Conectar
To evaluate the feasibility, effectiveness, and acceptability of a spherical video-based virtual reality training programme aimed at helping nurses manage workplace violence.
A convergent mixed-methods study.
This study included nurses from a tertiary medical centre in Taiwan. The training programme involved four interactive 360° scenarios focused on recognising, de-escalating, and responding to workplace violence. Quantitative measures included risk perception, confidence in coping with aggression, and technology acceptance. Qualitative measures included the participants' learning experiences. Quantitative and qualitative findings were integrated through joint displays.
The programme was feasible, with all participants completing the training. Nurses reported high levels of perceived usefulness and ease of use. Quantitative data revealed considerable improvements in risk awareness and confidence in responding to incidents of violence. Qualitative data revealed that immersion and emotional resonance enhanced engagement, fostered self-reflection, and reinforced learning. Technical challenges included subtitle placement and speech recognition accuracy.
Spherical video-based virtual reality is a feasible, acceptable, and effective training approach that improves nurses' preparedness for managing workplace violence by enhancing situational awareness and confidence in addressing high-risk situations.
Integrating spherical video-based virtual reality into continual education may strengthen nurses' workplace safety competencies, prevent harm from incidents of violence, and improve patient care in stressful environments.
Workplace violence undermines nurse safety and patient care. Current training modules often lack contextual realism. Our programme improved nurses' awareness, confidence, and reflective learning and was feasible and well accepted. The findings are relevant to nursing educators, hospital administrators, and policymakers seeking sustainable strategies for addressing workplace violence.
This study adhered to the Revised Standards for Quality Improvement Reporting Excellence.
Patients or the public were not involved in the design, conduct, or reporting of this study.
To investigate the relationship between nursing ethical leadership style, work environment (workload, interpersonal conflicts) and patients' objective nursing-sensitive outcomes (accidental falls, pressure ulcers, nosocomial infections, restraints and deaths).
Nationwide multicentre cross-sectional multilevel survey.
Validated self-report scales were used to assess nurses' perceptions of ethical leadership, workload and interpersonal conflict. Nursing staffing and objective patient' nursing-sensitive outcomes were measured at the ward level. Descriptive and inferential analyses were conducted. Structural equation modelling examined the relationships among these variables based on Donabedian's conceptual framework.
Data from 2349 nurses across 158 wards in 25 Italian acute care hospitals were analysed. The multilevel model showed an excellent fit. Ethical leadership was negatively associated with both workload and interpersonal conflict. Workload was significantly linked to higher rates of pressure ulcers, falls and deaths in patients. Ethical leadership was indirectly associated with improved patient outcomes through reduced workload.
Head nurses' ethical leadership has a pivotal role in shaping the work environment and enhancing nursing-sensitive outcomes by reducing workload and fostering positive interpersonal dynamics. These findings emphasise the need for healthcare organisations to invest in ethical leadership development as a critical strategy for improving care quality and promoting better patient outcomes.
These findings emphasise the need for healthcare organisations to invest in ethical leadership development as a critical strategy for improving care quality and promoting safer, more effective patient outcomes.
The study adhered to The Strengthening the Reporting of Observational Studies in Epidemiology checklist.
This study did not include patient or public involvement.
Cultivating moral values and principles in leadership enables leaders to effectively communicate these values to their staff. Addressing unethical behaviours, fostering open dialogue about organisational ethics, and supporting leaders in the ethical decision-making process contribute to a healthier nurses' work environment. Healthcare organisations investing in the development and promotion of ethical leaders improve care quality.
The study was registered in the research registry (www.researchregistry.com) under the record number (researchregistry7418), following a published protocol.
This study aimed to assess the psychological outcomes of family members of patients who were resuscitated in the Emergency Department (ED) and analyse factors associated with these outcomes.
This study utilised a cross-sectional design
Data were collected using a self-reported questionnaire sent to family members of patients who had undergone resuscitation in the ED from February 2024 to January 2025. Instruments for data collection included The Impact of Event Scale-Revised (IES-R), the short version of The Depression, Anxiety and Stress Scale–21 items (DASS-21), the Multicultural Quality of Life Index (MQLI) and questions related to demographic variables and the resuscitation event.
