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☐ ☆ ✇ Journal of Advanced Nursing

Latent Profiles of Nurses' Insomnia, Fatigue, Recovery, Psychological Distress and Burnout During the COVID‐19 Pandemic: Examining the Role of Organisational Support

Por: Hyeonmi Cho · Knar Sagherian · Linsey M. Steege — Febrero 16th 2026 at 06:39

ABSTRACT

Aims

To identify latent profiles of insomnia, fatigue, recovery, psychological distress and burnout among hospital nurses; examine variations in personal and work-related characteristics across profiles; investigate associations between profiles and outcomes such as patient care quality, nursing work satisfaction and workplace satisfaction; and assess the moderating role of organisational support on these relationships.

Design

A cross-sectional descriptive study.

Methods

This study analysed survey data from 2488 hospital nurses using latent profile analysis, multinomial logistic regression and hierarchical multiple linear regression.

Results

Four well-being profiles emerged: low, average, above-average and high well-being. Profiles differed significantly in personal and work-related characteristics. Nurses in the high well-being profile were associated with better patient safety, care quality and satisfaction. Organisational support moderated the negative associations between low well-being profiles and nursing work and workplace satisfaction.

Conclusion

Tailored interventions addressing factors associated with low well-being and enhancing organisational support may be beneficial for improving nurse well-being, delivering high-quality care and supporting nurse retention in sustainable healthcare environments.

Implications

Healthcare organisations should prioritise nurse well-being through targeted interventions, adequate staffing, recovery opportunities and stress management resources to support a resilient and sustainable workforce.

Impact

The findings revealed the diversity of well-being patterns among hospital nurses and provided insights for identifying subgroups at higher risk of impaired patient safety, reduced care quality and dissatisfaction with nursing work and the workplace. Greater organisational support was associated with weaker negative relationships between poor well-being and nurse outcomes.

Reporting Method

STROBE guidelines.

Patient or Public Contribution

No direct patient or public contribution.

☐ ☆ ✇ Journal of Advanced Nursing

What We Know—and Need to Know—About Nursing PhD Programs and Influences on the PhD–Faculty Pipeline: A Scoping Review

Por: Olivia M. Halabicky · Joshua Porat‐Dahlerbruch — Enero 31st 2026 at 06:40

ABSTRACT

Aims

To identify: (1) current evidence and gaps of PhD program components influencing PhD students' career outcomes; and (2) methods and tools used to assess the relationships between PhD program components and career outcomes.

Design

PRISMA scoping review.

Methods

Search terms included PhD nursing students, PhD education, PhD-prepared nurse, PhD in nursing, nursing faculty, and assistant professor. Studies empirically assessing PhD program components and career outcomes (e.g., desires, attitudes, actual employment) were included. Two researchers conducted screening, data extraction, and inductive content analysis.

Data Sources

PubMed, Scopus, and CINAHL in October 2025, without year and geographic location restrictions.

Results

The search yielded 379 studies. After title, abstract, and full-text screening, 13 studies were included. Analysis resulted in 10 factors spanning four categories: program preparation, readiness and satisfaction, impressions of the faculty role, and program support.

Conclusion

Experiences in the PhD program likely influence students' desire to pursue academia. While this review synthesized influential factors, given significant gaps in the literature, there are likely more factors influencing student career desires. A more robust understanding of the factors during the PhD program which influence career outcomes is needed.

Patient or Public Contribution

This study did not include patient/public involvement in design, conduct, or reporting.

☐ ☆ ✇ Journal of Advanced Nursing

Student Perceptions of Interprofessional Education Innovation to Address Pain Management and Substance Use: A Qualitative Descriptive Analysis

ABSTRACT

Aims

The aim of this study was to understand student perspectives regarding an interprofessional education (IPE) innovation using a single standardised patient (SP) in a large-group setting for a pain management and substance use simulation.

Design

A qualitative descriptive design was used.

