Conectar
To examine the trajectories, core characteristics, and maintenance factors of social avoidance in patients with breast cancer during the first postoperative year.
Longitudinal, explanatory sequential mixed-method design.
This longitudinal study enrolled 176 postoperative breast cancer patients, conducting six follow-up assessments over 1 year. Latent class growth analysis was employed to identify heterogeneous trajectories of social avoidance behaviour, with multivariate logistic regression subsequently analyzing predictive factors. Building on these quantitative findings, semi-structured in-depth interviews were administered to target individuals identified through the analysis. Phenomenological methods were then utilized to elucidate core manifestations and maintenance factors of social avoidance.
Among the 176 enrolled breast cancer patients, 138 completed all six follow-up assessments. Latent class growth analysis identified two distinct subgroups with significant differences in social avoidance trajectories: ‘persistent high social avoidance’ and ‘persistent low social avoidance group’. Logistic regression revealed melancholic temperament as an independent risk factor for ‘persistent high social avoidance group’, while choleric temperament demonstrated protective effects. Phenomenological analysis of qualitative data systematically identified four core themes: (1) affective manifestations, (2) behavioural patterns, (3) psychological drivers, and (4) environmental determinants of social avoidance.
This study revealed heterogeneous dynamic trajectories of social avoidance behaviour in breast cancer patients, with core manifestations encompassing both affective and behavioural dimensions, sustained by multiple factors of personality, psychology, and environment.
This mixed-methods study systematically examined the developmental trajectories, core manifestations, and sustaining factors of social avoidance behaviour in breast cancer patients. The results provide robust evidence to inform precision screening for social avoidance risk, early prevention initiatives, and tailored intervention strategies in clinical nursing practice.
Journal article reporting standards for mixed-methods research.
No patient or public contribution.
To evaluate the effectiveness of simulation on nursing students' translation into practice of clinical judgement, knowledge about the nursing process self-confidence and to comprehend the learning process and translation into clinical practice of competencies developed through clinical simulation in nursing students.
Two-arm, experimental, randomized controlled study designed using the explanatory sequential mixed method with qualitative step anchored in grounded theory.
Eighty undergraduate nursing students were allocated in practice groups and the groups were randomly assigned to an experimental (simulation; n = 39) or control group (study case; n = 41) and, after the intervention, participated in 3-day clinical practice activities and were assessed regarding clinical judgement, knowledge of the nursing process and self-confidence. Students in the experimental group were invited to focus groups.
Seventy-six students were analysed. The findings showed the effectiveness of simulation combined with clinical practice in the development and translation of clinical judgement (β = 5.03; p = 0.001) and knowledge of nursing process (β = 2.20; p < 0.001). There was no difference regarding self-confidence. A grounded theory emerged with three categories related to consolidation of prior knowledge, translating competencies into clinical practice and application of these competencies in nursing care that explain the theoretical category ‘learning and translating into clinical practice’.
Findings suggest that simulation combined with clinical practice can effectively enhance nursing students' clinical judgement and knowledge of the nursing process, facilitating the translation of these competencies into real-world practice. The qualitative findings suggest that simulation promotes meaningful learning and supports the practical application of nursing competencies.
This study supports the integration of simulation into nursing curricula to enhance clinical judgement and nursing process competencies. By promoting meaningful learning and facilitating knowledge transfer to clinical settings, simulation prepares students for real-world decision-making and strengthens the quality and safety of nursing care delivery.
No patient or public contribution.
RBR-7v374c6 (Brazilian Clinical Trials Registry) https://ensaiosclinicos.gov.br/rg/RBR-7v374c6
The Parent Support Team (PST) is an intensive early intervention home visiting programme delivered by child and family health nurses to families with infants aged 0–6 months experiencing psychosocial and health vulnerabilities. In contrast, mainstream services provide universal clinic-based care and scheduled developmental checks. This mixed-methods study aimed to: (1) describe demographic and psychosocial characteristics, service activity and well-baby check attendance among PST clients compared with mainstream service clients; (2) evaluate changes in maternal depressive symptoms following PST engagement; and (3) explore client experiences, including perceived outcomes and facilitators and barriers to change.
Convergent parallel mixed-methods study.