A total of 106 family members completed the questionnaire. Of this, 64.2% (n = 68) reported witnessing the resuscitation attempt, and 35.8% (n = 38) did not witness the event. Family members who witnessed the resuscitation displayed more symptoms of post-traumatic stress disorder (PTSD), measured by the IES-R, compared to those who did not witness the event. A statistically significant negative correlation was found between the IES-R and the MQLI scores, indicating that higher PTSD symptoms correlate with lower quality of life (QoL) ratings.
The findings of this study indicated that witnessing the resuscitation of a loved one in the ED is associated with increased PTSD symptoms.
Patients' and family members' cultural and religious needs should be acknowledged by the health care providers. Study findings indicate that family members prefer to be with the patient during the patient's resuscitation. However, without adequate support from hospital staff, this experience may cause adverse psychological effects. Strategies to support family members during and after resuscitation should be developed and integrated into the management of in-hospital resuscitation.
This study followed the STROBE guidelines.
No patient or public contribution.
To identify the latent frailty trajectory and explore corresponding predictors among older adults living with frailty who experience hip fracture surgery within 3 months after discharge.
From December 2022 to November 2024, 178 individuals were consecutively enrolled in a longitudinal observational study conducted at a tertiary hospital in Zhejiang Province, China.
The Reported Edmonton Frail Scale measured the frailty level at 5 points, which included baseline (pre-fracture), at discharge, 2 weeks, 1 and 3 months after discharge. Latent class growth models were set up for the frailty trajectory. Multinomial logistic regression was performed to explore the predictors of frailty trajectory classes.
One hundred fifty-three participants completed the full follow-up. Latent class growth models identified 3 frailty trajectories. Class 1: moderate frailty transformed to severe frailty (n = 27; 17.65%); Class 2: mild frailty transformed to moderate frailty (n = 86; 56.20%); Class 3: pre-frailty transformed to mild frailty (n = 40; 26.15%). A higher-level D-Dimer at admission and the five-item version of the Geriatric Depression Scale increased the incidence of Class 2 compared to Class 3. The higher scores of the Abbreviated Mental Test decreased the incidence of Class 2 compared to Class 3. Longer surgical waiting time, a higher-level five-item version of the Geriatric Depression Scale and the Age-Adjusted Charlson Comorbidity Index increased the incidence of Class 1 compared to Class 3. The higher scores of the Abbreviated Mental Test and Mini Nutritional Assessment Short Form decreased the incidence of Class 1 compared to Class 3.
Three frailty trajectory classes were identified among older adults living with frailty who experience hip fracture surgery after discharge within 3 months. D-Dimer at admission, surgical waiting time, depressive symptoms, cognitive status, comorbidity index and nutritional status are associated with these fluctuating frailty trajectories.
Modifiable factors such as improving nutrition and cognitive status and managing depression, comorbidities and preoperative evaluations provide methods for future interventions to prevent or mitigate frailty among this population.
What problem did the study address? Frailty is an inherent dynamic among older adults living with frailty who experience hip fracture surgery after discharge within 3 months. Some factors affect the mitigated frailty process in this population. What were the main findings? Three frailty trajectory classes were identified in this study. And the level of their frailty worsens 3 months after surgery compared to pre-fracture. D-Dimer at admission, surgical waiting time, depressive symptoms, cognitive status, comorbidity index and nutritional status are associated with these fluctuating frailty trajectories. Where and on whom will the research have an impact? The findings of this study provide screening, intervention and discharge plan evidence for healthcare workers in orthopaedics and geriatrics Departments. Helping community healthcare workers and primary caregivers set the theoretical basis for home-based intervention programs.
We have adhered to relevant EQUATOR guidelines using the STROBE reporting method.
No patient or public contribution.
Chronic kidney disease (CKD) is a significant public health problem that requires effective preventive and conservative methods to limit morbidity and death.
This study aims to give clinical practice an evidence-based basis for the clinical practice of healthcare professionals by methodically looking for the best available data on conservative strategies and CKD prevention in high-risk and early-stage patients.
The 6S evidence resource model was followed and states that evidence retrieval was done top-down, gathering necessary studies from January 2014 to July 30, 2024. Databases searched included BMJ Best Practice, DynaMed, NICE, GIN, SIGN, JBI Evidence Synthesis, JBI Evidence Implementation, Cochrane Library, and PubMed. Following the JBI grade of evidence and recommendation methodology, two reviewers independently examined and assessed the literature, extracting and summarizing evidence.