Method

Students representing eight health science programs from four universities were invited to participate in a simulation-based IPE program blending asynchronous and synchronous learning. DNP students were one of the largest professions represented (n = 92, 30%) along with students enrolled in Doctor of Pharmacy (n = 111) and Doctor of Medicine (n = 69) programs. Students were invited to complete a post-activity survey asking what parts of the IPE activity were most valued and what could be improved. Student responses were themed using a qualitative descriptive approach with inductive coding and constant comparison.

Results

Of 304 participating students, 155 (51%) responded to one or both open-ended questions. Respondents highly valued interprofessional team diversity. Responses highlighted the importance of: (1) using simulation with student teams to foster active learning, (2) student preparation using relevant curricular resources and (3) grounding interprofessional collaboration activities in student engagement and professional respect.

Conclusion

Findings confirmed that a cost-effective IPE activity using one SP within deliberately planned interprofessional activities can be engaging and meaningful. Students valued team-based collaboration across the disciplines of nursing, pharmacy and medicine.

Impact

Educators gathered evidence on the merits of a replicable, cost-effective IPE structure intended to expand team-based simulation learning opportunities. High-priority public health topics such as pain and substance use require multidisciplinary, integrative care to maximise health outcomes. To better prepare nurses and their health science collaborators, novel pedagogy in IPE may optimise student learning experiences.

Reporting Method

We followed the Standards for Reporting Qualitative Research (SRQR).

Patient or Public Contribution

Health sciences faculty served as facilitators in the IPE sessions. Facilitators were provided 1 h of training and observed student team breakout rooms to ensure that students were engaged and understood the assigned task. They provided feedback to session leaders after the sessions.

☐ ☆ ✇ Journal of Advanced Nursing

Core Components of Effective Home Visiting Programmes and Parenting Interventions Delivered by Nurses and Midwives—A Scoping Review

Por: Outi Savolainen · Hanna Rouvinen · Margaret M. Barry — Enero 22nd 2026 at 07:25

ABSTRACT

Aim

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.

Design

Scoping Review.

Data Sources

Nine academic databases and grey literature were searched between June and August 2024 for studies published between 2020 and 2024.

Methods

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.

Results

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.

Conclusion

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.

Implications for the Profession and/or Patient Care

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.

Impact

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.

Reporting Method

The EQUATOR guidelines for PRISMA were met.

Patient or Public Contribution

No patient or public contributions.

☐ ☆ ✇ Journal of Advanced Nursing

A Realist Evaluation of a Rapid Response System for Mental State Deterioration in Acute Hospital Settings

ABSTRACT

Background

Patient mental state deterioration presents significant challenges in acute hospital settings, affecting outcomes, increasing reliance on restrictive interventions, and placing additional strain on healthcare staff. Despite its prevalence, consensus on best practice remains limited. The De-escalation, Intervention, Early Response Team (DIvERT) is a pilot rapid response system introduced to improve early identification, enable timely interventions, reduce crisis incidents, and support ward staff in caring for patients with mental state deterioration.

Methods

A realist evaluation approach was used to test, validate, and refine program theories explaining DIvERT's mechanisms. Data collection included a cross-sectional survey, semi-structured interviews, field observations, a medical record audit, and incident report analysis. Analysis was guided by the Context-Mechanism-Outcome framework to explain DIvERT's effective functioning in responding to patient deterioration.

Findings

DIvERT facilitated early intervention through multidisciplinary collaboration, though organisational factors such as staffing constraints, workload pressures, and inconsistent assessment practices influenced effectiveness. Key mechanisms included structured escalation pathways, clinical skills, staff training, and interprofessional collaboration. Challenges included limited after-hours availability, reflecting the constraints of a pilot initiative, underreporting of incidents, and hierarchical decision-making. While causation cannot be directly established, trends indicate DIvERT was associated with fewer Code Grey responses, particularly during initial episodes of mental state deterioration.

