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Providing peer support can benefit youth peer support workers (peers)et by supporting self-determination, recovery and resilience to self-stigma. There is a need to clarify the role of the organisation in providing benefits for peers. We aimed to identify the organisational contexts and mechanisms that result in the creation of healthy workplaces for peers.
Rapid realist review guided by the Realist and Meta-Narrative Evidence Syntheses–Evolving Standards guidelines and Pawson’s iterative approach.
MEDLINE, CINAHL, PsycINFO, ERIC, SocINDEX, Google Scholar and Embase were searched from 1979 to 2025.
We included qualitative and quantitative peer-reviewed studies and grey literature that captured characteristics of organisational practices and employment considerations in youth peer support programmes.
Articles were screened independently by multiple reviewers. Inclusion criteria were adjusted to capture literature on organisational practices, and employment considerations for youth peer support programmes. Data were extracted and analysed retroductively to develop Context-Mechanism-Outcome Configurations (CMOCs).
Five employment-related risks to peer well-being were identified: (1) difficulty entering the job market, (2) lack of role clarity, (3) pressure to live up to ideals, (4) retraumatisation and (5) stigma. Six CMOCs were developed; all focused on the creation of equitable employment and supporting peer development and empowerment were developed.
Community-based mental health organisations can facilitate equitable peer employment through strategies that reduce professional stigma, enhance peer resilience and promote professional and personal development. Policy reform that addresses precarious work conditions is needed to support healthy work environments.
To describe the latest information on types of psychosocial interventions and their effectiveness on loneliness reduction among older adults in community and residential care settings, and the experience with these interventions.
Umbrella review.
The Joanna Briggs Institute methodology for umbrella reviews.
Cochrane Database of Systematic Reviews; Cumulative Index of Nursing and Allied Health Literature; Medline; Embase; Emcare; PsycINFO; ProQuest Dissertation & Thesis Global; Ovid Nursing Database; MedRxvi.
Twenty-two reviews were included. Seven major types of psychosocial intervention were identified: (1) social facilitation interventions, (2) psychological therapies, (3) health and social care provision, (4) animal-assisted interventions, (5) befriending interventions, (6) leisure and skill development, and (7) other interventions. Social facilitation interventions that provide synchronised interaction, psychological therapies, health and social care provision, and animal (−assisted) interventions demonstrated positive effects while leisure/skill development and befriending interventions warrant more rigorous evidence. Group settings, synchronised interaction and purpose-driven are identified as facilitators, whereas technological issues and safety issues are barriers to participation.
Seven types of psychosocial interventions are currently available for loneliness among community-dwelling older adults, and a positive effect in reducing loneliness was demonstrated in some types. Facilitators and barriers to their participation were synthesised. Two future research directions are suggested: (1) reviews on meaning-centred interventions to provide a comprehensive understanding and (2) implementation studies employing community-based paraprofessionals to promote programme scalability and accessibility.
Health and social care practitioners (e.g., nurses), researchers and policymakers are recommended to employ social facilitation interventions with synchronised interaction, psychological therapies, health and social care provision and animal-assisted interventions to address loneliness among community-dwelling older adults.
This review provided empirical information on available effective interventions to address loneliness among community-dwelling older adults. It also provided information for nurses to implement psychosocial interventions in the community.
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines
This study did not include patient or public involvement in its design, conduct or reporting.
PROSPERO CRD 42023482852, registered 25/11/2023
To explore whether large language models (LLMs), Generative Pre-trained Transformer (GPT)-3, GPT-3.5 and GPT-4 can autonomously manage a virtual fracture clinic (VFC) as a marker of their efficacy in an emergency department and with simple orthopaedic trauma.
Simulated UK VFC workflow.
11 clinical scenarios were generated, and GPT-4, GPT-3.5 and GPT-3 were prompted to write clinic letters and management plans.
The Readable Tool was used to assess the clarity of letters. Six independent orthopaedic surgeons then evaluated the accuracy of letters and management plans.
Readability was compared using the Flesch-Kincaid grade level: GPT-4: 9.11 (SD 0.98); GPT-3.5: 8.77; GPT-3: 8.47, and the Flesch readability ease: GPT-4: 56.3; GPT-3.5: 58.2; GPT-3: 59.3. Surgeon-rated accuracy comparisons indicated that GPT-4 exhibited the highest accuracy for management plans (9.08/10 (95% CI 8.25 to 9.9)). This represents a statistically significant progression in the capacity of a LLM to provide accurate management plans compared with GPT-3 at 6.84 (95% CI 5.41 to 8.27) and GPT-3.5 at 7.63 (95% CI 7.23 to 8.13) (p
LLMs can produce high-quality, readable clinical letters for common VFC presentations, and GPT-4 can generate management plans to aid clinicians in their administration. With clinician oversight, appropriately trained LLMs could meaningfully reduce routine administrative work. However, while the results of this study are promising, further evaluation of LLMs is required before they can be deemed safe for managing simple orthopaedic scenarios.
