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This study aimed to explore nurses' experiences with the Braden Scale, assess their readiness for artificial intelligence (AI) technologies, and understand the innovations they envision for clinical practice.
Explanatory sequential mixed design.
The study included 118 nurses in the quantitative data and 42 in focus groups. Quantitative data were collected using the MAIRS-MS. Qualitative data were analysed using phenomenological approaches and MAXQDA.
The average age was 33.38 ± 7.42 years and 88.1% were women. The average length of professional experience is 11.66 ± 8.22 years. The average time to administer the Braden Scale was 5.02 ± 4.36 min. While 55.1% of the participants found the Braden Scale inadequate, 55.9% stated that a more comprehensive risk assessment scale was needed and the MAIRS-MS score was 78.48 ± 16.66. The sub-themes were identified: Simple and quick applicability, early risk identification, validity and reliability issues, neglecting other risk factors, making it more comprehensive and specific, developing of a new risk assessment scale, technological improvements, patient data treasure chest, creating avatars and converting speech-to-text.
This study highlights critical gaps in the Braden Scale's effectiveness. Nurses identified significant shortcomings, including non-specificity and the neglect of key risk factors, which undermine its utility in clinical settings. They emphasised that stronger risk predictions and personalised care plans can be achieved by AI technology.
This study emphasises the need to revise the Braden Scale or develop a new one due to its limitations in risk assessment, providing crucial information to improve patient care and offering new perspectives on AI integration in PI risk assessment for nursing practice.
This study highlights nurses' experiences and suggestions for improving the Braden Scale in clinical practice, emphasising their expectations for AI technology and its potential to revolutionise patient care.
The study report was prepared following the Good Reporting of A Mixed Methods Study (GRAMMS) checklist.
No patient or public contribution.
To understand the role of simulation in ensuring the development of the competencies expected by newly graduated register nurses (NGRNs) from the work initiation up to 5 months of transition.
Mixed-method study design. A longitudinal phase employing the Nurse Competence Scale (NCS, from 0 to 100, excellent) to assess the perceived competencies among NGRNs (N = 151) at three time points (first day of work up to fifth month); followed by a qualitative phase involving four focus groups of preceptors (N = 16) to explore the potential role of simulation in the NGRNs' working transition. Integration was performed at findings level, using the building procedures and joint displaying the results.
During the different time periods, variations emerged in the NCS scores from 64.41 out of 100 in the first day of work to 61.82 after 15 days, reaching 69.25 and 73.21 at 3 and 5 months. Nine potentialities have been identified as having simulation supporting NGRNs during their transition to independent practice. Simulation may contribute to develop competencies in some competence domains (diagnostic function, managing situation, therapeutic intervention, quality assurance and working role) while not in others (helping role and teaching–coaching).
Early interventions, through integration of simulation sessions into strategies offered at the unit's level may be useful to ensure an effective working transition.
Problem the study addresses: Challenges in transition from education to working settings are increasing given the difficulties of the units in providing time and support to NGRNs. Main findings: Competencies of NGRNs' are fluctuant in the five first months of work, and sub-optimal in certain domains. Simulation may support the full development of most competencies. Impact on research: Healthcare organisations can support NGRNs to ensure smoother transitions by integrating simulations in their strategy.
This study was conducted following the Good Reporting of a Mixed-Methods Study.
Only healthcare professionals were involved.
To describe all nursing home staff members' confidence in engaging in complex clinical communication with residents and family carers, and to explore factors affecting their attitudes.
A convergent mixed-methods study used questionnaires (n = 288) and 15 group-based discussions involving 278 professionals across nine nursing homes between April and May 2025. Quantitative data were analysed descriptively, and qualitative data underwent inductive thematic analysis. Findings from the two strands were compared and integrated to develop mixed-methods inferences, with qualitative data given priority to confirm, expand or contrast the survey results.
Staff members reported limited confidence in sustaining complex clinical communication, mainly because of uncertainty in responding to family carers' questions, difficulty managing emotional reactions, lack of training and unclear role responsibility. Qualitative findings identified barriers at the facility (chronic understaffing, limited physician presence, structural limitations), team (hierarchical asymmetries, limited information sharing, intraprofessional conflicts) and resident/family levels (sensory/cognitive impairments, unrealistic expectations, distrust, role confusion, intra-family conflict). Integrated findings showed convergent and divergent patterns. Qualitative data added information on communicative and relational challenges with residents/families, understaffing-driven system barriers and structural limitations. Questionnaires suggested good leadership relationship and group cohesiveness, but group discussions revealed interprofessional and intraprofessional conflicts.
