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To explore the challenges and facilitators to consumer engagement in care during hospital attendance, integrating the perspectives of patients, informal carers and care providers.
A qualitative descriptive study using semi-structured interviews.
A total of 102 individual interviews were conducted with patients (n = 43), informal carers (n = 31) and hospital care providers (n = 28) recruited from across Australia using purposive, convenience and snowball sampling. Data were collected between March 2023 and January 2024. Interviews were audio-recorded, transcribed and analysed using thematic analysis.
Eight themes illustrating factors that facilitated or hindered consumer engagement were nested within three overarching domains: relational conditions for engagement; consumer capacity and support; and organisational, system, and safety conditions. Patients, carers and care providers identified many overlapping barriers and facilitators, but differed in how they experienced and emphasised them.
Consumer engagement in hospital care is shaped by individual, interpersonal, organisational, cultural, systemic and ethical factors. Improving engagement therefore requires care environments that actively legitimise patient and carer engagement while providing staff with the time, resources and policy clarity needed to support safe and meaningful participation.
Healthcare organisations could strengthen consumer engagement by improving staff communication practices and cultural sensitivity, supporting patient and carer health literacy, creating structured opportunities for engagement, clarifying confidentiality and safety boundaries, and considering locally feasible support roles or technologies. Such strategies require adaptation to workforce and resource constraints and should be evaluated in future research.
What problem did the study address? ○
Consumer engagement is central to high-quality, patient-centred care, yet the factors that shape it remain incompletely understood, with prior research typically focusing on single perspectives or discrete episodes of hospital care.
What were the main findings? ○
Eight themes were nested within three overarching domains: relational conditions for engagement; consumer capacity and support; and organisational, system, and safety conditions. Although themes were broadly consistent across patients, carers, and care providers, the groups differed in how they experienced and emphasised these factors.
Where and on whom will the research have an impact? ○
The findings will inform care providers, healthcare organisations, and policymakers in developing strategies to improve consumer engagement across hospital settings, with relevance to international contexts where patient-centred care is a priority.
This study adhered to the Consolidated Criteria for Reporting Qualitative Studies (COREQ) guidelines.
Patients and members of the public were involved in the study design, participant recruitment, and interpretation and dissemination of findings. A Patient and Carer Advisory Board provided input from inception to dissemination, ensuring the research addressed patient-relevant priorities.
Not registered.
To synthesise existing evidence concerning the application of AI methods in detecting depression through behavioural cues among adults in healthcare and community settings.
This is a diagnostic accuracy systematic review.
This review included studies examining different AI methods in detecting depression among adults. Two independent reviewers screened, appraised and extracted data. Data were analysed by meta-analysis, narrative synthesis and subgroup analysis.
Published studies and grey literature were sought in 11 electronic databases. Hand search was conducted on reference lists and two journals.
In total, 30 studies were included in this review. Twenty of which demonstrated that AI models had the potential to detect depression. Speech and facial expression showed better sensitivity, reflecting the ability to detect people with depression. Text and movement had better specificity, indicating the ability to rule out non-depressed individuals. Heterogeneity was initially high. Less heterogeneity was observed within each modality subgroup.
This is the first systematic review examining AI models in detecting depression using all four behavioural cues: speech, texts, movement and facial expressions.
A collaborative effort among healthcare professionals can be initiated to develop an AI-assisted depression detection system in general healthcare or community settings.
It is challenging for general healthcare professionals to detect depressive symptoms among people in non-psychiatric settings. Our findings suggested the need for objective screening tools, such as an AI-assisted system, for screening depression. Therefore, people could receive accurate diagnosis and proper treatments for depression.
This review followed the PRISMA checklist.
No patients or public contribution.
To examine the association between compassion fatigue and spiritual care competence amongst palliative care nurses, investigate the mediating role of palliative care quality and determine the moderating effect of job satisfaction.
Palliative care nurses face intense emotional demands and end-of-life stressors, increasing their risk of compassion fatigue and potentially affecting care delivery. Spiritual care competence is central to holistic palliative nursing; however, its association with compassion fatigue and the organisational factors shaping this relationship remain unclear.
A cross-sectional, correlational study.
