Conectar
To identify and synthesise qualitative evidence on nurses' perceptions of reasons for missed nursing care in hospitals.
Systematic review of qualitative evidence.
An extensive search of all relevant databases was conducted. Study selection, quality assessment, data extraction and meta-aggregation were performed independently by two reviewers according to the JBI guidelines for systematic reviews of qualitative evidence. Confidence in the findings was assessed using the ConQual approach.
The electronic databases CINAHL, PubMed, Embase, PsychInfo, and Scopus were searched in January 2024 and repeated in May 2025.
Thirty-one studies from hospital settings worldwide were included following critical appraisal, with overall quality rated moderate to high. The studies contributed 168 findings, which were organised into 10 categories and three synthesised findings: Organisational and system-level factors influencing missed nursing care, Teamwork and cultural factors influencing missed nursing care, and Individual nurse- and patient-related factors influencing missed nursing care.
Reasons for missed nursing care represent an interplay of systemic, organisational, and individual factors within complex resource-constrained contexts.
Healthcare organisations are recommended to implement system-level interventions, rather than relying solely on behaviour-focused solutions. Healthcare leaders should ensure flexible staffing, strong managerial support, and adequate resources to enable fundamental care. Building collaborative, interprofessional cultures that value relational and fundamental care as well as technical tasks is essential, together with education and mentorship that support nurses' decision-making, resilience, and clinical competence.
Hospital leaders, policymakers, and nurse managers can use the recommendations to reduce missed nursing care and promote a safe person-centred practice. Implementing systemic changes will improve nurses' working conditions and capacity to deliver comprehensive care, ultimately enhancing patient satisfaction and outcomes.
The ‘enhancing transparency in reporting the synthesis of qualitative research statement’.
No patient or public involvement.
The review is registered in the International Prospective Register of Systematic Reviews. PROSPERO CRD42023438198 (https://www.crd.york.ac.uk/PROSPERO/search)
To identify and synthesise existing evidence on family-centred care for Lesbian, Gay, Bisexual, Transgender, Queer and other diverse identities (LGBTQ+) people in acute hospital settings, including hospital-based palliative care, oncology, general in-patient and intensive care.
A scoping review guided by the JBI methodology.
Nine databases and grey literature sources were searched. Inclusion criteria focused on LGBTQ+ adults and family-related care experiences in hospital-based acute settings. After screening, qualitative, quantitative, and narrative data were extracted. Thematic analysis synthesised findings, with quantitative data narratively integrated.
Searches were conducted across nine databases and grey literature up to April 2025.
Five studies met inclusion criteria: three qualitative, one quantitative, and one reflective narrative. Four themes emerged: (1) invisibility and disclosure dilemmas, (2) exclusion of chosen families from visiting and decision-making, (3) barriers to inclusive communication and provider competence, and (4) enabling conditions for affirming care. Challenges occurred at interpersonal (e.g., provider assumptions, discomfort) and structural (e.g., lack of inclusive protocols, failure to recognise legal surrogates) levels. In the two studies reporting gender identity, transgender participants described heightened misrecognition and exclusion.
LGBTQ+ individuals and their chosen families face relational and structural barriers in acute hospital care. Inclusive interventions, protocols, and training are urgently needed to ensure affirming care.
Acute and intensive care providers should promote inclusive family engagement by using patient-preferred terminology, recognising chosen families, and advocating for inclusive policies and staff training.
This scoping review adhered to PRISMA-ScR guidelines.
No Patient or Public Contribution.
Registered with the Open Science Framework: 10.17605/OSF.IO/FSU8D (23/02/2025)
Examine the relationships between workplace trust, interpersonal trust, and nurses' physical and mental health, and specifically investigate the mediating role of resilience.
Nurses are central to healthcare delivery but frequently experience workplace violence, adversely affecting their well-being. Trust represents a higher-order mechanism that fosters positive attitudes and professional growth, potentially safeguarding nurses' resilience in coping with adversity. However, research elucidating how trust influences nurses' health via resilience remains limited.
A cross-sectional study was conducted using convenience sampling. A total of 2855 clinical nurses from general hospitals in Fujian Province, China, were surveyed between August and October 2022. Workplace trust and interpersonal trust were served as independent variables, Physical Component Summary and Mental Component Summary scores as dependent variables, and resilience as a mediator. Mediation analysis was performed using Mplus 8.3. The study was prepared and reported according to the STROBE checklist.