Limited confidence in complex clinical communication was linked to interacting barriers at the organizational, team and resident/family levels. Effective improvement requires combining education that builds communication skills and strategies for emotionally intense conversation, protected time and spaces, team and organizational initiatives that strengthen wellbeing and collaboration, and strategies that support residents' involvement, foster family trust, and reduce unrealistic expectations and role confusion.
Findings highlight the factors that undermine professionals' confidence in sustaining complex clinical communication in nursing homes, and offer targets that policymakers, nursing home managers and educators should consider to strengthen staff-resident/family interactions.
Mixed methods reporting checklist.
None.
The incidence of head and neck cancer (HNC) is rising globally, with patients undergoing extensive surgical resection for advanced disease frequently requiring prophylactic tracheostomy to secure the airway in the early postoperative period. Specialised HNC nurses undertake extended scope tracheostomy procedures, including tube changes and decannulations, yet practice varies widely between institutions and no standardised training framework exists.
To benchmark the roles and responsibilities of specialised HNC nurses in tracheostomy management across Australia, and to explore the facilitators, barriers and enablers of nurse-led extended practice.
National mixed-methods study.
An online REDCap questionnaire was distributed to nurses with inpatient HNC tracheostomy experience within the past 5 years (n = 22). A subset participated in semi-structured interviews (n = 11), analysed using inductive thematic analysis.
Most participants were senior metropolitan-based nurses with over 12 years of HNC experience. Nine (41%) performed tracheostomy tube changes and 14 (64%) conducted decannulations. Thematic analysis identified six themes: the central role of the multidisciplinary team; education and patient support; training and skill acquisition; extended scope of practice; challenges to nurse-led management; and benefits of nurse-led management. Skill acquisition was facilitated by mentoring and high-volume exposure; barriers included collegial resistance, equipment access and workload pressures.
Specialised HNC nurses report undertaking extended scope tracheostomy procedures across a range of Australian centres, with mentoring, high-volume clinical exposure and multidisciplinary collaboration described as key enablers. Standardised competency frameworks may help to reduce inter-institutional variation; however, the safety, efficiency and patient-level outcomes of these models were not directly evaluated in this study and warrant formal investigation in future research.
This study provides the first national descriptive data on the role of nurses in tracheostomy management for patients with HNC in Australia and offers a foundation for the development of standardised training pathways. The potential impact of such pathways on efficiency, length of stay and nursing workforce capacity warrants formal evaluation in future studies.
To examine the dimensions and meanings of the work environment of Primary Health Care nurses in relation to organizational conditions and professional practice.
Sequential explanatory mixed-methods study.
This study was conducted with Primary Health Care nurses in Manaus, Brazil. The quantitative phase included 243 participants using a validated work environment scale, analysed descriptively and compared across health districts. The qualitative phase involved 16 interviews analysed through thematic analysis. The phases were integrated using joint displays and meta-inferences to connect, compare and interpret the findings.
Work motivation was classified as healthy, particularly regarding meaning, recognition and autonomy, whereas safety and strategic management fell within the attention range, without differences across the districts. The qualitative findings confirmed and expanded these results and, for motivation, reframed them: motivation rested on the meaning nurses attribute to care rather than on favourable conditions, compensating for weaknesses in safety and management, the most fragile dimension.
The work environment is sustained from within, through professional commitment, whereas the structures that should protect and organize the work remain fragile, especially in a territorially complex, resource-constrained Amazonian setting.
The findings support continuous, institutionalized strategies for worker protection, violence prevention, psychological support and participatory management.
This study shows that professional engagement coexists with organizational challenges, informing policy and workforce interventions.
STROBE and COREQ guidelines.
No patient or public involvement.
To establish a core competency item system for home-based intravenous therapy nurses in primary hospitals under the ‘Internet + Nursing Services’ framework.