Using a convenience sampling approach, 141 nurses working in palliative care units across hospitals in different regions of Türkiye were recruited. Data were collected between April and August 2024 via an online questionnaire including demographic variables and validated instruments measuring compassion fatigue, palliative care quality, spiritual care competence and job satisfaction. Data were analysed using SPSS and PROCESS macro.
The mean spiritual care competence score was 107.9 ± 14.7. Compassion fatigue was negatively associated with palliative care quality and spiritual care competence, whereas palliative care quality was positively associated with spiritual care competence. Mediation analysis indicated a significant indirect association between compassion fatigue and spiritual care competence through palliative care quality. Moderated mediation analysis indicated that this indirect effect was significant only amongst nurses reporting higher job satisfaction.
Compassion fatigue was negatively associated with palliative care nurses' spiritual care competence. Mediation analysis suggested that this association was statistically explained by palliative care quality, whilst job satisfaction moderated the relationship between compassion fatigue and care quality.
Addressing compassion fatigue as a critical occupational risk in palliative care nursing is essential. Organisational strategies that enhance job satisfaction and support high-quality care delivery may help sustain nurses' spiritual care competence and promote high-quality palliative nursing practise.
No patients or members of the public were involved in this study. Palliative care nurses participated by completing online questionnaires.
This cross-sectional study was reported in accordance with the STROBE Statement.
The aim of this study was to explore end-of-life simulation in undergraduate nursing curricula in Australian and New Zealand institutions.
A cross-sectional descriptive research design was employed. The study is reported using the CROSS checklist.
A survey was distributed to 45 institutions with an accredited Bachelor of Nursing programme in Australia or New Zealand. The instrument comprised eight domains: simulation orientation, simulator type, simulation environment, instructional design, simulation event, pre-brief, debrief, and facilitation preparation and requirements.
Thirty institutions responded to the survey, with 25 suitable for data analysis. Eleven institutions included end-of-life simulation in their curriculum. The dominant modality used in the end-of-life simulation was high-technology manikins. All institutions used a validated approach to conducting the pre-brief and debrief. Variations were reported in the skill and clinical expertise required of end-of-life simulation facilitators and the approaches and modalities used in end-of-life simulations across institutions.
A small number of institutions reported including end-of-life simulations in their undergraduate nursing curriculum. This study found the end-of-life simulations integrated into undergraduate nursing curricula in Australia and New Zealand align with many elements of the Healthcare Simulation Standards of Best Practice. There were variations in the simulation modality and facilitation style used to deliver end-of-life simulations across institutions. While a pre-brief session was included, the elements covered and information conveyed to participants varied across institutions. Additionally, the content expertise required of simulation facilitators lacked clarity.
The influence the pre-brief has on the student learning experience requires further research. Moreover, the learning experiences of the participants in various simulation modalities, including the influence of SPs and debriefing approaches, warrant investigation. The role and impact of professional development and facilitator requirements, such as skills and clinical expertise, on the student learning experiences and outcomes in EOL simulation offer opportunities for further research.
There were no patient or public contributions in this study.
To provide practical insights that delve into the ethical issues and regulatory implications of generative artificial intelligence (GenAI) in healthcare. Ethical Challenges and Regulatory Impact in China is used as an example.
Despite China's efforts to strike a delicate balance between protecting public welfare and promoting technological advancement, numerous unresolved issues persist in the practical integration of generative artificial intelligence into healthcare settings.
Key issues such as data application, privacy protection, cost-effectiveness and regulatory remain areas of ambiguity that require clarification. Stringent ethical guidelines, data privacy protection measures and continuous supervision and evaluation of artificial intelligence decisions will help enhance the expected benefits of GenAI in healthcare.
The potential use of GenAI in healthcare has garnered widespread attention, emerging as a significant global research topic. However, its application in this domain presents substantial ethical and regulatory challenges. Compared to other fields, GenAI's role in healthcare is more sensitive and complex, necessitating an urgent assessment of its ethical implications for future development and deployment. Challenges and ethical considerations are particularly pronounced in developing countries with limited healthcare resources.
To investigate whether patient safety culture is associated with nurses' turnover intention and to examine correlational sequential pathways involving burnout and job satisfaction, drawing on Conservation of Resources theory.