Mean scores were Physical Component Summary: 51.12 ± 8.90, and Mental Component Summary: 48.20 ± 10.18. Workplace trust had significant direct effects on both Physical Component Summary and Mental Component Summary. Interpersonal trust had no significant direct effects on Physical Component Summary or Mental Component Summary. Resilience demonstrated significant mediating effects: for workplace trust on Physical Component Summary and on Mental Component Summary; and for interpersonal trust on Physical Component Summary and on Mental Component Summary.
Workplace trust directly enhances nurses' physical and mental health. While interpersonal trust lacks a direct link to health outcomes, both workplace and interpersonal trust significantly improve nurses' health indirectly by bolstering resilience. Resilience serves as a critical pathway through which trust fosters well-being.
No patient or public contribution.
Nurse managers and healthcare administrators should prioritise interventions to cultivate workplace trust (e.g., fostering trust among colleagues, and between nurses and the organisation/management) and strengthen interpersonal trust and psychological resilience. Enhancing these protective factors will better equip nurses to manage occupational and personal stressors, ultimately safeguarding and improving their physical and mental health.
To examine factors, including symptom burden profiles and self-care, associated with quality of life among individuals with heart failure and multimorbidity.
A cross-sectional design.
353 adults aged 50 years or older with heart failure and at least one additional chronic condition were recruited from a university-affiliated hospital. Three symptom burden groups were identified (low, moderate, and high) through latent profile analysis of the Edmonton Symptom Assessment Scale scores. The Heart Failure Self-care Index and EuroQoL-5D-5L measured self-care behaviours and quality of life. This study examined group differences and associations overall and stratified by symptom burden groups via multivariable linear regression.
A higher disease burden and the high symptom burden group compared to the low symptom burden group were associated with lower quality of life. Self-care maintenance was positively associated with a higher quality of life, but not in the high-burden group. Among individual symptoms, pain and depression were associated with lower quality of life. In the high-burden group, older age was positively associated with quality of life. Higher symptom burden groups included a greater proportion of women and middle-aged adults.
Symptom burden and self-care maintenance show significant associations with quality of life in multimorbidity. Symptom burden profiles identified through latent profile analysis may complement conventional approaches by targeting high-risk individuals, such as middle-aged individuals and women with high symptom burden, for follow-up and integrated multimorbidity management.
For healthcare providers, including nurses, these findings underscore the importance of holistic, symptom-based care approaches combined with routine support for self-care maintenance. Adopting a life-course approach, through early identification and management of high-risk individuals, may help promote aging in place with a better quality of life for those with heart failure and multimorbidity.
STROBE checklist.
No patient or public contribution.
To explore the qualitative literature regarding the experiences of survivors of critical illness re-engaging in activities of daily living.
Qualitative systematic review.
Databases were searched with three broad categories of search terms: (1) critical illness, (2) activities of daily living, and (3) participant experiences. Articles were included if they reported qualitative data on the experiences of adults who were re-engaging with activities of daily living after admission to an intensive care unit. The findings from these studies were thematically analysed.
A search of Medline, Embase, CINAHL, PsycINFO and AMED was conducted on the 9th September 2024.
After removing duplicates, the literature search identified 6267 articles. The full texts of 120 articles were reviewed, and 44 were included for data extraction. Thematic analysis identified three themes: (1) loss of autonomy, (2) striving to reclaim independence, and (3) shifting familial dynamics and imposing a burden.
Survivors of critical illness face significant challenges when re-engaging with daily activities. The effort to regain autonomy often leads to feelings of helplessness and a reluctance to engage in both daily tasks and social activities. The emotional burden of dependence and the perception of being a burden further complicate their recovery.
Health services should focus on integrating physical rehabilitation, mealtime support, and cognitive and psychological therapy to effectively cater to the diverse needs of critical illness survivors and their families.
This review highlights the complex challenges of re-engaging in activities of daily living after critical illness and emphasises the need for multidisciplinary rehabilitation to improve physical, cognitive, and emotional recovery.
Reporting of this review followed the ENTREQ checklist, in accordance with EQUATOR guidelines.
No Patient or Public Contribution.
The debate about whether health visiting, a specialist community public health nursing role, is at the level of advanced practice nurse has gone on for more than a decade. There is little empirical evidence that the role matches the traditional role of an advanced practice nurse, although many of the attributes of advanced practice nursing such as prescribing rights, managing complex cases, caseloads with undifferentiated need and advanced assessment and decision-making are certainly present.