Conclusion

This realist evaluation highlights the value of structured escalation pathways, multidisciplinary collaboration, organisational support, and tailored training in managing mental state deterioration. Preliminary trends suggest DIvERT may enable more proactive and timely early intervention, whereas traditional reactive hospital emergency response for aggression (Code Grey) was more often linked to repeat incidents. Workforce constraints and inconsistent assessment limited effective functioning, underscoring the need for strengthened training, integration into workflows, and improved after-hours coverage to support scalability and long-term success.

Implications for Profession and/or Patient Care

This study demonstrates that a proactive rapid response model (DIvERT) can strengthen the recognition and management of mental state deterioration in acute hospital settings. By formalising escalation pathways, improving interdisciplinary collaboration, and tailoring training to staff needs, the model supports safer and more timely responses to patient deterioration. Embedding such approaches into organisational workflows has implications for patient safety, staff confidence, and system efficiency.

Impact

The study addressed the challenge of inconsistent and reactive responses to patient mental state deterioration, which are often reliant on crisis interventions such as Code Grey. DIvERT facilitated early intervention through structured escalation processes, improved interdisciplinary collaboration, and enhanced staff skills. However, organisational barriers such as workforce constraints, after-hours gaps, and inconsistent use of mental state deterioration assessment tools limited its effective functioning. Findings are directly relevant to clinicians in acute hospital settings (particularly nursing and allied health staff), hospital administrators responsible for patient safety and workforce planning, and policymakers overseeing standards for recognising and responding to acute deterioration. The results highlight where investment in training, structured escalation systems, and organisational support can reduce reliance on restrictive interventions and improve both patient and staff safety.

Reporting Method

This evaluation adhered to the Realist And Meta-narrative Evidence Synthesis: Evolving Standards (RAMESES) II reporting standards for realist evaluations, as outlined in the EQUATOR Network guidelines.

Patient or Public Involvement

This study did not include patient or public involvement in its design, conduct, or reporting.

☐ ☆ ✇ Journal of Advanced Nursing

Infrared Devices Versus Traditional Palpation Approach for Peripheral Intravenous Catheter Insertion in Adults: A Systematic Review and Meta‐Analysis

ABSTRACT

Aims

This systematic review and meta-analysis evaluated the efficacy of infrared (IR) devices versus the traditional palpation technique for first-attempt success of peripheral intravenous catheter (PIVC) insertion in adults.

Design

Systematic review and meta-analysis of randomised controlled trials (RCTs).

Data Sources

A comprehensive search of PubMed, Embase, Cochrane Library, Scopus and CINAHL was conducted on 28 May 2024 and included articles in English or French published from 1st January 2000 onwards.

Review Methods

Eligible studies included RCTs comparing IR devices with the traditional palpation method for PIVC insertion in adults. The primary outcome was first-attempt success. Secondary outcomes included overall success, number of attempts, cannulation time and patient pain. The risk of bias was assessed using the RoB2 tool, and a random-effects model was applied for meta-analysis.

Results

Five RCTs were included, involving 690 patients and 704 catheters, including 289 PIVCs in patients with Difficult Intravascular Access (DIVA) criteria. First attempt insertion success was similar when using infrared devices (139/331, 42%) and traditional palpation (143/373, 38%) with Risk Ratio (RR) 1.08 (95% CI, 0.69 to 1.70). No significant statistical differences were noted in secondary outcomes: overall insertion success, number of attempts, time to cannulate and patient pain. Clinical and statistical heterogeneity were substantial (primary analysis I 2 = 83%).

Conclusion

Current evidence does not support the systematic use of infrared devices to improve PIVC insertion success, reduce the number of attempts or alleviate patient pain compared with traditional palpation in adults. Further high-quality studies with suitable sample sizes and varied populations are needed to better establish the potential place of infrared devices.

Impact

This study highlights the limited benefit of IR devices in routine clinical practice and underscores the need for further research into their use in specialised settings.

Patient or Public Contribution

No Patient or Public Involvement. This study did not include patient or public involvement in its design, conduct or reporting.