To examine residential aged care staff's experience of death and grief, and their support needs.
A mixed-methods sequential explanatory design, using an online cross-sectional survey that included the Texas Revised Inventory of Grief and the Grief Support in Health Care Scale. Followed by semi-structured interviews with direct care workers and managers working in residential aged care homes were conducted.
Over 60% of participants experienced five or more resident deaths in the previous 12 months. Although, different levels of grief were experienced among different roles, the importance of open communication and opportunities for farewells after resident death was highlighted. Participants suggested support and education to normalise grief and promote self-care.
Recognising staff grief following the resident death is important. Providing support and education may help improve staff wellbeing and contribute to the delivery of high-quality care for both residents and their families.
Staff grief after a resident death needs to be recognised, and continuing education and support are required for their wellbeing.
The STROBE and SRQR checklists were applied.
No Patient or Public contribution.
This study examined factors associated with the use of Indonesia’s National Health Insurance (NHI) among its beneficiaries in Maluku province.
Cross-sectional study.
The individual-level data were derived from the 2021 Social Health Insurance Sample Data. National health reports of Indonesia were used to provide the district-level variables. We performed multivariable logistic regression analyses to identify factors associated with NHI use among its beneficiaries in Maluku province.
Data were collected from 31 517 NHI beneficiaries registered in Maluku.
The primary outcome was the use of NHI insurance when accessing healthcare services (yes/no).
Only 14.79% of NHI beneficiaries in Maluku had ever used their insurance for healthcare services. Individual factors associated with higher NHI use included being under 60 years, females (adjusted OR (aOR)=1.29, p
Strengthening primary healthcare accessibility, improving the distribution of healthcare workers and addressing socioeconomic and geographical disparities are essential to ensure that the NHI scheme achieves equitable use across all regions in Maluku and other areas with similar settings.
To co-develop storyboards and scripts for multimedia resources to support the information needs of informal carers (carers) of older adults from Greek, Italian and Chinese (Cantonese- and Mandarin-speaking) Australian backgrounds during hospital-to-home transitions.
A modified experience-based co-design methodology was used to co-develop four storyboards and scripts with Greek, Italian and Chinese Australian carers and advocates from multicultural community-aged care organisations. To promote relevance, a Carer Advisory Group guided the research. The Carer Advisory Group, comprising 10 people, included carers and advocates from participating multicultural community-aged care organisations, a social worker from a large public health service, and policy representatives. Twenty-nine participants took part from June 2023 to April 2024. Data collection involved two rounds of co-development including 2 workshops, 9 small group interviews and 11 individual interviews. Round 1 focused on understanding participants' experiences of older adult care transitions, information needs and advice for other carers. This information was used to develop categories and example quotes to draft four storyboards reflecting participants' descriptions of the carer and patient journey during care transitions. Round 2 involved draft storyboards being presented to the same participants who advised on their acceptability. Certified interpreters and translators were used throughout data collection.
The co-developed categories, four storyboards and scripts are presented. Participants and the Carer Advisory Group agreed that the findings would be used to develop multimedia resources to support the information needs of carers and older adults from Greek, Italian and Chinese Australian backgrounds in care transitions.
The storyboards and scripts for multimedia resources are expected to improve access to information and services for carers and older adults from culturally and linguistically diverse backgrounds. The storyboards and scripts are examples to guide policymakers and leaders in improving transitional care in Australia and internationally.
The reporting of the study has adhered to the COREQ guidelines.
Informal carers were involved in the Carer Advisory Group which provided guidance and consultation to each phase of the project. Their contributions included reviewing the ethics application prior to submission for ethical review, and reviewing storyboards and scripts to optimise the relevance for informal carers and older adults.
To explore clinical nurses’ process of coping during COVID-19 and develop a grounded theory that can be used by leaders to support clinical nurses during a disaster.
The COVID-19 pandemic has provoked widespread disruption to clinical nurses’ work. It is important to understand clinical nurses’ processes of coping during disasters to support the nursing workforce during events such as global pandemics.
We employed the Corbin and Strauss variant of grounded theory methodology, informed by symbolic interactionism, and applied the EQUATOR guidelines for qualitative research publication (COREQ).