Retrospective data were extracted from electronic medical records for PST clients (909 mothers; 1038 children) and mainstream service clients (17,707 mothers; 21,764 children) between August 2019 and December 2022. Quantitative analyses described demographics, psychosocial characteristics, service use and maternal depressive symptoms. PST client experience surveys (166 mothers) were analysed using descriptive statistics and thematic analysis.
PST clients demonstrated greater psychosocial complexity and higher maternal depressive symptoms at entry than mainstream clients. PST mothers had more frequent service contacts and maintained stronger engagement with services after discharge. The proportion of mothers with clinically significant depressive symptoms decreased following programme participation. Survey findings indicated improved parenting confidence and practical skills. Positive outcomes were attributed to nurse qualities, opportunities to discuss concerns, a holistic care approach and the service model. Reported barriers included accessibility, scope of education topics and communication challenges.
The PST programme effectively engages vulnerable families, supports maternal mental health and promotes sustained connection with child and family health services.
Intensive early intervention home visiting programmes may improve outcomes for families with complex needs and warrant broader implementation.
SRQR guidelines were followed.
None.
Large language model tools are increasingly used in higher education, offering opportunities to support self-directed learning. In nursing education, course-specific AI virtual tutors may provide contextualised support while addressing concerns about content accuracy and alignment; yet empirical evidence remains limited.
This study evaluated the use and perceived impact of a co-designed AI-powered virtual tutor embedded in a graduate-level Master of Nursing (MN) course. We explored how students used the tutor, their perceptions of benefits and limitations, and its influence on learning and engagement.
A pilot study using a mixed-methods explanatory sequential design was employed. The tutor was trained on course-specific materials and integrated into the institutional learning management system. Data included anonymised usage logs and user interactions coded using Bloom's Taxonomy of Educational Objectives, post-course surveys assessing AI self-efficacy, usability, and learning impact, and semi-structured interviews with students and teaching assistants (TAs). Quantitative and qualitative strands were integrated through a joint display.
A total of 651 interactions by individuals within a group of ~120 MN students were logged. Interactions peaked in evenings and around assignment deadlines. Most interactions reflected lower-order education processes, with more application and analysis later in the course. Eleven participants completed surveys; students reported high AI self-efficacy and moderate tutor use. Perceived usefulness was mixed, but most reported the tutor enhanced both lower- and higher-level learning and recommended its future use. Interviews revealed that students valued the tutor's immediacy and course-specific accuracy, while TAs noted efficiency gains. Reported challenges included usability issues, scope limitations, privacy concerns, and risk of over-reliance on the tool.
A co-designed AI virtual tutor was feasible and valued for contextual relevance, though perceived usefulness was variable. Findings support responsible, pedagogically integrated use of AI tutors in graduate nursing education.
To assess the resilience of nurses exposed to workplace violence and analyse its influencing factors.
A cross-sectional study.
From October 2023 to April 2025, 396 nurses were recruited from hospitals in Shanghai and Nanjing, China. Personal Information Form, Hospital Workplace Violence Questionnaire, Resilience Assessment Scale for Medical Staff, General Self-efficacy Scale and Social Support Rating Scale were used to collect data. Descriptive statistics, t-tests, analysis of variance, Pearson's correlation analysis, multiple regression analysis and mediating effect analysis were used to analyse the data.
The mean resilience score was 67.38 ± 15.52. Professional title, self-efficacy and social support were the main influencing factors on resilience among nurses exposed to workplace violence. Resilience showed a significant positive correlation with both self-efficacy and social support. Self-efficacy was directly and positively associated with resilience, and was positively associated with social support, and social support partially mediated the relationship between self-efficacy and resilience.
Self-efficacy is directly and positively associated with resilience. Social support partially mediates the relationship between self-efficacy and resilience. These findings highlight the interaction between personal and environmental factors in shaping the resilience of nurses exposed to workplace violence.
Enhancing resilience among nurses exposed to workplace violence has important implications for increasing patient satisfaction and improving the quality of nursing.
Provided valuable insights into workplace violence within the nursing profession. Social support partially mediated the relationship between self-efficacy and resilience. Improving nurses' resilience requires enhancing personal self-efficacy and strengthening social support systems.
STROBE checklist was used.
To assess caregiver burden and its relationship with health literacy, self-efficacy, stigma, and social support among caregivers of children with tuberculosis in Shanghai, China.
Explanatory sequential mixed-methods design.