☐ ☆ ✇ Journal of Advanced Nursing

The Omission of Nursing Care in Emergency Departments: A Conceptual Analysis Using Walker & Avant's Methodology

Por: Josiane Provost · Émilie Gosselin · Christian M. Rochefort — Enero 16th 2026 at 16:16

ABSTRACT

Aim(s)

To analyse the dimensions of the omission of nursing care in emergency departments, including its attributes, antecedents, and consequences, using Walker & Avant's concept analysis method.

Design Concept Analysis

Methods: Walker and Avant's eight-step method defined attributes, antecedents, and consequences of the omission of nursing care in emergency departments.

Data Sources

A comprehensive literature review was conducted using CINAHL, MEDLINE, Embase, Health Management Database, and Cochrane Library, covering publications from 2001 to 2024. The search was conducted in August 2024.

Results

Key attributes were delayed, incomplete, or interrupted care, mostly due to insufficient staffing or unpredictable patient volumes. Antecedents included high workloads, inadequate skill mixes, and understaffing. Consequences were increased patient morbidity and mortality, nurse burnout, and job dissatisfaction. A research gap exists in paediatric-specific measurement tools.

Conclusion

Identifying dimensions of omitted nursing care in emergency departments informs interventions to improve patient safety and care quality. Developing paediatric-specific measurement tools is essential.

Implications for the Profession and/or Patient Care

The findings emphasise the need for improved staffing and resource allocation policies, reducing risks to patients and enhancing nurse satisfaction.

Impact

This study addressed the gap in understanding omitted nursing care specifically in emergency departments. Findings highlight systemic issues impacting patient outcomes and nurse well-being. The results will guide organisational improvements and future research globally.

Reporting Method

This study adhered to EQUATOR guidelines, following Walker and Avant's method for concept analysis.

Patient or Public Contribution

This study did not include patient or public involvement.

Impact Statement

This study underscores the critical impact of the omission of nursing care (ONC) in emergency departments (EDs) on patient safety, nurse well-being, and healthcare efficiency. ONC contributes to increased morbidity, mortality, and adverse events, highlighting the urgent need for improved staffing models and resource allocation. Training programmes should equip emergency nurses with prioritisation strategies to mitigate care omissions. Policymakers must recognise ONC as a key quality indicator, ensuring adequate workforce support. Additionally, this study identifies a gap in measuring ONC in paediatric EDs, calling for the development of tailored assessment tools and further research on intervention strategies.

☐ ☆ ✇ Journal of Advanced Nursing

Factor Structure and Longitudinal Invariance of the Cancer Behaviour Inventory: Assessing Cancer‐Coping Self‐Efficacy in Patients With Moderate‐to‐High Symptoms

ABSTRACT

Background

The Cancer Behaviour Inventory–Brief Version was designed to assess cancer-coping self-efficacy in clinical and research settings where minimising patient burden is essential. However, there is no evidence of its longitudinal validity. Although widely used in cancer research, the lack of evidence for longitudinal invariance significantly undermines its validity in studies spanning multiple time points. Establishing longitudinal invariance enables valid comparisons over time, enhancing our confidence in applying it in longitudinal research.

Aim

To examine the factor structure of the measurement and test its longitudinal invariance across four time points in cancer patients experiencing moderate-to-high symptoms during curative cancer treatment.

Design

A longitudinal psychometric evaluation.

Methods

This is a secondary data analysis of a randomised controlled trial in patients with moderate-to-high symptoms undergoing cancer treatment (N = 534). We conducted longitudinal invariance tests for the measurement using four time points. Other psychometric tests included confirmatory factor analysis, reliability analyses and correlations.

Results

Our confirmatory factor analysis supported the four-factor, 12-item structure for the Cancer Behaviour Inventory–Brief Version. Items 1 and 6 were found to be moderately correlated. The resulting 12-item measure demonstrated good internal consistency, with convergent and divergent validity supported by correlations with selected instruments. Finally, longitudinal invariance was tested, which revealed strict measurement invariance across four time points (CFI = 0.930, RMSEA = 0.045, SRMA = 0.056).

