was to investigate the feasibility and acceptability of Hi-BP and explore the preliminary direction of effects on illness and treatment beliefs, medication adherence and blood pressure (BP). A two-phased mixed-methods non-randomised feasibility study was conducted from April 2021 to March 2022 in eight community pharmacies across one Health Board in South-East Wales, UK. Hi-BP was delivered as a single researcher-led consultation to 69 patients in Phase 1 and by pharmacists to three patients in Phase 2. Feasibility was determined using predefined criteria, with acceptability explored qualitatively using semi-structured interviews. Quantitative outcome measures (illness perceptions, medication beliefs, medication-adherence, prescription dispensing and collection data, BP) were recorded at baseline and immediately post-intervention.Follow-up outcome measures were collected at two-weeks (medication-adherence) and three-months (all baseline measures). Hi-BP met feasibility criteria for pharmacist recruitment in both phases, and patient recruitment in Phase 1, but not Phase 2. Hi-BP was acceptable to the sub-sample of 15 patient participants interviewed in Phase 1; insufficient data were available to determine patient acceptability at Phase 2. Hi-BP was acceptable to pharmacists in Phase 1 and partially acceptable at Phase 2, due to competing demands on time for intervention delivery. All outcome measures were considered feasible for use, though a ceiling effect was noted for medication adherence. A potentially positive directional effect was found for illness perceptions (X2(2)=10.83,n=54,p=0.004), medication beliefs (BMQ-Necessity (X2(2)=11.71,n=54,p=0.003) and BP (Systolic BP Z=-3.91,n=51,p=2(2)= 2.4,n=45,p=0.299). In the Community Pharmacy setting, Hi-BP was well-accepted and has the potential for significant reductions in BP; however, further research is needed to explore pharmacist capacity to support implementation.To explore the utility of a quantitative person-centred approach to identify subgroups of commencing first-year rural nurses and examine their work attitudes and intentions.
Exploratory cross-sectional survey.
A survey of commencing first-year nurses was conducted in two Australian rural health districts in 2019 and 2020, with a 91% response rate. A two-step latent class analysis of 159 responses was undertaken with two indicators of perceived professional opportunity and three indicators of local connection and rural training. Three outcomes assessing work intention and attitudes were compared across subtypes.
Four subgroups (‘classes’) were identified. There were significant differences in the outcomes between the two classes interpreted as ‘rural-locals’. Rural-locals with the highest perceptions of available professional opportunities had the most positive outcomes of all four classes. Of the two ‘non-local’ classes, the class with high perceptions of professional opportunities was significantly happier than the rural-local and non-local classes with lower perceptions; however, class differences in future rural work intentions and attitudes were mixed.
The research found subtypes of rural first-year nurses which differed in terms of occupational happiness and future rural work attitudes. Early career nurses who were rural-locals with highest perceptions of professional opportunities had the highest intention to remain working rurally. This exploratory research demonstrates the relevance of person-centred and theory-informed approaches to rural health workforce recruitment and retention strategies.
The findings show that ‘rural background’ or ‘local’ are useful but insufficient classifiers to distinguish among commencing rural nurse health workforce, given rural work attitudes and future work intentions. Further attention at organisational and policy levels should be given to rural professional development opportunities for early career nurses to support retention.
This research has demonstrated how a quantitative person-centred approach can illuminate heterogeneous subgroups within a rural health workforce to inform more targeted recruitment and retention strategies. Researchers should look to larger datasets and methodological resources from psychological theories of work to realise this potential for informing organisational and governmental policy approaches.
The authors have adhered to the EQUATOR STROBE statement guidelines for reporting observational (cross-sectional) studies.
No patient or public contribution.
When providing end-of-life care, nurses are faced with challenges related to the dying process. Aesthetic concepts exert a more profound influence than empirical evidence or logical reasoning. However, while the aesthetic aspect in end-of-life care demonstrates the inherent beauty of nursing, there are few manifestations of aesthetics to express the professional challenges in end-of-life care as experienced by nurses.
This study aimed to investigate and elucidate the lived experiences of the professional challenges encountered by nurses in end-of-life care.
A hermeneutic phenomenological qualitative study was employed.
This study was conducted from September to December 2023 in China. The purposive sampling method was used to recruit ten registered hospice nurses engaged in end-of-life care in a hospital. Data collection involved ‘Storytelling and Drawing Technique’ followed by focus group discussion. van Manen's hermeneutic phenomenological approach was used in the data analysis.
Essential themes were grouped based on existential themes of van Manen's four lived worlds, delineating: (1) Lived body: insufficient comprehension depth; (2) Lived space: unfavourable ambiance within the ward setting; (3) Lived time: negative impact of traditional culture; and (4) Lived human relations: intricacies inherent in decision-making dynamics.
After understanding the challenges of nurses in end-of-life care reflected by aesthetic expressions, proactive steps can be taken to address these issues and thereby facilitate a positive transformation.
The authors have adhered to Consolidated Criteria for Reporting Qualitative Research(COREQ) Standards.
