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There is an urgent need to improve surgical antimicrobial stewardship (AMS), to enhance individual care and reduce population-level antimicrobial resistance, but it is a complex issue.
We aimed to conduct an ethnographic study asking what would work in practice to improve surgical antibiotic prescribing behaviour?
Adopting a socio-cultural-historical perspective, we undertook ethnographic observations of clinical practice (43.5 hours) and semistructured interviews (n=31) with surgical staff, AMS staff and patients at two English National Health Service hospitals. Interview transcripts and observational fieldnotes were analysed using the Framework Approach. Additionally, we integrated stakeholder engagement throughout to ensure the findings were meaningful.
Our analysis of all fieldnotes (based on 43.5 hours of observation) and interview transcripts (n=31 from interviews with 31 different participants) identified that, while surgical staff were aware of antimicrobial resistance, they seldom considered AMS urgent or important in the acute setting where lack of time and the desire to mitigate perceived risk often prevailed. Other surgical issues were perceived to dominate senior decision-makers’ focus, thus perpetuating the status quo. Furthermore, attention to AMS was not always prioritised at the organisational level or by resource-limited AMS teams. Consequently, there was an absence of relationships and tools that foreground AMS. Electronic prescribing systems frequently hindered antimicrobial review and exacerbated patterns of siloed inter-disciplinary working, and feedback on antimicrobial prescribing and patient outcomes was largely absent. To improve AMS, surgical teams wanted sustainable improvements which effectively account for the hierarchical relationships, division of labour, rapid workflow and high staff turnover. Infection experts should better integrate into surgical teams to build relationships and trust, and to proactively contribute to patient care.
We offer data-driven, theoretically informed strategies to support change. Contextually appropriate improvements that address the status and visibility of AMS in surgery will be key. Further research is needed to assess the impact and sustainability of the suggested approaches.
To explore the impact of Doctor of Nursing Practice (DNP) education on career advancement, job satisfaction, leadership competencies and contributions to healthcare systems.
The study utilised a scoping review methodology based on Arksey and O'Malley's (2005) framework.
The search strategy was developed with an academic librarian to ensure thoroughness and relevance. Seven databases were searched using MesH terms. Inclusion criteria focused on peer-reviewed studies examining DNP education's influence on career advancement, job satisfaction and leadership. Thematic analysis was used to identify patterns and themes.
Studies were selected based on their focus on DNP-prepared nurses, nursing faculty or advanced practice nursing students in healthcare or academic settings, published between 2004 and 2024.
Twenty-one studies met the inclusion criteria, highlighting DNP education's role in fostering leadership, professional development and evidence-based practice. Thematic analysis revealed the benefits of being a DNP graduate include contribution to professional development, contribution to leadership and contribution to the practice environment. The challenges to DNP graduates include underrecognition of competencies, high educational costs and limited academic opportunities that were also identified.
DNP education contributes to individual and professional growth, leadership development and healthcare system improvements. However, barriers such as financial constraints and inadequate recognition of DNP competencies must be addressed to maximise the impact of this educational model.
DNP education empowers nurses to lead healthcare innovations, enhance patient care quality and reduce disparities in health outcomes. Strengthening financial and systemic support for DNP graduates is essential for sustaining these contributions.
DNP education is a transformative force in nursing, offering significant opportunities for leadership development and healthcare advancements. Aligning DNP programmes with evolving global healthcare challenges can further strengthen their impact on the profession and patient care.
PRISMA-ScR guidelines were followed.