In the quantitative phase, 132 caregivers were recruited from a Shanghai Hospital, and 21 participated in the qualitative interviews. Data were collected (April 2023–April 2025) using the Zarit Burden Interview scale, Chinese Health Literacy Scale for Tuberculosis, General Self-Efficacy Scale, Tuberculosis-related Stigma Scale, Multidimensional Scale of Perceived Social Support, and semi-structured interviews. Quantitative data were analysed using descriptive statistics and multiple regression analyses, and qualitative data were analysed using content analysis.
Most caregivers were mothers (72.7%). Burden levels were classified as mild (58.3%), moderate (27.3%), or severe (2.3%). The quantitative analysis identified lower health literacy, limited social support, reduced self-efficacy, and being a female caregiver as significant predictors. Social support partially mediated and self-efficacy mediated the effect of perceived stigma and health literacy on caregiver burden, respectively. Qualitative themes revealed psychological and physical effects, impact on social life, and coping strategies.
Caregiver burden in paediatric tuberculosis is multidimensional and influenced by complex mechanisms. Interventions should address health literacy gaps, enhance self-efficacy, strengthen social support systems, and implement targeted stigma-reduction strategies while considering developmental-stage-specific needs.
Healthcare systems should routinely assess caregiver burden, and multidisciplinary teams should be trained to provide integrated targeted support.
This study demonstrates distinct stigma pathways and comprehensively shows that caregiver burden is significantly associated with modifiable psychosocial factors. Consequently, healthcare providers should develop targeted support interventions that address both psychological and practical caregiving challenges, ultimately contributing to improved patient care outcomes and caregiver well-being in tuberculosis management.
This study adheres to the Good Reporting of A Mixed Methods Study checklist.
None.
Workplace violence remains a persistent threat in emergency departments (EDs), yet violence risk is often assessed only at triage as a single-time-point activity. In practice, risk frequently evolves during care, shaped by situational stressors and interactional dynamics. How frontline situational awareness can be translated into structured, actionable risk management within ED workflows remains insufficiently explored.
To develop and pilot a nurse-led, triage-embedded, trigger-based pathway for dynamic violence risk management in the ED.
A mixed-methods study was conducted. Quantitative data (September–October 2025) captured trigger-initiated reassessments using the Dynamic Appraisal of Situational Aggression (DASA) during routine care. Qualitative focus groups explored trigger recognition, reassessment decision-making, and feasible responses. Findings were integrated to inform pathway development and refinement, followed by a one-month pilot.
Among 8443 adult ED encounters, 172 (2.0%) involved at least one trigger-initiated reassessment. Reassessments most commonly occurred during waiting and transitional phases of care and were frequently associated with increases in DASA scores. Nearly all aggressive incidents occurred in encounters that underwent trigger-initiated reassessment rather than baseline triage assessment alone. Qualitative findings indicated that reassessment was prompted by cumulative behavioural, interactional, and contextual changes, reflecting nurses' situational awareness. Reassessment was valued for formalizing intuitive concern, supporting communication, and legitimizing proportionate early action, while feasible responses were concentrated at lower to moderate perceived risk levels.
Violence risk in the ED is dynamic and closely linked to workflow and situational context. A trigger-based pathway that operationalizes nurses' situational awareness into structured reassessment and proportionate response may support earlier, more feasible violence risk management within routine emergency care.
This study was reported in accordance with relevant reporting guidelines for mixed-methods research, including the STROBE checklist for the quantitative component and the COREQ checklist for the qualitative component.
To explore the long-term communicative experiences of tracheostomised ICU survivors 12 months after discharge; to identify facilitators and barriers to communication with caregivers, family members, and healthcare professionals; to describe coping and communicative adaptation strategies; and to assess perceived quality of life and self-esteem.
This is a qualitative-dominant mixed methods study based on a multicentre Italian sample.
Twenty-three adult patients from several Italian hospitals were interviewed using a semi-structured guide 12 months after discharge. Qualitative data were analysed using reflexive thematic analysis. Quantitative data were collected through the EQ-5D-5L, EQ-VAS, and Visual Analogue Self-Esteem Scale (VASES), and analysed using descriptive statistics to explore patterns of QoL and self-esteem.