Conclusion

We found that the factor structure of the Cancer Behaviour Inventory–Brief Version remained stable over four time points in a sample of patients having moderate to high symptoms under cancer treatment. This supports its accountability for examining the changes in cancer-coping self-efficacy among cancer patients over time in longitudinal studies.

Implications

This study confirms that Cancer Behaviour Inventory–Brief Version has adequate internal consistency and demonstrated evidence of construct validity. Our conclusion of strict longitudinal invariance supports its credibility for continuous assessment of cancer-coping self-efficacy to evaluate patient outcomes and intervention processes over time in clinical and research settings.

Patient or Public Contribution

No patient or public contribution.

☐ ☆ ✇ Journal of Advanced Nursing

A Concept Analysis of Expertise Associated With Practicing Clinical Nurses in Hospital Settings

ABSTRACT

Aim

Analyse the concept of expertise among practicing clinical nurses in hospital settings.

Background

The generational loss of expert clinical nurses was exacerbated globally by the novel coronavirus. This ongoing loss combined with the increased complexity of hospitalised patients has prompted an urgent need to understand expertise among clinical nurses who practice in hospital settings.

Methods

Walker and Avant's concept analysis method was used. PubMed, Medline, CINAHL and Access Medicine were searched (1982–2025) for research studies and literature reviews published in English that addressed clinical nursing expertise in hospitals.

Results

Expertise is the knowledge and skills that are enculturated from immersion in a domain. Common attributes include obtaining salient information from different sources, interpreting patient situations rapidly and holistically, and performing actions that are individualised, immediate and appear instinctive. Common antecedents include deliberate accumulation of relevant experience and contextual connections within the hospital. Facilitating improved outcomes and facilitating improved outcomes are common consequences.

Conclusion

The attributes, antecedents and consequences of clinical nursing expertise are complementary and cross specialties. Experts' apparently instinctive actions are not intuitive but rather related to relevant past experiences, pattern recognition and skilled know-how. The requirements to develop expertise have evolved with the increased volume of available knowledge.

Implications for the Profession

Expertise requires cultivating relevant experiences through active engagement with patients and creating contextual connections with others regarding hospital systems and processes. Experts should be formally included when developing processes and guidelines. Low-fidelity proxy measures like years of experience should be replaced with psychometrically validated instruments to measure expertise.

Impact

This concept analysis addresses the ambiguity of clinical nursing expertise by synthesising over 40 years of literature and provides insights for clinical nurses and researchers regarding the importance of context and the growing complexity of care delivery.

Patient or Public Contribution

No patient or public involvement.

☐ ☆ ✇ Journal of Advanced Nursing

Patient Participation in Acute Surgical Wound Care: A Descriptive Qualitative Study

Por: Kita Liosatos · Georgia Tobiano · Brigid M. Gillespie — Diciembre 23rd 2025 at 00:53

ABSTRACT

Aim

To explore patients' experiences of participation in surgical wound care and provide an in-depth understanding of their experiences with post-operative wound care during and post-hospitalisation.

Design

A descriptive qualitative study.

Methods

Adult participants who had undergone surgery within 30 days were purposively selected from two surgical wards at Gold Coast University Hospital. Seventeen semi-structured phone interviews were conducted using a specifically developed and piloted interview guide. Textual data were analysed using inductive content analysis.

Results

Three main categories were identified. The first category, ‘I didn't expect how distressing post-operative wound care would be; it's tougher than I thought,’ highlights the significant and unexpected physical and emotional challenges participants faced, which initially hindered their engagement. The second category highlights the impact of healthcare professional interactions on patient participation, ‘I want to be involved, but conflicting advice and dismissive behaviour discourage me.’ The third category, ‘With my family's help, wound care got easier as I tried, learned, and recovered,’ illustrates how family support facilitated participants' independence and engagement over time.

