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Nursing‐Led Knowledge Translation Strategies to Improve Patient Safety in Hospital Settings: A Scoping Review

ABSTRACT

Aim

To conduct a scoping review of nurse-led Knowledge Translation strategies aimed at promoting and enhancing patient safety in hospital settings.

Design

Scoping review.

Methods

This review followed the Joanna Briggs Institute methodology and was reported according to PRISMA-ScR.

Data Sources

Twelve electronic databases and additional grey literature sources were searched for studies published between 2002 and 2023, with no language restrictions.

Results

From 23,691 records identified, 59 studies were included. The majority (n = 56) employed multifaceted Knowledge Translation strategies, incorporating simulation, audits, digital tools and interprofessional education. The interventions focused on patient safety-related events, including falls, pressure injuries and catheter-associated complications. Nursing leadership emerged as a key component, particularly in team training, developing care protocols and delivering feedback. Outcomes included reductions in adverse events, improved adherence to clinical guidelines and cost savings. Yet, sustaining behaviour changes over time and limited interprofessional and family engagement remained recurrent challenges.

Conclusions

Nurse-led Knowledge Translation strategies were heterogeneous, with increasing use of simulations, technologies and multifaceted approaches. Evidence suggests potential associations with fewer adverse events, improved care quality, individualized planning and cost efficiency. Challenges related to the sustainability of interventions persist. Findings underscore the importance of investing in nursing leadership and capacity-building to strengthen patient safety.

Implications for the Profession and/or Patient Care

Strengthening nurse-led KT capacities may enhance evidence-based care and improve safety outcomes. Investment in leadership and tailored implementation is critical.

Impact

What problem did the study address? The limited synthesis of how nurses lead KT strategies to improve patient safety in hospitals. What were the main findings? Most strategies were multifaceted, context-sensitive and associated with improved care processes and safety indicators. Where and on whom will the research have an impact? Findings are relevant to hospital nurses, nurse educators, managers and health systems seeking to implement evidence-informed safety interventions.

Reporting Method

This scoping review followed the PRISMA-ScR reporting guideline.

Patient or Public Contribution

This study did not include patient or public involvement in its design, conduct or reporting.

Trial Registration

Open Science Framework (OSF); registration identifier: 10.17605/OSF.IO/K3VJC

Clinical Trials in Central Venous Access Devices: An Evidence and Gap Map

ABSTRACT

Aims

To systematically map the landscape of central venous access device research from 2014 to 2024, identifying critical gaps in evidence that may impact nursing practice and patient outcomes across the full device lifecycle from selection through to removal.

Design

This review was conducted in accordance with the Guidance for producing a Campbell evidence and gap map and reported following Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines.

Data Sources

PubMed, Cumulative Index to Nursing and Allied Health Literature Complete, Scopus, and Cochrane Central Register of Controlled Trials were systematically searched with additional hand-searching of reference lists from included reviews.

Methods

We systematically reviewed literature published between 2014 and 2024, mapping 710 studies on central venous access device interventions and outcomes. Studies were categorised by design, population, setting, device characteristics, intervention types, and outcomes. Evidence was evaluated using the National Health and Medical Research Council levels of evidence framework.

Results

Of 710 included studies, 89 were systematic reviews and 621 primary studies, of which 41.1% (n = 292) were randomised controlled trials. Research was primarily conducted in high-income countries (n = 405, 65.2%) and focused on adults (n = 370, 59.6%) in hospital inpatient settings (n = 588, 94.7%). Catheter insertion and infection prevention dominated the evidence base, while device selection and removal procedures were less studied. Infection outcomes were extensively reported (bloodstream infection: n = 455, 13.6% of 3349 outcomes), while patient-reported outcomes (n = 218, 6.5%) and cost (n = 60, 1.8%) were underrepresented.

Conclusions

This review reveals that central venous access device research is predominantly focused on insertion and infection prevention while other key parts of nursing practice are under-supported.

Implications for the Profession and/or Patient Care

Future nursing research should address these gaps to improve evidence-based care across diverse populations and healthcare contexts, particularly focusing on understudied device types, settings, and vulnerable populations.

Reporting Method

This review was conducted and reported in accordance with the Guidance for producing a Campbell evidence and gap map.

Patient or Public Contribution

This study did not include patient or public involvement in its design, conduct, or reporting.

Implementation of the ‘Countdown to Theatre’ Approach to Bridge the Evidence–Practice Gap in Paediatric Preoperative Fasting: A Quality Improvement Initiative

ABSTRACT

Aim

To evaluate the ‘Countdown to Theatre’ intervention, a co-designed nurse-led approach developed using the COM-B framework to address context-specific barriers and facilitators to preoperative fasting practices.