No patient or public contribution
Motor neuron disease/amyotrophic lateral sclerosis (MND/ALS/ALS) is an incurable disease which leads to muscle weakness that worsens over time. MND/ALS is highly heterogeneous in its presentation, with many people experiencing a rapidly progressive trajectory of symptoms. Many people living with MND/ALS (plwMND/ALS) experience a combination of flaccidity and spasticity of the muscles involved in speech, swallowing, breathing and coughing. This makes it challenging to deal with the saliva and mucous (‘secretions") produced by the body. Failure to manage these problems effectively can lead to accumulation and aspiration of secretions, which may cause pneumonia and respiratory insufficiency. Knowing the best way to treat this problem is a challenge. Systematic reviews report substantive ongoing uncertainty regarding secretions management (SM). Little is known about the comparative effectiveness of secretion management interventions, their impact on quality of life and acceptability for plwMND/ALS and their unpaid/family.
A complex intervention systematic review of SM for plwMND/ALS and/or their carers will be conducted using an iterative logic model approach, designed in accordance with the principles and guidance laid out in a series of articles published by the Agency for Healthcare Research and Quality on complex intervention reviews . Eight electronic databases will be searched for publications between 1996 and present: Ovid Embase, EBSCO CINAHL, EBSCO Academic Search Ultimate, Scopus, EBSCO PsycInfo, Ovid MEDLINE and the Social Sciences Citation Index. This will be supplemented by hand searching of reference lists of included studies. Two reviewers will independently screen the results for potentially eligible studies using AS Review Lab (a semi-automated machine learning tool). Study selection, data extraction and risk of bias assessment, using Gough’s Weight of Evidence Framework, will be independently performed by two reviewers. A framework thematic synthesis approach will be employed to analyse and report quantitative and qualitative data. The reporting will be conducted in line with the Preferred Reporting Items for Systematic Review and Meta-Analysis Complex Intervention Extension Statement and Checklist.
This review will involve the secondary analysis of published information; therefore, ethical approvals are not required. Dissemination will be via presentation at scientific meetings, presentations to MND/ALS support groups and publications in peer-reviewed journals.
CRD42025102364.
Urban green and blue space (UGBS) interventions, such as the development of an urban greenway, have the potential to provide public health benefits and multiple co-benefits in the realms of the environment, economy and society. This paper presents the protocol for a 5-year follow-up evaluation of the public health benefits and co-benefits of an urban greenway in Belfast, UK.
The natural experiment evaluation uses a range of systems-oriented and mixed-method approaches. First, using group model building methods, we codeveloped a causal loop diagram with stakeholders to inform the evaluation framework. We will use other systems methods including viable systems modelling and soft systems methodology to understand the context of the system (ie, the intervention) and the stakeholders involved in the development, implementation and maintenance phases. The effectiveness evaluation includes a repeat cross-sectional household survey with a random sample of 1200 local residents (adults aged ≥16 years old) who live within 1 mile of the greenway. The survey is complemented with administrative data from the National Health Service. For the household survey, outcomes include physical activity, mental well-being, quality of life, social capital, perceptions of environment and biodiversity. From the administrative data, outcomes include prescription medications for a range of non-communicable diseases such as cardiovascular disease, type II diabetes mellitus, chronic respiratory and mental health conditions. We also investigate changes in infectious disease rates, including COVID-19, and maternal and child health outcomes such as birth weight and gestational diabetes. A range of economic evaluation methods, including a cost-effectiveness analysis and social return on investment (SROI), will be employed. Findings from the household survey and administrative data analysis will be further explored in focus groups with a subsample of those who complete the household survey and the local community to explore possible mechanistic pathways and other impacts beyond those measured. Process evaluation methods include intercept surveys and direct observation of the number and type of greenway visitors using the Systems for Observing Play and Recreation in Communities tool. Finally, we will use methods such as weight of evidence, simulation and group model building, each embedding participatory engagement with stakeholders to help us interpret, triangulate and synthesise the findings.
To our knowledge, this is one of the first natural experiments with a 5-year follow-up evaluation of an UGBS intervention. The findings will help inform future policy and practice on UGBS interventions intended to bring a range of public health benefits and co-benefits. Ethics approval was obtained from the Medicine, Health and Life Sciences Research Ethics Committee prior to the commencement of the study. All participants in the household survey and focus group workshops will provide written informed consent before taking part in the study. Findings will be reported to (1) participants and stakeholders; (2) funding bodies supporting the research; (3) local, regional and national governments to inform policy; (4) presented at local, national and international conferences and (5) disseminated by peer-review publications.
An effective prebriefing strategy is needed that can improve the learning outcomes of nurses in advanced life support education. This study aimed to identify the effects of prebriefing with online team-based learning on hospital nurses' knowledge, performance, and self-efficacy in advanced life support education. A nonequivalent control group pretest-posttest design was adopted. Nurses in the experimental group (n = 26) participated in prebriefing using online team-based learning followed by self-directed learning, whereas nurses in the control group (n = 27) experienced only self-directed learning before advanced life support education. Wilcoxon signed-ranks tests were used to identify the posttest-pretest differences of the study variables in each group. Both groups showed improved knowledge, individual performance, and self-efficacy after the education. Nurses in the experimental group reported higher self-efficacy scores compared with those in the control group. There were no differences between the experimental and control groups in knowledge, individual performances, or team performance. Online team-based learning as a prebriefing modality resulted in greater improvements in self-efficacy in advanced life support education. 
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