Based on the ‘Iceberg Model’ theoretical framework, a preliminary framework for the core competency item system of home-based intravenous therapy nurses in primary hospitals under the ‘Internet + Nursing Services’ framework was constructed from December 2024 to May 2025 through literature review and semi-structured interviews. The content of the item system items was finalised through two rounds of Delphi expert consultations with 20 experts and the weight quantification of items at each level was completed using the analytic hierarchy process (AHP).
The response rates for the two rounds of Delphi expert consultations were 100% and 90%, respectively; the authority coefficients were 0.88 and 0.91, respectively; the Kendall harmony coefficients were all > 0.2, with statistically significant differences (p < 0.05). The final core competency item system for home-based intravenous therapy nurses in primary hospitals under the ‘Internet + Nursing Services’ framework included 86 items, comprising four first-level items, 13 s-level items and 69 third-level items.
The core competency item system for home-based intravenous therapy nurses in primary hospitals under the ‘Internet + Nursing Services’ framework established in this study is scientific and reliable, providing a reference for the future development of a unified training system and professional evaluation standards for home-based intravenous therapy nursing personnel.
The indicator system built in this study has ensured the safety of patients' home intravenous treatment, improved the public's trust and acceptance of ‘Internet plus nursing services’ and optimised the accessibility of medical services and humanistic care.
This study focuses on the construction of a professional system, with nurses and nursing experts as the research subjects, without involving patients or the public.
To understand nurses' perceptions of non-technical skills in recognising and responding to clinical deterioration in hospital settings.
A mixed methods systematic review was undertaken, guided by the Joanna Briggs Institute Manual for Evidence Synthesis.
A systematic search of the primary research literature published between 2012 and October 2025 was undertaken. A convergent integrated approach to synthesis, without meta-analysis, was undertaken.
The MEDLINE, CINAHL, Scopus, PsychInfo and Embase electronic databases were searched. Reference lists of full-text articles retrieved were reviewed for additional data sources.
Twenty-four primary studies were included. Narrative synthesis resulted in six main themes: (1) situational awareness, (2) effective teamwork and communication, (3) leadership and culture, (4) intuition, (5) level of experience and (6) fear of retribution. Across studies, supportive team culture and strong communication facilitated recognition and escalation, whereas inexperience and fear of criticism delayed action.
Early recognition and response to a clinical deterioration is beyond simply detecting physiological parameters. The process of recognition and response to a deterioration is enabled due to non-technical skills. In situations where the team has effective and positive team culture, where there is psychological safety, where all levels of expertise are given a voice without fear of retribution, everyone is safe to raise the alarm. Strengthening these skills and supporting junior nurses may improve escalation practice.
The implementation of early warning scores or rapid response systems is a well-developed mechanism to improve outcomes for deteriorating patients. Unfortunately, there has been less emphasis and value placed on development of non-technical skills in the recognition and response to clinical deterioration. Organisations and professions need to mitigate barriers to the implementation of nurses' non-technical skills to improve patient outcomes.
What problem did the study address? ○
A lack of current synthesised evidence of nurses' non-technical skills in the recognition of, and response to, clinical deterioration.
What were the main findings? ○
Organisational cultures that devalue less experienced nurses and non-technical skills, risk delays in recognition and response to clinical deterioration.
Where and on whom will the research have an impact? ○
Patients, health care professionals and health care delivery may benefit from integration of non-technical skills into deterioration response frameworks, implemented within psychologically safe organisational cultures.
Reporting Method
Preferred Reporting Items for Systematic Reviews and Meta-Analyses (2020).
Patient or Public Contribution
No patient or public contribution. This review received no financial support.
Trial Registration
The protocol for this review was registered with PROSPERO (CRD42022327788) (crd.york.ac.uk/PROSPERO/display_record.php?RecordID=327788)
To establish a comprehensive pre-implementation baseline of pain management for people living with dementia (PLWD) in acute hospitals by exploring behavioural, contextual, organisational and clinical practice factors to inform the implementation of the DOTS approach.
Pain is common yet frequently under-recognised and inconsistently managed in PLWD in acute care. Behaviour change frameworks, such as COM-B, may help identify determinants of practice and inform implementation strategies.
Multiple-methods study, underpinned by the COM-B framework and guided by the Medical Research Council framework for developing and evaluating complex interventions.