Data collection entailed semi-structured interviews with experienced clinical nurses (n =20) across diverse settings. We analysed data by identifying key points in the nurses’ coping processes inductively building concepts around these points.
The predictor of nurses’ outcomes in this grounded theory was their confidence in their ability to cope during the pandemic. When nurses lacked confidence, they experienced working in the context of acute COVID—a state of chaos and anxiety, with negative consequences for nurses. However, when nurses were confident in their abilities to cope with the pandemic, they experienced working in the context of chronic COVID, a calmer state of acceptance. There were many workplace factors that influenced nurses’ confidence, including adequacy of personal protective equipment, clear information and guidance, supportive leadership, teamwork and adequate staffing.
Understanding clinical nurses’ experience of coping during COVID-19 is essential to maintain the nursing workforce during similar disasters.
Nurse leaders can target areas that support nurses’ confidence, such as adequate PPE and staffing. In turn, increased confidence enables clinical nurses to cope during disasters such as a global pandemic.
To evaluate the long-term efficacy of remote ischaemic postconditioning (RIPC) on functional outcomes in patients with acute ischaemic stroke (AIS) who received intravenous thrombolysis (IVT).
This was a post-trial follow-up study of a rater-blinded randomised controlled trial.
Single-centre study conducted in a tertiary hospital in China, with follow-up interviews performed via telephone approximately 4.8 years after randomisation (November 2022).
The original trial (NCT03218293) included 68 patients allocated either to the control group (n=34) or the RIPC group (n=32) between August 2017 and June 2018. For this follow-up, 62 patients (93.9%) were successfully contacted and included in the analysis.
The primary outcome was the proportion of patients achieving a favourable functional outcome, defined as a modified Ranking Score (mRS) 0 or 1 at long-term follow-up. Secondary outcomes included functional independence (mRS 0–2), recurrent stroke/transient ischaemic attack (TIA) and all-cause mortality. Binary outcomes were analysed using generalised linear models with inverse probability of treatment weighting (IPTW) adjustment. Time-to-event analyses employed IPTW-weighted Kaplan-Meier curves and Cox proportional hazards models, with statistical significance set at p
At a median follow-up of 4.8 years (IQR 4.6–5.1), the proportion of favourable functional outcome was higher in the RIPC group when compared with the control group (unadjusted risk ratio, 3.87; 95% CI 1.34 to 11.17; p=0.012 and IPTW-adjusted risk ratio, 5.92; 95% CI 1.45 to 24.24; p=0.017). The RIPC group also showed a trend towards improved stroke/TIA recurrence-free survival compared with the control group (IPTW-adjusted HR, 0.52; 95% CI 0.06 to 1.00; p=0.050).
IVT combined with repeated in-hospital RIPC may lead to improved long-term functional recovery and reduced stroke/TIA recurrence in patients with AIS. Larger multicentre trials are warranted to confirm these findings.
To develop precision health (PH) competencies and evaluate their comprehensiveness and fit into nursing practice.
A modified e-Delphi technique was used to gather perceptions and achieve consensus on the inaugural set of PH domains, competency statements and sub-competencies developed by a workgroup formed under the aegis of the American Nurses Association (ANA).
A set of PH competencies and sub-competencies was developed by the ANA workgroup, beginning with a literature review, followed by a multi-step work process of the group over 3 years (2022–2025). Then, a modified e-Delphi technique was conducted via a four-point Likert scale Qualtrics survey, using a purposive sample of PH experts. The respondents were asked to agree or disagree with each competency or sub-competency statement and suggest modifications. The threshold of concordance was set at 80%.
The ANA workgroup reached consensus on six domains, six competency statements and 43 sub-competency statements to represent PH in nursing practice in its entirety. Forty experts in the field evaluated and offered revisions to the final 44 sub-competencies that represent the knowledge and skills necessary for PH in general nursing practice. A majority of the competency statements obtained favourable agreement from the expert panel, and a typical pattern of convergence was observed over two rounds of evaluation.
The development of PH competencies is the essential first step in the attempt to integrate PH into nursing practice.
The competency statements will inform nursing curricula, clinical practice guidelines, funding opportunities and role expectations in all healthcare settings.
This work sets the stage for subsequent interprofessional practice initiatives and research exploring how these competencies influence patient outcomes, workforce readiness and the practical integration of advanced technologies into precise care.
Sr. Director: A inicios de la pandemia por la enfermedad de coronavi-rus (Covid‑19), producida por el virus SARS-CoV-2, las autoridades en salud emitieron recomendaciones a todos los países a fin de salva-guardar la integridad física de la población [Fragmento de texto].
FreshRSS 