Conectar
There is a significant need for trials that evaluate the treatment of University of Texas (UT) grade 2 and 3 diabetic foot ulcers (bone, joint, or tendon exposed wounds). We undertook a trial looking at the effect of intact fish skin graft (IFSG) on these deep and difficult-to-heal ulcers. 262 patients Intent to Treat (ITT) patients with UT grade 2 and 3 DFUs were randomised to receive intact fish skin graft (IFSG) or a standardised treatment (SOC) that adhered to the International Working Group on the Diabetic Foot (IWGDF) guidelines. The secondary endpoints that were measured included wound area reduction (WAR), healing rates at 20 and 24 weeks; closure rates by UT grade, perfusion, quality of life, pain reduction and IFSG safety. We report ITT (all randomised) (mITT previosly reported) The (WAR) at 12 weeks was 65.53% for IFSG versus 30.82% for SOC (p = 0.007). UT 2 wounds (60% of total) exhibited a closure rate of 47% versus 23% at 16 weeks for IFSG versus SOC (p = 0.0033). Target wound infections were comparable (39 vs. 37) and major outcomes were comparable during the 24 week period (target-limb amputations 8% vs. 7%). Time-to-heal favoured IFSG (restricted mean to 24 weeks 17.31 vs. 19.37 weeks; KM/log-rank significant; Cox HR 1.59). The in the treatment of deep complex diabetic foot wounds the addition of IFSG significantly improved the number of patients with total wound closure as well as the time to wound closure without increased risk of complications. This improvement in total wound closure and time to wound closure was noted across prior amputation status, quality of perfusion, and UT grade.
This community-led research study protocol emphasises placing black youth impacted by the legal system, their families and their communities at the forefront of substance use treatment development research and decision-making. The study, the Cultural Adaptation of a Substance Use Treatment (CAST) Project, challenges traditional top-down approaches to treatment creation, advocating for a grassroots model that centres community knowledge, values and active participation.
The CAST project is a US-based mixed-methods study with an exploratory design that examines the impact of racial discrimination on substance use in black youth impacted by the legal system. The study participants are black youth impacted by the legal system (N=15), parents of black youth impacted by the legal system (N=10) and community members who serve black youth (N=10) (total N=35 study participants). Study participants from each group (youth, parents and community members) will participate in three separate focus groups, respectively, to provide feedback on the culturally responsive content needed to best support black youth impacted by the legal system around substance use and mental health. The eight-step Assess, Decision, Adaptation, Production, Topical Expert, Integration, Training, Testing framework will be used as a guide to inform adaptations to the Motivational Enhancement Therapy and Cognitive Behavioural Therapy (MET/CBT12) for black youth impacted by the legal system. Once the cultural adaptation process has been completed, the study will conclude with an open feasibility and accessibility trial of the culturally adapted MET/CBT12 manual. The primary outcomes of this study are the feasibility and acceptability of the culturally adapted manual, measured by treatment attendance and participant feedback. Secondary outcomes include reductions in substance use and discrimination distress, and improvements in mental health symptoms.
This study was approved by the Institutional Review Board (IRB) at the University of California, San Francisco (IRB Protocol Number: 23-40126). All study procedures will be conducted in accordance with the ethical standards outlined by the institutional review board. The results from this study will be shared through peer-reviewed publications, academic conferences, community forums and policy briefs to support broader implementation of culturally adapted adolescent substance use interventions that address discrimination-related stress and substance use among black individuals impacted by the legal system.
To identify and synthesise existing evidence on family-centred care for Lesbian, Gay, Bisexual, Transgender, Queer and other diverse identities (LGBTQ+) people in acute hospital settings, including hospital-based palliative care, oncology, general in-patient and intensive care.
A scoping review guided by the JBI methodology.
Nine databases and grey literature sources were searched. Inclusion criteria focused on LGBTQ+ adults and family-related care experiences in hospital-based acute settings. After screening, qualitative, quantitative, and narrative data were extracted. Thematic analysis synthesised findings, with quantitative data narratively integrated.