Four major themes emerged: (1) A body that speaks no more, reflecting the initial experience of voicelessness and emotional isolation; (2) Finding new ways to be heard, describing adaptive communicative strategies and the supportive role of family; (3) When the voice returns, so does life, highlighting the transformative meaning of regaining one's voice; and (4) Living differently, capturing long-term psychological and social adjustments. Quantitative data confirmed reduced self-esteem and QoL (mean EQ-5D index = 0.61; EQ-VAS = 58.4; VASES = 54.2). Integrated findings revealed that communication impairment remained a determinant of reduced well-being 1 year after discharge.
This is the first Italian study to investigate in depth the communicative trajectories of tracheostomised ICU survivors. Findings highlight the crucial role of voice recovery in emotional adjustment and quality of life, supporting the need for structured, multidisciplinary post-ICU follow-up focused on communication and psychosocial rehabilitation.
These findings support health professionals in developing individualised post-ICU interventions to restore communication, improve QoL, and enhance social reintegration.
COREQ checklist was followed.
No patient or public contribution.
Mentoring in nursing is crucial for supporting newly qualified nurses, enhancing retention and promoting professional development. Despite its significance, limited research has explored nurse mentors' perspectives and their own development through mentoring.
To explore how a structured mentoring intervention influences nurse mentors' clinical teaching behaviour, self-efficacy and experiences of their professional role development.
A convergent mixed-methods study was conducted during a mentorship intervention across healthcare units in hospitals and municipalities in northern Sweden and Norway.
Forty-one experienced registered nurses participated as nurse mentors. Quantitative data were collected via validated instruments on clinical teaching behaviour and self-efficacy before and twice after the intervention. Qualitative data were collected through post-intervention focus group interviews. Quantitative data were analysed using Wilcoxon signed rank test; qualitative data were analysed using qualitative content analysis. Findings were triangulated to identify convergence and divergence.
Nurse mentors reported personal and professional growth, especially in relationship-building, mentoring skills and role clarity. Results showed consistently high ratings in clinical teaching behaviour and self-efficacy, with an increase in clinical teaching behaviour scores post-intervention.
Structured mentoring interventions support nurse mentors' development, improving clinical teaching practices and reinforcing their professional identity—key factors in nurse retention.
The findings highlight the need for sustained nurse mentor support and tailored mentorship frameworks to ensure effective, long-term mentoring in nursing.
What problem did the study address? Mentoring is essential for supporting newly qualified nurses, improving retention and fostering their professional development. Most mentorship research focuses on mentees, with limited insight into nurse mentors' perspectives and development.
What were the main findings? Nurse mentors experienced development in several areas throughout the intervention, particularly in building relationships, fostering meaningful mentoring skills and refining their role as nurse mentors.
Where and on whom will the research have an impact? This study can inform policy and practice by contributing knowledge on the development of sustainable mentoring frameworks. These frameworks support the formation of collaborative and stable work groups in clinical settings, enhancing nurse retention, professional development and the overall quality of patient care.
This study adhered to the Good Reporting of A Mixed Methods Study (GRAMMS) guidelines, by O'cathain et al. as recommended by the EQUATOR network.
No patient or public contribution.
Accelerated population aging has driven substantial growth in demand for palliative care services. Such services can effectively enhance the living quality for end-of-life patients through multidimensional interventions. Currently, China lacks a localised experience-oriented quality assessment scale for palliative care, resulting in gaps in service quality supervision. To develop a self-reported measurement for palliative care services, with the foundation in the Senses Framework.
This study developed a scale by extracting core contributors of palliative care experiences through 14 patients and 16 families' narratives. To refine and improve the scale, a total of 19 experts were invited to participate in a two-round Delphi expert consultation. Additionally, an empirical research was conducted, with 380 valid samples from two independent cohorts collected to complete the full psychometric testing of the scale.
The final Palliative Care Experience Scale (PCES) comprises two dimensions: sense of security and belonging, and sense of purpose and significance, with a total of 13 items. The total variance includes 79.26% that is explained by these two factors. Confirmatory factor analysis confirmed a stable factor structure for the PCES. The scale exhibited good reliability, with a total Cronbach' α of 0.937, McDonald' ω of 0.952, and Spearman-Brown corrected split-half reliability of 0.897. Cronbach's α for both dimensions exceeded 0.88. The scale's SEM was 1.50 and MDC95 was 4.16, offering a validated threshold to identify real changes in patients' palliative care experience.