The study was conducted across five wards in two acute hospitals in the United Kingdom. Healthcare staff (n = 148) completed an adapted 6-item COM-B self-evaluation scale (0–10). Semi-structured interviews with ward managers and a pain management specialist nurse (n = 6) were analysed using deductive thematic analysis. A retrospective review of patient documentation (n = 50) assessed compliance with the National Institute for Health and Care Excellence dementia guidelines.
Staff reported high perceived capability, opportunity and motivation, suggesting strong self-reported readiness to deliver effective pain management. However, qualitative findings highlighted barriers across the COM-B domains, including knowledge gaps and inconsistent use of pain assessment tools. Documentation review highlighted deficits in recording acute pain, chronic pain history and usual pain management strategies. Only five patients received analgesia within 60 min of admission, despite many presenting with fractures or serious infections.
A discrepancy exists between self-reported behavioural determinants and documented clinical practice, indicating inconsistent pain management for PLWD in acute care.
Interventions should prioritise strengthening healthcare staff's capability and embedding structured, system-level processes to support timely person-centred pain management.
STROBE guidelines were followed.
A multidisciplinary steering group, including clinical leaders and dementia representatives, contributed to the study.
To examine parents' perceptions and experiences of family-centered care in a pediatric intensive care unit and explore how communication, participation in care, and contextual factors shape these experiences.
An explanatory sequential mixed-methods design was used.
In the quantitative phase, 50 parents of children hospitalized in the pediatric intensive care unit for at least 48 h completed the Descriptive Information Form and the Family-Centered Care Assessment Scale. In the qualitative phase, 15 parents, selected through maximum variation sampling, participated in semi-structured interviews. Quantitative data were analysed using descriptive and nonparametric methods, while qualitative data were analysed using reflexive thematic analysis. Findings from both phases were integrated during interpretation.
Parents generally reported positive perceptions of family-centered care. Exploratory quantitative findings indicated higher family-centered care and support scores among parents who reported greater participation in their child's care. Qualitative findings were organized into four themes: meanings and expectations of family-centered care, communication and professional support, experiences of participation in care, and organizational and environmental influences on care. Integrated findings showed that respectful communication, emotional support, and meaningful parental involvement strengthened family-centered care experiences. In contrast, inconsistent professional approaches, limited involvement in decision-making, and inadequate physical conditions negatively influenced parental experiences.
Parents' experiences of family-centered care in the pediatric intensive care unit were shaped not only by communication with healthcare professionals but also by opportunities for participation, relational trust, and organisational conditions. Strengthening family-centered care may require more consistent communication practices, greater parental involvement in care and decision-making, and more family-supportive care environments.
The findings highlight the importance of effective nurse-parent communication, parental involvement in care, and supportive clinical environments in strengthening family-centered care practices in pediatric intensive care units.
The study followed the Good Reporting of a Mixed Methods Study (GRAMMS) guidelines.
To identify the barriers to timely access to palliative care from the perspective of Australian inpatients and their families.
A co-designed mixed methods study with an equal status explanatory design (QUAN ➔ QUAL).
Quantitative data were collected in Phase 1 via surveys to assess participants' knowledge and experience of palliative care. In the second phase, qualitative data were obtained via semi-structured interviews to explore participants' perceptions of palliative care and to identify barriers to palliative care.
A total of 194 complete patient survey responses and 52 family/visitor responses were received. Mean self-rated knowledge of palliative care was slightly higher than self-rated knowledge of end-of-life care in both groups. Patient respondents scored a mean of 9.3 out of 13 on the Palliative Care Knowledge Scale and family visitor respondents had a mean score of 9.7. Statistically significant differences in the mean Palliative Care Knowledge scores were found when patient and family respondents reported being familiar with palliative care. A total of 11 patients and nine family members participated in an interview in Phase 2. Three main themes and nine subthemes were identified. The three main barriers were Communication, Knowledge and Perceptions, and Accessibility.
Patients and family members perceived a range of barriers to palliative care at the individual, health professional, and system level. These findings highlight areas where targeted interventions should be developed to improve timely access to palliative care.