The current study aimed to develop, refine and test the Health Visiting Advanced Practice Scale to assess the scope of advanced practice of UK health visitors.
A cross-sectional and methodological scale validation design, following classical test theory.
The design consisted of three phases; the first involved scale development including item generation, phase two assessed the content validity index, and the third phase involved a cross-sectional survey to establish construct validity, content validity, and internal consistency reliability, and conduct exploratory and confirmatory factor analysis.
The initial 44-item scale underwent iterative exploratory and confirmatory factor analyses, leading to a refined 5-factor structure with 29 items covering domains such as family-centred care, leadership, prescribing, diagnostic reasoning, and professional practice. This final version demonstrated strong reliability and construct validity in the EFA but mixed fit indices in the CFA, supporting both internal consistency and validity of the scale.
The final scale offers a rigorously validated tool for assessing advanced practice among UK health visitors, capturing core domains such as family-centred care, leadership, prescribing, and diagnostic reasoning. By bridging theoretical frameworks with real-world practice, it fills a critical gap in evaluating and supporting the professional scope of this public health nursing specialty.
These findings provide valid and reliable insights for measuring and improving health visitors' advanced practice and developing future professional policies.
No patient or public contribution.
STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines for cross-sectional studies.
To propose a normative framework that guides nursing professional organisations to act as human rights intermediaries in the governance of artificial intelligence in healthcare.
Discursive paper.
The paper presents a triaxial framework that conceptualises the role of nursing professional organisations in artificial intelligence governance. The framework consists of a domain axis, which identifies key areas of engagement; a modality axis, which aligns actions with the specific functions of these organisations; and a human rights axis, which defines their role towards rights claimants and duty bearers.
The proposed framework provides a practical tool for nursing professional organisations to strategically plan and implement initiatives to influence the advancement and regulation of artificial intelligence. Its application can help ensure that healthcare innovation is equitable and rights-based.
This paper provides a blueprint for nursing leaders and policymakers to engage proactively with the ethical dimensions of artificial intelligence. It emphasises the salient roles of nursing professional organisations in advocating for the human right to health in a technologically driven healthcare landscape.
This paper addresses the gap in how the nursing profession can systematically engage with artificial intelligence governance. The main finding is a novel framework that provides a structured way for nursing professional organisations to act as human rights intermediaries. This research will have a significant impact on nursing leadership, patient advocacy groups, and policymakers involved in healthcare technology and ethics.
Initial parts of this paper were presented to allied health practitioners via a webinar, providing early feedback and dialogue that informed its development.
The rise in smartphone use presents opportunities and challenges in clinical settings. Despite guidelines restricting mobile phone use, nurses frequently rely on them for various purposes. While beneficial, smartphone use poses risks to information security, patient safety, and care quality, prompting the need for monitoring.
This study examined smartphone usage among nursing students and their perspectives on acceptable and unacceptable use during clinical placements.
This cross-sectional study used convenience sampling to recruit undergraduate nursing students from five universities in Australia and New Zealand. Participants completed the Attitude Towards Digital Device Use during Clinical Placement (Adduct) Scale online between September 2021 and August 2022. The survey included closed and open-ended questions. Descriptive and inferential analyses were conducted using SPSS. Exploratory factor analysis identified attitudinal dimensions, while group comparisons assessed demographic variations. Qualitative responses were thematically analysed. Reporting followed the Consensus-Based Checklist for Reporting of Survey Studies (CROSS).
Among 279 respondents, drawn from an eligible population of 2682 students, the response rate was 10.4%. Age significantly influenced perceptions of unacceptable smartphone use. Younger students (mean age = 25.0, SD = 9.8) were more likely to view such use as acceptable, with those up to 21 years reporting higher scores on the Unacceptable Use sub-scale compared to older peers (p = 0.024). Most respondents found smartphone use beneficial for accessing information and learning, though concerns included distractions and confidentiality breaches. Younger students were at greater risk of non-adherence to guidelines.
Smartphones can enhance learning and efficiency, but clear guidelines and education are needed to balance benefits with risks, particularly for younger students.
This study highlights the need for clear guidelines and structured training to balance educational benefits of smartphone use with the risks of distraction and breaches of patient confidentiality in clinical practice.
No patient or public pontribution.
This paper aims to synthesise the current, global evidence on addressing psychological concerns of women presenting with domestic and family violence within the ED and suggest avenues for future research.