Searches were conducted across nine databases and grey literature up to April 2025.
Five studies met inclusion criteria: three qualitative, one quantitative, and one reflective narrative. Four themes emerged: (1) invisibility and disclosure dilemmas, (2) exclusion of chosen families from visiting and decision-making, (3) barriers to inclusive communication and provider competence, and (4) enabling conditions for affirming care. Challenges occurred at interpersonal (e.g., provider assumptions, discomfort) and structural (e.g., lack of inclusive protocols, failure to recognise legal surrogates) levels. In the two studies reporting gender identity, transgender participants described heightened misrecognition and exclusion.
LGBTQ+ individuals and their chosen families face relational and structural barriers in acute hospital care. Inclusive interventions, protocols, and training are urgently needed to ensure affirming care.
Acute and intensive care providers should promote inclusive family engagement by using patient-preferred terminology, recognising chosen families, and advocating for inclusive policies and staff training.
This scoping review adhered to PRISMA-ScR guidelines.
No Patient or Public Contribution.
Registered with the Open Science Framework: 10.17605/OSF.IO/FSU8D (23/02/2025)
To identify obstacles faced by nurses when using health technologies in Intensive Care Units (ICUs).
Systematic review following PRISMA and registered in PROSPERO.
Six databases were searched. Two reviewers independently screened studies and appraised methodological quality using the Joanna Briggs Institute tool. Data were synthesized narratively.
Eight studies met eligibility criteria. Barriers clustered around limited training and technical competence, shorter professional experience, increased workload with multiple devices, organizational culture, and reduced direct patient contact, which may undermine patient-centered care. Heterogeneity of study designs precluded meta-analysis.
Obstacles to technology use in ICUs arise from individual and organizational factors. Addressing these barriers requires structured education, mentoring for novice nurses, workload management, and supportive policies that integrate technology without displacing bedside care.
Nursing leaders and educators should implement ongoing, ICU-specific technology training and mentoring. Managers and policymakers must ensure adequate staffing and promote Health Technology Assessment to align device implementation with clinical needs, safeguarding patient safety and the human dimensions of care.
This study investigated perinatal depressive symptoms among pregnant and postpartum Filipino women.
Cross-sectional survey.
The Philippines.
Participants were recruited online and face-to-face from maternal care facilities.
Perinatal depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale (EPDS) score, with prevalence calculated based on ≥13 cut-off, indicating clinically significant symptoms of depression. Patterns of depressive symptoms were examined by demographics, perinatal time period and other obstetric information using adjusted regression coefficients (ab) and risk ratios (aRR).
A total of 856 women participated in the study, comprising 356 pregnant and 500 postpartum women. EPDS scores were, on average, similar between pregnant (14.4) and postpartum women (14.1). Using the locally validated cut-off of ≥13 revealed that 69.1% of pregnant and 62.0% of postpartum women reported clinically significant depressive symptoms. Consistent EPDS scores and prevalence were observed across pregnancy trimesters and within 12 months postpartum and beyond. Women who received adequate prenatal care were less likely to experience antenatal (ab=–1.59, 95% CI –3.13 to –0.05) and postpartum (ab=–1.30, 95% CI –2.48 to –0.12) depressive symptoms. Postpartum EPDS scores and depressive symptom prevalence (EPDS score ≥13) were higher among 18–24-year olds (ab=1.96, 95% CI 0.30 to 3.61; aRR=1.23, 95% CI 1.03 to 1.47) and single mothers (ab=3.46, 95% CI 0.22 to 6.71; aRR=1.42, 95% CI 1.07 to 1.90), compared with older and married mothers, respectively.
At least 60% Filipino mothers experienced clinically significant perinatal depressive symptoms, which exceeds the established global average of 25%. Younger and single postpartum women were at greater risk, while pregnant and postpartum women who attended adequate prenatal visits were less likely to report depressive symptoms. Our study underscores the need for further research to uncover the true burden of poor perinatal mental health and calls for targeted early interventions and integrative public health strategies to support at-risk mothers, particularly those from socially disadvantaged backgrounds.