by Mehmet Yildirim, Timothy Carter, Holly Blake
Poor mental well-being is common among healthcare workers, affecting individual health, patient safety, and organisational performance. Mobile app-based self-care interventions are promising due to their accessibility, low cost, and ease of use. This study aimed to assess the feasibility of a self-monitoring mobile app called MYARKEO, to improve mental well-being among healthcare workers and healthcare trainees in the United Kingdom (UK). The study evaluated recruitment and retention rates, variability of key outcomes to inform a future randomised controlled trial (RCT), intervention engagement, barriers and facilitators to engagement, and potential refinements to the mobile app. A mixed-method feasibility RCT was conducted with two groups: an intervention group using MYARKEO to monitor mental well-being over 6 weeks, and a non-intervention control group. Data were collected at baseline and post-intervention and included the Warwick-Edinburgh Mental Well-being Scale (WEMWBS), the Depression Anxiety and Stress Scale (DASS-21), and the mHealth App Usability Questionnaire (MAUQ). Qualitative data were collected through semi-structured interviews (n = 13) and analysed using thematic analysis. Forty-nine participants (32 workers, 17 trainees; aged 18–60+) were included in the trial, with a 20.5% dropout rate. Daily app usage averaged 64.5%. Participants frequently monitored mood, sleep, food, and exercise. Interviews identified themes of “Usefulness,” “Enablers of engagement,” “Barriers to engagement,” and “Suggested intervention improvements.” This study demonstrates the feasibility of using a mobile app to monitor and promote mental well-being among healthcare workers and trainees. While app engagement was promising, challenges were identified, highlighting the need for refinements to the app’s content, interface, and design for future trials.Pain is a common complaint in patients presenting to an Emergency Department (ED). Data show that timely delivery of pain relief in this setting remains a challenge. Adequate treatment of pain requires recognition and assessment. The Royal College of Emergency Medicine advocates for early pain assessment and reassessment post-analgesia; however, it does not specify how best to do this. Therefore, a review of existing literature is needed to identify which pain assessment tools have been shown to be useful in the ED.
This scoping review will use the Joanna Briggs Institute methodology. A search of PubMed, Embase, Cumulated Index in Nursing and Allied Health Literature, Web of Science, Scopus and the Cochrane Library will identify relevant studies published in English since January 2004. Studies will be included that recruit adults (aged 18 years and over) presenting to an ED with acute pain (duration under 3 months). Publications must assess or compare tools for measuring pain in an ED setting. Full-text articles published internationally will be considered. After duplicate removal, abstract screening and full-text analysis by two independent reviewers will identify relevant papers, using the inclusion criteria. Discrepancy resolution will be via a third reviewer. Pain measurement tools and their evidence will be extracted, collated and described. The findings will be reported according to Preferred Reporting Items for Systematic reviews and Meta-Analyses for Scoping Reviews.
Ethical approval is not required for this review. Published results will be shared with relevant parties interested in ED pain management. Potential next steps include patient involvement in the evaluation of pain assessment tools identified in this review and implementation into practice. The insights of patients with relevant lived experience in assessing these tools would be invaluable to the objective of improving pain management in the emergency setting.
This project is registered with the Open Science Framework accessible at https://doi.org/10.17605/OSF.IO/ENVPY.
To explore the acceptability and feasibility of using a trauma-informed communication tool to convey client needs to health professionals; and to understand the barriers and enablers for clients using the tool.
Mixed methods design pilot study conducted by nurses from a regional community health service in Victoria, Australia, of purposively sampled clients who have a history of sexual assault and/or family violence and clinicians from a primary care service.
The investigators developed a pocket-sized communication card to convey clients' history of trauma and the clients' emotional and physical needs to health care providers.
Pre-intervention and post-intervention surveys using validated scales (‘Acceptability of Intervention Measure’ and ‘Intervention Appropriateness Measure’) were administered via anonymous online or paper-based survey.
Sixteen clients completed the pre-intervention survey and 12 clients completed the post-intervention client survey. Seven Nurses and three Social Workers completed the clinician survey.
Both clients and clinicians reported high rates of acceptability and appropriateness of the tool on the outcome measures. The most commonly reported barriers to using the tool were clients forgetting to use the card and concern about how health professionals may respond.
Content analysis of qualitative data revealed themes categorised as positive impacts (prevention of re-traumatisation), negative impacts (negative response from health professionals) and suggestions for improvement of the tool (developing a digital version, raising clinicians' awareness of the tool).
This novel tool has demonstrated a high degree of acceptability and applicability in a sample of clients with a history of trauma secondary to sexual assault and/or family violence, and community health clinicians, and several positive and negative impacts have been identified. Further research should focus on larger participant numbers and include developing a digital version and a clinician education component.