Design

A prospective mixed-method, pre–post study assessed the intervention's impact on fasting adherence and patient experience.

Methods

Participants included children booked for a procedure under general anaesthesia. Adherence was assessed through audited fasting duration, and patient experience was evaluated using caregiver/patient surveys. The intervention was implemented and monitored by nursing staff as a part of a structured quality improvement process. Nurses played a central role in embedding the approach into daily workflows and reinforcing fasting timelines

Results

Over 9 months, 901 observations were undertaken from 774 patients. Fasting duration decreased from 7.6 to 5.7 h (mean difference −1.94; 95% CI −3.04, −0.86). Parent-reported patient experience surveys showed improvement in many areas, including an increase in overall satisfaction (from 44.7% to 68.8%).

Conclusion

The intervention successfully reduced prolonged fasting and improved patient experiences, demonstrating the value of co-designed approaches in addressing evidence–practice gaps in perioperative care.

Implications for Patient Care

The principles of co-design, structured implementation and the application of the COM-B framework provide a replicable model for addressing similar challenges in healthcare. The study highlights the pivotal role of nurses in improving perioperative practices, supporting both patient safety and satisfaction. Future research should explore the intervention's applicability across diverse settings and patient populations.

Impact

Despite evidence-based guidelines, excessive preoperative fasting remains prevalent in practice. This study demonstrates that a structured, nurse-led intervention can successfully reduce fasting durations and enhance patient experience, reaffirming the nursing profession's capacity to lead meaningful change in perioperative care.

Reporting Method

Standards for quality improvement reporting excellence (SQUIRE 2.0).

Patient or Public Contribution

Patients and caregivers contributed to the co-design of the intervention, ensuring that it addressed practical challenges related to preoperative fasting.

Longitudinal Mediating Role of Cancer‐Coping Self‐Efficacy Between Symptom Occurrence and Quality of Life Among Cancer Patients: A Cross‐Lagged Panel Model

ABSTRACT

Purpose

Although the positive correlation between self-efficacy and quality of life and the negative correlation between symptom occurrence and self-efficacy are well established in the cancer literature, the underlying mechanism, whether self-efficacy mediates the effect of symptoms on quality of life, remains unclear due to the cross-sectional design of prior studies. Longitudinal investigation is crucial for establishing the causal mechanism of self-efficacy in mitigating the adverse impact of cancer-related symptoms on quality of life.

Aim

To examine the longitudinal mediating effect of self-efficacy on the relationship between symptom occurrence and quality of life among 534 cancer patients on treatment with moderate to high symptoms.

Methods

This is a secondary data analysis of the longitudinal mediating effect. A sample of patients with moderate to high symptoms on cancer treatments (N = 534) from a randomised controlled trial was used. We adopted a cross-lagged panel model (CLPM) approach to test the longitudinal mediating effect with three waves. The longitudinal invariance of the measurement was previously tested.

Results

The results showed that cancer-coping self-efficacy predicted the following assessment of symptom occurrence, but not vice versa. Also, cancer-coping self-efficacy had an immediate direct impact on quality of life and the influence sustained to the following assessment. Our mediating analysis showed that cancer-coping self-efficacy totally mediated the relationship between symptom occurrence and quality of life (unstandardized β = −0.008, standardised B = −0.036, p = 0.036, CI95 = [−0.001, −0.016]).

Conclusion

Our findings provide initial evidence supporting the causal mechanism of cancer-coping self-efficacy in interventions that aim for symptom management and quality of life improvement.

Implications

This study is the first to test the longitudinal mediating mechanism of cancer-coping self-efficacy in the relationship between symptom occurrence and quality of life among the cancer population. Further testing using a randomised controlled trial of a specifically designed self-efficacy-enhancing intervention is needed.

Patient or Public Contribution

No patient or public contribution.

‘Living Well With a PICC at Home’: Co‐Design and Evaluation of a Peripherally Inserted Central Catheter (PICC) Booklet

ABSTRACT

Aim

To co-design an information booklet to support adults living with a peripherally inserted central catheter (PICC) at home.

Design

A sequential, mixed-method approach using Boyd's co-design framework.

Method

A diverse project team led co-design of a PICC booklet based on preferences and PICC management strategies identified through content analysis of interviews with 15 Australian health consumers (January 2022–March 2023) using a qualitative descriptive approach. A draft booklet was developed, reviewed by the team and prototyped, which was evaluated by consumer participants and an external nurse panel, with readability assessed using Flesch Reading Ease and Flesch–Kincaid scores. The project team reviewed feedback, reached consensus on changes and collaborated with designers to produce the final booklet.