This study aimed to assess the association between lipid accumulation product (LAP) index, a novel index combining waist circumference (WC) and triglyceride levels, and anthropometric indices, metabolic factors and hepatic function markers in obese subjects with non-alcoholic fatty liver disease (NAFLD).
Cross-sectional study.
Specialised and subspecialised outpatient clinics of Tabriz University of Medical Sciences.
Overall, 232 adult patients with obesity and ultrasound-proven NAFLD were included in the present study.
Anthropometric measurements (body weight, height and waist and hip circumferences) were measured, and serum levels of glucose, lipid profile, ferritin and liver enzymes were assessed subsequent to an overnight fasting.
Mild and Moderate NAFLD were found in 43.5% and 48.2% of the participants, respectively. LAP index markedly increased with higher grades of steatosis, showing values of 63.72±22.26, 84.57±44.96 and 112.14±56.97 for healthy, grade I and grade II groups, respectively (p
In conclusion, the LAP index was not only associated with anthropometric indices, metabolic parameters and hepatic function markers, but also increased in line with higher grades of liver steatosis in NAFLD.
To investigate the effects of organisational interventions on the incidence, healing and management of pressure injuries in adult patients in acute hospital settings.
Systematic review.
The review included adult patients at risk of or with pre-existing pressure injuries in acute hospital settings, excluding mental health units, emergency departments or operating theatres. Interventions employed in the included studies were categorised using the Cochrane Effective Practice and Organisation of Care taxonomy.
Cochrane Central Register of Controlled Trials, Ovid MEDLINE, Ovid Embase, EBSCO CINAHL Complete and Web of Science Core Collection were searched from 01 January 2012 to 31 December 2023.
Of 8861 records identified, 7 prevention studies met the inclusion criteria. Six studies reported reductions in pressure injury incidence. Included studies employed various combinations of 14 organisational strategies to enhance practices. Educational interventions were utilised in six studies, including educational meetings, materials and outreach visits. Other common strategies included audit and feedback, communities of practice and continuous quality improvement. The interventions targeted patients and clinicians, primarily nurses, with some involving multidisciplinary teams. The focus was on enhancing healthcare practices through systematic approaches and stakeholder engagement.
Organisational strategies targeting both patients and clinicians as part of an intervention bundle may enhance the prevention of pressure injuries in acute hospital settings. Further, high-quality effectiveness–implementation hybrid trials are required to evaluate these strategies.
Organisational factors influence clinicians' ability to implement evidence-based practices. The effectiveness of specific organisational strategies in acute settings is uncertain. Multiple organisational strategies targeting patients and clinicians may improve the implementability of a pressure injury prevention intervention.
This study adhered to PRISMA guidelines.
Neither patients nor the public were directly involved in this study.
Alcohol consumption is an increasingly recognised modifiable risk factor for dementia, yet whether it has differential impacts on dementia subtypes and its role in disease progression remains unclear. This study aims to: (1) quantify the association between alcohol intake and incidence of dementia subtypes and (2) examine whether individuals who drink heavily and develop dementia referred to hereafter as ‘alcohol-related’—have poorer post-diagnosis outcomes compared with other dementia cases. Clarifying these relationships will determine whether alcohol selectively increases risk for specific dementia phenotypes or broadly heightens neurodegenerative vulnerability, with implications for prevention, clinical counselling and therapeutic targeting.
