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To identify healthcare professionals' experiences of innovation competence and the factors associated with it; and to examine the instruments developed to assess innovation competence and its associated factors among healthcare professionals.
A mixed-methods systematic review.
Researchers independently screened original studies by title and abstract (n = 2996) and then full text (n = 189). Eighteen studies were included: 16 quantitative and two qualitative. Qualitative data were analysed using inductive content analysis, and quantitative data were tabulated and synthesised narratively.
The review followed the Joanna Briggs Institute Mixed Methods Systematic Review methodology. Searches were conducted in Scopus, CINAHL, Ovid Medline, ProQuest, Web of Science, PsycArticles, and Medic. Articles published in English or Finnish with no date restrictions were included. The search covered records from database inception to August 2024.
From qualitative studies, we identified three categories describing experiences of innovation competence: Competences for Innovation in Healthcare, Application and Impact of Innovation in Healthcare, and Challenges and Strategies for Implementing Innovation. Quantitative studies identified three conceptual domains: Individual Capacities in Innovation, Innovation-related Competence Behaviours, and Social and Organisational Enablers. Four categories of factors associated with innovation competence emerged: sociodemographic, career-related, organisational, and academic factors.
Healthcare professionals' innovation competence is a multifaceted construct encompassing individual abilities, behavioural expressions, and social and organisational engagement. A systematic and multilevel approach that targets both personal attributes and organisational enablers is needed to strengthen competence. Enhancing innovation competence can improve the healthcare sector's ability to respond to complex challenges and sustain innovation capacity.
Findings inform the development of education programmes and leadership strategies to enhance innovation competence among healthcare professionals, supporting innovation implementation in healthcare organisations.
No patient or public involvement was included in this study.
PROSPERO: CRD42024614551
To explore whether a delay from referral to first contact with nurse-led community health services is associated with the likelihood of subsequent emergency department attendance.
We use individual linked administrative data on use of community health and hospital services. We identify a cohort of 343,721 individuals referred to community health services in England by their primary care provider in 2019. We then track their subsequent community healthcare contacts and emergency department attendances.
We exploit variation in the time to contact caused by weekend delays, which create longer times to first contact for people referred later in the working week. The main analysis compares patients referred on Thursday with those referred on Tuesday.
We show that 6.7% of patients referred on Thursday wait an extra two days for their first community contact relative to those referred on Tuesday. Despite this delay, we find no evidence that people referred on Thursday are more likely to have a subsequent emergency department attendance compared to those referred on Tuesday.
We do not find delayed community health services contact to be associated with an increased risk of emergency attendance amongst patients referred to community services by their primary care provider. This suggests that short delays in contact time are not detrimental for this group.
Shifting care from hospital to community settings is a key priority for health systems internationally. In England, community health services face significant staffing shortages, limiting the extent to which services can be responsive and support the desired strategic shift. Our findings suggest that these constrained community providers could use their limited capacity to prioritise responding quickly to other patients without harming those referred via primary care.
STROBE guidelines.
This study did not include patient or public involvement in its design, conduct, or reporting.
To explore baseline activities of daily living (ADL) profiles and their association with memory decline over time in cognitively healthy, community-dwelling older adults.
Observational panel study.
This study analysed data from Waves 7–10 of the English Longitudinal Study of Ageing (the search was performed on May 28, 2024), including 2925 older adults aged above 65 with no dementia or cognitive impairments at baseline (Wave 7, 2014–2015). To categorise participants by their daily functional abilities at baseline, latent class analysis was conducted to derive participants' activities of daily living profiles. A linear mixed model was used to explore whether these baseline activity profiles might predict different memory decline rates (trajectories) over time, accounting for baseline demographic factors (gender, age, ethnicity, education, marital status and chronic diseases).
Social demographics (younger age, female gender, white ethnicity, higher education and being partnered) and ADL profiles outweigh health conditions in predicting participants' memory function. Different baseline profiles were linked to different memory decline trajectories. An impairment profile with grocery shopping capability was linked to slower memory decline.
