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To evaluate whether information about patients' poor sense of security in hypothetical vignette scenarios increases nurses' projected intent to report safety events.
Quantitative, cross-sectional factorial survey vignette experiment administered online.
A convenience sample of 60 nurses from adult inpatient hospital units at a Midwest academic medical center participated in February 2025. Participants responded to demographic questions and eight factorial vignettes, each describing a patient-reported safety breach and incorporating four patient-related factors. Four vignettes included information that the patient had a poor sense of security, and four did not, presented in random order. Following each vignette, participants rated their level of concern about the patient's report, perceived harm to the patient, and likelihood of reporting the patient's concern. A linear mixed-effects modelling approach, accounting for clustering within participants, was used to estimate the effects of the sense of security information factor on nurses' responses.
The sense of security information was associated with higher ratings of (a) degree of concern, (b) perceived harm to the patient, and (c) intent to report the patient's concern, after adjusting for vignette- and participant-level covariates. The vignette patient's perception of physical harm was positively associated with all three ratings. Nurses' greater hospital experience was associated with lower ratings across outcomes.
Obtaining information that the patient felt insecure was associated with heightened concern about the safety event, greater perceived harm, and increased intent to report the concern.
Sense of security assessment may be a risk-agnostic, patient-centered intervention that nurses can routinely perform, regardless of the safety event circumstances.
Although a system of evidence-based practices within a safety culture is essential to hospital safety efforts, nurses' judgements of and responses to patient safety concerns play a critical role and should not be overlooked.
STROBE guidelines.
This study did not include patient or public involvement in its design, conduct, or reporting.
To explore the lived experience of young people aged 16–24 years diagnosed with melanoma and that of their significant other in England.
Interpretive phenomenological analysis.
Data were collected between August 2023 and January 2024 from one specialist cancer centre in England. Thirteen young people were approached, and 10 took part. Each young person was asked to nominate a significant other. Five nominated a significant other, and five nominated no one. Although interviews were offered face-to-face, virtual was the preferred method. In-depth semi-structured interviews were audio-recorded with the participant's consent. Interview data were transcribed verbatim and analysed.
The core conceptual thread woven throughout the findings was ‘It's like being on a rollercoaster,’ which is representative of the ups and downs of the treatment trajectory, often without the support of age-appropriate specialist care. Four superordinate themes were identified: ‘Is something wrong?’, ‘Suddenly it's serious’, ‘Out on a limb’ and ‘Finding our place’.
Although most young people were treated in a primary treatment centre for adults with cancer, their experience was challenging from route to diagnosis through their treatment and beyond. Few received age-appropriate care to support their physical, emotional, and social wellbeing to help them navigate the experience.
There is limited evidence exploring the experiences of teenagers and young adults living with melanoma or that of their significant other. This enriched understanding supports improvement of the care pathway and service delivery for these young people and their families.
One young person with lived experience was paid as a consultant to be part of the research team. He helped develop the grant application and research questions, data analysis, and writing this paper.
To locate and synthesise clinical guidelines for nurses and other health professionals undertaking routine virtual health (telehealth) assessment, triage and follow-up care. To locate practice guidelines where clinician and client are not in the same physical location and health assessments are undertaken ‘virtually’.
This review used JBI methodology for scoping reviews and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Scoping Review extension (PRISMA-ScR).
Search considered primary research, practice guidelines, case reports, expert opinions, professional organisation web-based resources and grey literature. Medline (Ovid), Cumulative Index to Nursing & Allied Health (CINAHL) and Scopus databases were searched in relation to all health professions. Grey literature search included guideline databases, literature databases, customised Google search engines, targeted websites and consultation with content experts. Citation searching was included.
Search identified 2359 peer-reviewed articles and 31 sources of grey literature (1997–2024). After screening, 22 peer-reviewed and 9 grey literature sources met the eligibility criteria for inclusion. Studies were spread across diverse practice settings. Chronological sequencing provided visibility to innovations in telehealth practice over time from telephone-based practice to the introduction of video conferencing and the use of wearable devices for the transmission of remotely recorded clinical information.
Standardised guidelines to safe practice for virtual health assessment are not well documented. The paucity of clinically orientated guidelines may be due to complexity and the resourcing needed to maintain clinically current guidelines across the full breadth of clinical specialisations, practice settings and telehealth modalities. Further research and development are needed in this growing area of care.
The review highlights that clinically relevant guidelines are critical to safety and quality in virtual health contexts. Findings will inform future design and development of clinical practice guidelines for nurses engaged in virtual health assessment, triage and follow-up care.