This population-based cohort study of alcohol and dementia will use linked UK electronic health records from Clinical Practice Research Datalink, Hospital Episode Statistics and Office for National Statistics (ONS). Participants will be eligible if they have available linked data from January 1998, when ONS death registrations became available, until the end of follow-up. Alcohol exposure will be defined through self-reported recorded weekly alcohol units and diagnostic codes for harmful or dependent alcohol use. Primary outcomes including incident all-cause and subtype-specific dementia (eg, Alzheimer’s, vascular, Lewy body, Parkinson’s, frontotemporal) as well as secondary outcomes (ie, mortality, care-home entry and neuropsychiatric symptoms). Key covariates encompassing socio-demographic factors, smoking and relevant comorbidities will be adjusted for. Multivariable Cox proportional hazards and Fine-Gray competing risk models will estimate associations with dementia incidence. Post-diagnosis prognosis will be compared for dementia in individuals with a history of heavy alcohol use (‘alcohol-related’) and dementia in individuals with minimal alcohol exposure (‘non-alcohol-related’) cases using survival and logistic regression models. Multiple testing correction will be applied across dementia subtype comparisons. Alcohol exposure will be modelled continuously and non-linearly using restricted cubic splines and categorically using binary indicators of harmful/dependent use. Missing covariate data will be assessed and addressed using appropriate methods, including multiple imputation and complete-case analysis. Data extraction and analysis are scheduled from October 2025 to October 2026.
Use of de-identified routine data will proceed under existing Research Ethics Committee and data governance approvals. Findings will be disseminated via open-access peer-reviewed journals, academic conferences and summaries targeted at patient, public and policy audiences. The results of this study will be reported according to the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) and The REporting of studies Conducted using Observational Routinely-collected health Data (RECORD) guidelines.
Surgical site infections (SSI) in vascular surgery have a huge impact on patients’ morbidity and mortality and healthcare systems worldwide. Dialkylcarbamoylchoride (DACC) is a synthetically produced material that can irreversibly bind and inactivate bacteria that exhibit cell-surface hydrophobicity (CSH). The DACC in the Reduction of Surgical Site Infection (DRESSINg) trial is a multicentre randomised controlled trial which aims to assess the effectiveness of DACC-coated post-operative dressings in the prevention of SSI in vascular surgery. Seven hundred and eighteen participants undergoing clean or clean-contaminated lower limb vascular surgery will be randomised in a 1:1 ratio to either DACC-coated dressings or standard dressings for their postoperative wounds. The primary outcome is the incidence of SSI defined by the Centers for Disease Control and Prevention (CDC) criteria or total ASEPSIS score of 21 or more within 30 days of surgery. The secondary outcomes include satisfactory wound healing with a total ASEPSIS score of 10 or less, quality of life pre and post surgery, Bluebelle wound healing scores, resource use and financial (£), and environmental (KgCO2e) cost analyses. This multicentre randomised controlled trial will provide level 1 evidence on the effectiveness of preventing SSI in lower limb vascular surgery.
This study aims to investigate the association between physical fitness and markers of cognitive function in adults aged 40 and above in Qatar.
A cross-sectional study.
The Qatar Biobank, data of 1000 adults aged 40 and above.
A population of 1000 adults aged 40 years and older was included. Available data comprised measures of physical fitness including cardiorespiratory fitness, muscular strength, body composition and physical fitness capacity, as well as cognitive function assessed through tests of short-term visual memory and psychomotor coordination.
This paper investigated the physical fitness effect on cognitive functioning through short-term visual memory and psychomotor coordination testing. Logistic regression was used to measure the association between physical fitness and cognitive functioning tests.
Our study showed that lower physical fitness capacity was significantly associated with lower psychomotor coordination in females (OR=1.57, p=0.040) and showed no significant association in males (OR=1.65, p=0.062). For short-term visual memory, the association was significant in females (OR=1.68, p=0.042) unlike in males (OR=1.58, p=0.062). Males with greater muscle strength were about half as likely to have lower psychomotor coordination (OR=0.48, p=0.04). In females, a higher body fat percentage was associated with poorer cognitive function, with each 1% increase in body fat being linked to 6% higher odds of low short-term visual memory (p=0.02) and low psychomotor coordination (p=0.006). Cardiorespiratory fitness showed no statistically significant association with short-term visual memory and psychomotor coordination level in either sex.
