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To better understand what enables evidence-based practice, this study investigated contextual factors influencing evidence-based practice in general, and in relation to the implementation of bladder-monitoring guidelines in orthopaedic care.
Convergent parallel mixed method.
This study was part of a hybrid research project across 17 Swedish orthopaedic sites. The data collection (2021–2023) included interviews with orthopaedic staff and patients post-hip surgery, patient survey free-text responses, and a staff survey on organisational context. Data were analysed with deductive content analysis and descriptive statistics, later integrated using a mixed methods approach.
Evidence-based practice was supported by context factors such as staff collaboration and multiprofessional engagement. Staff addressed patient safety and equality by using evidence-based guidelines, but rarely involved the patients. Orthopaedic fast-track procedures positioned patients as passive recipients, while staff voiced a call for a more person-centred context. Positive attitudes, leadership engagement, use of champions, and adequate staffing enabled evidence-based practice, though a shortage in evaluation and high staff turnover hindered its implementation.
Orthopaedic context is characterised by several enabling organisational context factors for evidence-based practice, although patients lacking recognition of their needs and queries justify greater focus on person-centredness and mutual information exchange. Audit and feedback are crucial for improvements, but were lacking in the orthopaedic care context.
Assessments of efforts made to implement evidence-based practice and its outcomes should incorporate nursing care. Slimmed care processes require attention to ensure patient participation.
The orthopaedic care context is enabling for evidence-based practice, although staff are challenged by fast-track procedures with extensive information exchange and insufficient person-centredness.
The Mixed Methods Reporting in Rehabilitation & Health Sciences checklist.
No patient or public contribution.
Identifier: NCT 04700969
Knee osteoarthritis (OA) causes pain, reduced function and disability and may require total knee replacement (TKR). Although TKR is effective, up to 20% of patients remain dissatisfied, partly due to poor preoperative function and unrealistic expectations. Long waiting times for surgery may worsen patients’ function, yet preoperative physiotherapy is rarely offered. Prehabilitation—exercise and education before surgery—could improve postoperative recovery, but current evidence is limited. This trial investigates whether adding prehabilitation to standard care before TKR improves postoperative patient-reported joint awareness, enablement and knee function.
This multicentre, randomised controlled parallel-group trial is planned to be conducted within two specialised orthopaedic outpatient rehabilitation units in the southeast healthcare region of Sweden. Eligible patients (40–85 years, awaiting unilateral TKR) are randomised 1:1, stratified by age (≤67, >67 years), to either 8 weeks of prehabilitation—comprising two times per week supervised exercise therapy (strength, range of motion and balance) and education—in addition to standard care, or to standard care alone. Standard care consists of self-care, a single standardised preoperative education session and standardised postoperative rehabilitation. Assessments are conducted at baseline, post-intervention, 1 week pre-surgery and 6, 12 and 52 weeks post-surgery. A total of 110 patients will be recruited to the trial. Primary outcomes are joint awareness (Forgotten Joint Score-12) and patient enablement (modified Patient Enablement Instrument-2). Secondary outcomes are patient satisfaction (5-category Likert scale), the Knee injury and Osteoarthritis Outcome Score, the EuroQol 5 Dimension 3 Level questionnaire, the International Physical Activity Questionnaire—short form, objective function and accelerometer-based physical activity. Analyses will follow intention-to-treat and per-protocol principles. Between-group and within-group differences will be tested using t-tests or non-parametric equivalents, and linear mixed models or generalised linear models. Multiple linear regression and logistic regression will be used to analyse predictor variables for the primary outcomes. Sensitivity analyses will be performed to quantify the magnitude of missing data from patients lost to follow-up.
The trial has received ethical approval from the Swedish Ethical Review Authority (reg. no.2023-05120-01) and complies with the Declaration of Helsinki. Signed informed consent is collected for all patients before entering the trial. Results will be submitted for publication in a peer-reviewed journal and presented at international/national conferences. The findings may improve future clinical guidelines and care pathways for patients undergoing TKR.
To identify and synthesise qualitative and quantitative evidence of nurse managers' qualities, practices and styles related to leading nurses' interprofessional collaboration.
Mixed-methods systematic review.
