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To identify and synthesise qualitative evidence on nurses' perceptions of reasons for missed nursing care in hospitals.
Systematic review of qualitative evidence.
An extensive search of all relevant databases was conducted. Study selection, quality assessment, data extraction and meta-aggregation were performed independently by two reviewers according to the JBI guidelines for systematic reviews of qualitative evidence. Confidence in the findings was assessed using the ConQual approach.
The electronic databases CINAHL, PubMed, Embase, PsychInfo, and Scopus were searched in January 2024 and repeated in May 2025.
Thirty-one studies from hospital settings worldwide were included following critical appraisal, with overall quality rated moderate to high. The studies contributed 168 findings, which were organised into 10 categories and three synthesised findings: Organisational and system-level factors influencing missed nursing care, Teamwork and cultural factors influencing missed nursing care, and Individual nurse- and patient-related factors influencing missed nursing care.
Reasons for missed nursing care represent an interplay of systemic, organisational, and individual factors within complex resource-constrained contexts.
Healthcare organisations are recommended to implement system-level interventions, rather than relying solely on behaviour-focused solutions. Healthcare leaders should ensure flexible staffing, strong managerial support, and adequate resources to enable fundamental care. Building collaborative, interprofessional cultures that value relational and fundamental care as well as technical tasks is essential, together with education and mentorship that support nurses' decision-making, resilience, and clinical competence.
Hospital leaders, policymakers, and nurse managers can use the recommendations to reduce missed nursing care and promote a safe person-centred practice. Implementing systemic changes will improve nurses' working conditions and capacity to deliver comprehensive care, ultimately enhancing patient satisfaction and outcomes.
The ‘enhancing transparency in reporting the synthesis of qualitative research statement’.
No patient or public involvement.
The review is registered in the International Prospective Register of Systematic Reviews. PROSPERO CRD42023438198 (https://www.crd.york.ac.uk/PROSPERO/search)
The debate about whether health visiting, a specialist community public health nursing role, is at the level of advanced practice nurse has gone on for more than a decade. There is little empirical evidence that the role matches the traditional role of an advanced practice nurse, although many of the attributes of advanced practice nursing such as prescribing rights, managing complex cases, caseloads with undifferentiated need and advanced assessment and decision-making are certainly present.
The current study aimed to develop, refine and test the Health Visiting Advanced Practice Scale to assess the scope of advanced practice of UK health visitors.
A cross-sectional and methodological scale validation design, following classical test theory.
The design consisted of three phases; the first involved scale development including item generation, phase two assessed the content validity index, and the third phase involved a cross-sectional survey to establish construct validity, content validity, and internal consistency reliability, and conduct exploratory and confirmatory factor analysis.
The initial 44-item scale underwent iterative exploratory and confirmatory factor analyses, leading to a refined 5-factor structure with 29 items covering domains such as family-centred care, leadership, prescribing, diagnostic reasoning, and professional practice. This final version demonstrated strong reliability and construct validity in the EFA but mixed fit indices in the CFA, supporting both internal consistency and validity of the scale.
The final scale offers a rigorously validated tool for assessing advanced practice among UK health visitors, capturing core domains such as family-centred care, leadership, prescribing, and diagnostic reasoning. By bridging theoretical frameworks with real-world practice, it fills a critical gap in evaluating and supporting the professional scope of this public health nursing specialty.
These findings provide valid and reliable insights for measuring and improving health visitors' advanced practice and developing future professional policies.
No patient or public contribution.
STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines for cross-sectional studies.