A descriptive, correlational design.
This study used data collected during 2023 from a hospital-wide patient safety culture survey conducted in four hospitals in South Korea. The sample comprised 3082 nurses from diverse units. Relationships among patient safety culture, burnout, job satisfaction, and turnover intention were examined using a mediation model within a structural equation modelling framework (WLSMV estimator with probit link), controlling for age and hospital tenure.
Patient safety culture was associated with lower burnout and higher job satisfaction. Burnout was associated with lower job satisfaction and with a higher likelihood of turnover intention, whereas job satisfaction was associated with a lower likelihood of turnover intention. When burnout and job satisfaction were considered together, the association between patient safety culture and turnover intention was explained through these two factors rather than by a direct pathway.
Patient safety culture functions as an organizational resource that relates to reduced burnout and enhanced job satisfaction, which together relate to lower intention to leave.
Strengthening patient safety culture—alongside efforts to reduce strain and foster positive job attitudes—may support nurse well-being and improve retention, thereby supporting continuity and safety of patient care.
This study addresses persistent nurse turnover intention in hospitals and identifies patient safety culture as an organizational lever that operates through reduced burnout and improved job satisfaction. The findings can guide nurse leaders and policymakers in hospitals to implement culture-focused strategies that support staff well-being, enhance retention, and sustain safe patient care.
STROBE guidelines were followed.
No patient or public contribution.
The aim of this study is to assess nurse practitioner students' perceptions and engagement with Isabel's artificial intelligence (AI) based differential diagnosis tool to support their decision-making skills during their theoretical and clinical placement training.
This pilot study used a cross-sectional design.
Twenty-six nurse practitioner students provided feedback on their use of an AI differential diagnosis tool in both academic and clinical contexts. This survey used the Post-Study System Usability Questionnaire to assess the engagement levels and usability of the AI tool. Additional questions were included to evaluate the usage patterns, adequacy in training and confidence in diagnosis.
There were mixed engagement levels: 44.4% (n = 8/18) used Isabel in two subjects—typically one or both clinical placement units—and 27.8% (n = 5/18) in one subject; students most often used the tool to confirm differential diagnoses. Usability was rated positively with the disease ranking, red flag diagnosis and link to national guideline features demonstrating the highest student usage. While most students found the tool beneficial to use during clinical placement and completing university assignments, some reported challenges due to insufficient training, impacting confidence in clinical application.
Isabel has potential as a valuable educational tool in Nurse Practitioner programs, but successful implementation depends on adequate training and support. The findings highlight the importance of comprehensive training and support to maximise AI tool utilisation, with direct implications for programme curricula, clinical education strategies and potential improvements in diagnostic reasoning skills for future nurse practitioners.
This study provides an example of integrating artificial intelligence (AI) guided clinical decision-making training in nurse practitioner (NP) education. The findings can be used by educational institutions to trial similar AI-integrated learning approaches, enhancing diagnostic competence and potentially improving patient care outcomes.
The Study adhered to the STROBE checklist for reporting.
No patient or public contribution was made to this study.
To examine the role of self-efficacy in the relationship between medication adherence and self-care behaviours in patients with Inflammatory Bowel Disease by describing their levels and exploring the interconnections among these variables.
Multicenter, cross-sectional.
A total of 452 patients were recruited through consecutive non-probabilistic sampling across nine Italian outpatient Inflammatory Bowel Disease Units. Data were collected using validated tools: the Morisky Medication Adherence Scale-8, the Self-Care Self-Efficacy Scale, and the Self-Care of Chronic Illness Inventory. Descriptive statistics, Pearson correlations, and mediation analyses were performed to explore associations and the mediating role of self-efficacy between medication adherence and self-care behaviours.
Participants had a mean age of 43.49 years; 50.9% were male, 49.2% had Crohn's disease, and 50.8% had ulcerative colitis. Only 10.2% reported high medication adherence, while most showed medium or low adherence. The mean self-efficacy score was 74.82. Medication adherence was positively associated with self-care maintenance, and self-efficacy statistically accounted for part of this association. Lower levels were observed in self-care monitoring and management behaviours.
