Conectar
Transgender and gender-diverse individuals often face significant barriers to accessing gender-affirming care, such as hormones and/or surgery, leading to poorer mental health, lower quality of life, and higher rates of substance use and suicidal ideation. Vaginoplasty, the most commonly sought genital gender-affirming surgery (GGAS), is desired by over half of all trans women but has been performed in only a minority. This is due largely to limited surgeon availability and long wait times. Peer support has been shown to improve health outcomes and reduce stigma in marginalised populations, including trans communities, but has never been studied for efficacy during the perioperative period of GGAS. Building on priorities identified by multi-stakeholder engagement from the Transgender & Non-Binary Surgery Allied Research Collective, the Support for Transgender and Nonbinary Individuals Seeking Vaginoplasty (STRIVE) study aims to evaluate the efficacy of a centralised peer support and education intervention for patients seeking vaginoplasty, addressing a critical gap in perioperative care.
The STRIVE Study is a pragmatic, multi-site randomised controlled trial enrolling trans adults seeking full depth vaginoplasty. Participants are randomised to one of two arms; enhanced usual care, or a facilitated group intervention. The primary outcome is coping self-efficacy at 6 months, with a secondary outcome of surgical readiness. Primary analysis uses an intention-to-treat approach with linear mixed effects modelling, adjusting for selected baseline values and site. The feasibility evaluation data collected via qualitative interviews will be analysed thematically.
Approvals were granted by the primary site’s Institutional Review Board on 10 May 2024 (STUDY00026957). The trial was registered on 24 May 2024. Results will be published in open access journals and made available to community members in plain language formats.
To map the evidence on post-incident strategies for workplace violence in global hospital settings, define current literature gaps and provide direction for future research.
Scoping review guided by Joanna Briggs Institute methodology.
A narrative synthesis, framed by the Haddon Matrix, categorised post-violence strategies by focus on staff (victims), aggressors (vectors), or the physical/social environment.
Six databases (MEDLINE, Embase, Web of Science, CINAHL, PsycINFO, Health Management Information Consortium) and Google Scholar were searched in January 2024.
Twenty-seven articles were included. Post-violence strategies addressed: (1) staff support through debriefs and psychological, clinical and procedural assistance; (2) behaviour management, individualised plans, alerts and accountability measures for aggressors; and (3) system-level responses via incident investigations, feedback processes and integrated monitoring. These strategies were typically embedded within larger multicomponent workplace violence programmes, with limited disaggregation of their specific effects.
The evidence base for tertiary prevention of workplace violence remains sparse. Most articles in this review equated success with violence reduction, reflecting a traditional (Safety-I) focus on risk mitigation, with limited attention to broader outcomes such as staff perceptions of safety or job-related affect. This underscores the need for a clearer focus on the mechanisms by which such interventions are expected to create change, providing an opportunity to refine theory and practice.
The post-violence period offers a key juncture for mitigating incidents' ripple effects. As frontline staff are often the primary ‘recipients’ of interventions, future research and service improvement initiatives should focus more closely on outcomes relevant to staff experiences.
Incorporating a Safety-II perspective, which emphasises resilience and adaptive performance, could enable hospitals to strengthen ongoing operational capabilities in the aftermath of violence and help to redress the conditions that facilitate its recurrence.
PRISMA-ScR.
None.
Healthcare systems face a growing challenge: as technology advances, patients increasingly feel like data points in systems that prioritise efficiency over empathy. This paper addresses the global healthcare crisis of disconnection, arguing that fundamental change requires putting human experience at the centre through Caring Science principles in nursing.
COVID-19 clearly revealed this disconnect. While showcasing scientific advances, it exposed gaps in compassionate care and fair access globally. Nurses struggled to maintain human connection while dealing with resource shortages and isolation protocols, proving that advanced medical treatments alone cannot address the physical, emotional, spiritual, and social factors that influence health.
This work draws on peer-reviewed studies, contemporary research, and theories of human caring to demonstrate the global responsibility and urgent need for integrating caring practices into healthcare systems. Collectively, this evidence underscores both the necessity of intervention and the effectiveness of Caring Science as a strategy for transforming organisational practices while highlighting a pressing truth: healthcare systems worldwide must move beyond efficiency alone and intentionally weave caring practices into their structures.
This analysis examines Caring Science through three key areas: Relational, Organisational, and Global. Using Watson's Theory of Human Caring and current research, the paper shows how caring relationships can improve through thoughtful use of innovation. Recent healthcare improvements demonstrate promising results when technology integration enhances both nurse empowerment and patient outcomes within frameworks that prioritise human connection.
Future directions position Caring Science as a mature, evidence-informed framework for addressing healthcare's complex challenges. The paper calls for ‘sacred activism’—a commitment to protecting caring's essential dimensions while embracing beneficial innovation, positioning nursing to lead healthcare transformation through both the art and science of nursing that honours human dignity.
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