by Caio R. Monteiro, Victor Augusto de Oliveira, Rabeche Schmith, João Pedro A. Rezende, Tales L. Resende, João A. Negrão, Marina A. C. Danés
This study aimed to evaluate the effects of rumen-protected methionine (RPM) supplementation on productive and physiological responses of primiparous Holstein cows during summer. We hypothesized that RPM supplementation would maintain or improve milk yield and composition due to beneficial physiological, redox, and inflammatory responses in cows exposed to summer heat. The trial was conducted in a randomized block design during nine weeks in Brazil using 80 primiparous cows (182 ± 64 DIM; 42.9 ± 4.7 kg/d milk). Cows were blocked by milk yield and DIM and assigned to a control diet (CON; no added RPM) or the same diet supplemented with RPM (Mepron®, Evonik) at 0.75 g/kg diet dry matter, targeting 20 g/cow/day (product contains 62% metabolizable methionine) to the average cow. Milk yield and composition, vaginal temperature, respiratory rate, and plasma samples were collected in weeks 3, 6, and 9. Data were analyzed using mixed models including treatment, week, and their interaction as fixed effects, and block and cow as random effects. Cows were maintained under naturally occurring summer conditions. Environmental monitoring during weeks 3, 6, and 9 indicated elevated temperature–humidity index (THI) values, with values remaining above the heat-stress threshold (THI > 68) for 68.3% of the monitored hours (mean THI = 70.6; range 61.0–84.4). Overall (least squares mean across weeks 3, 6, and 9), RPM increased milk yield by 2.0 kg/d (44.9 vs. 42.9 kg/d), protein yield by 50 g/d (1,464 vs. 1,414 g/d), lactose yield by 108 g/d (2,109 vs. 2,001 g/d), and total solids yield by 176 g/d (5,331 vs. 5,155 g/d). Lactose concentration was lower in RPM (4.71 vs. 4.76%). Fat yield was unaffected, but a treatment × week interaction was observed for fat content. Milk fatty acid (FA) profile was unchanged, although treatment × week interactions were observed for individual fatty acids (C16:0, C18:0, C18:1, and preformed FA). Plasma glucose was lower, and insulin was higher in RPM than in CON cows (39.3 vs. 43.2 mg/dL and 0.52 vs. 0.35 ng/mL, respectively). Antioxidant capacity improved, with RPM cows having greater ferric reducing antioxidant power (32.9 vs. 28.5 µM) and lower malondialdehyde (2.48 vs. 2.78 nmol/mL). Other biochemical, inflammatory, and immune markers were unaffected. Respiratory rate was slightly higher in RPM than in CON cows (55 vs. 50 breaths/min). Mean vaginal temperature did not differ between treatments; however, a treatment × time × hour interaction was observed. Supplementation with RPM improved milk and solids yield, and enhanced antioxidant capacity and insulin levels, supporting its use to improve metabolic resilience under warm conditions.by Jimmy Andreyvan Cainamarks-Alejandro, Liliana Cruz-Ausejo, Miguel Angel Burgos-Flores, Jaime Rosales-Rimache, Jonh Astete-Cornejo, David Villarreal-Zegarra
BackgroundThe COVID-19 pandemic marked an increase in depressive, anxiety, and post-traumatic stress disorder symptoms, more specifically among healthcare workers, teachers, and police officers. These workers face external and occupational factors which had a significant impact on mental health, significant increase in workload and direct exposure to the virus, shortage of personnel protective equipment, and instances of abuse, including discrimination. Mental health care in primary care requires a process of early identification and timely referral of complex cases. Telehealth emerges as an effective alternative for addressing challenges in mental health care, although its implementation encounters obstacles.
ObjectiveTo design a telehealth service that facilitates screening, initial management, and timely referral for mental health diagnoses in workers with prior SARS-CoV-2 infection, and to evaluate usability, acceptability, and user satisfaction.
MethodsMixed-method study with a user-centered design approach involving key external and internal service users in three sequential stages (pre-design, co-design, and post-design). The study phases lasted 6 months, involving a total of 23 participants in the pre-design phase (contextual inquiry and preparation and training), 12 participants in the co-design phase (framing the issue, generative design, and sharing design), and in the post-design phase, 4 participants were involved in service implementation, and 81 participants—drawn from the subgroup of 134 users who received psychoeducation—were included in the efficacy assessment.
ResultsThe proposal included the development and evaluation of a service model guide and a telehealth software platform. First, the participants took part in a series of workshops (Pre-design, Co-design) where they provided ideas for meeting the product requirements, based on the Design Thinking methodology framework. The telehealth service model was named TelePsico CENSOPAS. It comprised four processes: a) Service promotion; b) User pre-identification; c) Appointment management; d) Psychoeducation counseling and referral. The Telehealth platform was designed through three cycles of an iterative process and integrated a proprietary development platform with third-party service technologies for communication support and information exchange. During post-design, the pilot test involved 698 screened patients; 193 were identified with mental health risks, and 134 of them received psychoeducation sessions. In addition to user acceptance, the usability score of the platform was 86.1 ± 16.9 SD, satisfaction dimensions of the service was 45.1 ± 7.2 SD for satisfaction with care processes, and 36.7 ± 5.2 SD satisfaction with psychological care.
ConclusionThe proposal for mental health telehealth services and its supporting platform was successfully developed and accepted by both internal and external users, particularly within well-structured occupational health services in workplaces serving vulnerable occupational groups. In addition, it achieved higher satisfaction and usability scores than Peru’s outpatient care services. These findings support the replicability of user-centered design frameworks—such as design thinking—within the occupational health sphere.
To identify the factors associated with low psychological resilience among university students in the Grand Est region of France at the end of the first national COVID-19 lockdown.
A cross-sectional online survey was conducted (May 2020) among students at the University of Lorraine using the LimeSurvey platform and institutional mailing lists.
Higher education setting in north-eastern France, involving students from the University of Lorraine (multicampus public university) and Sciences Po Nancy, a political science institute in the same region.