While the perspectives of health professionals are well known, the perceptions of patients and families on the barriers to palliative care are underreported. A wide variety of complex issues that could impede timely access to palliative care were identified at the individual, health professional and system level. Health consumer perspectives are essential to fully understanding the barriers to palliative care access. The findings of this research can be used to inform future interventions to improve access to palliative care.
Good Reporting of A Mixed Methods Study (GRAMMS) checklist (Data S2) (O’Cathain et al., 2008).
The study was guided by a steering group of health consumers and health professionals working in partnership with the research team through all stages of the research process.
Health literacy has become increasingly important in healthcare and education. The aim is to provide an overview of school nurses' activities to increase health literacy in schools, and to analyse their conceptual understanding of health literacy.
This mixed-methods study consists of an online survey (n = 65), two focus group interviews (n = 16) and non-participatory observations with school nurses in Germany (n = 5), and expert interviews with interest-holders (n = 10). School nurses' health literacy-related activities, conceptual health literacy understanding, and critical health literacy (measured by the Critical Health Competence Test) were assessed. Quantitative data were analysed descriptively, and the qualitative data by content analysis. Quantitative and qualitative findings were integrated and triangulated using a convergent design.
School nurses address health literacy among students and their relatives through counselling, teaching support, and acute care. Their services are primarily based on a functional health literacy understanding. Experts view schools as key settings for health literacy, led by school nurses.
School nurses use real-life oriented, low-threshold activities to address health literacy and empower students. School nurses' critical health literacy and evidence-based practice could be improved.
School nurses represent a valuable resource to address health literacy in German schools, in line with international approaches. These interventions should be expanded.
This study followed the criteria for Good Reporting of A Mixed Methods Study (GRAMMS), the consolidated criteria for reporting qualitative research (COREQ) and the Checklist for Reporting Results of Internet E-Surveys (CHERRIES).
No direct patient or public contribution.
To identify strategies for fostering sustainable second-order problem-solving behaviours among hospital nurses. The study evaluates the impact of an emotive audio narrative stimulus and examines barriers and enablers in a simulated clinical environment.
Mixed-methods observational study.
Eighty hospital nurses were randomly assigned to either an emotive patient-safety audio narrative or a control condition before completing two simulated tasks embedded with system-level operational failures. Real-time behaviours were coded; quantitative data were analysed using chi-square tests and logistic regression. Semi-structured interviews elicited actionable recommendations for practice implementation.
Despite widespread detection of operational failures (96.2%), second-order problem-solving behaviours remained infrequent across both tasks (overall 21.9%). While the narrative triggered strong emotional responses, it did not increase escalation or formal reporting behaviours. Nurses identified normalization of deviance, time pressure and absence of feedback loops as structural barriers to problem-solving agency. Conversely, team debriefings, audit-feedback mechanisms and simulation-based failure training were cited as enablers.
Emotional triggers raise awareness but do not bridge the awareness–action gap. Sustainable second-order problem-solving requires organizational strategies—such as team reflection, audit feedback and simulation training—that empower nurses and strengthen system learning.
To reduce patient harm from unresolved operational failures, healthcare organizations must promote failure awareness alongside redesigning work systems that facilitate escalation, interdisciplinary collaboration and empower nurses to improve flawed processes sustainably.
GRAMMS checklist.
Not applicable.
To achieve expert consensus on quality indicators for evaluating discharge planning processes in inpatient mental healthcare settings. This study is part of a larger multiphase project to develop an instrument to measure and evaluate the quality of discharge planning in mental healthcare.
A modified two-round Delphi study.
A province-wide multidisciplinary expert panel comprising nurses, social workers, occupational therapists and psychiatrists across Ontario, Canada completed two online survey rounds. Panel members assessed 79 preliminary indicators identified from a prior concept analysis and focus groups, rated the importance of each indicator and provided narrative feedback to support indicator refinement.
In Round 1, 37 panellists evaluated 79 quality indicators. Seventy-four indicators achieved the predefined consensus threshold; however, further review of panel feedback resulted in the removal, consolidation and refinement of indicators due to conceptual overlap, redundancy, or feasibility concerns. Thus, fifty-three indicators were retained following Round 1. In Round 2, 36 panellists reviewed the revised indicator set and evaluated three new candidate indicators. Two additional indicators achieved consensus and one indicator was reinstated, resulting in a final set of 56 indicators across seven domains: Comprehensive Needs Assessment (n = 14), Information Gathering and Synthesis (n = 3), Patient Capacity Assessment (n = 4), Collaborative, Patient-Centred Care (n = 14), Resource Availability Management (n = 5), Care and Service Coordination (n = 7) and Discharge Plan (n = 9).