Seventy-nine publications were identified: 18 guidelines, 1 randomized controlled trial, 2 expert consensus statements, 36 evidence summaries, and 22 systematic reviews and meta-analyses. Key findings were summarized across eight aspects: risk assessment and early detection, risk factors and prevention of genetic factors, management of diabetic nephrology, impact of bariatric surgery on preventing CKD, screening and diagnosis, treatment and prevention strategies, lifestyle modifications, and CKD prevention.
This study summarized the best evidence for preventing CKD from eight aspects, which can help clinical or community medical professionals develop and apply CKD preventive strategies for high-risk groups and early-stage patients. By using these evidence-based strategies, healthcare professionals can reduce the incidence and progression of CKD, leading to fewer hospitalizations, improved kidney function preservation, and enhanced long-term survival and quality of life for patients. Future research should address identified gaps and explore the implementation of these strategies in diverse clinical settings.
Women with overweight or obesity tend to engage in low levels of exercise and face challenges in initiating and maintaining exercise throughout pregnancy.
This study aimed to evaluate the effectiveness of a peer-led walking and mobile health (mHealth) app intervention on self-efficacy and change in exercise behavior stage, based on the transtheoretical model (TTM), of women with overweight or obesity from pregnancy to one month postpartum.
The study was a randomized controlled trial with an experimental design. A total of 114 pregnant women (BMI ≥ 24 kg/m2 and gestation < 16 weeks) were recruited from prenatal clinics in Taiwan from July 2021 to May 2022. The intervention group (IG) received the peer-led walking program with mHealth support, while the control group (CG) received standard antenatal care. Follow-ups were conducted at 24–28 weeks (T2), 36–40 weeks (T3), and one month postpartum (T4).
The IG had significantly higher exercise self-efficacy scores from T1 to T3 compared to the CG. IG participants showed notable progress in exercise behavior stages, transitioning from the contemplation stage at T1 to preparation and action stages at T2 (χ 2 = 13.208, p < 0.01), with some reaching the maintenance stage by T3 (20.9%, χ 2 = 9.49, p < 0.05). In contrast, most of the CG participants remained at the contemplation stage throughout pregnancy to early postpartum.
The peer-led walking intervention with mHealth has the potential to enhance self-efficacy and promote sustained exercise behavior of women with overweight or obesity during and after pregnancy and is a valuable approach to establishing long-term exercise behavior.
ClinicalTrials.gov: NCT 05022680
Patients undergoing abdominal surgeries have a chance to experience surgical-related anxiety. But the most effective non-pharmacological interventions in managing this anxiety have not yet been identified.
To examine the effectiveness of different types of non-pharmacological interventions, and identify the effective components on pre- and postoperative anxiety management among patients undergoing abdominal surgeries.
A systematic search of randomized control trials (RCTs) examined the effects of non-pharmacological interventions on preoperative and/or postoperative anxiety (Primary outcomes) among patients undergoing abdominal surgery was conducted across MEDLINE, Ovid Nursing, AMED, PsycINFO, CINAHL, EMBASE, Cochrane Library, HyRead, and WANFANG DATA from 1987 to March 1, 2024. Secondary outcomes including postoperative pain, postoperative analgesics consumption, resumption of postoperative bowel movements, and length of hospital stay were also examined. Cochrane Risk of Bias Tool (version 2.0) was used for quality assessment. Meta-analysis was performed to synthesize the findings. Narrative summaries were provided for the studies that could not be included in the meta-analysis.
This review included 35 RCTs. The interventions of included studies were categorized as prehabilitation, sensory stimulation, preoperative counseling, information provision, and psychological interventions. Meta-analysis revealed that preoperative counseling was beneficial in managing preoperative anxiety (SMD = −1.36; 95% CI = −1.96, −0.76), postoperative anxiety (SMD = −1.30; 95% CI = −1.62, −0.98), and postoperative pain (SMD = −0.84; 95% CI = −1.21, −0.47). Meanwhile, psychological interventions adopting relaxation exercises had potential effects in reducing postoperative opioid consumption and shortening time to postoperative bowel movement.
Adopting preoperative counseling is suggested for the management of pre- and postoperative anxiety and postoperative pain among patients undergoing elective abdominal surgeries. A one-off lasting for 20–45 min preoperative counseling including individualized information about the coming surgery and perioperative process, and a discussion addressing patients' concerns is recommended. Future research is needed to explore the effects of relaxation exercise on important patients' outcomes such as postoperative analgesics consumption and time to resume bowel movement among patients undergoing abdominal surgery.