This study developed an assessment scale of palliative care quality based on the Senses Framework, uniquely centred on patient experiences. Validated through robust methodologies, this scale fills a gap in the evaluation of experiential dimensions of palliative care in China, providing a scientific and feasible measurement tool for the continuous improvement of services.
This study addresses the critical gap of a culturally adapted, patient experience-centred tool for evaluating palliative care service quality in China. Its core finding is the successful development and full psychometric validation of the 13-item Palliative Care Experience Scale (PCES). This research provides a reliable tool for palliative care clinical practice and academic research to capture patients' care experience, offers clinicians and administrators a practical instrument to identify service gaps and guide quality improvement, and delivers foundational reference data for policymakers to advance patient-centred palliative care development in China.
We adhered to the relevant EQUATOR reporting guidelines. The development and validation process followed the COSMIN framework for patient-reported outcome measures.
Patients receiving palliative care and familes played an integral role in designing and conducting this study. In Phase I, qualitative data from semi-structured interviews with 14 patients and 16 families helped define core thematic constructs and develop the initial item pool, which ensured the scale's content validity were based on their real-life experiences. In Phase III, we recruited a new, independent cohort of participants to complete the psychometric testing of the scale, providing key data for its validation.
Deficient palliative care coverage and nursing training in Ecuador warrant examining self-efficacy to inform education strategies and strengthen equitable services.
To examine Ecuadorian nurses' self-efficacy in Palliative Care.
A sequential explanatory mixed-methods study was conducted. Convenience samples of nurses completed the Self-Efficacy in Palliative Care Questionnaire and participated in online semi-structured interviews. Descriptive statistics were used for quantitative data. A side-by-side joint display supported integration.
497 nurses completed the questionnaire (90.4% female; 11.47 years of experience). Teamwork scored highest, while communication scored lowest. Eighteen nurses were interviewed (88.8% female; 11.5 years of experience). Participants reported communication difficulties related to emotions, prognosis, denial, collusion of silence and paediatric cases. They expressed strong confidence in pain management but more difficulty with agitation and dyspnoea. Spiritual care was mainly understood as facilitating access to religious figures. Although teamwork was perceived positively, tensions with physicians and an excessive focus on physical aspects were noted.
Quantitative and qualitative findings aligned overall, with dissonances regarding psychological and social communication.
Strengthening communication and comprehensive patient management competencies, as well as addressing interdisciplinary tensions, is necessary to improve and consolidate Palliative Care in Ecuador.
This study adhered to EQUATOR guidelines and used COREQ for qualitative reporting.
No patient or public contribution.
Evidence-based practice (EBP) plays an indispensable role in ensuring the safety and quality of nursing interventions, especially in labor-intensive and technology-dependent clinical environments such as intensive care units (ICUs). However, implementing EBP continues to be challenging due to perennial structural, organisational, and workforce issues. Concepts of implementation science can provide a framework with which to assess and facilitate the integration of factors that drive EBP implementation within ICUs.
To assess the level of EBP implementation within ICUs and examine the barriers and facilitators that drive EBP implementation using the PARIHS framework.
A concurrent mixed method design was utilised. The study was performed in the ICUs of two tertiary hospitals and involved nurses who completed survey questionnaires and participated in focus group discussions and semi-structured interviews. Ethics approval was obtained from relevant research ethics committees.
EBP implementation was low. EBP skills and training need significantly predicted levels of EBP implementation. Factors comprising context and facilitation affected nurses' experiences of implementing EBP, grouped into three themes of Identity, Power Ownership, and Dynamism. Meta-inferences showed that evidence, context, and facilitation can be characterised as a continuum, providing a three-dimensional perspective of implementing EBP.
The PARIHS framework has provided an alternative perspective with which to approach EBP implementation, foregrounding the role of context and facilitation in promoting the uptake of evidence into clinical practice.
Critical care nurses have contributed to the development of the research design and data collection plan.
To evaluate the ‘Countdown to Theatre’ intervention, a co-designed nurse-led approach developed using the COM-B framework to address context-specific barriers and facilitators to preoperative fasting practices.
A prospective mixed-method, pre–post study assessed the intervention's impact on fasting adherence and patient experience.