This study showed that ADL profiles had a substantial correlation with memory decline, accounting for the significant impact of sociodemographic factors. An impairment profile that preserved grocery shopping abilities appeared to offer protective benefits and potentially slow memory decline.
Strengthening nursing strategies that support older adults in maintaining the ability to grocery shop, such as guiding caregivers to promote involvement rather than shopping for the older adults entirely, or accompanying older adults grocery shopping as part of community nursing care, might help delay age-related memory decline in this population.
Patients or members of the public were not directly involved in the study's design, conduct, reporting, or dissemination plans.
To evaluate whether information about patients' poor sense of security in hypothetical vignette scenarios increases nurses' projected intent to report safety events.
Quantitative, cross-sectional factorial survey vignette experiment administered online.
A convenience sample of 60 nurses from adult inpatient hospital units at a Midwest academic medical center participated in February 2025. Participants responded to demographic questions and eight factorial vignettes, each describing a patient-reported safety breach and incorporating four patient-related factors. Four vignettes included information that the patient had a poor sense of security, and four did not, presented in random order. Following each vignette, participants rated their level of concern about the patient's report, perceived harm to the patient, and likelihood of reporting the patient's concern. A linear mixed-effects modelling approach, accounting for clustering within participants, was used to estimate the effects of the sense of security information factor on nurses' responses.
The sense of security information was associated with higher ratings of (a) degree of concern, (b) perceived harm to the patient, and (c) intent to report the patient's concern, after adjusting for vignette- and participant-level covariates. The vignette patient's perception of physical harm was positively associated with all three ratings. Nurses' greater hospital experience was associated with lower ratings across outcomes.
Obtaining information that the patient felt insecure was associated with heightened concern about the safety event, greater perceived harm, and increased intent to report the concern.
Sense of security assessment may be a risk-agnostic, patient-centered intervention that nurses can routinely perform, regardless of the safety event circumstances.
Although a system of evidence-based practices within a safety culture is essential to hospital safety efforts, nurses' judgements of and responses to patient safety concerns play a critical role and should not be overlooked.
STROBE guidelines.
This study did not include patient or public involvement in its design, conduct, or reporting.
To compare the power styles that nurses perceive and expect from nurse managers at two time points. The study aims to investigate any changes in nurses' perceptions and expectations regarding the power styles of nurse managers over a six-year period.
Repeated cross-sectional desing.
The study was conducted with 158 nurses at Time-1 and 103 nurses at Time-2. Data were collected using the Personal Information Form and the Perceived Leadership Power Questionnaire. For data analysis, frequency and percentage distribution, arithmetic mean, t-test, and Cronbach's Alpha were applied.
It was determined that the power style most perceived by nurses in their nurse managers was Referent Power at Time-1 and Expert Power at Time-2, while the expected power style was Expert Power at both Time-1 and Time-2.
It was observed that the perceived power styles of nurse managers changed over the course of the study. The power styles perceived by the nurses were consistent with the power styles they expected.
The perceived power styles of nurse managers may change over time. Identifying this change could facilitate the determination of effective leadership and communication styles.
The study examined changes in nurses' perceptions of nurse managers' power styles over time. Nurses perceived Referent Power in Time-1 and Expert Power in Time-2, while expecting Expert Power in both periods. This research contributes to enhancing leadership in nursing, understanding power dynamics in nurse-manager relationships, and improving nursing care quality.
STROBE statement selected as EQUATOR checklist.
No Patient or Public Contribution.
This study examines the mediating roles of distress, burden and social support, as well as the moderating effect of social support, in the relationship between the risk of prolonged grief and psychopathology in bereaved family caregivers of palliative care patients.
A cross-sectional study was conducted with 125 bereaved family caregivers. Validated assessment tools and the PROCESS macro in SPSS were used for mediation and moderation analyses.
Emotional burden mediated the relationship between prolonged grief risk and psychopathology, while distress and physical burden did not. Instrumental social support was a key mediator, highlighting the protective role of practical assistance, whereas emotional social support did not show significant mediation. Both types of social support moderated the relationship, buffering the negative impact on mental health.
Findings underscore the complex interactions between bereavement risk factors and psychopathology. Addressing emotional burden and enhancing social support may help reduce mental health risks in bereaved caregivers.