A multidisciplinary expert panel reached consensus on 56 quality indicators evaluating discharge planning processes in inpatient mental healthcare settings. The findings provide an evidence-informed foundation for future development and testing of measurement approaches to evaluate discharge planning quality in mental healthcare.
The discharge planning domains and quality indicators identified in this study may support future efforts to evaluate discharge planning processes, identify gaps in care and inform quality improvement initiatives aimed at supporting continuity of care and transitions from hospital to community settings.
This study addresses the lack of standardized quality indicators for evaluating discharge planning processes in inpatient mental healthcare settings. Through a two-round Delphi process, a multidisciplinary expert panel reached consensus on 56 indicators reflecting core components of discharge planning, including comprehensive needs assessment, patient capacity evaluation, coordination of community services and supports, housing-related planning and follow-up care. The study findings provide a foundation for future development and psychometric evaluation of a standardized measurement instrument to assess discharge planning quality.
This study is reported in accordance with the Guidance on Conducting and Reporting Delphi Studies (CREDES) recommendations.
No patient or public contribution.
To develop a care-bundle of non-pharmacological strategies with the potential to prevent constipation in people with dementia in Residential Aged Care (RAC).
Mixed-methods intervention development study using Modified Delphi and co-design, informed by evidence, current constipation prevention practices and stakeholder collaboration to define best practice.
The draft bundle was developed using evidence from a scoping review, consultations with aged care professionals and staff at two RAC homes and field observations. It was then refined through expert and lived-experience panels via an online Modified Delphi survey (rating relevance, acceptability and feasibility) and a face-to-face workshop to finalise items for the constipation prevention care-bundle.
Health data, interviews, observations, surveys and workshops.
The draft care-bundle comprised 24 items; 13 reached ≥ 78% agreement in the Modified Delphi, including dietitian consultation, adequate fibre, individualised hydration and toileting plans, beverage cart, constipation risk assessment, privacy during toileting, dementia-friendly signage, toileting positioning, contrasting toilet seat, electronic alerts, staff education and resident/family information.
An evidence-informed and co-designed care-bundle was co-developed with potential to prevent constipation in residents with dementia.
This research has implications for nursing practice by offering an alternative to reliance on pharmacological strategies for preventing constipation in people with dementia.
This co-designed and evidence-informed care-bundle has potential to reduce the incidence of constipation among the growing population with dementia. To ensure sustained use, it was co-designed with stakeholders to be fit-for-purpose.
There were no reporting guidelines for this co-design study identified.
End-users, including frontline staff and older people receiving care, as well as carers of people with dementia, were engaged in the co-design as equal partners in the constipation prevention care-bundle development process.
To construct and evaluate a decision tool that minimizes physical restraint (PR) use while maintaining positive patient outcomes in an adult intensive care unit (ICU). It also aimed to understand nurses' perspectives regarding implementing the decision tool into routine ICU practice.
A mixed-method design.
This study employed a mixed-method design, consisting of a Delphi study to develop a physical restraint decision tree (PRDT), a quasi-experimental study to evaluate the effect of PRDT on minimizing PR use in an adult ICU, and a qualitative interview to understand nurses' perspective and satisfaction of using the PRDT in daily practice. We compared the data on PR use and patient outcomes before and after applying the PRDT in an ICU.
The PR rate was 48.1% before applying the PRDT from January to June 2018, significantly dropped to and maintained at 10.1% after implementing the PRDT from October 2018 to December 2022. After the implementation of the PRDT, the average length of ICU stays significantly reduced from 4.66 to 3.71 days; the average daily cost of ICU stays per patient dropped from 5084.13 CNY to 4312.02 CNY. No adverse events, such as catheter extrusion and fall, had occurred. Nurses encountered high satisfaction regarding integrating the PRDT into ICU practice.
The PRDT provides a structured, evidence-based approach to guide clinical decisions of lowering PR use in daily ICU practice. Implementation of the PRDT significantly reduced PR use without increasing adverse events.