Our findings suggest that overall physical fitness capacity is associated with better cognitive function in Qatari adults. The relationship between specific fitness measures and cognitive function varied by sex, with muscle strength having a stronger effect for males and body composition for females. These results highlight the potential importance of maintaining physical fitness for cognitive health in adulthood.
To assess health service use between days 43 and 365 postdelivery, comparing individuals with and without severe maternal morbidity (SMM).
Population-based cohort study.
Linked datasets from Population Data BC in British Columbia, Canada, April 2013–March 2021.
Postpartum individuals aged >18 years with a hospital or home delivery, with/without SMM occurring from 20 weeks’ gestation through 42 days post partum. Ectopic pregnancies, missing identifiers and maternal deaths at delivery or within 42 days post partum were excluded.
The primary outcome was high health service use, defined as being in the 95th percentile for use of one or more of the following non-obstetric visits: emergency department, hospitalisations and outpatient visits to a primary care physician or specialist—each occurring between 43 and 365 days after delivery hospitalisation discharge. Secondary outcomes included being in the 95th percentile for each visit type. Log binomial regression assessed the rate and risk of high health service use in SMM compared with non-SMM pregnancies, adjusting for confounders.
The cohort included 261 287 deliveries (5575 (2.1%) with SMM). Those with >15 visits within 43–365 days postdelivery were classified as having high health service use. SMM-affected individuals were twice as likely to have high health service use (9.2% vs 4.3%; adjusted relative risk (aRR)=1.96, 95% CI 1.78 to 2.17). Individuals with non-hypertensive cardiovascular SMM had markedly higher health service use (21.4% vs 4.3%; aRR=5.18, 95% CI 3.28 to 8.16). There was heterogeneity in the association between SMM and high health service use among those without versus with previous comorbidities, without versus with high service use in the 2 years prior to delivery, and without vs with preterm birth.
Our study revealed high health service use after SMM. These findings can help guide the development of standardised postpartum care pathways.
This process evaluation explores patient and healthcare professional acceptability of community-based monitoring versus hospital-based care for patients with quiescent neovascular age-related macular degeneration (QnAMD).
Qualitative process evaluation was conducted as part of a randomised controlled trial.
Six hospitals and six community-based practices.
25 patients and 16 healthcare professionals (ophthalmologists and optometrists). This approach helped differentiate between common issues and those specific to community-based monitoring.
The Quality-Assured Follow-Up of QnAMD by non-medical practitioners trial aimed to examine whether non-medical practitioners follow-up patients with QnAMD in the community in a safe and clinically and cost-effective way. The process evaluation aimed to examine whether the intervention was acceptable by patients and professionals. The process evaluation was based on interviews which contained open-ended questions focused on patient experience and confidence in community-based care, issues concerning the practicalities of the organisation and management of the clinic, and resources including IT and digital equipment. The theory of acceptability framework was used to interpret the findings.
Patients reported positively on the experience of receiving QnAMD services in the community and highlighted staff professionalism and clear communication. Key themes were the proximity of care provision for patients, IT interoperability and the real-world costs of running the service. Some patients randomised to the hospital showed preference for the intervention to take place in the hospital, mediated mainly by prior experience of hospital care and travel distance. The location of the clinic and transport routes affected the experience of attending appointments, with strong preference expressed for proximity to one’s home. Inaccessibility due to non-modifiable internal building structures in the community and parking in hospital eye services was reported by a small proportion of patients. Healthcare professionals reported positively about their ability to deliver QnAMD services in community settings but raised concerns about the compatibility of technological infrastructure that facilitates the sharing of optical coherence tomography image and video files. Some optometrists were also concerned about the financial sustainability of the intervention after the end of the trial due to the costs involved in the administration of QnAMD follow-up care.
The delivery of QnAMD services in the community by non-medical personnel was broadly accepted by both patients and practitioners. This implies that non-medical practitioners can follow up patients with QnAMD in the community in a safe way. Further research would be needed to establish whether similar results would be obtained during routine practice outside a research project and whether the long-term follow-up for QnAMD would be financially sustainable for independent as well as chain community optometry practices.