A total of 3708 students fully completed the online questionnaire, including the Brief Resilience Scale (BRS), resulting in an estimated response rate of 7.1%. All students enrolled at the University of Lorraine and Sciences Po Nancy during the 2019–2020 academic year were eligible to participate.
The primary outcome was psychological resilience, measured using the BRS. Secondary measures included perceived social support assessed with the Multidimensional Scale of Perceived Social Support, quality of interpersonal relationships evaluated using the Quality of Interpersonal Relationships Scale (Échelle de la Qualité des Relations Interpersonnelles, EQRI) and frequency of positive and negative thoughts measured with the Thermometer of Thoughts Tool. Factors associated with low resilience were analysed using bivariable and multivariable logistic regression.
Among 3708 students included in the sample, corresponding to a response rate of approximately 7.1%, 50.6% had normal resilience, while 37.3% reported low resilience. Female gender (OR=2.1, 95% CI: 1.8 to 2.6) and low social support (OR=1.7, 95% CI: 1.1 to 2.6) were the factors associated most strongly with low resilience. Negative thoughts (OR=1.4, 95% CI: 1.4 to 1.5), lower quality of relationships with people in general (OR=1.5, 95% CI: 1.3 to 1.8) and studying arts, humanities or languages (OR=1.4, 95% CI: 1.0 to 1.8) were identified as factors associated with low resilience. Increased age (OR=0.9, 95% CI: 0.9 to 1.0) and flat sharing (OR=0.6, 95% CI: 0.4 to 0.9) were inversely associated with low resilience levels.
Resilience seems to be impacted primarily by internal and micro-environmental factors. Consolidating levels of individual resilience of at-risk populations by acting on these factors could be the key to improving their mental health.
Microcirculatory dysfunction drives the end-organ pathophysiology of circulatory shock but is not reflected within existing clinical indices of perfusion, such as blood pressure. The choroidal vasculature of the retina can be measured non-invasively and we hypothesised that this may reflect dysfunction in other organs. We tested the feasibility of measuring the choroid in intensive care and explored associations between choroidal measurements and clinical parameters.
A pilot study of optical coherence tomography conducted in a sample of general intensive care unit (ICU) patients.
A tertiary mixed ICU within the UK.
15 patients were recruited. One patient was excluded following withdrawal of active treatment. 12/14 (86%) of the remaining patients had successful baseline imaging and 6 (40%) of these had follow-up imaging within intensive care. These patients had a mean age of 56.3 years, were 71% (10/14) male and mean Acute Physiology and Chronic Health Evaluation 2 (APACHE2) score on ICU admission was 20.4.
Choroidal anatomy, including choroidal and suprachoroidal thickness, as well as volumetric analysis of intrachoroidal blood vessels, was assessed using automated image segmentation along with clinical, physiological and biochemical data at ICU admission and after an interval of 12–72 hours. Feasibility and safety data were assessed throughout ICU admission.
Baseline choroidal vascular index and choroidal thickness were positively associated with fluid balance, and negatively with APACHE2 score, haematocrit and albumin content. A measurable suprachoroidal space was seen in nine (75%) patients (range 25.0–110.0 microns) and was inversely associated with heart rate. There was substantial intraindividual variation in choroidal measurements over time. There were no safety concerns.
Measuring the choroid is feasible in patients with Intensive Care Society Level 2 or Level 3 requirements. The suprachoroidal space may be markedly enlarged in these patients. Exploratory associations with systemic variables suggest that the choroid may provide information about the microvascular function of other major organs. Size and change of choroidal measurements may reflect perfusion pressure and vascular leakage.
Adnexal torsion is a gynaecological emergency in which prompt diagnosis and management are critical to preserving ovarian function. However, the clinical presentation is often non-specific, and diagnosis primarily relies on pelvic ultrasound, a modality with limited sensitivity that can lead to misdiagnosis and unnecessary surgery. Contrast-enhanced ultrasound (CEUS) has emerged as a promising imaging technique that may enhance diagnostic accuracy by better characterising adnexal vascularisation.
The aim of this study is to assess whether the addition of CEUS to standard diagnostic procedures can reduce the rate of unnecessary emergency surgeries. Specifically, we compare two diagnostic strategies in cases of high clinical suspicion of adnexal torsion: the current standard approach versus an experimental strategy incorporating CEUS. The primary outcome is the rate of inappropriate surgical interventions, defined as emergency surgery performed within 6 hours without intraoperative confirmation of torsion.
This is a prospective, open-label, multicentre, randomised (1:1), controlled, superiority trial. A total of 256 women presenting with a high clinical suspicion of adnexal torsion will be enrolled over a period of 36 months. Participants will be randomly assigned to either the standard diagnostic strategy or an experimental strategy that includes CEUS. The primary endpoint is the proportion of emergency surgical procedures (performed within 6 hours of hospital admission) in which adnexal torsion is not confirmed.