PROSPERO registration number: CRD42023359484
Mindfulness-Based Interventions (MBIs) have gained traction in various healthcare settings, particularly for stress reduction among healthcare professionals. This meta-analysis aimed to evaluate the effectiveness of MBIs on reducing stress and depression in obstetrical nurses.
A comprehensive literature search was done across multiple databases, including Cochrane Library, PsycINFO/PsycNet, PubMed/MEDLINE, Web of Science, and Google Scholar. The risk of bias for each included study was assessed using the Cochrane Risk of Bias Tool. Subgroup analyses were done according to intervention time (less than 8 weeks, 8 weeks, more than 8 weeks) and population. Meta-analysis was done using random-effects models. Effect sizes were calculated using standardized mean differences (SMD). Heterogeneity was assessed using the I 2 statistic.
The sample size in 55 studies was 4612 nurses and midwives (2904 in the intervention group and 1708 in the control group). The meta-analysis showed a significant overall effect of MBIs on reducing stress levels (SMD = −0.71; 95% CI [−0.97, −0.44]; p < 0.001), and depression (SMD = −0.74; 95% CI [−1.35, −0.13]; p < 0.001) among midwives and nurses. Subgroup analysis showed that the effects of intervention duration on reducing stress (X 2 = 3.01, p = 0.220) was not significant, but its effect on depression (X 2 = 61.46, p = 0.000) was significant.
Healthcare organizations should integrate structured MBIs into staff wellness initiatives to promote mental well-being. Nursing education programs can include mindfulness components to strengthen coping skills. Future work should also examine combined mindfulness–CBT programs (e.g., MINDBODYSTRONG) and address organizational factors contributing to burnout for a more comprehensive approach.
To identify obstacles faced by nurses when using health technologies in Intensive Care Units (ICUs).
Systematic review following PRISMA and registered in PROSPERO.
Six databases were searched. Two reviewers independently screened studies and appraised methodological quality using the Joanna Briggs Institute tool. Data were synthesized narratively.
Eight studies met eligibility criteria. Barriers clustered around limited training and technical competence, shorter professional experience, increased workload with multiple devices, organizational culture, and reduced direct patient contact, which may undermine patient-centered care. Heterogeneity of study designs precluded meta-analysis.
Obstacles to technology use in ICUs arise from individual and organizational factors. Addressing these barriers requires structured education, mentoring for novice nurses, workload management, and supportive policies that integrate technology without displacing bedside care.
Nursing leaders and educators should implement ongoing, ICU-specific technology training and mentoring. Managers and policymakers must ensure adequate staffing and promote Health Technology Assessment to align device implementation with clinical needs, safeguarding patient safety and the human dimensions of care.
Human papillomavirus (HPV) is a major contributor to several preventable cancers. Although the HPV vaccine is recognized by the Centers for Disease Control and Prevention (CDC) as safe and effective, uptake among U.S. adolescents remains below optimal levels. Disparities in vaccination rates are shaped by both individual characteristics and social determinants of health (SDOH).
To systematically review and synthesize the literature examining individual factors and social determinants of health associated with HPV vaccine initiation and completion among adolescents aged 9–18 years in the U.S.
A systematic search was conducted in accordance with PRISMA guidelines, yielding 37 eligible studies from an initial pool of 2092 articles. The STROBE checklist was used to assess methodological quality, and the Levels of Evidence framework by Melnyk and Fineout-Overholt guided appraisal of study strength.
Across included studies, initiation and completion rates averaged 47% and 40%, respectively. Key predictors of higher vaccine uptake included provider recommendation, health insurance coverage, urban residence, older age, and higher parental education. Disparities were most evident among adolescents living in rural areas and those from minority or low-income backgrounds. Barriers reported in several studies included parental safety concerns and logistical challenges. Evidence regarding parental knowledge and attitudes was mixed: smaller studies suggested an influence, whereas the largest population-based study reported no significant effect.
Addressing HPV vaccination disparities requires a multifaceted approach, including improving healthcare access in underserved regions, strengthening provider–parent communication, and implementing policy interventions such as school-based vaccination programs and state mandates. Normalizing HPV vaccination as part of routine adolescent care is essential for reducing HPV-related cancer morbidity and mortality. These findings also have implications for catch-up vaccination in young adults aged 15–26 and shared clinical decision-making up to age 45, which remain important strategies for increasing protection across the lifespan.