Two authors independently selected studies based on predefined inclusion criteria, assessed quality and extracted data. A thematic synthesis with a convergent qualitative design was used.
CINAHL, PubMed and Scopus were searched from January 1, 2010, to September 7, 2025. Citations of relevant articles were screened.
A total of 32 articles were included. The analysis revealed two leadership core qualities, five core practices, and three core styles of nurse managers that promote nurses' interprofessional collaboration. Core qualities were proficiency and mindset. Core practices comprised empowering, communicating and informing, commitment to interprofessional collaboration, creating possibilities, and establishing an enhancing atmosphere. Core styles included authentic, transformational, and transactional leadership styles.
The results reflect the situational nature of nursing leadership related to interprofessional collaboration. Successful leadership requires managers to adopt primarily a transformational leadership style, yet more traditional leadership is required occasionally. Results indicate that nursing leadership is foremost a process that evolves within its context.
Greater clarity on how leadership influences nurses' interprofessional collaboration supports leaders, organisations, and educational institutions in developing and sustaining effective leadership.
This review demonstrates that the quality of nursing leadership is a central factor for successful interprofessional collaboration.
The PRISMA guidelines for Systematic Reviews and Meta-Analysis were used.
This study did not include patient or public involvement in its design, conduct or reporting.
To psychometrically validate a comprehensive core competence (3C) instrument to measure the core competence of healthcare professionals in clinical settings.
Instrument development and validation study.
This study focused on the fourth phase of instrument development and validation, which involves refining the scale and assessing its psychometric properties. Secondary data from self-reported assessments of core competency levels by healthcare professionals (628 nurses and 450 physicians) working at healthcare institutions in Oman were used. Structural validity was examined via exploratory factor analysis using oblique rotation (Promax). The stability of factorial validity was assessed through transformation analysis and invariance testing using confirmatory factor analyses. Internal consistency was evaluated using Cronbach's alpha.
The development and validation process produced a 3C instrument including 39 items across 11 factors: research and innovation (4 items), patient sustainable care (5 items), strategic leadership (4 items), safety promotion (3 items), tech integration (3 items), quality excellence (4 items), collaborative care delivery (4 items), professional growth (3 items), communication excellence (3 items), ethics and compliance (3 items) and professional practice (3 items). The instrument explained 65.3% and 67.6% of the total observed variance for nurses and physicians, respectively, with Cronbach's alpha for each component above the minimum acceptable value of 0.70.
The 3C instrument, developed through structured validation, comprehensively assesses healthcare professionals' core competencies, bridging the gap in existing tools with robust psychometric properties.
Healthcare professionals must develop robust and versatile core competencies to address increasing quality and safety patient care demands, escalating costs, unsustainable delivery models and rising stakeholder expectations. The developed 3C instrument is valuable for (1) comprehensively assessing core competencies, (2) suggesting an immediate and short-term action plan and (3) stimulating policies to drive the transformation of the delivery system over the longer term.
No patient or public contribution.
To explain the relationships between nurses' self-leadership and professional autonomy, job satisfaction, and intention to leave the profession.
A descriptive cross-sectional study design.
A total of 230 registered nurses responded to a survey including a Finnish version of the Dempster Practice Behaviour Scale and the Revised Self-Leadership Questionnaire in fall 2024. Structural equation modelling was used to test hypotheses.
Nurses assessed their self-leadership practices as moderately good. The model indicated that self-goal setting, evaluating beliefs and assumptions, and job satisfaction have positive relationships with professional autonomy, while self-reward and self-punishment have negative relationships with it. It also demonstrated that natural reward strategies have a positive relationship with job satisfaction, while self-punishment has a negative relationship with it. Nurses' professional autonomy and job satisfaction reduce their intention to leave, while evaluating beliefs and assumptions increase it.
Goal setting and using constructive mindsets develop ways of thinking that positively impact nurses' autonomy. This, in turn, leads to higher job satisfaction and lower intention to leave. Natural reward strategies that involve performing meaningful tasks surrounded by empowering people increase job satisfaction. However, not all self-leadership strategies are beneficial: self-punishment can lower professional autonomy and job satisfaction. Additionally, evaluating one's own beliefs and assumptions might increase the intention to leave due to reflective thoughts about the profession.