The study was approved by the French Ethics Committee, the CPP (Comité de Protection des Personnes) on 28 October 2024. The results of this study will be published in peer-reviewed journals and presented at relevant national and international conferences. The ethical approval number from the CPP is 6115.
NCT06677554; 2024-511720-13-00.
The use of bone-anchored prostheses (BAPs) has greatly increased quality of life for lower limb amputees. However, the long-term frequency of skeletal fractures and the need for arthroplasty surgery in the lower extremities following BAP use is scarce.
The current study aimed to investigate the frequency of fractures and arthroplasties in the lower limb after BAP surgery with the Osseointegrated Prosthesis for the Rehabilitation of Amputees (OPRA) system.
Retrospective cohort study using the OPRA database and medical record review for data collection.
A single-centre study at a tertiary hospital.
All patients with a transfemoral BAP (OPRA system) who underwent surgery between 1999 and 2019, and had completed at least 2 years of follow-up were included in the study. Patients with bilateral transfemoral amputations were excluded. A total of 100 patients were included.
The primary outcome measure was to identify patients who had a fracture or had undergone arthroplasty surgery in the lower extremities after BAP surgery.
Of the 100 patients included, 16 patients (16%) had an event in their lower limb. 11 patients (11%) had a fracture, all of the femur, and six patients (6%) underwent arthroplasty surgery due to osteoarthritis. Long-term prosthetic use was not affected by the occurrence of an event.
Patients with BAP may be at a higher risk for femur fractures and arthroplasty surgery than the general population. Although encouraging that prosthetic usage is not affected after a fracture or arthroplasty surgery, prospective studies on larger cohorts and control groups need to be conducted.
Urgent and emergency care (UEC) systems in England face unprecedented pressures, with record accident and emergency attendances, persistent breaches of ambulance response targets and poorer outcomes for time-sensitive conditions. National UEC recovery plans have introduced multiple innovations—such as same-day emergency care, virtual wards and specialty hubs—to manage these pressures and improve patient flow. Rural coastal areas are particularly vulnerable to excessive demand due to higher levels of deprivation, older populations with complex health needs, seasonal surges that generate unpredictable demand and challenges in attracting and retaining staff. Following the Chief Medical Officer’s 2021 Annual Report, funding research and developing bespoke solutions to manage UEC demand and address geographical disparities has been recognised as a national priority. The Elevate study responds to this priority by identifying and evaluating innovative models of UEC in rural coastal communities in England.
The Elevate study is a 30-month, mixed-methods evaluation that comprises three interlinked work packages: (1) National service mapping—outlining provision of innovative models of UEC in rural coastal areas of England. This will be developed through document review and interviews with regional and national service leaders. (2) Quantitative analysis—quasiexperimental and longitudinal approaches will use National Health Service (NHS) England’s Emergency Care Data Set and linked routine NHS datasets to evaluate the impact of UEC models on health and process outcomes. Standard and bespoke metrics will be developed and used to assess performance. (3) Qualitative case studies—up to 12 case studies of UEC models in rural coastal communities. Interviews with patients and staff and non-participant observation will explore how and why different UEC models influence patient experience, clinical outcomes, resource use and the workforce. Findings will be integrated using the Consolidated Framework for Implementation Research to identify components of UEC models that are effective, scalable and sensitive to local context,
Ethical approval for qualitative components was granted by the North of Scotland Research Ethics Committee (25/NS/0099). Dissemination will include peer-reviewed publications, policy briefs, creative media and community engagement activities to ensure findings are communicated inclusively and effectively to policymakers, health and social care practitioners and the public.
Research Registry (researchregistry11126).
The current German treatment guideline for chronic ischaemic heart disease (IHD) recommends that general practitioners (GPs) deliver brief advice on physical activity (PA) to patients with IHD. Such advice consists of at least three elements (ie, 3As): (1) assessing the PA level, (2) advising on PA and (3) assisting with recommendations. This study examined the extent to which individuals with self-reported IHD in Germany reported the receipt of such advice.
Cross-sectional population-based face-to-face survey (from June 2023 to August 2024).
Households across Germany.
1004 individuals aged 35+ years with self-reported IHD and GP contact.
Primary outcome: self-reported proportions of receipt of GP-delivered PA advice according to the 3As. Main secondary outcome: associations between person characteristics and the likelihood of receiving PA advice.
