Conectar
Dissemination of evidence-based burn first-aid is critical for improving clinical outcomes for patients with acute burn injuries. The overarching goal of this research is the successful and sustainable translation of 20 min of cool running water (20CRW), administered within 3 hours of a burn, as a first-aid treatment for acute thermal injuries within emergency departments (EDs) and emergency medical services (EMSs). Despite the well-established benefits of 20CRW, this treatment is not included in relevant USA burn first-aid guidelines and has not been adopted in clinical settings as a standard first-aid treatment.
This protocol outlines an investigation using an effectiveness-implementation hybrid type III design to evaluate the effectiveness of 20CRW implementation into ED and EMS settings in Sacramento, California. The principal aim of this research is to implement 20CRW as a first-aid treatment for acute thermal burn injuries within participating ED and EMS settings. We will assess adherence to 20CRW guidelines and provision following implementation into routine clinical practice. In addition, we will evaluate the clinical effectiveness of 20CRW in improving patient outcomes, and the acceptability of 20CRW as a burn first-aid treatment, considering both clinician and burn survivor perspectives. This research will generate critical evidence on the implementation and clinical impact of 20CRW in US emergency care settings. It will also evaluate whether the co-designed implementation strategies effectively support adoption of 20CRW within the US ED and EMS settings.
Institutional Review Board (IRB) approval has been awarded for this research (IRB ID: 18834-5) from the University of California Davis Office of Research Ethics Committee. Results of this investigation will be disseminated across participating hospital and EMS organisations, presented at national and international conferences and published in open access peer-reviewed journals.
Stem cell transplant (SCT) is a potential cure for haematological malignancies whose outcomes are predicted to be poor on chemotherapy alone and cases difficult to treat using standard of care treatment. There is growing evidence to show that not all patients who would benefit from SCT receive it due to inequities in the treatment pathway. The role of socioeconomic deprivation on inequities in the SCT setting is unclear due to conflicting findings. We aim to synthesise the UK evidence base in this area from the point of diagnosis to transplant to guide further research and policy to improve survival for underserved patients.
Primary electronic searches will be performed in bibliographic databases including MEDLINE, Embase, Proquest Databases, Central & CDSR, Stem Cell Evidence and Web of Science and Google Scholar for grey literature. Eligibility criteria will include observational studies of UK patients diagnosed with haematological malignancies treated with SCT, where outcomes are reported according to socioeconomic deprivation. Two independent reviewers will screen each study and assess the quality of all included studies using the Newcastle-Ottawa grading system. Outcomes of interest include delay in diagnosis/referral, treatments/interventions received, referral to transplant, presence of comorbidities affecting transplant eligibility, transplant utilisation rates, waiting time to transplant and survival rates. Post-transplant outcomes are beyond the scope of this review. Inequities in SCT due to socioeconomic deprivation will be narratively summarised. Meta-analysis will be conducted dependent on data availability. This protocol has been registered with PROSPERO (2024: CRD42024620592).
Ethical approval is not required for this study as it is a secondary analysis of published data.
We are not aware of any ethical concerns regarding SCT or treatment of donors in the studies included in this research. This systematic review will retrieve, screen and extract data from UK research. SCT and the treatment of donors in the UK follow the National Health Service (NHS) and NHS Blood and Transplant guidelines and policies and are regulated by the Human Tissue Authority and Medicines and Healthcare Products Regulatory Agency. The data which will be used in this review will consist of data from NHS digital/NHS England or single NHS centre data, which will follow the guidelines and regulations above.
The findings will be submitted for peer-reviewed publication, shared at conference presentations, and disseminated to both clinical and patient groups including National (Black, Asian, Mixed Race and Minority Ethnic) BAME Transplant Alliance and the National Institute for Health Research Blood and Transplant Research Unit in Precision Transplant and Cellular Therapeutics.
CRD42024620592.
Chronic wounds account for a considerable burden on the overall US healthcare system, affecting an estimated 10.2 million people and costing as much as $148 billion dollars in 2022 alone. Elderly patients suffer disproportionately, as nearly 85% of the chronic wound population is over the age of 65 years old. Despite the burden chronic wounds place on elderly patients and the overall healthcare system, the full mechanism of wound healing changes as one ages has not been fully elucidated. The major deficits in wound healing in the elderly are a function of both skin structural changes and alterations in wound healing kinetics resulting from molecular shifts in gene profiles. Elderly individuals exhibit reduced skin integrity, characterized by a disorganized epidermis, thinned dermis and subcutaneous fat, and a less stable basement membrane, impairing protection from external insults. Simultaneously, wound healing is disrupted across all four stages, as low-level persistent inflammation from increased fibroblast senescence delays the onset of the proliferative phase and limits overall healing capacity. We hope that this review can bridge the knowledge gap in this field and ultimately lead to future discoveries in aiding the prevention of aging skin and the improvement in wound healing outcomes.