Not applicable.
Stroke is a global health concern. A timely response to a stroke can help reduce morbidity and mortality. However, barriers to timely response include poor recognition of stroke symptoms. Stroke symptom messages are designed to increase stroke recognition and encourage individuals to seek urgent medical assistance. The Face, Arm, Speech, Time (FAST) and Balance, Eyes, Face, Arm, Speech, Time (BE FAST) are commonly used stroke symptom messages shown to improve stroke symptom recognition and response. However, cultural factors and language differences may limit the effectiveness of stroke symptom messages and their acceptability in different countries and contexts. There has not been a comprehensive examination of the stroke symptom messages used worldwide and how these messages have been adapted in various settings.
We explored what stroke response messages are being used globally, and the contextual factors that influence the adoption of a stroke response mnemonic in different settings.
A 14-item survey was disseminated by the World Stroke Organization to its networks. The survey contained open- and closed-ended questions and allowed uploading relevant stroke symptom campaign materials. The survey was analyzed using descriptive statistics and a content analysis.
All except one survey respondent used a stroke symptom message. Fifteen respondents (27%) reported they did not translate their stroke awareness messaging. Of these 15 respondents, they used the English versions of FAST (n = 8), BE FAST (n = 4), and both FAST and BE FAST (n = 3). Forty respondents (71%) reported that they/their organization used an acronym to raise public awareness of the signs/symptoms of stroke that was different from FAST or BE FAST (English), many of which were direct or indirect translations or influenced by FAST and BE FAST. Survey responses shared insights and recommendations related to the content, tailoring and dissemination of stroke symptom messages.
Study findings highlight the global use of stroke symptom messages and their contextual adaptations to fit diverse settings and contexts. The challenges in applying universal or commonly used stroke symptom messages to different contexts were highlighted.
Nurses could have a key role in raising awareness of stroke symptoms and the development of locally adapted stroke symptom messages.
Although the UK is a multicultural society, racially minoritised populations are often under-represented in healthcare research owing to the significant barriers to participation they experience.
Commentary on: Ghavi A, Hassankhani H, Meert KL. Parental supporter in pediatric resuscitation: A mixed-method study with Delphi and analytic hierarchy process. J Nurs Scholarsh. 2023 Nov 29. doi: 10.1111/jnu.12947. Epub ahead of print. PMID: 38031298.
Implications for practice and research Parental presence during resuscitation is widely recommended, despite a lack of empirical evidence to guide its implementation. This study explores the characteristics and role of the parental supporter and provides an evidence-based foundation to develop this role in clinical practice.
International guidelines on paediatric resuscitation support parental presence during resuscitation.
Commentary on: Taylor SP, Kowalkowski MA, Skewes S, Chou SH. Real-world implications of updated surviving sepsis campaign antibiotic timing recommendations. Crit Care Med. 2024 doi: 10.1097/CCM.0000000000006240.
Implications for practice and research Antibiotic delivery in suspected sepsis must be prioritised within the clinical context emphasising the need to individualise antibiotic timing according to patient profiles. In the absence of shock, a more lenient approach to antibiotic timing could support the rational use of antibiotics.
Sepsis is a life-threatening response to infection and remains a critical challenge with high morbidity and mortality rates. The Surviving Sepsis Campaign (SSC) guidelines serve as a cornerstone for sepsis management and are pivotal in standardising care. Taylor et al’s article
Commentary on: MacGregor KA, Ho FK, Celis-Morales CA, et al. Association between menstrual cycle phase and metabolites in healthy, regularly menstruating women in UK Biobank, and effect modification by inflammatory markers and risk factors for metabolic disease. BMC Med. 2023;21:488.
Implications for practice and research Fat mass, physical activity level and cardiorespiratory fitness were identified as factors that influence the relationship between the menstrual cycle and levels of glucose, triglycerides, the triglyceride-to-glucose index, high-density lipoproteins (HDL) and low-density lipoproteins (LDL) cholesterol and the total-to-HDL cholesterol ratio. Future studies should investigate whether these relationships indicate a causal mechanism responsible for the variations in metabolic control throughout the menstrual cycle.
The rate of impaired metabolic regulation is rising among premenopausal women, characterised by decreased insulin sensitivity, increased fasting blood sugar levels and abnormal lipid profiles.