Conclusions

The spectrum of patient participation in surgical wound care is dynamic and impacted by environmental, physical and psychological factors. This research deepens understanding of patient participation by highlighting the importance of family support and a temporal perspective in patients' wound care journeys.

Impact

Findings showed participants were unprepared for surgical wound care, greatly influenced by healthcare provider communication and family support, and evolved in participation as time passed and their wounds healed. Additionally, participants valued intent just as significantly as their behaviours and regarded even minor involvement as totally participative. These insights can inform strategies to improve patient participation in surgical settings.

Reporting Method

SRQR (Standards for Reporting Qualitative Research).

Patient and Public Contribution

No patient was involved in this study.

☐ ☆ ✇ Journal of Advanced Nursing

Challenges, Skills and Training Needs of Nurses in Managing Paediatric Obesity in Primary Care Settings

Por: C. Miguel‐Atanes · A. R. Sepúlveda · M. T. Alcolea — Diciembre 23rd 2025 at 00:53

ABSTRACT

Aim

To explore the perceptions of primary care nurses regarding their skills and the challenges they face in managing paediatric obesity.

Design

Qualitative descriptive study.

Methods

Data were collected between May 2022 and March 2024 from focus groups with primary care nurses (n = 25) and analysed using thematic analysis.

Results

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.

Conclusion

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.

Implications for the Profession

This study highlights the needs related to nurses' communication skills. It is recommended to implement training courses focused on this topic.

Reporting Method

Adherence to COREQ guidelines was maintained.

Patient or Public Contribution

There was no patient or public contribution.

☐ ☆ ✇ Journal of Advanced Nursing

From Starch to Scrubs: What Nurses' Uniforms Say About Nursing and Our Professional Identity

Por: Debra Jackson · Patricia M. Davidson — Diciembre 23rd 2025 at 00:53
Journal of Advanced Nursing, Volume 82, Issue 1, Page 9-11, January 2026.
☐ ☆ ✇ Journal of Advanced Nursing

Influence of Social Determinants of Health on Adherence to Lifestyle Modifications in Individuals With Prediabetes: A Mixed Methods Study

ABSTRACT

Aim

To explore the relationship between social determinants of health and adherence to lifestyle recommendations, and how these determinants can help explain contextual and interpersonal factors contributing to adherence among individuals with prediabetes.

Design

Explanatory sequential mixed methods study integrating a cross-sectional quantitative analysis with an ethnomethodological qualitative approach grounded in critical social paradigm.

Methods

The quantitative phase used data from the intervention arm (n = 86) of the PREDIPHONE trial, a randomised controlled study evaluating the effectiveness of a nurse-led telephone intervention for lifestyle changes in glycaemic control. Adherence was measured using a composite index, analysed as both a continuous and categorical variable. Correlation analysis examined adherence and age. Chi-square and ANOVA tests were used to analyse differences in participant characteristics across adherence quartiles. The qualitative phase included individual semi-structured interviews and a focus group with participants showing high or low adherence. Thematic content and discourse analysis were employed, ensuring validity through triangulation, reflexivity and discourse saturation.

Results

Employment status was identified as a significant factor, with unemployed or retired participants showing better adherence. Although no statistical differences in adherence were found by social class or gender, lower social class participants reported financial barriers to healthy eating and time constraints limiting physical activity (PA). Women reported facing greater challenges due to caregiving responsibilities, whereas men benefited from household support.

Conclusions

Employment status emerged as a determinant of time availability for self-care, alongside social class and gender in adherence to lifestyle modifications. Women, especially those from lower social classes, experienced heightened barriers to adherence, underscoring the need for tailored, gender-sensitive and equity-focused interventions.

Implications

Addressing social determinants is essential for effective lifestyle advice among individuals with prediabetes.

Impact

The study highlights the role of social class and gender in adherence.

Reporting Method

STROBE and COREQ guidelines.

Patient Contribution

Through interviews and focus group.