Healthcare professionals in palliative care should implement targeted interventions to reduce burden and strengthen support systems for bereaved caregivers. Nursing-led initiatives focused on emotional burden reduction may mitigate psychopathology risks.
Findings are relevant for healthcare professionals in palliative care and those designing interventions for bereaved caregivers. Emotional burden mediated the relationship between prolonged grief and psychopathology, while instrumental and emotional social support moderated its effects.
This study adhered to STROBE guidelines for cross-sectional research.
Beyond caregiver participation in data collection, patients and healthcare professionals contributed to study design, protocol development and dissemination.
To apply the capability approach to understand ICU nurses’ decision-making autonomy.
A qualitative study using Amartya Sen’s capability approach as a conceptual framework.
This study reanalyzed qualitative data from a previous investigation involving semi-structured interviews with 39 experienced Canadian ICU nurses who described their decision-making processes in managing post-cardiac surgery bleeding. The analysis examined how resources (e.g., information, therapeutic and human), conversion factors (personal, social and institutional) and professional agency interact to shape nurses’ decision-making capabilities.
Nurses’ decision-making capabilities encompass: (1) obtaining necessary information, (2) interpreting information to make judgements and (3) making actionable decisions. These capabilities enable nurses to achieve valued outcomes such as clinical effectiveness, patient and family comfort, professional growth and personal fulfilment. However, they are shaped not only by clinical expertise or competency but also by structural and contextual factors, including resource constraints, institutional policies, interprofessional dynamics and hierarchical relationships. These factors influence nurses’ autonomy and real opportunities to translate clinical judgements into action.
The capability approach offers a reflective lens for examining the contextual conditions that shape nurses’ autonomy. By shifting the focus beyond individual competence, it highlights the broader structural and relational influences on nurses’ ability to make and implement clinical decisions.
Understanding decision-making as a capability underscores the importance of creating supportive environments where nurses can apply their expertise. The findings call for context-sensitive strategies in education, policy and practice that valorise nurse agency and respond to the systemic factors influencing decision-making in critical care settings.
What problem did the study address? This study examined the gap between nurses’ clinical expertise and the ability to act on decisions in practice, exploring how contextual factors influence their autonomy in critical care settings. What were the main findings? Decision-making autonomy is shaped by the interaction of individual, organisational and systemic factors—including access to resources, team dynamics and institutional norms—underscoring the need for context-sensitive strategies to support nurses’ decision-making. Where and on whom will the research have an impact? These findings can inform educators, policymakers and healthcare leaders seeking to strengthen decision-making, education and support, especially in complex or resource-constrained environments.
This report adheres to the Standards for Reporting Qualitative Research.
This study did not include patient or public involvement in its design, conduct, or reporting.
Nurse practitioner-sensitive outcomes (NPSOs) are critical indicators of the quality and effectiveness of nursing care provided to older adults. These outcomes, which include metrics such as falls, pressure ulcers, infection rates, frailty, delirium, length of stay, hospital readmissions, and quality of life (QoL), are essential for assessing the impact of nurse practitioners (NPs) and enhancing patient safety. Despite their importance, the current literature on NPSOs in services for older adults remains limited. This scoping review aims to address this gap by systematically mapping the existing research, identifying key themes, and uncovering areas needing further exploration. By doing so, the authors seek to provide a comprehensive overview that will inform future research directions and contribute to the enhancement of clinical practice in older person services (OPS). This review is important for healthcare providers, policymakers, and researchers who are committed to improving the quality of nursing care and outcomes for older people.
The aim of this scoping review is to map the existing research on NPSOs in services for older adults. This review seeks to identify key themes and gaps in the current literature to guide future research and enhance clinical practice in this area.
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines were utilised to structure this scoping review.
From initial screening of 3593 manuscripts drawn from seven databases, 66 were deemed eligible for full screen. Five studies met the inclusion criteria and were ultimately selected for data extraction and analysis. The most common outcome measures reported were complications and comorbidities, and QoL.
This review highlights that the reporting of NPSOs in older person care is lacking and requires further attention.