The PRDT can serve as a tool for standardizing practices across the ICU, ensuring that restraint use is consistent with best practice guidelines and minimizing variability in care.
SQUIRE 2.0 guidelines.
No patient or public contribution.
Nurses' scope of practice is central to healthcare delivery. While scope of practice is well described conceptually, there is limited empirical research capturing how it is enacted in everyday clinical practice. This study aimed to describe scope of practice in home-based care, focusing on care activities, clinical decision-making, professional autonomy and contextual modulators.
A multi-method observational design.
Three nursing teams within home healthcare services in a Norwegian municipality—the DECIDE project.
Quantitative and qualitative data were collected through structured observations guided by a conceptual framework. Data were analysed using descriptive statistics and qualitative categorisation.
A total of 827 care activities were observed across 239 observations. Care activities most often addressed physical and medical needs, while psychosocial needs were less frequently observed. Registered nurses more often engaged in both direct and indirect care and primarily delivered compensatory care. Clinical decision-making was most frequently observed during assessment, while other phases of the nursing process, particularly evaluation, were less evident. These patterns were consistently associated with contextual modulators observed during care delivery.
Nurses' scope of practice in home-based care is enacted through care activities and emerges as a context-sensitive, system-level phenomenon shaped by contextual modulators. Registered nurses frequently performed tasks beyond planned visits, while non-registered nurses concentrated on activities of daily living. Both groups showed limited engagement with the evaluation phase of the nursing process.
Strengthening clinical leadership, decision-making autonomy, and organisational support may support enactment of scope of practice and improve care quality in home-based settings.
The study followed reporting standards for mixed-methods research and was appraised using the Mixed Methods Appraisal Tool.
Patient and public involvement was incorporated at the DECIDE project level but not in this observational study.
To explore factors in the implementation of the Promoting Resilience in Nurses program that may help explain variation in outcomes between intervention and control groups in the randomised controlled trial of the program.
A convergent mixed methods process evaluation conducted alongside a randomised controlled trial.
Data collection included participant satisfaction surveys, follow-up participant interviews, unit/team manager surveys on barriers and facilitators to staff program participation, and a program fidelity survey. Quantitative data underwent descriptive analysis, and qualitative data were thematically analysed. Findings were integrated with trial outcomes using joint display to generate meta-inferences.
Nurses reported high program satisfaction. Both nurses and managers found the program valuable and supported its wider implementation. Barriers to implementation included heavy workloads and staff shortages. Meta-inferences indicated that positive changes in nurses' trial outcomes resulted from strong program fidelity (95% full delivery) and the program's provision of cognitive and emotional self-regulatory skills, stress management and coping strategies and interpersonal skills.
Implementing this effective resilience program requires stakeholder support to address implementation barriers and embedding of the program into standard professional development.
Maintaining nurses' wellbeing, resilience, and practice is a shared responsibility. Healthcare organisations can provide nurses with wellbeing resources and support, including effective resilience interventions. Nurses can utilise these resources and engage in self-care to maintain their wellbeing and practice.
This is the first reported process evaluation of a nurse resilience program. Identified implementation factors help explain nurses' positive mental health and wellbeing program outcomes and barriers and facilitators to wider program implementation.
The Good Reporting of A Mixed Methods Study (GRAMMS) was used to inform the reporting of this study.
No patient or public contribution.
The Promoting Resilience in Nurses trial, in which this process evaluation is embedded, was registered with the Australian New Zealand Clinical Trials Registry (ACTRN12620001052921) on 15 October 2020. Full details are accessible at the registration website (https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380026). The protocol of this process evaluation has been published in the International Journal of Mental Health Nursing (doi.org/10.1111/inm.12989).
To describe the quality of nurse–patient interactions when nurses use Electronic Health Record systems in four acute hospital wards.
An explanatory sequential mixed methods study.
Sixteen researcher observations were conducted using a published Quality of Interactions Schedule tool to evaluate the duration and quality of nurse–patient interactions. Observations were followed by 16 nurse and 16 patient interviews. Data were analysed by descriptive statistics and thematic analysis and integrated to inform overall study meta-themes.