Medication adherence was positively associated with self-care maintenance, and self-efficacy partially explained this relationship.
Routine assessment of medication adherence and self-efficacy may help identify patients at risk of poor self-care. Interventions aimed at strengthening self-efficacy, such as motivational interviewing, nurse-led counselling, and digital monitoring tools, may improve adherence and self-care maintenance.
The study addressed low medication adherence and suboptimal self-care in patients with IBD. Findings support integrating self-efficacy-enhancing strategies into multidisciplinary care to improve adherence and self-care behaviours.
Patients completed validated self-report questionnaires; however, they were not involved in the study design, conduct, analysis, or manuscript preparation.
Artificial intelligence-based conversational agents (CAs) have shown transformative potential in healthcare, yet their application in cancer health education has remained underexplored, particularly regarding usability and patients' experiences. Existing reviews lack a dedicated focus on user perspectives, limiting insights into how CAs can be optimised for patient needs.
To explore the usability and experience of artificial intelligence-based conversational agents in health education for cancer from the user perspective.
A scoping review was conducted with the Joanna Briggs Institute Scoping Reviews conduct guidance and reported according to the preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews checklist.
A search was performed in PubMed, Embase, CINAHL, Web of Science, PsycINFO, IEEE Xplore Digital Library and ACM Digital Library from their inception to March 6, 2024. The references to the articles included were also searched. The Pillar Integration Process was employed to chart data.
A total of 12 studies were included in this scoping review, which revealed that CAs supported diverse educational contexts, including cancer-related knowledge (41.7%), pretest genetics (33.3%), self-management (16.7%) and psychological skills (8.3%). Three studies reported that patients preferred interactions with multiple options or ‘read more’ functions. Patients were generally optimistic about the CAs and reported that CAs provided informational, physical, and psychological support for them. However, limitations such as insufficient customisation, lack of empathy, and defects in understanding free-input questions were noted.
This review demonstrated that CAs are promising complementary tools in cancer education, alleviating healthcare burdens while enhancing patient engagement, which was particularly critical in resource-limited settings. However, clinical implementation requires more rigorous validation of safety protocols and high-quality original studies.
Nurses and policymakers should consider CAs valuable tools to enhance cancer health education, provided that they align with patient needs and institutional safety standards.
To evaluate whether simulation-based I-PASS handoff training improves ICU nurses' knowledge, perceptions of handoff communication and safety attitudes.
Effective handoff communication is crucial for ensuring patient safety and reducing errors. However, simulation-based training (SBT) with structured protocols, such as I-PASS, is rarely used in Egyptian nursing education, highlighting a gap.
A quasi-experimental design was employed.
A convenience sample of 57 ICU nurses was studied from June to December 2023. Data were collected using the I-PASS Handoff Knowledge Questionnaire, Perception of Handoff Communication Tool and Patient Safety Questionnaire. Nurses completed baseline assessments, participated in two simulation-based I-PASS scenarios and repeated assessments post-intervention. Statistical analyses examined the training's impact and its relationships with participants' socio-demographic characteristics.
Significant improvements were observed in I-PASS knowledge, perceptions of handoff communication and safety attitudes (all p < 0.001). Nursing qualifications and place of residence have shown a significant correlation with perceptions of handoff communication and safety attitudes (p < 0.05).
Simulation-based I-PASS handoff training significantly enhances ICU nurses' knowledge, perceptions of handoff communication and safety attitudes. Targeted, context-sensitive educational interventions are necessary to strengthen handoff practices and improve patient safety within the Egyptian healthcare system.
Structured simulation-based training, such as I-PASS, can be effectively integrated into nursing education to standardise handoff communication and improve patient safety outcomes in intensive care settings.
No patient or public contribution.
To evaluate the impact of implementing a prototype of simulation-based educational technology on raising awareness among ICU nurses, improving communication in nursing handover, and promoting patient safety.
Qualitative study based on the conceptual framework of patient safety. The COREQ tool guided the presentation of the research report.