Among individuals with self-reported IHD, 36.4% (95% CI 33.4% to 39.4%) received all 3As of PA advice, 42.1% (95% CI 39.1% to 45.2%) received one or two elements, 9.9% (95% CI 8.1% to 11.8%) received no advice at all and 3.8% (95% CI 2.7% to 5.1%) were advised to avoid PA (7.9% did not remember/refused to answer). Women (vs men) were more likely to receive no advice (OR=1.74, 95% CI 1.11% to 2.72%), while middle (vs younger) aged individuals (OR=0.46, 95% CI 0.22% to 0.99%), those with PA levels of 1–149 min/week (vs no PA; OR=0.16, 95% CI 0.08% to 0.31%) and of 150+ min/week (vs no PA; OR=0.13, 95% CI 0.07% to 0.23%) and those with higher (vs lower) education (OR=0.39, 95% CI 0.20% to 0.76%) were less likely to receive no advice. Individuals living in urban (vs rural) areas (OR=0.65, 95% CI 0.46% to 0.88%) and those with PA levels of 1–149 min/week (vs no PA; OR=0.59, 95% CI 0.37% to 0.95%) and of 150+ min/week (vs no PA; OR=0.55, 95% CI 0.36% to 0.84%) were less likely to receive only one or two (vs all) of the 3As. Of those who received at least one element of advice (n=788), 72.5% reported they were more active afterwards, with a higher proportion when all 3As (vs only some elements) were provided (86.8% vs 59.6%).
Only one-third of individuals with self-reported IHD in Germany received comprehensive PA advice. Specific person characteristics, such as female gender and lower education, were associated with lower proportions of received PA advice. Efforts are needed to improve GP-led PA guidance, particularly for underserved groups.
German Clinical Trials Register (DRKS00031304).
This study aims to evaluate relationships between self-reported fine motor ability and quality of life (assessed by life satisfaction and life problems) from people with spinal cord injury (SCI) at T1 and above.
Observational cohort study (current analysis from a cross section)
279 individuals with SCI at T1 or above
Community members sampled from records from two Midwestern hospitals and a speciality hospital in the Southeast United States
Fine motor ability was assessed via the Spinal Cord Injury Functional Index-Short Form 9A, while two facets of quality of life, life satisfaction and life problems, were assessed by the Life Situation Questionnaire-Revised version (LSQ-R). Pearson correlations and multivariate analysis were utilised to identify cross-sectional relationships between fine motor ability, life satisfaction and life problems.
Fine motor ability was positively correlated with total life satisfaction score (r=0.16; p=0.02) and was negatively correlated with the total life problems score (r=–0.18; p=0.01), health problems factor (r=–0.24; pβ=0.25; p=0.02), fewer life problems (β=–0.40; pβ=–0.11; pβ=–0.10; p
The results identified significant, modest associations between self-reported outcomes, as better fine motor ability was related to less social isolation, fewer health problems and higher life satisfaction. Further investigation into the relationship between fine motor ability, life satisfaction and life problems is warranted.
Fibrosing interstitial lung disease (F-ILD) are a heterogeneous group of diseases with multiple subtypes. Both idiopathic pulmonary fibrosis and other ILDs associated with a risk of developing progressive pulmonary fibrosis (PPF) are subtypes of this category. A multidisciplinary team discussion, including a chest high-resolution CT (HRCT), is usually considered the gold standard for diagnosis of F-ILD. Repeated HRCT is one of several established methods to assess progression and thus development of PPF, but it is associated with substantial costs and radiation exposure. Thoracic ultrasound (TUS) and other ultrasound (US) methods have emerged as radiation-free methods for both diagnosing and monitoring disease severity in F-ILD. Yet, consistent knowledge on the use of different TUS- and US methods in patients with F-ILD is limited.
The LORD study is a prospective cohort study conducted in participants with F-ILD at a tertiary ILD centre in Denmark. Physiological testing and patient-related outcome measures, together with TUS- and US examinations, will be performed at inclusion, after 6 and 12 months. The correlations between these assessments will be evaluated. HRCT will be conducted between 3 months prior to and 1 month after baseline, and after 1 year. At least 34 participants will be included.
The protocol was approved by the Danish Data Protection Agency (journal number: 22/45135) and the Science Ethics Committee for the Region of Southern Denmark (journal number: S-20220036). Results will be published in peer-reviewed international journals and will be presented at an international congress.
The study evaluated the feasibility and efficacy of a non-immersive virtual reality (VR) system on upper extremity (UE) recovery in ischaemic stroke patients in comparison to a conventional physiotherapy.
An open-label, parallel-group, randomised controlled trial randomly assigned the participants to two groups, VR intervention or conventional physiotherapy.
Two tertiary stroke care centres in South India participated in the study.
Sixty first-ever ischaemic stroke patients (1–6 months of stroke onset) having spasticity grades of 1 or 1+ as per Modified Ashworth scale and Brunnstrom recovery stages of 3, 4 or 5 in the UE were included in the intention-to-treat analysis.
High-intensity non-immersive VR-based comprehensive rehabilitation gaming system with a duration of 12 weeks (3 days/week) was compared with equally intensive conventional physiotherapy.