To explore the facilitators and barriers to staff providing psychologically safe care in inpatient mental healthcare when restrictive practices are used.
Qualitative descriptive interview study.
Twenty semi-structured interviews were conducted with staff with experience working in inpatient mental healthcare in England. Analysis included principles of framework analysis, informed by the Theoretical Domains Framework.
Access to resources and a safe environment for both patients and staff were recognised as important (environmental context and resources) but access was impacted by competing organisational priorities and expectations (beliefs about capabilities). Participants recognised knowledge gaps in themselves and their colleagues (knowledge). Being able to confidently make decisions about risk was seen as central to the staff role (social/professional role and identity). Collaboration between staff is needed to make positive change and progression towards psychologically safe care (social influences). Empathy and compassion were driving factors in participants trying to use psychologically informed alternatives, but burnout hindered this (emotions).
Ensuring that staff feel supported in their role to implement psychosocial informed alternatives to restrictive practices, as well as providing safe environments for both patients and staff, could support the integration of psychologically safe care on inpatient mental health wards.
Key facilitators and barriers to staff providing psychologically safe care are identified to support practice and improvements to patient care.
Consolidated criteria for reporting qualitative studies (COREQ).
Former patients and members of the public were involved in the conceptualisation of key concepts and design of this study.
Ankle fracture fixation surgery may be performed with or without the use of a tourniquet. Surgeons who use a tourniquet report reduced intraoperative bleeding, which improves the visualisation of anatomical structures. This may facilitate more accurate fracture fixation and restoration of the anatomical configuration of the ankle joint, potentially leading to improved functional outcomes. An additional proposed benefit of tourniquet use is reduced operative time. In contrast, surgeons who choose not to use a tourniquet report concerns that it may exacerbate postoperative pain and increase the risk of venous thromboembolism, surgical site infection and other complications. However, existing clinical trials are limited by small sample sizes and high risk of bias, preventing the ability to draw robust conclusions. This study aimed to assess the feasibility of conducting a randomised controlled trial (RCT) to evaluate the potential benefits and risks of tourniquet use in ankle fracture fixation surgery.
This study comprises a two-centre, participant-blinded and surgeon-blinded parallel-arm RCT and an integrated qualitative interview study. A computer-generated randomisation service will allocate up to 50 patients to undergo ankle fracture fixation surgery either with or without the use of a tourniquet. Participants will be followed up for 3 months postoperatively. Primary outcomes include recruitment and retention rates, data completeness, success of blinding and adherence to allocated intervention. Secondary outcomes include postoperative pain, quality of the surgical field, intraoperative blood loss, blood transfusions, procedure duration, skin assessment, awareness of tourniquet use, health-related quality of life (EuroQol-5D-5L), Olerud-Molander Ankle Score and intraoperative and postoperative complications. The integrated qualitative study will consist of semistructured interviews with up to 12 patients and 12 trauma and orthopaedic surgeons (~24 interviews). Interviews will explore perspectives on the feasibility trial, identify factors associated with unblinding and examine barriers and potential solutions to the design and delivery of a future definitive trial. Interviews will be analysed using inductive thematic analysis.
National Research Ethics Committee (East of England-Essex) approved this study on the 8 May 2025 (REC 25/EE/0051). The results will be disseminated via peer-reviewed publication.
Medical malpractice imposes a substantial clinical and economic burden worldwide. Pressure injuries (PIs) are amongst the most frequently litigated adverse events and represent a major source of preventable patient harm. To characterise the medicolegal landscape of PI-related malpractice, the Westlaw legal database was queried for cases litigated between 1990 and 2024. A total of 590 cases met inclusion criteria, with data extracted from court documents. The mean patient age was 71 years; 53.4% were female and 46.6% male. Nursing homes were the most commonly named defendants (59.8%), followed by hospitals and outpatient surgical practices (37.3%) and individual physicians (14.1%). The mean settlement was $383 099, compared with a mean jury award of $2 100 787. Adverse legal outcomes were strongly associated with allegations of inadequate care, poor clinical outcomes and gross provider negligence. When prevention and timely management fail, the consequences extend beyond patient harm to substantial legal and financial liability. Targeted interventions such as standardised risk assessment, rigorous documentation, staff education, appropriate staffing ratios and institutional accountability may mitigate both PI incidence and litigation risk. Strengthening these measures represents a critical opportunity to improve patient safety whilst reducing medicolegal exposure.