Implementing professional autonomy and self-leadership practices in organisational structures enhances nurses' valuable role. Empowering leadership encourages nurses to set goals, evaluate beliefs and assumptions, and reward themselves. Moreover, nurses' self-punishment can be avoided with a healthy, open work environment. Self-leadership skills should be strengthened in nursing education to prepare nurses for work demands.
The STROBE checklist.
No patient or public contribution.
To systematically map evidence on the application of AI systems in nursing workforce management, with a targeted focus on the role of nurse leaders.
A scoping review.
A comprehensive literature search was conducted across six databases: CINAHL, IEEE Xplore, MEDLINE/PubMed, PsycINFO, Scopus, and Web of Science. Studies published in English between January 2015 and December 2024 were included.
Studies that focused on AI in the context of nursing leadership or workforce management were included, while those examining AI in healthcare but without a specific focus on nursing leadership/management were excluded.
A total of 1014 articles were retrieved, and 12 were included in this review. Eleven articles were published between 2022 and 2024. The findings show that AI systems in nursing management have been applied in several domains, including workforce planning, nursing safety, and staff prediction models. Although studies highlight the positive optimising potential of AI systems, others underscore the ethical implications of AI with respect to nursing leadership and management, particularly regarding discriminatory stereotypes in AI-generated nurse imagery and the critical role of nurse leaders in ethical AI integration in care. Only one study identified important barriers to AI integration, underlining the need for enhanced AI training for nurse managers.
Findings suggests that the application of AI systems in nursing leadership/management is in its early phases, with limited engagement of nurses in innovating and implementing AI-enabled systems. A substantial problem related to AI adoption remains—AI integration hinges on addressing the readiness and engagement levels of nurse leaders early on in the process of AI systems' innovation. To promote AI integration, AI competency, trust, and optimisation in healthcare, developing a basic working understanding of AI together with a culture of multidisciplinary AI development teams that include nurses are potentially proactive strategies.
This study adhered to the PRISMA-ScR guideline.
No patient or public contribution.
To explore first-line managers' experience of guideline implementation in orthopaedic care during the COVID-19 pandemic.
A descriptive, qualitative study.
Semi-structured interviews with 30 first-line nursing and rehabilitation managers in orthopaedic healthcare at university, regional and local hospitals. The interviews were analysed by thematic analysis.
First-line managers described the implementation of guidelines related to the pandemic as different from everyday knowledge translation, with a swifter uptake and time freed from routine meetings in order to support staff in adoption and adherence. The urgent need to address the crisis facilitated guideline implementation, even though there were specific pandemic-related barriers such as staffing and communication issues. An overarching theme, Hanging on to guidelines for dear life, is substantiated by three themes: Adapting to facilitate change, Anchoring safety through guidelines and Embracing COVID guidelines.
A health crisis such as the COVID-19 pandemic can generate enabling elements for guideline implementation in healthcare, despite prevailing or new hindering components. The experience of guideline implementation during the COVID-19 pandemic can improve understanding of context aspects that can benefit organizations in everyday translation of evidence into practice.
Recognizing what enabled guideline implementation in a health crisis can help first-line managers to identify local enabling context elements and processes. This can facilitate future guideline implementation.
During the COVID-19 pandemic, the healthcare context and staff's motivation for guideline recognition and adoption changed. Resources and ways to bridge barriers in guideline implementation emerged, although specific challenges arose. Nursing managers can draw on experiences from the COVID-19 pandemic to support implementation of new evidence-based practices in the future.
This study adheres to the EQUATOR guidelines by using Standards for Reporting Qualitative Research (SRQR).
No Patient or Public Contribution.
To describe nurse leaders' perceptions of factors related to the development of their own interpersonal communication competence.
Qualitative descriptive study.
Individual semi–structured interviews were conducted with 21 nurse leaders in three wellbeing service counties in Finland. Data were collected between February and April 2024 and analysed using an inductive content analysis.
The analysis identified two main categories, each comprising several subcategories: (1) individual factors related to development, which encompassed participants' perceptions on how inherent qualities, personal experiences, reflexivity, motivation and communication training were related to the development of interpersonal communication competence, and (2) interpersonal factors related to development, which demonstrated the role of situational contexts, feedback and social support in competence development.