To examine practical, ethical, and organisational implications of the use of a key technology deployed in the care of hospitalised people with dementia—visual identifiers—through a comparative analysis with parallel interventions in other spheres of healthcare and social activity.
Discursive paper.
We contrast visual identification systems used for hospitalised patients with dementia with other, ostensibly similar, systems to understand how they differ in key characteristics: what they disclose, to whom and with what intended consequence.
Certain distinctive features of the ways identifier systems are used to improve dementia care appear particularly consequential for their impact. Given how much is expected of such identifiers, they are likely to fail at least a proportion of patients.
We argue that it is important to critically evaluate the interests served by visual identifiers, identifying the dimensions of quality they can enhance and those that may be negatively impacted.
Visual identifiers for people with dementia can contribute to the ‘taskification’ of nursing care, implying that achieving person-centred care is a matter of following defined protocols rather than an emergent, relational, time-consuming process. Staff may end up prioritising risk avoidance and hospital routines (tasks that are measurable and auditable) rather than embracing the unpredictability of developing relationships with patients.
Visual identifiers are a part of well-established strategies to improve hospital care for those with cognitive impairment. While these identifiers aim to prompt healthcare professionals to deliver individually tailored care, research suggests that they are unable to consistently ensure the desirable quality of care. Understanding influences on how they are deployed can help reshape the expectations placed on such low-tech interventions and inform more reflective use.
Patients and public were not directly involved in the development of this discursive paper.
Research and evidence-based practice in nursing have a direct impact on the quality of care to patients. Its enactment in daily practice remains challenging, with nurses' insufficient research capacity and capability being one challenge, and the limited current state of knowledge another.
To map the knowledge landscape around capacity-building programmes aiming to increase evidence-based nursing practice and research activity in acutecare hospitals.
Scoping review using Joanna Briggs Institute methodology and PRISMA-ScR reporting guidelines.
Articles from 2013 to 2023 were searched on PubMed, CINAHL, Medline/OVID, Cochrane Library, PsycINFO, Scopus and Web of Science. Two researchers screened their eligibility independently. To be eligible, studies needed to focus on nursing/midwifery in acute care settings, address research capacity-building practices and be either an empirical, review or theoretical publication. Data were extracted in a structured format and synthesised narratively.
Twenty-four articles were included, consisting of 12 empirical, 6 reviews and 6 non-data-based articles. Our analysis identified two dimensions of research capacity: (1) individual research capability and (2) organisational research capacity, each influenced by various determinants. Findings suggest that four key elements are required to build a research capacity programme: (1) context assessment, (2) multilevel leadership and management engagement, (3) programme tailored to context and (4) clear outcome indicators. We found nursing research capacity programmes lacked clear definitions and a consensus on a conceptual framework.
This review systematically synthesised the knowledge landscape on nursing research capacity building programmes in acute care hospitals, bringing clarity regarding concepts, dimensions, determinants and structural key elements.
The conceptual model developed through this review encourages comprehensive and comparable research capacity-building programmes, which can accelerate enhancement of research skills, literacy, activities and evidence-based practice among nurses, thereby improving quality of care and patient outcomes.
No patient or public contribution.
To explore how practical nurses perceive telehomecare in relation to sustainability.
This study had a qualitative exploratory design.
Ten practical nurses working with telehomecare were interviewed in February–April 2024. The interviews were individual, semi-structured and were analysed through Braun and Clarke's reflexive thematic analysis.
The overarching theme of this study was ‘Telehomecare: A catalyst for a multifaceted transformation towards sustainable practices in homecare nursing’, with three main themes and seven subthemes. The three main themes were ‘Reshaped delivery of care’, ‘Reformed work environment’ and ‘Reallocated resources'. The findings reveal that nurses have multifaceted perspectives on telehomecare in relation to sustainability, recognising both its positive and negative impacts on healthcare organisations, nurses and clients while also acknowledging that more sustainable practices demand significant changes in the healthcare environment.