The research was conducted with 18 nurses from the ICU of a public hospital in Rio de Janeiro, Brazil, who worked directly in nursing handover. The technology implemented was developed based on communication failures identified in a previous stage of the macro research project. This evidence supported the development of a simulated scenario of a nursing handover of a critical patient, which was recorded in audio and video. The video addressed content (absence, incompleteness and lack of ordering of information) and behavioural errors (interruptions, distractions, noise and lack of clarity) during communication between intensive care nurses. The video was implemented with nurses through the use of telesimulation with debriefing. Finally, the nurses were subjected to a semi-structured interview to evaluate the potential of the technology, whose data underwent thematic analysis with an inductive model.
The nurses recognised the communication failures portrayed as part of their daily practice, reflected on their mistakes, and on actions to be adopted to change behaviour during the handover.
The simulation-based technology prototype has the potential to promote self-reflection and raise nurses' awareness of the need to change behaviours during the handover.
The simulation-based technology prototype can be applied as an educational strategy to improve communication safety in nursing handover.
No patient or public contribution.
To evaluate the accuracy of the Emergency Severity Index (ESI) assignments by GPT-4, a large language model (LLM), compared to senior emergency department (ED) nurses and physicians.
An observational study of 100 consecutive adult ED patients was conducted. ESI scores assigned by GPT-4, triage nurses, and by a senior clinician. Both model and human experts were provided the same patient data.
GPT-4 assigned a lower median ESI score (2.0) compared to human evaluators (median 3.0; p < 0.001), suggesting a potential overestimation of patient severity by the LLM. The results showed differences in the triage assessment approaches between GPT-4 and the human evaluators, including variations in how patient age and vital signs were considered in the ESI assignments.
While GPT-4 offers a novel methodology for patient triage, its propensity to overestimate patient severity highlights the necessity for further development and calibration of LLM tools in clinical environments. The findings underscore the potential and limitations of LLM in clinical decision-making, advocating for cautious integration of LLMs in healthcare settings.
This study adhered to relevant EQUATOR guidelines for reporting observational studies.
To evaluate the artificial intelligence-assisted lymphedema education material in patients undergoing breast cancer surgery.
A comprehensive, successful methodological design was used to evaluate the portability of the expandable, AI-supported lymphedema education material for breast cancer. The study was reported in accordance with the STROBE statement (see Data S1 for the completed STROBE [Strengthening the Reporting of Observational Studies in Epidemiology] checklist). When preparing the AI-supported lymphedema education material managed with breast cancer treatment, it is first determined in the education of patients. Then, the commands of the Chat GBT-4 program are included in the scope of the transferred education content. For the created education content, readability was first evaluated and expert opinion was taken for the final version of the draft.
While preparing the AI-assisted lymphedema education material in the study, expert opinions were obtained, and the educational needs of the patients were determined by scanning the literature. Then, 12 commands were given in the ChatGPT-4 program to create the educational content. Formulas were used to evaluate the readability of the created educational content in Turkish and the readability of the health literature. The validity of the lymphedema education material was presented to 10 experts. The experts evaluated the understandability and actionability of the educational material using the Patient Education Materials Evaluation Tool and the Global Quality Scale, which evaluates the quality of the educational material.
It was concluded that the readability index of the lymphedema education material for Turkish was 67.3, and the Turkish readability level was ‘easily understandable’. The readability index of health literature was found to be 11.28, 9.68, 10.58, 39.0, and 11.26, respectively. When the internal consistency coefficient between the experts was examined, it was found to be 0.74. It was determined that the Patient Education Materials Evaluation Tool understandability score average was 92.10 ± 9.03, and the actionability score average was 81.60 ± 18.47. The Global Quality Scale score average, which evaluates the suitability and quality of the content of the AI-supported educational material, was found to be 4.10 ± 0.87.
At the end of the study, it was determined that the educational material was reasonable regarding understandability and actionability. The Turkish readability level was also reasonable and easily understandable.
This study is one of the proactive attempts to use AI in preparing educational materials for nurses and healthcare professionals.
No patient or public contribution.
To understand how Registered Nurses perceive the impact of nursing leadership on managing moral distress and mitigating burnout.
Moral distress and burnout are pervasive issues in nursing, compromising well-being, patient safety and workforce sustainability. Leadership is a critical factor in shaping workplace culture and mitigating these challenges, yet evidence remains limited.