Results

Consumer participant strategies were classified into four categories: enhancing coping, taking responsibility and understanding information, modifying life and accessing supports. Two pre-determined categories were included (participant recommendations for PICC education resource content and top tips for living with a PICC). The prototype was evaluated as highly relevant (3.9/4), comprehensive (3.8/4) with an appropriate writing style and visual appeal. Readability scores were 76.1/100 (Flesch Reading Ease) and 6.9 (Flesch–Kincaid grade level). The final booklet contained 13 sections.

Conclusion

A co-design approach successfully created a novel PICC information booklet with positive evaluations.

Implications

Provides understanding of consumer information preferences to inform PICC education and offers insight into consumer-developed strategies and knowledge for living with a PICC.

Impact

A co-designed PICC information booklet based on consumer knowledge may augment nursing education for people living with a PICC to improve outcomes.

Reporting Method

The qualitative component follows the EQUATOR network COREQ guideline. A co-design research reporting standard is not available.

Patient or Public Contribution

A consumer representative was a member of the project team and contributed to study design, interpretation of findings and development of the booklet and manuscript.

Essential Factors That Support National Implementation of Designated Registered Nurse Prescribing: A Systems‐Thinking Approach

ABSTRACT

Aim

To explore multidisciplinary clinical, academic, policy and governance stakeholders' perceptions of enablers and barriers to implementing designated registered nurse prescribing in Australia, using a systems-thinking approach.

Design

A two-phase explorative study using a systems-thinking lens to investigate complex health-system interdependencies.

Methods

Fifty-three participants were recruited from all Australian states and territories, including registered nurses, nurse practitioners, pharmacists, medical practitioners and health-service planners. Phase 1 involved interviews and focus groups conducted between February 2024 and April 2024 (n = 45), analysed using deductive content analysis, guided by the Sustainability of Innovation Framework. Phase 2 was a face-to-face workshop conducted in August 2024 (n = 28), with data from participant discussions and observer field notes analysed inductively and refined through reflexive dialogue. Reflexive analysis of the findings allowed the construction of recommendations for implementation in various healthcare contexts.

Results

In Phase 1, participants representing all Australian jurisdictions and healthcare contexts identified that successful adoption of designated registered nurse prescribing is contingent upon several interrelated system components. These interconnected factors influence each other within the broader healthcare system and serve as the focus for Phase 2.

In Phase 2, participants reported context-specific service models, stakeholder engagement, financial support, clear messaging and workforce/organisational readiness for new models of care and service delivery were recognised as dynamic interrelated elements. Three overarching themes for successful implementation were generated: The Standard—just one piece of the puzzle. Harnessing collective capability. Shared wisdom for success.

Conclusion

National implementation of registered nurse prescribing requires consistent but context-responsive reforms. A systems-thinking approach underscores the need for whole-of-system strategies, acknowledging interdependencies and avoiding rapid, unplanned implementation. This study highlights that sustainable adoption of registered nurse prescribing in Australia depends on recognising system interdependencies and their dynamic nature.

Implications for the Profession and/or Patient Care

Designated registered nurse prescribing has the potential to improve timely access to medicines and enhance patient-centred care when implemented with whole-of-system support.

This study provides key systems-level recommendations to guide policymakers and healthcare services to successfully implement designated registered nurse prescribing across various settings.

Impact

This study highlights key stakeholders' perspectives, providing valuable insights on the essential elements required for the successful adoption of this expanded practice.

Broad systems-level recommendations are offered to guide policymakers and healthcare services to successfully implement designated prescribing across various settings, taking into account the complexity of the healthcare system.

Reporting Method

Consolidated criteria for reporting qualitative research guidelines.

Patient or Public Contribution

This study did not include patient or public involvement in its design, conduct or reporting.

Registration

Not registered.

Ten‐Year Update of Nurse Practitioner Service Impact on Patient and Health Service Outcomes in Emergency Care Settings—A Systematic Review

ABSTRACT

Aims

To provide a 10-year update on the best available evidence evaluating the impact of nurse practitioner services on cost, waiting times, patient satisfaction, representation rates, and length of stay in emergency and urgent care settings.

Design

Systematic review.

Data Sources

The search was completed on January 28, 2025, in Embase (Elsevier), Medline (EBSCOhost), CINAHL (EBSCOhost), Cochrane Library (Wiley), Emcare (Ovid), Web of Science Core Collection (Clarivate) and Scopus (Elsevier). The data range (2014–2024) was used to limit the search.

Methods

The search was conducted with results imported into Covidence. In Covidence, two reviewers conducted screening, data extraction, and quality appraisal of articles, and findings were analysed using a narrative synthesis approach. Eligible studies examined nurse practitioner services in emergency or urgent care settings, reporting outcomes of cost, waiting times, patient satisfaction, representation rates, and length of stay.