Telehomecare has significant impacts on multiple dimensions of sustainability within healthcare and notable drawbacks. These findings emphasise the critical need for comprehensive education and training in sustainable digital work practices to enhance healthcare professionals' awareness of environmental impacts. This underscores the importance of transformative leadership that drives organisational change towards sustainable healthcare practices and implements effective sustainability policies.
The findings present some aspects of telehomecare that contribute to a lesser environmental impact from a nursing care perspective, encouraging healthcare leaders to make conscious and effective strategic decisions towards more sustainable healthcare. The findings strengthen nurses, leaders and policymakers' knowledge and awareness of sustainable nursing activities in the digital milieu, highlighting the urgent need for transformation of healthcare practices to decrease the environmental impact.
The study followed the consolidated criteria for reporting qualitative studies (COREQ).
This study did not include patient or public involvement in its design, conduct or reporting.
To explore the roles and training of advanced practice nurses specialised in acute pain management, as reported in the current literature.
Scoping review.
We searched PubMed, Scopus and CINAHL in December 2023 to identify relevant studies published from 1996.
Relevant literature was identified, screened, and analysed using a structured scoping review process. Two reviewers independently selected and extracted data from eligible studies, with a third reviewer resolving any disagreements.
A total of 1682 records were screened, and 36 studies met the inclusion criteria. Four main themes emerged: job titles, roles, training, and barriers. The review revealed substantial variation in job titles and role descriptions across clinical settings and geographic regions, with more comprehensive role definitions found in countries like the United States and the United Kingdom. Training pathways, including postgraduate qualifications and certification, varied significantly and many low- and middle-income countries lacked structured training frameworks. Barriers identified included regulatory limitations, insufficient educational infrastructure and lack of legal authority to practice.
This review highlights significant international variation in the definition, training and regulation of advanced practice nurses in acute pain management. There is an urgent need to develop global standards, including unified competencies and certification pathways, to ensure consistent and effective care.
Standardising competencies and training will support role recognition, improve consistency in clinical practice and promote high-quality care for individuals experiencing acute pain.
This review addresses the global inconsistency in role definition and training of advanced practice nurses in acute pain management. Findings may inform educators, health professionals, policymakers and regulators, particularly in resource-limited settings.
This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR).
No patient or public contribution.
Exploring the concept of patient agitation in the intensive care unit.
Patient agitation in the intensive care unit is of widespread concern and linked to negative outcomes for patients, staff, and family members. There is currently no consensus on what constitutes agitation in the intensive care context, hindering effective and tailored prevention and management.
Concept Analysis.
Walker and Avant's eight-step concept analysis approach.
A comprehensive search was carried out in the databases MEDLINE, PsychINFO and CINAHL. A total of 32 papers published between 1992 and 2023 were included, reviewed, and analysed to explore definitions, attributes, antecedents and consequences of patient agitation.
Patient agitation in the intensive care unit is characterised by excessive motor activity, emotional tension, cognitive impairment, and disruption of care, often accompanied by aggression and changes in vital signs. Antecedents encompass critical illness, pharmacological agents and other drugs, physical and emotional discomfort, patient-specific characteristics and uncaring staff behaviours. Consequences of agitation range from treatment interruptions and poor patient outcomes to the psychological impact on patients, families, and staff.
Agitation in the intensive care unit is a complex issue which significantly impacts patient treatment and clinical outcomes. For healthcare professionals, patient agitation can contribute to high workloads and job dissatisfaction. Due to the complex nature of agitation, clinicians must consider multifaceted strategies and not rely on medication alone. Further research is needed to fully understand patient agitation in the ICU. Such understanding will support the development of improved strategies for preventing and managing the behaviours.
A clearer understanding of patient agitation supports the development of tailored interventions that improve patient care, guide ICU training, and inform future research.
This concept analysis was developed with input from a patient representative.
To describe obstacles and ideas for improvement for the delivery of cardiopulmonary resuscitation and basic life support to wheelchair users.
A descriptive qualitative study underpinned by constructivism was conducted.
Semi structured interviews were completed with 26 participants from three cohorts: formal and informal carers, wheelchair users and healthcare professionals. Data were collected via online and in person interviews between February and June 2024. All participants were located in Australia, with the exception of one who was located in the United Kingdom. Data were analysed using thematic analysis.