Older adults face growing risks of depression and anxiety, yet stigma, comorbidities, cost, and limited access impede receipt of conventional care. Digital mental health interventions (DMHIs), including immersive virtual reality (VR), exergaming, and mobile apps, may reduce these barriers.
To evaluate the efficacy of DMHIs in reducing depressive and anxiety symptoms among adults aged ≥ 50 years.
We conducted a PRISMA adherent systematic review and meta-analysis of randomized controlled trials. Interventions included immersive VR, exergaming/physical digital platforms, mobile applications, and digital cognitive training. Standardized mean differences (SMDs) were pooled with random effects models; heterogeneity was assessed with I 2.
Nineteen RCTs (n = 718; mean ages 50.9–84.7 years) met inclusion criteria. Across studies, DMHIs significantly reduced depressive symptoms (SMD = −0.656, 95% CI = −0.932 to −0.380; p < 0.001) and anxiety symptoms (SMD = −0.559, 95% CI = −0.740 to −0.380; p < 0.0001). Immersive and physically engaging modalities (e.g., VR, exergaming) outperformed app-based approaches. Heterogeneity ranged from moderate to high (I 2 ≈ 69.6%–97%).
Offer DMHIs: especially VR or exergaming when access to in-person therapy is limited or as an adjunct to usual care. Provide brief onboarding and, when feasible, caregiver support to boost adherence and confidence with technology. Select or configure age-friendly interfaces (e.g., large fonts, simple navigation) to address common usability barriers. Integrate DMHIs into stepped-care or rehabilitation pathways and monitor outcomes with validated tools (e.g., GDS, STAI). Address equity by supplying devices/connectivity solutions and consider cost-effectiveness and long-term engagement in implementation plans.
Trial Registration: PROSPERO ID: CRD420250655153
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.
Hospital falls and associated injuries are a global issue associated with harm and significant costs to individuals and society, especially for older adults. Hospital standards specify the minimum level of care required to optimise patient safety, quality and outcomes. Standards are often used during hospital accreditation. This investigation analysed the content and quality of hospital falls standards across the globe.
Hospital standards were located by searching online databases (PubMed, CINAHL, Google Scholar, MEDLINE), ChatGPT, the grey literature via internet search engines, and websites of accreditation agencies, government agencies, and other relevant organisations. We searched for standards from the 60 largest countries by population plus the 60 countries with the highest gross domestic product (n = 82 after accounting for duplicates). For inclusion, hospital standards had to mention ‘fall/s’. Data were analysed using a deductive framework synthesis and content analysis to identify emergent themes.
Forty-one standards used by at least 72 countries were identified from our search. Sixteen were excluded from detailed analysis because they did not mention falls and 3 could not be retrieved. A total of 22 standards were included in the final detailed analysis. Included standards showed wide variations in content and quality. Seven were assessed as high quality, 12 medium quality, and 3 were deemed to be of low quality. Some lacked details on hospital falls screening, assessment, prevention, and management. Consumer engagement in development, implementation, or evaluation was not mentioned in all standards. Procedures for falls data collection and reporting were seldom documented. Hospital standards infrequently referred readers to contemporary research or clinical practice guidelines.
There are variations in the quality and content of standards on hospital falls. International collaboration is recommended to increase the consistency and validity of hospital falls standards across nations, in order to optimise healthcare outcomes.
The findings of this global analysis of hospital falls standards have the potential to impact falls rates and fall-related injuries in hospital patients by providing data to inform the content, evidence base and use of hospital standards to optimise the safety and quality of care delivery. The findings inform the review, design and implementation of hospital accreditation procedures to improve patient outcomes, patient experiences, and service quality.
To explore the lived experiences and daily interactions of older couples living with multimorbidity.
A descriptive-interpretive qualitative study based on a generic interpretive description framework.
A total of 20 dyads were recruited using a purposive sampling strategy, and 24 semi-structured in-depth interviews were conducted between May 2023 and January 2025. Reflexive thematic analysis was used to analyse data.
Four overarching themes were generated: (1) dynamic relationship structures; (2) diverse interaction patterns; (3) double burdens; and (4) double resilience. Dynamic relationship structures occurred in dyadic and triadic forms. Diverse interaction patterns involved independence, interdependence and dependence. Double burdens manifested as physical toll, financial hardship, emotional contagion and perceptual misalignment, whereas double resilience was reflected in the nudge effect, emotional resonance and promotion of family ownership of health.