Results

Title and abstract screening were performed on 2329 records. Of these, 236 full-text articles were reviewed, and 17 underwent critical appraisal and data extraction. Narrative analysis of outcome measures yielded mixed results, with both favourable and unfavourable findings reported regarding nurse practitioner services.

Conclusions

Global evaluation of nurse practitioner services in emergency care remains inconsistent. Nevertheless, emerging evidence supports their positive impact, particularly in improving patient outcomes. To effectively inform policy, workforce planning and clinical integration, there is a need for professional benchmarks that provide clear frameworks for the evaluation of patient-centred outcomes and operational impacts in emergency departments.

Implications

Evidence related to nurse practitioner services in emergency and urgent care clinics highlights the positive impact of nurse practitioner services on patient wait times and satisfaction; however, there is limited and variable evidence of impact on health care costs and outcomes.

Impact

This paper recommends that evaluating emergency nurse practitioner services requires homogeneous research using consistent professional benchmarks and evaluation frameworks.

Reporting Method

This systematic review follows the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines.

Patient or Public Contribution

This study did not include patient or public involvement in its design, conduct, or reporting.

Trail Registration

PROSPERO 2025 CRD420250645148.

Care Needs for Patients Screened Positive for Cognitive Impairment and Delirium: A Cross‐Sectional Observational Study

ABSTRACT

Aim

To describe the point prevalence of cognitive impairment in hospitalised adults and evaluate the association with care needs and perceived risks of complications.

Design

Multi-site cross-sectional study on a single day in May 2023.

Methods

Trained clinician auditors screened adult inpatients in acute medical, surgical, oncology, geriatric, mental health, convalescent, and rehabilitation wards for cognitive impairment using the 4AT in seven healthcare facilities and recorded need for support with basic activities of daily living, incontinence, and perceived risks of complications (falls, pressure injuries, and malnutrition). Data were summarised and compared across 4AT categories, and the strength of association between 4AT and each outcome was estimated using multivariable regression models.

Results

Data were available for 1145 inpatients on 68 wards (mean age 68 years [SD = 18], 583 [58.9%] female, 449 [39.2%] on acute medical units). Cognitive impairment (4AT of 1 or more) was identified in 482 (42.1%) participants. Participants with 4AT 1–3 had 2.0–3.6 times the odds of need for supervision or assistance with activities of daily living, while those with 4AT 4 or more had 2.9–5.3 times the odds of need for assistance.

Conclusion

Cognitive impairment is very common in adult inpatients and is associated with significantly higher physical care needs.

Implications for the Profession and Patient Care

Hospital care models must support staff to address the higher care needs in people with cognitive impairment to protect a large patient group from hospital-acquired harm.

Patient or Public Contribution

No patient or public contribution.

Reporting Method

This study adheres to the STROBE reporting guidelines.

Exploring Parents' Experiences and Perceptions of Caring for Children With Feeding Difficulties and Developmental Disabilities: A Descriptive Qualitative Study

ABSTRACT

Aim

To explore the experiences and perceptions of Singaporean parents in managing feeding difficulties among children with developmental disabilities.

Study Design

A descriptive qualitative study design was used.

Methods

Twenty parents were recruited via convenience sampling from a paediatric feeding clinic in a public hospital in Singapore between July and October 2024. One-to-one interviews were conducted using a semi-structured interview guide. Thematic analysis was used to analyse the data.

Results

Four themes were identified: (1) Feeding as a ‘guessing’ game; (2) mutual understanding within the family and community; (3) beliefs regarding developmental disabilities and feeding difficulties; and (4) challenges in accessing adequate support. There were a total of nine subthemes supporting these themes.

Conclusion

This study revealed that parents of children with developmental disabilities faced challenges in adjusting to their child's feeding preferences, dealing with conflicting views on feeding practices among caregivers, and accessing adequate support. Parents also valued instrumental support from grandparents and domestic helpers, as well as emotional support from online peers. Additional research and targeted interventions are needed to better support parents of children with developmental disabilities in managing feeding difficulties.

Implications

Policies should facilitate the provision of feeding-specific resources, treatment, and education for parents. Additionally, healthcare providers should proactively assess feeding-related concerns and address misconceptions to enhance parental awareness of feeding difficulties and how they can improve the feeding practices of their children with developmental disabilities. Future research should obtain a more in-depth understanding of how differing beliefs in feeding difficulties between parents can impact the child's developmental outcomes, as well as the support and resources that may address feeding needs in these children.

Reporting Method

This study followed the reporting guidelines outlined by the Consolidated criteria for Reporting Qualitative (COREQ) research checklist.

Public Contribution

This study did not include patient or public involvement in its design, conduct, or reporting.