☐ ☆ ✇ Journal of Advanced Nursing

How Government Policies and Organisational and Sectoral Circumstances Influence Nurse Practitioner and Physician Assistant Employment and Training: A Realist Analysis Using Surveys

ABSTRACT

Aims

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.

Design

An online, cross-sectional survey study.

Methods

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.

Results

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.

Conclusion

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.

Impact and Implications

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.

Patient or Public Contribution

Healthcare professionals were part of the study population.

☐ ☆ ✇ Journal of Advanced Nursing

Identifying the Virtual Workload of Advanced Practice Nurses in the Delivery of Direct Patient Care: A Time and Motion Study

Por: A. Fitzgerald · A. Flynn · M. Ryder — Diciembre 8th 2025 at 03:04

ABSTRACT

Aim

To identify the proportion of Advanced Practice Nurses' workload that takes place virtually in the delivery of direct patient care.

Design

An observational study was conducted for this research.

Methods

An overt non-participatory time and motion study was undertaken using a predefined data collection tool to identify the activities of the study participants, and the mode used for delivery of the activities identified.

Results

Fourteen Advanced Practice Nurses were observed. A total of 5190 min of observation time was conducted. The time participants were observed delivering direct patient care virtually (care delivered without in-person contact) was recorded in minutes and calculated as a percentage of their overall observation time. The proportion of time recorded in the delivery of virtual direct patient care was calculated as 22% of participants' work time. The primary modes of telecommunication technologies used in this research were landline telephones and desktop computers. The most frequently performed direct patient care activity was gathering and interpreting assessment data to formulate a plan of care.

Conclusion

This is the first research to calculate the proportion of Advanced Practice Nurses' time that is spent delivering direct patient care virtually. The findings indicate that a substantial proportion of Advanced Practice Nurse time is spent delivering virtual care.

No Patient or Public Involvement

No patient or public contribution in this research.

Implications for the Profession

Implications for the profession and/or patient care.

Impact

What problem did the study address? There is an increase in the digitalisation of healthcare delivery, resulting in virtual care provided by nurses. It is therefore important to explore what and how much virtual care is delivered by Advanced Practice Nurses in Ireland. The study calculated the proportion of Advanced Practice Nurses' time spent in the delivery of virtual direct patient care. What were the main findings? A significant volume of work is conducted virtually. It should be conducted in a secure environment using secure devices. The nurses conducting virtual direct patient care ought to be adequately resourced with appropriate technology supported by electronic recording of care delivered to ensure accurate communication between healthcare professionals. Education for nurses conducting virtual work should be provided from the outset. Where and on whom will the research have an impact? The research will impact nurse leaders by providing them evidence of the delivery of virtual direct patient care by nurses. This leads to an opportunity to explore funding models where direct patient care is delivered yet unseen. There is a requirement to provide nurses with the necessary equipment to support the delivery of virtual patient care. Further research is recommended on the virtual role of nurses in healthcare delivery.

Reporting Method

The STROBE cross-sectional guidelines were followed to report the research.

☐ ☆ ✇ Journal of Advanced Nursing

The Associations Between Nurses' Perceived Adequacy of Staffing and Quality of Nursing Care and Job Enjoyment: A Multilevel Modelling Approach

ABSTRACT

Aim

To explore the associations of (1) shift-to-shift Nurse Perceived Adequacy of Staffing Scale (NPASS) scores and (2) the relative contribution of individual NPASS items to nurse-perceived quality of care (NPQoC) and job enjoyment.

Design

Multihospital prospective observational study.

Methods

The study was conducted across 15 medical, surgical or acute admission hospital wards in three teaching hospitals in the Netherlands. Vocationally and bachelor-trained nurses conducted 1550 measurements of perceived adequacy of staffing using the NPASS, NPQoC and job enjoyment in 797 shifts. Multilevel models were used to assess associations between NPASS scores and NPASS items and the outcome variables.