The feasibility outcome was the compliance with the treatment. The primary efficacy outcome was the improvement in the motor function assessed by the Fugl-Meyer assessment (FMA) and Wolf motor function test (WMFT). The secondary outcomes included the performance in activities of daily living by the Barthel index (BI) and the quality of life by the 36-item short form health survey (SF-36).
The treatment compliance was similar in two groups (p=0.19). Both groups improved in motor performance, activities of daily living and quality of life. However, there were no significant differences in the FMA (p=0.58), WMFT (functional ability scale, p=0.33; performance time, p=0.44), BI (p=0.84) and SF-36 (physical, p=0.87; mental, p=0.99) scores between the groups.
The non-immersive VR system was feasible, effective and safe; however, it was not found to be superior to conventional physiotherapy. The trial was stopped early and did not reach its proposed sample size and hence, the findings are to be interpreted cautiously.
Clinical trial registry India: CTRI/2021/11/038339 (https://ctri.nic.in/Clinicaltrials/pmaindet2.php?EncHid=NTc1OTI=&Enc=&userName=CTRI/2021/11/038339).
To report on the unique perspectives of senior nursing leaders on the value proposition of the Clinical Nurse Specialist (CNS) role, their organisational experience and the barriers and facilitators to optimise and promote the long-term sustainability.
A qualitative sub-study of a larger multi-method study focused on informing policy recommendations to optimise the CNS workforce, informed by integrated knowledge translation.
Chief Nursing Officers (CNOs) and other senior leaders in all health authorities in British Columbia, Canada, were invited to participate in semi-structured interviews via video call between August–December 2023. We recruited 13 participants from diverse health regions, including 5 CNOs.
Leaders collectively conveyed a renewed interest in the CNS role to support nursing and multidisciplinary teams to better meet patient and system needs, and a sense of urgency to optimise the role in diverse settings. The overarching theme of “success by design” was supported by three thematic priorities: (1) understanding the CNS role, (2) a role that needs protection and connections and (3) moving forward together. Views were aligned to co-construct implementation-ready policy recommendations to guide provincial strategies.
Senior leaders reported a common understanding of the value-add of the CNS workforce and had a shared experience of barriers to optimisation. Contemporary policy guidance is needed to equip health systems to address this gap.
Across international regions, the role of CNSs is not fully optimised. This is a wasted opportunity to address the pressing need for nursing practice leaders to transform health systems and improve outcomes. This study provides new knowledge about the perspectives of Chief Nursing Officers and other nursing leaders to shape comprehensive and targeted policy recommendations and address enduring and new challenges to realise the full impact of the CNS workforce.
We have adhered to COREQ reporting guidelines (See supplemental file).
This study did not include patient or public involvement in its design, conduct, or reporting.
by Mireille Jasmin, Geneviève Piché, Aude Villatte, Andrea Reupert, Marie-Ève Clément, Anne Dorothee Müller, Marianne Fournier-Marceau, Darryl Maybery, Marie-Hélène Morin, Stéphane Richard-Devantoy
BackgroundParenting responsibilities can be particularly challenging for patients receiving mental health services, often resulting in a range of negative impacts on children. Incorporating a family-focused approach into the usual care of parents with mental illness has been recommended to promote patient recovery while supporting the well-being of children and the entire family unit. This study aimed to document the family-focused practices undertaken by psychiatrists working with parents who have a mental illness and to explore potential facilitators and barriers to these practices.
MethodsA sequential explanatory mixed-method design was used, combining an online survey and individual interviews. Family-focused practices were reported by 27 psychiatrists through the French version of the Family-Focused Mental Health Practice Questionnaire. Follow-up qualitative individual interviews were conducted with 5 psychiatrists. Item-by-item analysis of the quantitative data was performed, followed by a thematic analysis of the qualitative data, integrating findings from both sources.
ResultsAlthough psychiatrists acknowledge their patients’ parenting role, most are reluctant to provide further support. Key barriers to family-focused practice include the predominantly individual-focused nature of psychiatric care, stigma, consent issues, and limited collaboration between adult and child services. Facilitators include psychiatrists’ professional autonomy, personal experience, and confidence in conducting family meetings.
ConclusionPsychiatrists can play a pivotal role in identifying, acknowledging, and providing appropriate support to parents with mental illness and their families, including children. Developing comprehensive guidelines and targeted training is essential to equip psychiatrists with effective strategies for addressing parenting challenges in patients with complex mental health issues. Additionally, psychoeducational resources for children should be incorporated. Implementing these initiatives may lead to more compassionate, targeted care and improved outcomes for parents and their families.