Two major themes were identified: (1) obstacles to providing cardiopulmonary resuscitation and basic life support to a wheelchair user and (2) aspirations for improving cardiopulmonary resuscitation and basic life support for wheelchair users.
Participants shared ideas for how to improve emergency care for wheelchair users, highlighting a need for further research, testing and development of an education intervention.
Improving knowledge about providing emergency care to a wheelchair user could improve outcomes, save lives and reduce the life expectancy gap experienced by people with disability.
Approximately 2% of the global population use a wheelchair. Wheelchair use complicates the delivery of cardiopulmonary resuscitation and basic life support. There are currently no guidelines informing emergency care for wheelchair users available globally. Recognition of common symptoms of distress exhibited by wheelchair users, and options for the delivery of practical emergency care are required for wheelchair users.
The paper adheres to the EQUATOR reporting guidelines utilising the SRQR checklist.
Patients and the public were the driving force in recognising the gap in knowledge regarding the delivery of CPR to wheelchair users. Questions from patients and the public shaped the aims and methodological choices for this study.
To explore the experiences of and reasons for midwives leaving practice.
A qualitative approach applying a social constructivism interpretative framework.
Twenty participants were selected for interviews based on reasons for leaving midwifery practice between October 2022 and April 2023. Thematic analysis was used to identify themes, and results were checked for trustworthiness through a third coder, community engagement and member checking with two participants.
One overarching theme with six subthemes characterised the experience of leaving midwifery practice. All participants reported the overarching theme: Caring for myself and my close community became incompatible with the work of midwifery. Five subthemes reflected negative aspects of midwifery work: value incongruence; racism in midwifery; not feeling respected/valued (+compensation); high workload leading to low quality of care; negative practice climate and psychosocial safety climate. The theme of strong professional commitment and identity weighed into their decision to leave. Negative experiences working in birth centres were prominent across themes.
Participants reported leaving the profession of midwifery when they reached an unsustainable balance between the demands of work life and personal life. The decision to leave midwifery was emotional; participants maintained a strong connection to midwifery. The leaving process supports a theoretical premise for midwifery turnover behaviour. The work life of midwives is a complex composite of challenges that are reflective of identified problems with maternity care in the United States.
Midwives are not leaving practice because they want to leave midwifery but because they are unable to meet non-work-related caring demands. Family-friendly policies, such as flexible schedules and leave policies, could help retain the midwifery workforce.
Based on recommendations from representatives of historically marginalised groups within the midwifery community, we offered participants to be interviewed by a midwife of colour.
This scoping review aimed to explore what is known about Indigenous peoples' experiences with palliative and end-of-life care in Canada.
A scoping review.
A systematic search was performed from database inception to May 2022: CINAHL, Academic Search Complete, ERIC, Cochrane, Medline, PsychINFO, Indigenous Collections, Indigenous Peoples of North America and EMBASE. No date limitations were applied. Unpublished and grey literature was searched using the Google search engine. A search update was conducted in April 2024.
This scoping review was conducted in accordance with the Joanna Briggs Institute methodology for scoping reviews. Titles, abstracts and full text were screened for inclusion by two reviewers. Mapping and thematic analysis were used to analyse, collate and summarise extracted data.
Fifty-three sources were included in the review. While the methods, locations and context vary across the literature, common themes emerged: Disparities in Indigenous representation in palliative and end-of-life care literature, challenges in accessing palliative and end-of-life care, priorities related to palliative and end-of-life care and experiences specific to end of life.
This scoping review revealed several key insights into Indigenous peoples' experiences with palliative and end-of-life care.
Findings identify the need to enhance cultural safety in palliative and end-of-life care and support community capacity to develop and lead palliative and end-of-life care research and initiatives. Furthermore, findings suggest the need for palliative and end-of-life care initiatives that are Indigenous-led, grounded in Indigenous research methods and distinctions-based.
We have adhered to relevant EQUATOR guidelines. We followed the PRISMA-Scr in the reporting of this scoping review.
No patient or public contribution. This study did not include patient or public involvement in its design, conduct or reporting.
FreshRSS 