A Survey of Nurses' Views of the Current and Future Role of Community Registered General Nurses (CRGN)

ABSTRACT

Aim

To explore the views of community registered general nurses and directors of public health nursing on the current and future role of the community registered general nurse in the Republic of Ireland.

Design

Anonymous cross-sectional descriptive survey.

Methods

Two questionnaires were developed; one targeted at community registered general nurses and one targeted at assistant directors of public health nursing or directors of public health nursing who were working with community registered general nurses. Social media was used to recruit participants. Descriptive statistics were used while data from open-ended questions were analysed using NVivo software.

Results

A total of 97 community registered general nurses and 28 assistant directors of public health nursing or directors of public health nursing completed the surveys in 2023. There was consensus that community registered general nurses provide holistic care, including case management of adults with complex health needs living in the community. However, lack of promotional opportunities coupled with poor remuneration has resulted in job dissatisfaction. Respondents felt that community registered general nurses should focus on older adults, whereas public health nurses should focus on child health.

Conclusion

The role of the community registered general nurse needs to be clarified, and a promotional pathway developed to attract new graduates to this post.

Impact

This paper outlined the current role and vision for the future role of community registered general nurses.

Reporting Method

CROSS guidelines.

Client or Public Contribution

No patient or public contribution.

What Does This Paper Contribute to the Wider Global Clinical Community?

This paper contributes to the challenges community nurses face regarding increased demand for community nursing, lack of career structure for some community nurses, and difficulties with staff retention within the community.

A novel approach for longitudinal analysis of serum biomarkers of joint metabolism and knee injury in military officers

by Liubov Arbeeva, Virginia B. Kraus, Amanda E. Nelson, Maryalice Nocera, Leigh F. Callahan, Richard F. Loeser, Kenneth L. Cameron, Jesse R. Trump, Stephen W. Marshall, Yvonne M. Golightly

Purpose

To investigate the longitudinal relationships between serum biomarkers of joint metabolism, knee injury, and Knee Injury and Osteoarthritis Outcome Score (KOOS) using novel methodologies.

Methods

Data were collected from military officers who enrolled as cadets between 2004–2009, with follow-up conducted between 2015–2017. Analyses included 234 officers who had no history of knee ligament/meniscal injury at the time of military academy matriculation, had serum biomarker measurements at matriculation and graduation, demographic data, and KOOS assessment at follow-up. Biomarkers included Collagen Type II (C2C) and Type I and II (C1,2C) collagenase-generated cleavage epitopes, C-terminal propeptide of Type II collagen (CPII), and C- and N-terminal telopeptides of type I collagen (CTX and NTX). Angle-based Joint and Individual Variation Explained (AJIVE) was used to determine demographic determinants of biomarker levels and individual modes of variation specific to biomarker levels at matriculation and graduation, stratified by sex.

Results

We confirmed known associations of joint metabolism biomarkers with age in both sexes and with smoking in males. Matriculation biomarker data in males suggested a protective biomarker profile characterized by high cartilage synthesis and low cleavage of type I and II collagen in association with healthy KOOS scores at follow-up. CPII measured at matriculation was negatively associated with incident injuries after adjustment for smoking status (p = 0.03, logistic regression), confirming results from AJIVE.

Conclusion

These exploratory analyses suggest that CPII alone, or in combination with other joint metabolism biomarkers, may help identify individual risk of knee injury.

Factor Structure and Longitudinal Invariance of the Cancer Behaviour Inventory: Assessing Cancer‐Coping Self‐Efficacy in Patients With Moderate‐to‐High Symptoms

ABSTRACT

Background

The Cancer Behaviour Inventory–Brief Version was designed to assess cancer-coping self-efficacy in clinical and research settings where minimising patient burden is essential. However, there is no evidence of its longitudinal validity. Although widely used in cancer research, the lack of evidence for longitudinal invariance significantly undermines its validity in studies spanning multiple time points. Establishing longitudinal invariance enables valid comparisons over time, enhancing our confidence in applying it in longitudinal research.

Aim

To examine the factor structure of the measurement and test its longitudinal invariance across four time points in cancer patients experiencing moderate-to-high symptoms during curative cancer treatment.

Design

A longitudinal psychometric evaluation.

Methods

This is a secondary data analysis of a randomised controlled trial in patients with moderate-to-high symptoms undergoing cancer treatment (N = 534). We conducted longitudinal invariance tests for the measurement using four time points. Other psychometric tests included confirmatory factor analysis, reliability analyses and correlations.