Using advanced forms of medical technology such as extracorporeal organ support to take over organ function in the face of critical illness is a manifestation of the technological expertise to support and prolong life. However, clinician focus on the technical aspects of extracorporeal organ support both in research and clinical practice has the tendency to relegate to the background and disregard multiple, non-technical components such as the meanings, interactions, and experiences of nurses, families and other healthcare professionals.
To understand how experiences and social interactions of critically ill children, families, and healthcare professionals are influenced by the use of extracorporeal organ support.
Hermeneutic review of the literature.
CINAHL, PubMed and Web of Science followed by cross-citations and snowballing.
A total of 24 studies were included in the review, representing four conceptual streams, namely (1) extracorporeal organ support as a biomedical intervention, (2) relationality concerning extracorporeal organ support, (3) performativity in using extracorporeal organ support and (4) the agential role of extracorporeal organ support.
The hermeneutic framework helped foreground perspectives demonstrating that extracorporeal organ support is not merely a piece of medical technology, but is an active fulcrum upon which human and material elements revolve, interact, and integrate to form multiple assemblages that can influence how the huge volume of nurse work can be reframed beyond the perpetuation of the patient-machine connection and affect the ways by which patients and families are cared for.
Understanding extracorporeal organ support as more than a medical device can enable nurses to develop informed plans of care and advocate for the interests of the family and that of the critically ill child who remains a passive recipient of care in an intensive care bed.
No patient or public contribution.
To explore the barriers, facilitators, and outcomes of strategies that have been implemented to improve the experience of cultural safety for First Nations inpatients in the Australian hospital setting.
Scoping review.
Guided by the Joanna Briggs Institute scoping review methodology and reported using PRISMA-ScR, six databases were searched with data extracted and synthesised.
Cumulative Index to Nursing and Allied Health Literature (CINAHL), Emcare, Informit, Medline, ProQuest and Scopus databases. Searches were undertaken in March 2024.
Forty-three articles representing 39 studies were included. Strategies were categorised as governance, service delivery, hospital environment, clinician education, and First Nations workforce. First Nations researchers were co-authors in most studies, and emergent themes were grounded in First Nations priorities, with an emphasis on developing the First Nations health workforce. Findings included (i) First Nations health staff being identified as cultural brokers between First Nations patients and non-First Nations clinicians; (ii) experiences of cultural safety being amplified when First Nations and non-First Nations health staff worked together; and (iii) strong governance being critical to addressing institutional racism and enabling cultural safety.
Embedding the voice of First Nations peoples in governance and an organisational commitment to strengthening the First Nations workforce are essential drivers for implementing cultural safety strategies in Australian hospitals.
Working together respectfully and collaboratively offers a pathway forward for First Nations and non-First Nations health service clinicians and management to deliver culturally safe hospital care.
Culturally safe hospital care is integral to promoting the health of First Nations people. This study maps cultural safety strategies used in the Australian inpatient hospital setting, explores if and how these strategies have improved cultural safety and identifies barriers and facilitators to implementation. Fostering approaches to support understanding and respect between First Nations and non-First Nations clinicians and staff is integral to promoting culturally safe hospital care. Hospital leadership, policymakers and staff can benefit from understanding the drivers of culturally safe hospital care.
Reported using PRISMA-ScR.
Guidance on this research was received from Aboriginal leaders at the first author's hospital workplace.
A research protocol was prepared in advance and registered: https://osf.io/sfzby/?view_only=03c2349ebdae4a7ba95a621d9b7e8bc4.
Clinical trials have produced inconclusive results regarding the optimal glucose range for a patient with sepsis in the intensive care unit (ICU) receiving insulin treatment.
To investigate the optimal glucose range in patients with sepsis in the ICU independent of confounding covariates.
Targeted trial emulation of glucose ranges using causal inference targeted maximum likelihood estimation and longitudinal mixed-effects models combined with survival models.
Single-centre, academic referral hospital in Boston, Massachusetts, USA.