Qualitative systematic review.
A qualitative systematic review was conducted following JBI methodology and PRISMA guidelines. Comprehensive searches across MEDLINE, PsycINFO, Embase, CINAHL and Scopus identified 5927 articles, with two studies meeting the inclusion criteria. Data were appraised using the JBI Critical Appraisal Checklist and synthesised via meta-aggregation. Confidence in findings was assessed using the ConQual approach.
Four major themes emerged: (1) Behind the barriers, (2) Breaking point, (3) Weathering the storm and (4) Leadership for lasting change. Leadership influenced nurses' psychological safety, ethical decision-making and resilience. Inadequate support amplified moral distress, and effective strategies included authentic communication, team solidarity and systemic interventions.
Leadership plays a pivotal role in mitigating moral distress and burnout. Evidence highlights the need for structural changes and support to sustain registered nurses' well-being and retention.
Findings offer direction for leadership strategies that promote ethical workplaces, shared decision-making and mental health supports to enhance resilience and patient care.
Strengthening leadership capability is vital for workforce sustainability, care quality and nurse retention.
Authors have adhered to relevant EQUATOR guidelines.
This study did not involve patients or the public in its design, conduct or reporting.
To explore the impact of simulation-based training on communication and empathy skills among nurses working with elderly patients in the Abha region of Saudi Arabia. The study also aimed to identify the barriers and facilitators to applying these skills in real-world clinical practice.
A qualitative study.
Semi-structured interviews were conducted between June and July 2024 with 17 nurses from urban and rural healthcare settings in the Abha region. Data were analysed using both deductive framework analysis, guided by social support theory, and inductive thematic analysis to identify key themes related to communication, empathy, and the application of simulation-based skills in practice. We adhered to the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist.
The study involved 17 participants aged 22–50 years, with diverse educational backgrounds and work experience. The findings indicated that simulation-based training significantly improved nurses' confidence in delivering difficult news and their ability to empathise with elderly patients. Nurses working in urban settings with regular access to simulation training reported better outcomes compared to those in rural settings with less frequent training opportunities.
Simulation-based training has a positive impact on enhancing communication and empathy skills among nurses, but challenges in real-world application remain. Efforts should be made to improve the accessibility of simulation training and address the barriers preventing its effective implementation in clinical practice.
Healthcare practitioners and policymakers should prioritise simulation-based training in nursing education and professional development to improve the quality of care for elderly patients.
The Consolidated Criteria for Reporting Qualitative Research (COREQ).
The engagement and interview data from nursing participants provided valuable insights into the impact of simulation-based training on communication and empathy in elderly care.
To examine the feasibility of using a large language model (LLM) as a screening tool during structured literature reviews to facilitate evidence-based practice.
A proof-of-concept study.
This paper outlines an innovative method of abstract screening using ChatGPT and computer coding for large scale, effective and efficient abstract screening. The authors, new to ChatGPT and computer coding, used online education and ChatGPT to upskill. The method was empirically tested using 400 abstracts relating to public involvement in nursing education from four different databases (CINAHL, Scopus, ERIC and MEDLINE), using four versions of ChatGPT. Results were compared with a human nursing researcher and reported using the CONSORT 2010 extension for pilot and feasibility trials checklist.
ChatGPT-3.5 Turbo was most effective for rapid screening and had a broad inclusionary approach with a false-negative rate lower than the human researcher. More recent versions of ChatGPT-4, 4 Turbo, and 4 omni were less effective and had a higher number of false negatives compared to ChatGPT-3.5 Turbo and the human researcher. These more recent versions of ChatGPT did not appear to appreciate the nuance and complexities of concepts that underpin nursing practice.
LLMs can be useful in reducing the time nurses spend screening research abstracts without compromising on literature review quality, indicating the potential for expedited synthesis of research evidence to bridge the research–practice gap. However, the benefits of using LLMs can only be realised if nurses actively engage with LLMs, explore LLMs' capabilities to address complex nursing issues, and report on their findings.
Nurses need to engage with LLMs to explore their capabilities and suitability for nursing purposes.
No patient or public contribution.
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