Participants included children booked for a procedure under general anaesthesia. Adherence was assessed through audited fasting duration, and patient experience was evaluated using caregiver/patient surveys. The intervention was implemented and monitored by nursing staff as a part of a structured quality improvement process. Nurses played a central role in embedding the approach into daily workflows and reinforcing fasting timelines
Over 9 months, 901 observations were undertaken from 774 patients. Fasting duration decreased from 7.6 to 5.7 h (mean difference −1.94; 95% CI −3.04, −0.86). Parent-reported patient experience surveys showed improvement in many areas, including an increase in overall satisfaction (from 44.7% to 68.8%).
The intervention successfully reduced prolonged fasting and improved patient experiences, demonstrating the value of co-designed approaches in addressing evidence–practice gaps in perioperative care.
The principles of co-design, structured implementation and the application of the COM-B framework provide a replicable model for addressing similar challenges in healthcare. The study highlights the pivotal role of nurses in improving perioperative practices, supporting both patient safety and satisfaction. Future research should explore the intervention's applicability across diverse settings and patient populations.
Despite evidence-based guidelines, excessive preoperative fasting remains prevalent in practice. This study demonstrates that a structured, nurse-led intervention can successfully reduce fasting durations and enhance patient experience, reaffirming the nursing profession's capacity to lead meaningful change in perioperative care.
Standards for quality improvement reporting excellence (SQUIRE 2.0).
Patients and caregivers contributed to the co-design of the intervention, ensuring that it addressed practical challenges related to preoperative fasting.
This study sought to explore the relationship between whistleblowing and ethical sensitivity among nurses and midwives working in delivery rooms.
A sequential mixed-methods research design.
Online data collection included 209 participants (quantitative/snowball sampling) via demographic forms and Ethical Sensitivity Questionnaire, and 9 interviews (qualitative) with semistructured questions.
The ethical sensitivity levels of the participants were found to be high. It was determined that the ethical sensitivity levels were higher in individuals who were married, had a bachelor's degree, were midwives, worked in shifts and wanted to make an ethical report in the past but could not do so. Qualitative data showed that the participants were most inclined to report legal violations such as theft, invasion of privacy and abuse of office. It was determined that whistleblowing was usually reported verbally or in writing to senior management; that whistleblowers felt brave but were afraid of possible negative consequences.
Ethical sensitivity was identified as a factor that influences whistleblowing among nurses and midwives working in delivery rooms. In the qualitative phase, participants tended to identify legal violations as whistleblowing triggers and mostly reported such incidents to high-level managers.
This study reveals the hesitancy of nurses and midwives to report, underlining the importance of a supportive health culture—an organizational climate within healthcare institutions that fosters transparency, psychological safety and ethical behavior to promote patient safety and accountability.
The study found that nurses' and midwives' ethical sensitivity influences their whistleblowing behaviours, with most reports directed at managers for legal violations. Fear of sanctions underscores the study's role in enhancing ethical climate and patient safety.
MMAT guidelines were followed.
Nurses and Midwiwes contributed to the results of the research, ensuring that it determined link between Whistleblowing behavior and ethical sensitivity.
To develop and validate the End-of-Life Care Assessment Tool for Dementia (EoLC-ATD).
A methodological study with multiple phases.
Five sub-studies comprising: a review of 90 validated dementia measures to compile an item bank of advanced dementia symptoms; focus groups with registered nurses on advanced dementia symptom identification and relevance of item bank inclusions; Delphi surveys with dementia experts seeking consensus on the EoLC-ATD constructs and items; pilot testing of the EoLC-ATD; and field testing of the EoLC-ATD in persons with dementia.
The item-bank included 180 symptoms, most of which focus group nurses (n = 17) identified as occurring in advanced dementia. Delphi surveys with dementia experts (n = 31) achieved 70% consensus for 25 of 26 EoLC-ATD items. Pilot testing of the EoLC-ATD by two nurses in eight persons with dementia showed good agreement for six constructs (Cohen's Kappa 0.856–0.927) and 26 items (Cronbach's alpha 77.0). An ‘other sympto’ item was included following RN recommendation. The 27-item EoLC-ATD field tested by 17 nurses in persons with dementia (n = 113) accurately identified advanced dementia symptoms (Cronbach's alpha 77.0, p < 0.001). Mortality at 180 days after baseline EoLC-ATD was significant (p < 0.001, area under the ROC curve p = 0.769).
The EoLC-ATD accurately and reliably identified symptoms of advanced dementia.