Results

Our confirmatory factor analysis supported the four-factor, 12-item structure for the Cancer Behaviour Inventory–Brief Version. Items 1 and 6 were found to be moderately correlated. The resulting 12-item measure demonstrated good internal consistency, with convergent and divergent validity supported by correlations with selected instruments. Finally, longitudinal invariance was tested, which revealed strict measurement invariance across four time points (CFI = 0.930, RMSEA = 0.045, SRMA = 0.056).

Conclusion

We found that the factor structure of the Cancer Behaviour Inventory–Brief Version remained stable over four time points in a sample of patients having moderate to high symptoms under cancer treatment. This supports its accountability for examining the changes in cancer-coping self-efficacy among cancer patients over time in longitudinal studies.

Implications

This study confirms that Cancer Behaviour Inventory–Brief Version has adequate internal consistency and demonstrated evidence of construct validity. Our conclusion of strict longitudinal invariance supports its credibility for continuous assessment of cancer-coping self-efficacy to evaluate patient outcomes and intervention processes over time in clinical and research settings.

Patient or Public Contribution

No patient or public contribution.

Palliative Care for People With Very Severe to Extreme Behavioural and Psychological Symptoms of Dementia (BPSD): A Scoping Review

ABSTRACT

Aim

To explore current evidence regarding the provision of palliative care for individuals with very severe to extreme behavioural and psychological symptoms of dementia (BPSD) in a hospital setting.

Design

Scoping review.

Reporting Method

The PRISMA-ScR reporting guideline.

Methods

The JBI guidelines for scoping reviews were followed. A data extraction form assisted in the identification of key findings via a process of content analysis.

Data Sources

Studies were obtained from bibliographic databases of PubMed, CINAHL, and PsycINFO.

Results

This review included six articles, and nine categories emerged from the findings. Symptom assessment and management, pain assessment challenges, atypical presentation of end-stage dementia, complex prescribing and treatment practices, principles of person-centred care, collaboration; training for health care professionals; emotional impact on staff; and family and caregivers.

Conclusions

This scoping review highlighted a significant gap in the literature regarding palliative care for people living with very severe to extreme BPSD in hospital settings. This review highlighted key differences in the presentation of people with BPSD needing palliative care. There is a need for tailored models of care, specialised training and education for health professionals, families, and carers, and recognition of dementia as a terminal illness.

Implications for the Profession and/or Patient Care

The results of this review provide valuable insights into the level of understanding about the unique palliative care needs for people experiencing very severe to extreme BPSD, making an important contribution to the planning and development of future models of care.

Impact

Mapping the available literature highlights a paucity of research in palliative care for people with very severe to extreme BPSD in hospital settings. There is a need for rigorous research studies and models of care developed and informed by the evidence for this small population necessitating unique care needs.

Patient or Public Contribution

No patient or public contribution.

A Concept Analysis of the Dynamics of Risk, Midwifery Agency and the Maternity Early Warning Tool

ABSTRACT

Aim

To examine the concept of midwifery agency when using Maternity Early Warning Tools.

Design

Concept analysis using Rogers' evolutionary method.

Methods

Data were collected from interviews with midwives working in various Australian maternity settings. A subset of the dataset was collected and analysed (2021–2022) to examine how agency functions when midwives use Maternity Early Warning Tools.

Results

Three conceptual attributes fundamental to agency were identified: considered judgement, reasoned clinical decision-making, and collaborative action. These attributes reveal how midwives navigate the interface between structured risk management tools and relational, woman-centred care.

Conclusions

Maternity Early Warning Tools can either limit or enhance professional agency. When used reflexively, they become artefacts that support learning, communication, and sound clinical judgement. Viewing these tools as enablers rather than enforcers sustains midwifery expertise and strengthens interdisciplinary collaboration.

Implications for the Profession and/or Patient

Sustaining midwifery agency protects both professional integrity and the quality of woman-centred care.

Impact

What problem did the study address? How the use of Maternity Early Warning Tools influences midwives' agency.

Delirium in the Acute Care Setting From the Families Perspective: A Scoping Review

ABSTRACT

Aim

To explore the existing literature on delirium within the acute care setting from the family members' perspective and summarise key findings.

Design

A scoping review guided by Arksey and O'Malley's methodological framework and refined by the Joanna Briggs Institute.

Review Methods

The Population, Concept, and Context framework recommended by the Joanna Briggs Institute's scoping review protocol identified the main concepts in the primary review question. The inclusion criteria focused on primary research studies from any chronological date that explored the family members' experience of delirium within the acute care setting. Following screening by two independent reviewers, data extraction was conducted and presented in tabular form, detailing the study aim, sample, setting, methods, key findings and recommendations for future research and clinical practice.

Data Sources

A comprehensive search was conducted in January 2025 using CINAHL+, MEDLINE, JBI, Cochrane Library, Web of Science, Scopus and Google Scholar. Citation searching and reference lists supplemented this review to identify relevant studies.