Commentary on: Veresova M, Michail M, Richards H, et al. Emergency department staff experiences of working with people who self-harm: A qualitative examination of barriers to optimal care. Int J Mental Health Nurs. 2024. doi: 10.1111/inm.13353
Implications for practice and research Support from specialist mental health clinicians is a key mechanism for improving self-harm care among emergency department (ED) staff. Findings underpin the need for compassion and empathy when treating people presenting in distress, especially those who present multiple times. Future research should focus on strategies for improving implementation of self-harm clinical guidelines in EDs.
Emergency departments (EDs) have a crucial role in suicide prevention. Around 18% of people who died by suicide presented to ED in the month prior to death, commonly for self-harm.
Commentary on: Alanazi N, Gu F, Li CS, et al.Lorenz RA, Hong CC. Sleep Quality and Associated Factors Among Survivors of Breast Cancer: From Diagnosis to One Year Postdiagnosis. Oncol Nurs Forum. 2024 Feb 19;51(2):163-–174. doi: 10.1188/24.ONF.163-–174. PMID: 38442284.
Implications for practice and research Sleeping disorders are common in breast cancer patients and increase in the first year after diagnosis. Nurses should be aware of the high frequency of these disturbances, which persist after the conclusion of most therapies. The determinants of worsening sleeping quality in breast cancer survivors need to be understood, including the role of treatments, the type of surgery and psycho-social or contextual factors.
Breast cancer is the most common cancer in women worldwide. While research in recent decades has focused on minimising treatment, the disease still impacts women’s lives in many ways. Because increased sleep disturbances affect approximately...
Commentary on: Le Lagadec MD, et al 2024, ‘Nurse by numbers: The impact of early warning systems on nurses’ higher-order thinking, a quantitative study.’ Journal of Advanced Nursing.
Implications for practice and research It is essential to ensure that early warning systems (EWS) are used in a balanced manner, enhancing clinical judgement without undermining the use and development of nurses’ critical thinking abilities. Research into the long-term effects of EWS on cognitive skills and the varying impacts across different levels of nursing experience could yield valuable insights for optimising their use in healthcare.
In modern healthcare, the use of tools such as early warning systems (EWS), has become integral to patient safety, particularly for detecting early signs of patient deterioration.
Commentary on: Goto R, Pinchuk I, Kolodezhny O, et al (2024). Mental health of adolescents exposed to the war in Ukraine. JAMA Pediatrics, 178 (5), 480-488. doi: 10.1001/jamapediatrics.2024.0295.
Implications for practice and research Individuals screening positive require diagnostic evaluation to inform psychiatric treatment decisions and mental health interventions. Future research should expand these findings with objective measures of war/trauma exposure and full diagnostic assessment.
The study by Goto et al screened adolescents across Ukraine for mental health consequences of war.
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.
To systematically examine how structural vulnerability has been defined and operationalised in United States-based health research, identify conceptual consistencies and methodological gaps, and propose core dimensions of structural vulnerability along with implications for future application in health research.
A systematic mixed-studies review using a parallel-results convergent synthesis design.
PubMed, Embase, Scopus and CINAHL were searched from first publication through 2024 using the terms ‘structural* vulnerab*’ AND health.
Peer-reviewed English-language empirical studies conducted in the United States that applied the concept of structural vulnerability were identified. The Mixed Methods Appraisal Tool was used to assess study quality. Study content was analysed to identify how structural vulnerability was defined and operationalised.
Thirty-seven predominantly high-quality studies published between 2011 and 2024 met inclusion criteria. Structural vulnerability was consistently defined through two interrelated dimensions: as a social positionality (characterised by constrained resilience, limited agency and imposed risks rooted in systemic discrimination and social hierarchies) and as a critical analytic framework for examining structural determinants of health. Quantitative studies predominantly used individual-level indicators (e.g., income, housing) and cross-sectional designs. Qualitative studies focused on experiences of structural vulnerability in relation to health outcomes and infrequently translated findings into structural interventions. The most frequently studied outcomes were infectious disease, substance use and mental health.
Structural vulnerability, as a conceptual and empirical lens, reveals how systems produce—and can potentially reduce—health risks. Findings underscore the need for geographically diverse and longitudinal studies, as well as multidimensional measures. Advancing health equity demands critiquing systemic causes of inequities and pursuing justice-oriented interventions.
Nursing, positioned at the intersection of public health, social sciences and policy, is uniquely equipped to engage structural vulnerability as a critical analytic tool to address health inequities, design interventions and advocate for policy reform.
What problem did the study address? This study addressed a lack of clarity in the definition and operationalization of structural vulnerability in health research.