Use of a tool to communicate impacts of trauma may prevent re-telling of traumatic stories by clients and enhance quality of care delivery.
The Good Reporting of a Mixed Methods Study (GRAMMS) has been used to report the results of this study.
During development of the tool, it was reviewed by a lived experience consumer representative, the health organisations' consumer advisory panel, and a small sample of clients.
The aim of this integrative review was to explore registered nurses' understandings of organisational culture and cultures of care in aged care.
Integrative literature review.
A literature search was conducted of Medline (OVID), CINAHL Plus with Full Text, Scopus, Proquest Nursing and Allied Health, and Informit databases in June 2024. In October 2024, a search for grey literature was conducted focusing on Google Scholar, the Analysis and Policy Observatory (Australia), Australian Government websites, European Union Institutions and Bodies, and usa.gov. The inclusion criteria were Australian and international literature published in English between 2004 and 2024. The inclusion criteria were amended to focus on literature published from 2014 to 2024.
Seventeen research studies met the inclusion criteria for the review. Four primary themes were identified: competing hierarchies of power; the multifaceted role of nurses in long-term care settings; standing still is not an option; and implications for culture change strategies in practice.
Registered nurses in aged care are pivotal to evolving clinical and administrative practice and creating organisational cultures that affirm the rights of older people, including providing a supportive workplace for those who care for them, in an environment focussed on developing and sustaining quality care. Viewing the complex relationships at different organisational levels through the prism of Foucault's ideas on disciplinary power generates new insights into the role of registered nurses in aged care settings. This review also underscores that research on organisational culture in aged care is at a formative stage. There is potential for future research that fosters a robust evidence base to support the development of organisational cultures that nurture a person-centred environment ultimately leading to improved care and staff experience.
Registered nurses in aged care settings are advocating for a transformative shift in organisational cultures that prioritises inclusivity, compassion and person-centred care. Empowering nurses through clinical and administrative leadership roles is crucial for cultivating person-centred organisational cultures in aged care settings. It is essential that policymakers invest in the development of registered nurses who can excel in clinical and operational roles at management and executive levels. Policy changes that promote frameworks that facilitate nursing leadership are essential for establishing and maintaining person-centred workplace cultures.
Prisma extension for scoping reviews (PRISMA—ScR).
This study did not include patient or public involvement in its design, conduct, or reporting.
To identify effective interventions to lower cardiovascular disease (CVD) risk factors among Asian Indian (AI) immigrants.
As the second largest immigrant group in the USA, AI immigrants experience CVD prevalence rates as high as 13% among males and 4.4% among females; these rates are significantly higher than other Asian subgroups and the general US population. Despite extensive knowledge of CVD risk factors, there have been few cardioprotective interventions in this population.
Interventional studies of first-generation AI immigrants aged 18–70 years, conducted between 2000 and 2025, will be identified, including randomised controlled trials, factorial and cross-over designs, and cluster randomised trials. We will include AIs with and without a specific family history of CVD, or personal history of type 2 diabetes mellitus, hyperlipidaemia or obesity. Exclusion criteria include AIs born in the USA or visiting.
The Arksey and O’Malley methodology framework and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews will be used for analysis. A preliminary review of interventions to lower the CVD risk in AIs will guide the research questions (stage 1). Relevant articles published between 2000 and 2025 will be retrieved using electronic databases and search terms (stage 2). Two independent reviewers will select studies based on eligibility criteria (stage 3). Reviewers will determine eligibility status, screen full texts and retrieve relevant publications. Reviewers will extract data, capturing study design, sample characteristics, types of interventions, outcomes and key findings (stage 4). A summary of results will be presented (stage 5). The review will identify the most effective interventions, potential areas for future research and practical recommendations to improve CVD outcomes among AI immigrants.
Included studies will meet ethical standards in research. Findings will be disseminated through manuscripts, presentations at relevant conferences and community outreach programmes to promote effective interventions.
FreshRSS 