Results

Seventeen studies met the inclusion criteria. Families' experiences of delirium were categorised into (1) lack of awareness and understanding of delirium; (2) communication and informational needs of family members regarding delirium; (3) the emotional impact delirium has on family members, and (4) family desire to participate in their loved one's care.

Conclusion

This review highlighted a paucity of literature addressing the experiences of family members who witness delirium in the acute care setting. The existing research underscored the need for clear communication and information regarding delirium to mitigate the negative emotional impact that delirium places on families.

Impact

This scoping review provides insights into the challenges facing families witnessing delirium in the acute care setting. A better understanding of family members' experiences can guide the development of a supported family-centred approach to delirium care.

Patient Contribution

No patient/public contribution.

<i>Mycobacterium tuberculosis</i> complex lineages and drug resistance patterns among tuberculosis patients with or without diabetes mellitus in southern Ghana

by Emelia Konadu Danso, Prince Asare, Amanda Yaa Tetteh, Phillip Tetteh, Augustine Asare Boadu, Ivy Naa Koshie Lamptey, Augustina Angelina Sylverken, Kwasi Obiri-Danso, Jane Sandra Afriyie-Mensah, Abraham Adjei, Dorothy Yeboah-Manu

Drug-resistant (DR) tuberculosis (TB) and diabetes mellitus (DM) are intersecting epidemics that complicate management of both diseases and worsen patient outcomes. We conducted a prospective cohort study of 758 GeneXpert-confirmed pulmonary TB patients, of whom 75 had DM. Demographic, clinical, radiographic, and anthropometric data were collected at baseline. Sputum samples were cultured for mycobacterial isolation, and the obtained isolates were characterized for Mycobacterium tuberculosis complex (MTBC) lineage and drug-susceptibility testing using spoligotyping and microplate alamar blue assay. The TB-diabetes (TB-DM) comorbid cohort was older [TB-DM: 53/75 (70.7%) vs. 241/683 (35.3%) aged 41–60 years) (p 

Morphological diversity in the honeyeater hyolingual apparatus and its relationship with nectarivory

by Amanda E. Hewes, Cassandra Fieldson, Maude W. Baldwin, William A. Buttemer, Alejandro Rico-Guevara

Honeyeaters (Aves, Meliphagidae) are a speciose clade of nectarivorous birds, and there is immense diversity in the degree to which different species within the family rely on nectar. Honeyeater tongues are commonly described as similar to a paintbrush, with this morphology being interpreted as an adaptation for increasing nectar extraction efficiency. However, there has been limited work documenting the degree of interspecific diversity in tongue morphology across the family or the extent to which such diversity correlates with dependance on nectar. This information is also lacking for the hyoid bones, the structures responsible for moving the tongue in and out of the mouth. We aimed to fill this knowledge gap by examining honeyeater tongues and hyoids from across the family. We found that there are six distinct tongue types across the Meliphagidae, and that certain genera such as Acanthorhynchus and Phylidonyris have a unique tongue morphologies. Using phylogenetic generalized least square regressions, we found that tongue length (not size corrected) and the proportion of tongue that is bristled were both positively correlated to degree of nectarivory, while tongue length (relative to bill length), tongue depth (relative to bill depth) and tongue width (relative to bill width) were not correlated to nectarivory. Finally, we found no correlation between hyoid length (relative to bill length) and nectarivory, suggesting that the capacity for further tongue protrusion is unrelated to nectar dependence in honeyeaters. Similar studies should be conducted across other groups of avian nectarivores to expand our understanding of dietary ecomorphology beyond bill shape, which has been the focus of the majority of research on food handling adaptations in birds thus far.

Planetary Health in Nursing: A Scoping Review

ABSTRACT

Aim

To map the extent of the use of the term ‘planetary health’ in peer-reviewed nursing literature.

Design

Scoping Review.

Data Sources

CINAHL, ProQuest Nursing & Allied Health Premium, MEDLINE, APA PsycINFO, ProQuest Dissertations & Theses and Web of Science were searched in January and February 2024 for English and French-language publications. A follow-up search was conducted on 10 June 2024 to determine if additional literature was published.

Review Methods

A scoping review was conducted using the Arksey and O'Malley methodology for scoping reviews. To be included the article had to explicitly use the term ‘planetary health’ and ‘nursing’ or ‘nurses’.

Results

Sixty-eight articles met the criteria for the scoping review and were included in this review, with the majority published between 2017 and 2024. Predominant literature included discussion papers, commentaries and editorials. A lack of original research is apparent. Most of the publications were calls to action for nurses to advance planetary health in nursing education, practice, research and advocacy work.