Spinal cord injury (SCI) predisposes patients to pressure injuries (PIs) often requiring surgery. Multiple factors influence postoperative complications and recurrence, though their associations remain unclear. We performed a PRISMA-guided systematic review and meta-analysis to assess predictors of acute postoperative complications and PI recurrence in SCI patients undergoing surgery. PubMed, Scopus and Embase were searched. Studies with ≥ 15 participants were eligible; 24 (n = 2566 subjects) were included, with 15 (n = 1976 subjects) quantitatively synthesized. Risk of bias was assessed with the Newcastle-Ottawa Scale. A random-effects model meta-analysis was performed, and odds ratios (OR) were pooled when > 2 studies were available; otherwise, findings were narratively synthesized. Moderate-quality evidence showed prior flap reconstruction increased complication risk (aOR = 4.98). Low-quality evidence linked diabetes (OR = 1.39) and smoking (OR = 1.35) with complications. Higher recurrence risk was associated with prior flap reconstruction (OR = 1.80) and thoracic injury (OR = 2.21), while cervical injury was protective (OR = 0.37). Prior flap reconstruction resulted as the strongest predictor of complications and significantly increased the odds of recurrence. These findings underscore the importance of a multidisciplinary approach for preventing the first occurrence of flap reconstruction and subsequent procedures.
Burn injuries constitute a significant health concern, requiring immediate first aid to mitigate further tissue damage and complications. Most countries worldwide recommend application of 20 min of cool running water (20CRW) within 3 hours of the burn as the cornerstone in burn first aid management. Despite its widespread acceptance and proven benefits in reducing the severity of burns and subsequent interventions, concerns regarding the risk of hypothermia following this intervention persist, representing at least a perceived barrier to the delivery of 20CRW. When it does occur, hypothermia in patients with burns has been associated with higher mortality rates, even after controlling for burn injury severity. Developing an understanding of the incidence of post-burn hypothermia following 20CRW, with a specific focus on potential predictive and/or causative factors, is quintessential.
A retrospective cohort study of all adult and paediatric patients with thermal burn injuries presenting to one of 11 participating Australian or New Zealand hospitals between 1 January 2024 and 31 December 2024 will be conducted. The primary outcome is the incidence of hypothermia in patients with burns following their arrival at the emergency department (ED). Secondary outcomes include influence of burn first aid cooling, risk factors influencing hypothermia, impact of hypothermia on clinical patient outcomes and incidence of hypothermia in patients with burns in non-ED settings.
Ethical approval was granted by the Children’s Health Queensland Human Research Ethics Committee (CHQHREC; HREC Ref No: HREC/25/QCHQ/114285) as well as Health and Disability Ethics Committees, New Zealand (HDEC; Ref No: 2026 EXP 23892). The study findings will be formally disseminated through peer-reviewed journals and conference presentations.
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.
A prospective mixed-method, pre–post study assessed the intervention's impact on fasting adherence and patient experience.
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
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%).
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.
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.
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.
Standards for quality improvement reporting excellence (SQUIRE 2.0).
Patients and caregivers contributed to the co-design of the intervention, ensuring that it addressed practical challenges related to preoperative fasting.
The cover image is based on the article by Caring Science as a Mature Solution to Global Healthcare Challenges by Sara Horton-Deutsch et al., https://doi.org/10.1111/jan.70237
To explore the barriers and facilitators influencing emergency department clinicians' adherence to the Australian Peripheral Intravenous Catheter (PIVC) Clinical Care Standard, using the Behaviour Change Wheel (BCW).
Suboptimal PIVC practices are frequently linked to a range of patient-important adverse outcomes. The first Australian Peripheral Intravenous Catheter Clinical Care Standard was introduced in 2021, aiming to standardize practice. However, a recent national survey revealed a lack of adherence to the Standard among emergency department clinicians.
A qualitative descriptive study.