Adults fulfilling sepsis 3 criteria with at least three glucose readings and insulin treatment from the Medical Information Mart for Intensive Care (MIMIC)-IV database (2008–2019).
Five predefined glucose distributions with means at 100, 130, 160 (baseline), 190 and 220 mg/dL mimicking current guidelines’ recommendations (140–180 mg/dL).
The primary outcome was in-hospital mortality. Modified counterfactual treatment-policy risks across distinct time-weighted glucose ranges were estimated.
Of 73 181 eligible patients, 8002 patients with a median age of 66 years (41% women, 67% white ethnicity, 57% diabetes) were included. There was a U-shaped curve between glucose range and mortality in patients without diabetes, but overall, this association was not significant (mean glucose at 100 mg/dL with 21% mortality and mean glucose at 220 mg/dL with 26% mortality, p-for-trend 0.26). Mortality was lowest at 17%, with mean glucose between 130 and 160 mg/dL. Hypoglycaemic events (
Our data suggest a U-shaped association of glucose and mortality with an optimal average glucose between 160 and 190 mg/dL. These results confirm current guideline recommendations. Together with recent results from randomised controlled trials, intensivists should aim for a liberal glucose range in most patients.
To explore and map the landscape of doctoral nursing research across eight countries.
A scoping review.
This review followed the Joanna Briggs Institute methodology for scoping reviews and included doctoral theses in nursing defended between 2020 and 2023 in Austria, Italy, Israel, the Netherlands, Poland, Portugal, Slovakia and the United Kingdom.
Searches were conducted across 15 national and university repositories (4 national, 11 university) in the eight participating countries.
This review included 431 doctoral nursing theses, the majority of which employed quantitative methodologies and focused on patient populations and healthcare professionals. Key topics included clinical nursing care, quality of care, quality of life, home care, perinatal care and the work environments.
Nursing doctoral research shows progress in healthcare delivery, patient care and education via digital tools, holistic approaches and professional development. Yet gaps persist in mental health, paediatrics and marginalised groups. Limited qualitative/mixed-methods research and weak interdisciplinary collaboration reveal further opportunities.
This review underscores that nursing doctoral research is addressing major healthcare and professional challenges. Nonetheless, the identified gaps emphasise the need for more comprehensive and inclusive research to enhance equity and guide future nursing practices and policies.
This review provides an overview of the scope of doctoral nursing research across eight countries, identifying key trends and research gaps. The findings are expected to inform nursing academia, policymakers, and healthcare professionals by guiding future research priorities, fostering interdisciplinary collaboration, and promoting equitable, patient-centred care practices.
No direct involvement in data collection; one lay reviewer gave feedback on readability and practice implications, informing minor refinements.
To explore community nurses' experiences of changes to their roles in palliative and end-of-life care.
An e-survey was followed by focus groups.
Fifty-one community nurses with recent experience of delivering end-of-life care in the United Kingdom completed a survey about changes to their roles. A purposive sample of 35 respondents participated in focus groups exploring these changes in more depth; thematic analysis was used with constant comparison.
As well as two new roles—prescribing and verifying death—many participants talked about a broader expansion of their role, increasing their leadership in making complex end-of-life care decisions with patients and families. Most nurses expressed pride in their new knowledge and skills, and satisfaction with the care they were providing. Yet many also expressed distress that heavy workloads impaired their capacity both to provide good clinical care and to train junior colleagues. The importance of General Practitioner support with complex cases was often highlighted, but accessing such support was sometimes difficult.
While welcoming the opportunity to extend their palliative care roles, many participants indicated experiencing moral distress.
Excessive workloads and patchy medical support threaten the retention of the experienced nurses upon whom community palliative care depends.
Our findings suggest that new and extended palliative care roles are viewed positively by nurses. To be sustainable, these changes require better workload management and consistent medical back-up.
We adhered to relevant EQUATOR guidelines, using the SRQR checklist.
Our Public and Clinician Advisory Group helped shape questions and commented on findings.
FreshRSS 