Conclusions

Literature confirms that planetary health is a recent and an important topic in nursing, and nurses have a well-documented role to play in planetary health, given the numerous calls to action in nursing leadership, education, practice and research. There is a need to publish the essential work nurses are doing in planetary health in various nursing domains.

Impact

This scoping review revealed a clear and urgent call to action for nurses to address planetary health. Given this finding, nurses have a responsibility to advocate for a planetary health approach in the profession and take action to contribute to planetary health through education, research, practice and advocacy.

No Patient or Public Contribution

Not applicable, as no patients or public were involved.

Peripheral Intravenous Catheter Care at Australian Emergency Departments: A Cross‐Sectional Observational Study

ABSTRACT

Background

Peripheral intravenous catheters (PIVCs) serve as crucial devices for essential care administration in emergency departments (ED). In Australia, to standardise clinical practice, the national PIVC Clinical Care Standard was introduced in 2021, however adherence to the Standard has not been adequately explored. Therefore, this study aims to investigate ED clinicians' adherence to the Standard via prospective audit.

Method

This cross-sectional observational study of PIVCs was conducted in three Australian EDs between 2022 and 2023. Data were collected in alignment with the quality indicators in the PIVC Clinical Care Standard. Research nurses collected the data from bedside observation and chart audit, with data analysed descriptively.

Findings

Out of 1568 episodes of PIVC care recorded, there were notable shortcomings. ED nurses and doctors provided minimal patient partnership during insertion episodes: PIVC self-care education (n = 4, 1.4%), discussion of potential risks/benefits (n = 8, 2.9%), and reporting of concerns (n = 16, 5.8%). Insertions primarily occurred at the antecubital fossa (n = 225, 81.2%), with a common issue being inadequate time for antiseptic solution to air dry (n = 156, 56.3%). Ongoing needs assessment was unable to be assessed due to documentation limitations, which were generally incomplete. Idle catheters (inserted but not used) were prevalent (n = 115, 41.8%), and only a quarter of inpatient ward admissions (n = 75, 27.3%) had clear indications for PIVC use.

Conclusion

These findings highlight the suboptimal ED PIVC practices that require attention and improvement. Innovative interventions and technology are necessary to address some of these suboptimal practices due to their complexity and persistent challenges, despite previous efforts by clinicians and researchers.

Implications for the Profession and Patient Care

The findings underscore the need for well-resourced efforts to ensure adherence to evidence-based practices in dynamic clinical settings.

Reporting Method

The study is reported following the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement.

Patient or Public Contribution

None.

Patient Perception of Involvement in Nursing Bedside Handover: A Cross‐Sectional Study

ABSTRACT

Background

In Australia, aligned to safety and quality standards, the health system implements standardised practices that include patient involvement in nursing bedside handover. Despite this mandate, it remains unclear whether patients are genuinely participating in nursing bedside handovers and whether their perspectives are being considered.

Aim

To explore patient perceptions of their involvement in nursing bedside handovers.

Methods

A cross-sectional survey study was conducted in two acute metropolitan hospitals in Western Australia from July 2021 to March 2022. The survey administered to patients, comprised three sections: demographic information; involvement in bedside handover; and perceptions of bedside handovers; utilising close-ended and Likert scale questions. Open-ended questions further explored participation in bedside handovers. Descriptive statistics and comparative analyses were performed and responses to open-ended questions underwent summative deductive content analysis.

Results

Of the 390 participants, over half reported five or more bedside handovers (n = 197, 50.7%). Most perceived the importance of (n = 334, 79.0%), and expressed their satisfaction with (n = 327, 89.6%), involvement in bedside handover. Perceptions of handover were mostly positive. There were a few significant differences throughout based on type of hospital, gender and age-group. Open ended responses shared perceptions on the perceived benefits, challenges and barriers and ways to enhance involvement in bedside handover. Patients expressed several challenges, including lack of awareness of their right to participate, the approach of nurses and the timing of handovers as hindering their participation in bedside handovers.

Conclusion

Patients perceived the importance of, were mostly satisfied with, and had positive perceptions of bedside handover. However, several challenges hindered effective patient participation. Further research is needed into bedside handover as it is essential to enhance patient-centred quality care that aligns with national safety and quality healthcare standards.

Impacts

Understanding the significance of patient involvement in bedside handovers motivates patients to actively share information about their care, leading to increased patient satisfaction and the promotion of patient-centred care. Addressing challenges through targeted strategies can enhance patient participation, communication, increased patient satisfaction and foster a more patient-centred approach to care.

Patient or Public Contribution

The conduct of this study was supported by the consumer advisory group in the participating hospitals who also reviewed the survey questionnaires and conducted face validity of the survey.

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