This study frames the development of nurse leaders' interpersonal communication competence as a lifelong and continuous process. The findings emphasise the interplay of individual and interpersonal factors, encompassing various competence categories and dimensions. This dynamic underscores the importance of developing interpersonal communication competence in workplaces through various practices, in addition to formal communication training.
The findings enhance our understanding of nurse leaders' interpersonal communication competence and the factors related to it. The study also identifies various practices for fostering nurse leaders' communication competence.
The study provides valuable insights for healthcare organisations and educational institutions by highlighting the importance of providing nurse leaders with opportunities to promote their interpersonal communication competence through both formal communication training and their daily work activities.
Reporting adhered to the SRQR checklist.
No patient or public Involvement.
Radiological imaging is a central facet of the multidisciplinary evaluation of suspected child physical abuse. Current guidelines for the imaging of suspected child physical abuse are often unclear, incomplete and highly variable regarding recommendations on critical questions, thereby risking clinical heterogeneity, unstructured decision-making and missed diagnoses. We, therefore, aim to develop and report an evidence-based and consensus-derived international guideline for the radiological investigation of index and contact children in the context of suspected physical abuse and to ascertain areas of scientific uncertainty to inform future research priorities.
The international guidelines for the imaging investigation of suspected child physical abuse (IGISPA) consensus group includes formal representation from 127 recognised experts across 14 subspecialties, six continents and 32 national and/or international organisations. Participants will be divided into five longitudinal subgroups (indications for imaging, skeletal imaging, visceral imaging, neuroimaging and postmortem imaging) with three cross-cutting themes (radiography, genetics and adaptations for low- and lower-middle-income countries). Each subgroup will develop preliminary consensus statements via integration of current evidence-based guidelines, systematic literature review and the clinical expertise of a multinational group of experts. Statements will then undergo anonymised voting in a modified e-Delphi process and iterative revision until consensus (≥80% agreement) is achieved. Final statements will undergo both internal and external peer review prior to endorsement.
As an anonymous survey of consenting healthcare professionals, this study did not require ethical approval. Experts provided written informed consent to participate prior to commencement of the modified Delphi process. The IGISPA consensus statement and any subsequent guidance will be published open access in peer-reviewed medical journals.
If a person is in diabetes remission, even if only for a short time, this reduces the risk of later diabetes complications and lowers healthcare costs. A recent study shows that long-term remission of type 2 diabetes can be achieved through calorie restriction using total diet replacement. However, this intervention involves support through face-to-face meetings every 2 to 4 weeks over a 2-year period, which is not feasible in routine care with limited resources. Therefore, we have developed an eHealth programme to help patients achieve diabetes remission through calorie restriction in a cost-effective manner. Our primary hypothesis is that an eHealth programme will be non-inferior to face-to-face meetings in helping patients with type 2 diabetes achieve remission through caloric restriction. Our second hypothesis is that eHealth support will be more cost-effective than face-to-face support.
The eHealth DIabetes remission Trial is a multicentre, two-arm, non-inferiority, open-label, randomised controlled parallel group trial with blinded endpoint assessment conducted at two centres in Sweden. The study duration is 2 years. People with type 2 diabetes (≤6 years duration) use total diet replacement (approximately 900 kcal/day) with the aim of losing 15 kg and achieving diabetes remission. Participants are randomly assigned to either the eHealth support group or the face-to-face support group. The treatment programme to achieve and maintain weight loss is the same in both groups, but the method of support differs between the groups. The primary outcome is haemoglobin A1c (HbA1c) after 1 year. The secondary outcome is HbA1c at 6 months and 2 years. Other important secondary outcomes are diabetes remission rate, body weight and cost-effectiveness. The latter is assessed using the incremental cost per quality-adjusted life-years gained.
The study was approved by the Swedish Ethical Review Authority (Dnr 2022-02242-01, 2023-03707-02). The results will be published in peer-reviewed scientific journals and discussed at national and international conferences and with patient organisations.
ClinicalTrials.gov (NCT05491005).
FreshRSS 