The EoLC-ATD provides registered nurses with a single measure of advanced dementia symptoms that will help in identifying symptom-responsive palliative care requirements.
The EoLC-ATD will address the current lack of a validated dementia symptom measure for use by aged care home registered nurses to identify unique palliative and end-of-life care needs according to presenting symptoms in persons living with advanced dementia.
STROBE Statement for cohort and mixed methods studies.
An eight-member Expert Advisory Group, which provided guidance and advice throughout the study, was composed of three carers of persons living with dementia, two dementia care clinicians, a dementia care clinical educator, and two dementia clinician researchers.
To describe the experiences of Finnish registered nurses aged 45 and over working during menopause.
Multiple methods study.
The data were collected from Finnish registered nurses aged 45 and over, using two different methods. Quantitative data (n = 3487), collected in January 2023, were analysed using descriptive statistical methods. Qualitative data were collected during the summer of 2023 through individual interviews (n = 23). The participants were recruited from a survey, where registered nurses (n = 3487) who responded to the survey indicated their willingness to participate in the interview study (n = 718). Participants for the interviews were selected through random sampling, and interviews were conducted until saturation was reached. The quantitative data were analysed with descriptive statistics, and qualitative data were analysed using inductive content analysis. The results of quantitative and qualitative data were combined in the discussion section.
Limited attention has been given to understanding the menopause and its consequences on the nursing workforce. Menopause remains a taboo topic, with a perceived divide between genders and generations, even within the healthcare sector. However, peer support from female colleagues of a similar age was considered invaluable. During menopause, nurses did not receive sufficient support from their managers or occupational health services, despite experiencing various challenges. Fatigue, for instance, was reported by 76% of nurses aged 45 and over. Nevertheless, nurses continued working despite their symptoms, as taking sick leave was perceived as difficult.
The consequences of menopause on nursing work are not yet sufficiently recognised within workplaces, or by the leadership and occupational health services. Support for nurses working during menopause seems to be insufficient. Open and informed discussions are needed across various levels of society to increase understanding of the problems of working during menopause.
The research findings can be used to develop improved occupational health and nursing management practices to support the well-being of menopausal nurses in the workplace.
Currently, there is insufficient knowledge about working as a registered nurse during menopause. However, research findings are enhancing our understanding of the impact of menopause on nursing work and the corresponding needs during this period.
The Standards for Reporting Qualitative Research (SRQR).
To co-design an information booklet to support adults living with a peripherally inserted central catheter (PICC) at home.
A sequential, mixed-method approach using Boyd's co-design framework.
A diverse project team led co-design of a PICC booklet based on preferences and PICC management strategies identified through content analysis of interviews with 15 Australian health consumers (January 2022–March 2023) using a qualitative descriptive approach. A draft booklet was developed, reviewed by the team and prototyped, which was evaluated by consumer participants and an external nurse panel, with readability assessed using Flesch Reading Ease and Flesch–Kincaid scores. The project team reviewed feedback, reached consensus on changes and collaborated with designers to produce the final booklet.
Consumer participant strategies were classified into four categories: enhancing coping, taking responsibility and understanding information, modifying life and accessing supports. Two pre-determined categories were included (participant recommendations for PICC education resource content and top tips for living with a PICC). The prototype was evaluated as highly relevant (3.9/4), comprehensive (3.8/4) with an appropriate writing style and visual appeal. Readability scores were 76.1/100 (Flesch Reading Ease) and 6.9 (Flesch–Kincaid grade level). The final booklet contained 13 sections.
A co-design approach successfully created a novel PICC information booklet with positive evaluations.
Provides understanding of consumer information preferences to inform PICC education and offers insight into consumer-developed strategies and knowledge for living with a PICC.
A co-designed PICC information booklet based on consumer knowledge may augment nursing education for people living with a PICC to improve outcomes.
The qualitative component follows the EQUATOR network COREQ guideline. A co-design research reporting standard is not available.
A consumer representative was a member of the project team and contributed to study design, interpretation of findings and development of the booklet and manuscript.
We aim the isolated and combined effects of sedentary behaviour exposure time and physical activity levels on muscle strength in older adults.
This prospective observational cohort study, analytical in nature, using exploratory survey methods and physical performance testing. With 5-year longitudinal follow-up (2015–2020).