The study was conducted across two Australian emergency departments in 2023. Utilizing purposive sampling, semi-structured interviews were conducted. The analysis incorporated both deductive and inductive approaches, mapping the findings to the BCW.
Interviews with 25 nurses and doctors revealed nine key subthemes. The main barriers were the stressful environment, insufficient education and training, and the absence of a feedback mechanism. The main facilitators were recognition of suboptimal practice, belief in the importance of patient engagement, and the desire to improve practice.
Multiple complex factors have an impact on clinicians' adherence to the Standard. The identified interventions will serve as a guide for future implementation of the Standard.
The findings inform healthcare organizations of the significance of implementing strategies to enhance clinicians' acceptance of the Standard. Clinicians should consider incorporating the multifaceted interventions developed in accordance with the BCW for future implementation projects.
Promoting adherence to standards opens avenues to challenge suboptimal practice and has the potential to instigate a culture shift in the fundamental skills of frontline clinicians.
The study is designed and reported according to the Consolidated Criteria for Reporting Qualitative Research checklist.
No patient or public contribution.
This qualitative study aimed to identify nurses' and allied health professionals' perceptions and experiences of providing hospital-acquired pressure injury (HAPI) prevention in a paediatric tertiary hospital in Australia, as well as understand the perceived barriers and facilitators to preventing HAPI.
A qualitative, exploratory study of hospital professionals was undertaken using semi-structured interviews between February 2022 and January 2023.
Two frameworks, the Capability, Opportunity and Motivation Model of Behaviour (COM-B) and the Theoretical Domains Framework (TDF), were used to give both theoretical and pragmatic guidance. Participants included 19 nursing and allied health professionals and data analysis was informed by the framework approach.
Analysis revealed nine core themes regarding professionals' beliefs about the barriers and facilitators to HAPI prevention practices across seven TDF domains. Themes included HAPI prevention skills and education, family-centred care, automated feedback and prompts, allocation and access to equipment, everybody's responsibility, prioritizing patients and clinical demands, organizational expectations and support, integrating theory and reality in practice and emotional influence.
These findings provide valuable insights into the barriers and facilitators that impact paediatric HAPI prevention and can help identify and implement strategies to enhance evidence-based prevention care and prevent HAPI in paediatric settings.
Overcoming barriers through evidence-based interventions is essential to reduce HAPI cases, improve patient outcomes, and cut healthcare costs. The findings have practical implications, informing policy and practice for improved preventive measures, education, and staffing in paediatric care, ultimately benefiting patient well-being and reducing HAPIs.
No patient or public contribution. The focus of the study is on healthcare professionals and their perspectives and experiences in preventing HAPIs in paediatric patients. Therefore, the involvement of patients or the public was not deemed necessary for achieving the specific research objectives.
Healthcare systems face a growing challenge: as technology advances, patients increasingly feel like data points in systems that prioritise efficiency over empathy. This paper addresses the global healthcare crisis of disconnection, arguing that fundamental change requires putting human experience at the centre through Caring Science principles in nursing.
COVID-19 clearly revealed this disconnect. While showcasing scientific advances, it exposed gaps in compassionate care and fair access globally. Nurses struggled to maintain human connection while dealing with resource shortages and isolation protocols, proving that advanced medical treatments alone cannot address the physical, emotional, spiritual, and social factors that influence health.
This work draws on peer-reviewed studies, contemporary research, and theories of human caring to demonstrate the global responsibility and urgent need for integrating caring practices into healthcare systems. Collectively, this evidence underscores both the necessity of intervention and the effectiveness of Caring Science as a strategy for transforming organisational practices while highlighting a pressing truth: healthcare systems worldwide must move beyond efficiency alone and intentionally weave caring practices into their structures.
This analysis examines Caring Science through three key areas: Relational, Organisational, and Global. Using Watson's Theory of Human Caring and current research, the paper shows how caring relationships can improve through thoughtful use of innovation. Recent healthcare improvements demonstrate promising results when technology integration enhances both nurse empowerment and patient outcomes within frameworks that prioritise human connection.
Future directions position Caring Science as a mature, evidence-informed framework for addressing healthcare's complex challenges. The paper calls for ‘sacred activism’—a commitment to protecting caring's essential dimensions while embracing beneficial innovation, positioning nursing to lead healthcare transformation through both the art and science of nursing that honours human dignity.
FreshRSS 