Colon cancer (RC) patients holding an intestinal stoma recorded lower health-related quality of life (HRQOL) levels. Intestinal stoma leads to several difficulties, like travel, work, and sporting activities. Patients with an intestinal stoma frequently experienced changes in their HRQOL. The COH-QOL-Ostomy questionnaire comprehensively measured these changes across physical, psychological, social, and spiritual domains. We reviewed literature in order to assess any differences in HRQOL between females and males and between intestinal stoma permanence among these patients. We conducted a literature review from: British Nursing Collection, Embase, MEDLINE, Nursing & Allied Health Database, PubMed, Scopus and Web of Science databases, without any time limits. The protocol was registered with PROSPERO no. CRD420251040414. A total of 492 records were identified. Of these, 362 records were removed, obtaining 130 potential records. However, 126 of these were excluded as they did not meet the inclusion criteria including only 4 records for further analysis. The COH-QOL-Ostomy questionnaire has been considered to assess HRQOL total score and its related sub dimensions, specifically physical, psychological, social and spiritual well-being. For each item, a Likert scale has been associated raging from zero (worse outcome) to 10 (good outcome). A total of 915 observations were collected, specifically 401 related to females and 514 to males. Additionally, a total of 670 observations were recorded: 338 belonging to the temporary group and 332 to the permanent one. Data reported a significant difference in the Psychological Well Being dimensions between the two groups, in favour of the female group (t = −3.66; p = 0.035). Considering the ostomy permanence, the temporary group reported a significant and better total quality of life score (t = −7.53; p = 0.017), Psychological Well Being dimension (t = −5.24; p = 0.035), and in social dimension (t = −8.09; p = 0.015), too. Sex-related differences in HRQOL assessments could help patients to achieve the most appropriate interventions to ameliorate QOL perceptions. Permanence criteria for ostomy could better address healthcare professionals for a specific clinical pathway to improve, especially in social support, which could positively contribute to better self-care for these patients.
As a framework to conceptualise well-being, the capability approach (CA) combines structural drivers with personal freedoms, making it a compelling approach for understanding women’s health and well-being (WHW). The WHW Project of the Exemplars in Global Health initiative chose the CA for its conceptual framing, while emphasising the influential role of gender and other intersecting inequalities (intersectional gender inequality) in shaping health and well-being over the life course. We discuss the Exemplars in Global Health – Women’s Health and Well-being (EGH-WHW) Framework and a scoping review that supports it.
To identify well-established and/or validated CA-based frameworks and measures attuned to intersectional gender inequality that analyse women’s well-being over the life course and across multiple geographies. If needed, to develop a new conceptual framework to analyse WHW over the life course through an intersectional gender inequality lens.
The scoping review, which was carried out between January and May 2024 and re-run in May 2025, adhered to the methodology by Arksey and O’Malley, Levac et al and Daudt et al, and the PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) checklist. The EGH-WHW Framework was developed by a multidisciplinary Working Group comprising representatives of organisations in the WHW Project consortium.
The review drew upon database searches (Scopus, PubMed) and targeted online hand searches for CA-based frameworks and measures.
All CA-based frameworks and measures of multidimensional well-being were included. CA-based empirical research was considered if it applied a framework or measure; or if it analysed multidimensional well-being across multiple geographies.
Information about each type of CA-based application—its choice of well-being dimensions, methods, focus on inequality, intersectionality and the life course—was recorded in a data charting form. Thematic summative syntheses of publications about each CA-based framework or measure led up to an overall evaluative synthesis of the fit between existing work and our requirements.
The review culminated in 94 publications, including six frameworks and 14 measures that met only some of the WHW Project’s requirements: multidimensionality of well-being; attention to intersectional gender inequality and the life course; as well as demonstrated and intended measurements across multiple geographies.
The review reaffirms the need for the EGH-WHW Framework, which recognises that WHW depend on their freedom ‘to be’ and ‘to do’, and proposes three interconnected clusters of dimensions depicting key capabilities, agency and functionings that are sensitive to intersectional gender inequality and the life course. Each dimension is mapped to specific indicators to support comparative assessments of country performance and drivers of progress across low-income and middle-income countries.
The EGH-WHW Framework distinguishes itself from other CA-based frameworks by incorporating both an intersectional gender lens and a life course perspective. The framework’s conceptualisation of multidimensional well-being allows for a rich and nuanced foundation on which to build policies and programmes that address the complex determinants of health, well-being and human rights of different groups of girls and women.
We conducted a feasibility study to evaluate the feasibility of recruiting patients to examine the effect of near vision glasses in young infants at risk of cerebral visual impairment.
A three-arm, parallel-group, open-label randomised feasibility trial.
Tertiary neonatal intensive care in London, UK.
We included babies born before 29 weeks of gestation or at full term with hypoxic ischaemic encephalopathy. Babies who needed ongoing inpatient care, with established eye anomalies or with very high refractive errors at baseline (±8.00D) were not included. Infants with retinopathy of prematurity were not excluded.