A total of 459 older adults participated in the baseline, with a total of 224 being included/located again in the follow-up. We evaluate muscle strength using handgrip tests and sit-to-stand tests. The international physical activity questionnaire was used to measure physical activity and sedentary behaviour. Generalised Estimation Equations tested both independent and combined effects, reporting results as β coefficients and confidence intervals.
Older adults exhibiting low sedentary behaviour displayed enhanced handgrip strength compared to those with high sedentary behaviour. Notably, older adults who were sufficiently active with low sedentary behaviour, sufficiently active with high sedentary behaviour, and insufficiently active with low sedentary behaviour showed increased handgrip strength compared to their counterparts who were insufficiently active with high sedentary behaviour. This trend was consistent for lower limb strength.
Interventions that encourage a reduction in sedentary behaviour and an increase in physical activity are essential to maintain muscle strength among older adults.
The findings of this study underscore the importance of addressing both sedentary behaviour and physical activity levels in clinical interventions aimed at preserving muscle strength in older adults. Routine assessments of physical activity and sedentary behaviour could help tailor personalised exercise programs, potentially enhancing functional independence and reducing the risk of frailty and disability in older patients.
Patients were involved in the sample of the study.
This study was conducted in accordance with the Strengthening Research in Observational Studies in Epidemiology (STROBE) guidelines.
First, to investigate residential aged care staff's knowledge and understanding of residents after viewing their digital life story. Second, to examine the stability of this knowledge and understanding. Third, to explore staff's self-reported care practices following digital life story viewing.
Australian aged care quality standards include person-centred care practices, although opportunity for residents' identity expression can be limited by the facility environment. Staff cannot implement such practices without first understanding residents' history, preferences, and values.
The study used a convergent mixed methods design.
Residential aged care staff (n = 61) viewed a resident's digital life story and completed a measure of their knowledge and understanding of the resident at pre-test, post-test, and follow-up. At post-test and follow-up, staff were also asked to indicate if viewing the story had improved their interactions and care practices with the resident and to describe changes in their practice. Pre-test, post-test and follow-up scores of the measure were compared using a repeated measures analysis of variance with post hoc comparisons. Qualitative responses were analysed using thematic analysis.
Scores at post-test and follow-up were significantly higher than at pre-test, showing a stable improvement in knowledge and understanding of residents. Staff responses indicated their knowledge and understanding of residents' life story enhanced their care towards the residents.
Watching digital life stories was associated with stable improvements in staff's knowledge of residents, with staff feeling better equipped to personalise care practices.
Digital life stories about aged-care residents may support staff's improved knowledge and understanding of their care-recipients. With such understanding, staff are more equipped to implement person-centred care practices by Australian aged care quality standards.
The study adhered to guidelines for Revised Standards for Quality Improvement Reporting Excellence (SQUIRE 2.0).
No patient or public contribution.
This study aimed to comprehensively examine social and clinical factors contributing to postpartum depression among women in Nepal and identify their perspectives/experiences regarding postpartum mental health.
The explanatory sequential mixed-method study was conducted in two phases. In the quantitative phase, data were collected via survey of 200 postpartum women at immunisation clinics of two hospitals in Kathmandu Nepal. Measures included sociodemographic and perinatal factors and the Edinburgh Postpartum Depression Scale. Regression models were conducted to analyse data. In the qualitative phase, in-depth interviews were conducted with 15 participants having depression scores ≥ 10. Data were analysed using the thematic content analysis method. Qualitative and quantitative findings were integrated using the joint display and the narrative weaving approach to generate results.
Findings show that 28% of postpartum women screened positive for depressive symptoms, requiring referral for further evaluation. Integrated findings indicate that prenatal mental health problems, low birth weight or medical conditions among infants, intimate partner violence, partner substance abuse, and a lack of postpartum social support were major contributors to postpartum depression.
Depression is highly prevalent among women 6–12 months postpartum in Nepal and is associated with several clinical and social factors.
These findings have important implications, emphasising the need for routine screening using validated tools for early identification, timely treatment and referral of women at-risk for postpartum depression. Evidence-based clinical and community initiatives are needed to promote positive outcomes for women and their families.
External experts were consulted for survey questions and qualitative interview guide, then refined those instruments based on their feedback to improve construct validity. The immunisation clinic staff provided input during study design, for participant recruitment and data collection. Key findings were presented to stakeholders to validate the interpretation of findings.
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