Three study meta-themes emerged: (1) Limited social, open, reciprocal and face-to-face nurse–patient communication; (2) Cumbersome computer systems monopolised nurses' time and attention and impeded face-to-face communication; and (3) Nurses' use of Electronic Health Record scripts fostered a task-orientated agenda.
Nurses, healthcare employers and system developers need to consider the unintended impact of nurses' use of Electronic Health Records on the quality of nurse–patient interactions. Nurses need to evaluate practices that promote, and not hinder, quality nurse–patient interactions when nurses use Electronic Health Record systems in acute care settings. Researchers developing Electronic Health Record systems need to involve nurses and patients.
Balancing the complex tripartite relationship between the nurse, patient and digital interface has implications for nursing practice, education and research. The challenges encountered when nurses use Electronic Health Records need to be addressed to promote quality nurse–patient interactions. Less obtrusive Electronic Health Record technology is required that is developed with nurses who are the principal users. Nurse educators need to promote techniques that facilitate person-centred communication when nurses use Electronic Health Record systems and researchers need to evaluate practices that promote quality nurse–patient interactions. Digital transformation will continue to dominate nursing in the future and the significant findings from this study will help inform further exploration and developments in this area.
Patients consented to the collection of data and for the data to be used in future potential publications. Patient participants were all discharged from the acute care hospital soon after data collection.
This study examined the factors influencing psychological crisis vulnerability (PCV) in older patients with multimorbidity and identified barriers/facilitators to expressing psychological distress. This was aimed at supporting clinical interventions and ageing policies.
A cross-sectional study.
This study was designed using explanatory sequential mixed methods. In the quantitative study, 685 older patients in the inpatient and outpatient clinics of a tertiary hospital were selected using convenience sampling, and a cross-sectional survey was conducted using the Psychological Crisis Vulnerability Scale (PVS). In the qualitative study, 14 older patients with multiple chronic diseases in the geriatric department were interviewed in depth, and the interaction mechanism between vulnerability and self-disclosure was analysed. Qualitative themes on disclosure barriers/facilitators were contextualised within the high PCV subgroups (scores ≥ 80), demonstrating how vulnerability modulates self-disclosure.
The quantitative study showed that the PCV score of older patients with multimorbidity (69.4 ± 12.8) was significantly lower than that of the community older norm, indicating that their PCV was at the lower to middle level. Multifactorial analysis showed that residence status, economic situation, marital status, age, type of chronic disease, and hospitalisation in the preceding 6 months were the main factors affecting PCV. The qualitative study extracted hindering factors (e.g., introverted personality, family atmosphere, negative cognition, economic pressure, negative feedback, insufficient knowledge, and time weakening) and facilitating factors (e.g., perceived benefits after disclosure, a good support system, and a strong willingness to express oneself) affecting self-disclosure.
PCV in older patients with multimorbidity emerges from multidimensional determinants and complex self-disclosure dynamics.
Strategic improvements in risk assessment protocols, positive expressive behaviour cultivation, layered psychosocial support frameworks, and healthy ageing policy execution collectively enhance mental well-being and sustainable ageing trajectories.
The study follows the STROBE guidelines.
Older patients from tertiary hospitals participated in this study.
To examine how nurse practitioners in Australia request diagnostic imaging and identify educational and system-level barriers that influence this practice.
Cross-sectional national survey.
An online survey of nurse practitioners in Australia.
Survey responses from 119 nurse practitioners demonstrate that diagnostic imaging is widely used and viewed as integral to nurse practitioner practice, yet educational preparation is inconsistent. Although most felt confident and well-prepared to request imaging, insufficient imaging content in nurse practitioner programs and knowledge gaps related to radiation exposure and rebate processes were highlighted. Systemic barriers, including restricted patient rebates, organisational constraints and resistance from radiology providers were frequently cited as barriers to practice.
Diagnostic imaging is integral to nurse practitioner practice, yet inconsistent educational preparation and significant structural barriers hinder full utilisation.
Reducing structural barriers and enhancing diagnostic imaging education would enable nurse practitioners to work to full scope, reduce duplication in practice and ultimately improve patient access.
Findings inform an under-examined component of nurse practitioner practice and highlight priorities for future healthcare policy and education.
The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist for cross-sectional studies.
No patient or public contribution.
FreshRSS 