Results

Higher NPASS scores were significantly associated with improved NPQoC and job enjoyment. An increase in 1.0 point NPASS score leads to an increase of 0.97 points in NPQoC and 1.04 points in job enjoyment. Of the NPASS items, energy level, adherence to protocols and the opportunity for adequate breaks had the most positive effect on both outcomes.

Conclusion

Perceived adequacy of staffing as measured by the NPASS is highly relevant for improvements in both NPQoC and job enjoyment.

Implications for the Profession and/or Patient Care

Decision-makers on nurse staffing should incorporate the NPASS in staffing methods to ensure adequate staffing and the associated benefits. Policies that ensure adequate breaks, adherence to protocols and maintenance of nurses' energy levels during the shift should be implemented with special attention.

Impact

This study provides supportive evidence for incorporating nurses' perceived adequacy of staffing, as measured by the NPASS, to ensure adequate staffing. This is crucial for nurse retention, and therefore vital to maintaining accessible healthcare given the global nursing shortages.

Reporting Method

The STROBE checklist was used to conduct and describe the study.

Patient or Public Contribution

This study did not include patient or public involvement in its design, conduct or reporting.

☐ ☆ ✇ Journal of Advanced Nursing

Peripheral Intravenous Catheter Care at Australian Emergency Departments: A Cross‐Sectional Observational Study

Por: Hui (Grace) Xu · Anna Doubrovsky · Claire M. Rickard · Lauryn Rockliff · Christopher Tang · Amanda J. Ullman — Noviembre 18th 2025 at 05:14

ABSTRACT

Background

Peripheral intravenous catheters (PIVCs) serve as crucial devices for essential care administration in emergency departments (ED). In Australia, to standardise clinical practice, the national PIVC Clinical Care Standard was introduced in 2021, however adherence to the Standard has not been adequately explored. Therefore, this study aims to investigate ED clinicians' adherence to the Standard via prospective audit.

Method

This cross-sectional observational study of PIVCs was conducted in three Australian EDs between 2022 and 2023. Data were collected in alignment with the quality indicators in the PIVC Clinical Care Standard. Research nurses collected the data from bedside observation and chart audit, with data analysed descriptively.

Findings

Out of 1568 episodes of PIVC care recorded, there were notable shortcomings. ED nurses and doctors provided minimal patient partnership during insertion episodes: PIVC self-care education (n = 4, 1.4%), discussion of potential risks/benefits (n = 8, 2.9%), and reporting of concerns (n = 16, 5.8%). Insertions primarily occurred at the antecubital fossa (n = 225, 81.2%), with a common issue being inadequate time for antiseptic solution to air dry (n = 156, 56.3%). Ongoing needs assessment was unable to be assessed due to documentation limitations, which were generally incomplete. Idle catheters (inserted but not used) were prevalent (n = 115, 41.8%), and only a quarter of inpatient ward admissions (n = 75, 27.3%) had clear indications for PIVC use.

Conclusion

These findings highlight the suboptimal ED PIVC practices that require attention and improvement. Innovative interventions and technology are necessary to address some of these suboptimal practices due to their complexity and persistent challenges, despite previous efforts by clinicians and researchers.

Implications for the Profession and Patient Care

The findings underscore the need for well-resourced efforts to ensure adherence to evidence-based practices in dynamic clinical settings.

Reporting Method

The study is reported following the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement.

Patient or Public Contribution

None.

☐ ☆ ✇ Journal of Advanced Nursing

Siblings' and Parents' Experiences With the ‘Sibling Talks’ Intervention: A Qualitative Interview Study in a Primary School Nursing Context

Por: Lise‐Marie Bergvoll · Anne Clancy · Monica Martinussen · Karin T. M. Van Doesum · Hilde Laholt — Noviembre 18th 2025 at 05:14

ABSTRACT

Aims

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.

Design

A qualitative exploratory design.

Methods

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.

Results

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.

Conclusion

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.

Impact

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.

Reporting Method

The study followed the Consolidated Criteria for Reporting Qualitative Research (COREQ).

Patient or Public Contribution

There was no patient or public contribution.

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