What were the main findings? The definition of structural vulnerability is consistent across quantitative and qualitative studies, but there are marked variations in its operationalization. Quantitative studies predominantly rely on individual-level indicators, while qualitative studies use it as a theoretical framework to guide analysis, interpret findings and examine structural determinants of health.
Where and on whom will the research have an impact? This review offers a clear framing for integrating structural vulnerability in health research in efforts to advance health equity.
PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) reporting guideline.
This study did not include patient or public involvement in its design, conduct or reporting.
Burnout, a form of moral suffering, has become more commonplace among health care workers in recent years. Measures of general resilience have been widely used to capture improvement in burnout but lack the ability to capture the anguish that comes with burnout from a moral standpoint. The purpose of this analysis was to understand whether moral resilience is uniquely related to burnout beyond a measure of general resilience in a sample of interprofessional health care workers.
Secondary analysis of cross-sectional survey data.
In total, 702 interprofessional health care workers participated in a cross-sectional survey. Key measures included the Rushton Moral Resilience Scale (RMRS), the Connor-Davidson Resilience Scale (CD-RISC-10), and the Maslach Burnout Inventory-Human Services Survey (MBI-HSS). Hierarchical multiple regression modeling was used to examine the effect of moral resilience (RMRS) in predicting the three dimensions of burnout (MBI-HSS) over and above general resilience (CD-RISC-10).
Moral resilience explained five, six, and 4% of variance for personal accomplishment, depersonalization, and emotional exhaustion, respectively, after accounting for general resilience (CD-RISC-10) and all covariates.
Findings highlight the clear conceptual differences between general and moral resilience and their unique relationship to burnout. Accounting for moral resilience will facilitate an improved multi-level response to moral suffering among health care workers.
Measuring and understanding the differences between general resilience and moral resilience is vital for us to better facilitate the necessary support(s) for health care workers experiencing moral suffering. This will contribute to more sustainable clinical environments, reduced burnout and suffering, and improved patient outcomes.
This qualitative study aimed to understand how dyads of parental donors and adolescent young adult recipients make sense of living donor liver transplantation from donation to adolescence.
This qualitative study used a focused ethnographic design.
Twelve dyads of parental liver donors and their adolescent young adults were interviewed together using a semi-structured interview guide. Data was collected from April 16 to July 30, 2019. All of the interviews were audiotaped and transcribed. The theoretical framework of sensemaking was implemented. Thematic analysis was used, concepts were categorised, connections were made and references to the coding were conducted.
Thematic analysis contributed to the emergence of three categories: connections, reflections and life transitions, and the overarching theme of gratitude for being given or giving the gift of life.
The dyads' gratitude increased over time through the social process of sensemaking.
As living donor liver transplantation in the paediatric population enters its third decade, understanding how it shapes relationships in dyads of parental donors and adolescent young recipients over time can provide new insights for nurses who work in paediatric transplantation.
This study's findings address the current gap in the literature on the long-term impact of living donor liver transplant dyads and highlight the role of nurses who provide care and guidance at the time of evaluation and surgery to the ongoing support during the years that follow.
This qualitative study followed EQUATOR guidelines and adhered to the COREQ checklist for qualitative studies.
No patient or public contribution.
To explore healthcare professionals' experiences of providing compassionate care and identify care situations considered challenging, with attention to the factors that contribute to these challenges.
A cross-sectional qualitative study was conducted involving 878 healthcare professionals in New Zealand who completed an anonymous online survey between February and May 2022. Of these, 115 participants provided detailed narrative responses describing patient care situations that challenged the provision of compassionate care. These qualitative responses were analysed using content analysis, guided by the Transactional Model of Physician Compassion and reported following the COREQ qualitative reporting guidelines.
Three major themes emerged: (1) fragmented services, resource constraints, and compartmentalisation of care; (2) clinician compassion needs and motivations; and (3) patient-related challenges impacting compassionate care. Over 90% of narratives described barriers to compassionate care that were linked to interconnected patient, clinician, clinical, and systemic factors—rather than being focused on individual patient influences alone.
Challenges to compassionate care are rarely attributable to individual patient characteristics alone. Instead, they reflect complex interactions among patient, provider, clinical, and systemic factors, underscoring the need for multilevel interventions to foster equitable, compassionate care.
This study highlights that barriers to compassionate care are embedded in complex systemic, clinician, and patient domains. Findings underscore the need for interprofessional collaboration, resilience-building strategies, and integrated approaches to enhance compassionate and equitable healthcare delivery.
None.
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