This discursive paper draws on clinical experience and research of the authors and critical synthesis of current literature on management of victim-survivors of DFV presenting with psychological symptoms in ED.
Academic databases and grey literature were systematically searched to identify relevant sources, and findings were narratively synthesised.
DFV victim-survivors often present with mental health symptoms in ED; however, many health professionals in EDs fail to correctly identify the underlying trauma and offer support to address DFV. The most reported barriers to DFV screening/identification include time constraints, privacy issues, and lack of education/training about DFV and its support mechanisms. As a result, only mental health symptoms are being treated, ignoring the broader psychosocial needs of DFV victim-survivors. Use of trauma-informed support models is recommended to address the mental and psychosocial needs of DFV victim-survivors visiting the ED.
DFV victim-survivors visiting the ED are often treated for their mental health symptoms without addressing their underlying trauma and risk of future victimisation. To address the ongoing adverse impact of DFV, it is necessary to ensure holistic and continual support from ED professionals for victims.
The importance of not only education but the implementation of sustained education and training programs surrounding DFV identification, screening, and cannot be understood. DFV is a global problem whereby many victim-survivors become healthcare patients. It would be poor decision making for clinicians to not prioritise appropriate responses to this societal problem within their clinical practice.
To describe the clinical profile, comorbidity burden, follow-up and healthcare utilisation in patients labelled as having Chronic Obstructive Pulmonary Disease (COPD) in Primary Care (PC) nursing consultations.
Real-world data COPD, retrospective, observational study using routinely collected data in electronic health records (EHR). This study adheres to the STROBE reporting guidelines for cross-sectional studies.
Three Primary Care centres in Catalonia, Spain, belong to the Catalan Health Service.
All patients aged ≥ 15 years with a recorded diagnosis of COPD in their EHR, excluding institutionalised individuals and those deceased before study onset. Final sample: 474 patients (105 women, 369 men; mean age 70 years) from a reference population of 28,000 individuals.
Data included socio-demographics, smoking/alcohol, mMRC dyspnea, inhaled therapy/adherence, spirometry, comorbidities, Adjusted Morbidity Groups (GMA), active COPD care plans and 12-month healthcare use.
EHR showed a high rate of missing data in follow-up variables (inhaler adherence 28.5%; dyspnea 17%–20%). Despite that, all participants were ‘labelled’ as COPD, most of them lacked spirometric confirmation. Active smoking was highly prevalent (52.3% women, 45.0% men). Hypertension, obesity and osteoarthritis were the most common comorbidities; anxiety, depression, osteoporosis and thyroid disorders were more frequent in women. Higher GMA complexity correlated with more Primary Care visits, especially nursing consultations, particularly in patients with cardiovascular disease and diabetes (p < 0.001) for 12 months follow-up. No significant differences between groups were found in urgent or hospital care use.
EHR-labelled COPD patients with cardiometabolic comorbidity received more structured nursing follow-up and more annual visits than without. Improving EHR recording, integrating spirometry with the EHR, and prioritising high-complexity profiles could enhance monitoring, treatment optimisation and equity—nursing consultations are a key lever.
No patients or members of the public were directly engaged in the study design or data analysis. Nevertheless, the research was motivated by patient needs and aims to improve healthcare services.
To explore the role transition journey of spousal caregivers of people living with dementia based on transition theory.
A meta-synthesis.
This review employed a directed content analysis approach to systematically synthesise qualitative evidence. The findings were reported in accordance with the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) guidelines and the Joanna Briggs Institute (JBI) Manual for Evidence Synthesis.
A comprehensive search was conducted in eight electronic databases for studies published from the inception of each database to November 2024.
This review ultimately included a total of 31 studies. Three themes were identified, including role stage, role transition properties and role transition conditions of spousal caregivers of people living with dementia. Role stage of spousal caregivers of people living with dementia encompassed seven sub-themes; role transition properties of spousal caregivers of people living with dementia included five sub-themes; role transition conditions of spousal caregivers of people living with dementia involved six sub-themes.
This review synthesises evidence to explore the role transition journey of spousal caregivers of people living with dementia. The role transition properties highlight the impact of critical points and events, as well as caregivers' awareness, engagement, change and difference and transition time span during their role transition journey. The role transition conditions emphasise that personal meanings, cultural beliefs and attitudes, socioeconomic status, preparation and knowledge, as well as community and society simultaneously influence the role transition journey of the caregivers.
The Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) guided the reporting of the study.
No patient or public contribution.
PROSPERO registration number: CRD 42024623402
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