This study adopted a dyadic perspective to explore the experiences and interactions of older couples living with multimorbidity. The caring dynamics and blurred roles of patient and care partner deviate from the traditional unidirectional, linear model of ‘one person caring for the other’. Formal or informal caregiving support from third parties, as well as the nudge effect and emotional resonance between spouses, may help orient older couples as they navigate the challenges associated with multimorbidity.
Our findings indicate that community nurses can play a proactive role in identifying older couples living with multimorbidity through routine care attendance and assessments, enabling early recognition of health management needs. Geriatric nurses can leverage insights into couples' interaction patterns to tailor more effective care plans at different stages of illness, monitor emerging risks and identify optimal timing for third-party support. By facilitating a responsive triadic network, nurses can help ensure continuous and sustainable health care.
Adhered to SRQR guidelines for qualitative research.
This study did not include patient or public involvement in its design, conduct, or reporting.
To report on the unique perspectives of senior nursing leaders on the value proposition of the Clinical Nurse Specialist (CNS) role, their organisational experience and the barriers and facilitators to optimise and promote the long-term sustainability.
A qualitative sub-study of a larger multi-method study focused on informing policy recommendations to optimise the CNS workforce, informed by integrated knowledge translation.
Chief Nursing Officers (CNOs) and other senior leaders in all health authorities in British Columbia, Canada, were invited to participate in semi-structured interviews via video call between August–December 2023. We recruited 13 participants from diverse health regions, including 5 CNOs.
Leaders collectively conveyed a renewed interest in the CNS role to support nursing and multidisciplinary teams to better meet patient and system needs, and a sense of urgency to optimise the role in diverse settings. The overarching theme of “success by design” was supported by three thematic priorities: (1) understanding the CNS role, (2) a role that needs protection and connections and (3) moving forward together. Views were aligned to co-construct implementation-ready policy recommendations to guide provincial strategies.
Senior leaders reported a common understanding of the value-add of the CNS workforce and had a shared experience of barriers to optimisation. Contemporary policy guidance is needed to equip health systems to address this gap.
Across international regions, the role of CNSs is not fully optimised. This is a wasted opportunity to address the pressing need for nursing practice leaders to transform health systems and improve outcomes. This study provides new knowledge about the perspectives of Chief Nursing Officers and other nursing leaders to shape comprehensive and targeted policy recommendations and address enduring and new challenges to realise the full impact of the CNS workforce.
We have adhered to COREQ reporting guidelines (See supplemental file).
This study did not include patient or public involvement in its design, conduct, or reporting.
This study aims to explore the views and experiences of people with dementia, informal caregivers and professionals regarding eating and drinking difficulties.
A qualitative systematic review was conducted.
The Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines were used to conduct this systematic review. The quality of the included studies was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research, and the data were thematically synthesised using Thomas and Harden's three-stage method.
Six electronic databases (PubMed, EMBASE, Cochrane Library, Web of Science, CINAHL and PsycINFO) were searched from their respective inception dates to August 2025 to identify relevant studies.
Thematic analysis of the 16 included studies identified four key themes: (1) Physiological and psychological changes in people with dementia and caregivers; (2) factors influencing eating and drinking in people with dementia; (3) needs and recommendations for people with dementia, informal caregivers and professionals; (4) selection of eating methods for end-stage people with dementia.
Eating and drinking difficulties affect the well-being of both patients and caregivers. A good dining environment improves mealtime pleasure but demands caregivers' time and energy. All parties emphasised the importance of effective communication. In end-stage dementia, professional assistance is crucial for enteral nutrition decisions.
Collaboration among patients, caregivers and professionals is vital for creating tailored nutritional plans and improving mealtime environments, thereby enhancing nutritional intake. In advanced dementia, providers must provide balanced information on comfort feeding versus enteral nutrition to aid decision-making.
What problems were addressed in this study? This study addressed the lack of a consolidated, tri-perspective understanding of eating and drinking difficulties in dementia care settings. What are the main findings? Four key themes were identified: physiological and psychological changes, influencing factors, stakeholder needs and end-of-life decision-making. Where and on whom will the research have an impact? This will impact care practices for people with dementia and inform the training and support of informal caregivers and healthcare professionals.
FreshRSS 