At 8 weeks corrected age, we allocated 18 infants to wear glasses (+3.00D over full cycloplegic refraction) immediately (intervention 1), 18 to wear the same glasses at 16 weeks (intervention 2) and 19 infants were allocated to standard treatment (no glasses).
Recruitment and retention of study participants (primary), compliance wearing glasses, preferential-looking visual acuity (with glasses) and visual function as determined using A Test Battery of Child Development for Examining Functional Vision at 3-month and 6-month age post-term.
Of 70 eligible families, 55 consented and 34 attended baseline assessments, and 28 completed the study. Non-attendance was due mainly to prolonged inpatient stay, infant health and scheduling conflicts. Glasses were worn for similar periods in each group (Intervention 1: median 2 hours/day (95% CI 1 hour to 4 hours); Intervention 2: median 2 hours/day (95% CI 1.5 hours to 3 hours)). Visual acuity improved from baseline to 6 months. Mean (SE) LogMAR (Minimum Angle of Resolution) improvements were standard care: 0.47 (0.45); intervention 1: 0.66 (0.44); intervention 2: 0.37 (0.36). Among the 29 very preterm infants, there were similar findings: standard care: 0.35 (0.35); Intervention 1: 0.67 (0.47); Intervention 2: 0.34 (0.40). As a functional measure, object permanence was present at the following rates by randomised arm: standard care: 29%; whereas intervention 1: 56%; and intervention 2: 44% (OR intervention 1 vs standard care: 3.13 (95% CI 0.38 to 25.57), ie, not statistically significant).
We demonstrate feasibility for a definitive RCT (randomized controlled trial) with good recruitment and retention and observed potential benefits for vision and development following the dispensing of glasses at 8 weeks post-term age compared with untreated controls. We identified methodological modifications to further improve recruitment processes for a future larger study.
Positive aspects of caregiving among family carers of persons living with dementia not only benefit the carers' health, but also enhance the quality and sustainability of invaluable informal care resources. To better inform the development of carer support intervention to optimise positive aspects of caregiving, this paper tested the integrative theoretical model based on stress coping and meaning-making paradigms.
Longitudinal exploratory study.
From January 2018 to August 2021, 390 Chinese family carers of persons living with dementia were recruited from the geriatric clinics in Hong Kong. The criterion variable was measured by the Positive Aspect of Caregiving Scale at baseline and 6 months thereafter. The predictors were measured using the Dementia Management Strategies Scale, the Caregiving Self-Efficacy Scale, the Meaning-Focused Coping Scale, the Medical Outcome Study Social Support Survey, the Duke University Religion Index, the Positive Affect Index and the Intrinsic Motivations to Care. Path analysis tested the hypothesised model.
The carers aged 56.2 (SD = 12.2); about two-thirds being female and adult-child caregivers. The hypothesised model showed an unsatisfactory model fit. The model was optimised by modification index with consideration of the theoretical plausibility in making the changes (CFI = 0.971, RMSEA = 0.057, SRMR = 0.027). After adjusting the baseline PAC, the 6-month PAC was predicted by self-efficacy in controlling upsetting thoughts and obtaining respite as well as meaning-focused coping. Various contextual factors strengthened the self-efficacy and meaning-focused coping, indirectly increasing PAC. Whereas carers' intrinsic motivation towards care and good dyadic relationships increased the carer's self-efficacy in emotional regulation, social support and religiosity played indispensable roles to facilitate meaning-focused coping.
PAC in dementia context is evolved from an integration of stress coping and existential meaning-making paradigms. Enhancing emotion and role regulation as well as meaning-focused coping are crucial to enhance the positive experience of the family carers.
This project has generated a theory-driven and evidence-based predictive model to explain the manifestation of positive aspects of caregiving in dementia caregiving. The findings provide precise directions on how to empower family caregivers to create a fulfilling and meaningful caregiving adventure.
Substantial evidence indicates the role of positive aspects of caregiving in enhancing the carers' health outcomes in the context of dementia. However, inadequate theorization of this phenomenon delimits the momentum to develop proactive strategies to optimise such a positive caregiving experience. This longitudinal study indicated that positive aspects of caregiving are evolved from an integrative stress coping and existential meaning-making paradigm. More specifically, a sense of self-efficacy in emotional and role regulation as well as the use of meaning-making coping predict a higher level of positive aspects of caregiving. A context, which is characterised by high religiosity, good intrinsic motivation of care and a good dyadic relationship, also favours the cultivation of this positive experience during life adversity. This study facilitates a paradigm shift in supporting family carers in a dementia context and advances the theorization of positive human experience in facing life adversity.
The reporting method complies with the STROBE, stands for observational study.
Family carers of persons with dementia actively shared their experience in family caregiving.
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