Conectar
by Aline Veras Morais Brilhante, Christina César Praça Brasil, Raimunda Magalhães da Silva, Marjan Askari, Luciana Andrade da Mota Sampaio, Jonas Loiola Gonçalves, Layane Sabóia, Lucas Alessandro Macedo Cruz, Helena Rodrigues Dias, Luciel Almeida Cavalcanti, Maria Julya Albuquerque Parente, Mariana Tavares Rocha, Melania Maria Ramos de Amorim
Autistic women experience increased obstetric and perinatal risks, partly driven by communication barriers within maternity care. Evidence on how these barriers are experienced in low- and middle-income countries remains scarce. This study aimed to analyze communication barriers in perinatal care based on narratives of autistic women who experienced pregnancy, childbirth, and postpartum care in Brazil. A qualitative study was conducted using the Hermeneutic-Dialectic Circle (HDC) approach. Thirty-four autistic women (22 with support level 1 and 12 with support level 2, including three non-speaking participants with complex communication needs) were recruited through convenience sampling, supplemented by active recruitment through participant referral, and participated in semi-structured interviews conducted in multiple accessible formats (video call, real-time messaging, in-person, and augmentative and alternative communication). Data were analyzed using constant comparative methods within the hermeneutic-dialectic framework, guided by the social model of disability and the neurodiversity paradigm. Three central categories were constructed: (1) communicational demands of autistic women and their non-recognition, including alexithymia, sensory hypersensitivity, and need for predictability; (2) institutional and interpersonal communication failures, encompassing symptom invalidation, disrespectful care, and exclusion of non-speaking women; and (3) experiences of respectful and effective communication, demonstrating that adapted strategies promote safety and autonomy. Participants’ narratives indicate that communication barriers in perinatal care for autistic women operate systemically rather than individually. Training healthcare professionals and implementing accessible communication strategies are essential to promote respectful, safe, and inclusive maternity care.by Chia-En Hsieh, Li-Hua Huang, Ya-Lan Hsu, Tzu-Jung Wu, Hsiang-Chu Pai
ObjectivesThis study explored the association between work stress and professional commitment among clinical nurses, focusing on the serial multiple mediating effects of resilience and coping. Clinical nurses experience high levels of work stress that may negatively impact their professional commitment. However, the mechanisms underlying this relationship, particularly the mediating roles of resilience and coping, remain unclear.
Materials and MethodsThis cross-sectional study was conducted at a single medical center and involved 345 clinical nurses recruited from internal medical and surgical wards, obstetric and pediatric wards, and emergency and critical care units. The valid response rate was 97.2%. All participants were recruited from inpatient units within the same medical center, ensuring a consistent clinical setting across all departments. Descriptive, univariate, and Pearson correlation analyses were performed, and mediation effects were tested using PROCESS Model 6.
ResultsNurse stress was significantly negatively associated with professional commitment (total association: c = −0.0808, p Conclusion
Higher nurse stress was significantly associated with lower professional commitment. Resilience and coping were significantly associated with this relationship as serial mediating factors. Given the cross-sectional design, these findings should be interpreted as associations rather than causal effects. Strengthening resilience and adaptive coping may help support nurses’ professional commitment.
To show the Stoic contributions to professional performance during perinatal grief.
An integrative literature review.
This integrative literature review covers the period from 1993 to 2026. Electronic searches were conducted in the PubMed and Web of Science databases, as well as the Virtual Health Library (VHL) portal, using the descriptors ‘perinatal death’ and ‘nursing’.
Following data extraction and analysis through the interpretative lens of Stoic philosophy, three thematic categories emerged: (1) Psychosocial and Cultural Aspects of Mourning; (2) Challenges of Nursing Practice in Bereavement Contexts; and (3) Support Strategies and Practical Interventions for Bereaved Families. Guidance and support are needed as essential interventions for women experiencing grief. On the other hand, a lack of training among professionals to offer this care was revealed. An important finding among the interventions mentioned is the following: giving a keepsake of the baby, using cold cribs and making the parents feel at ease, creating the role of a mourning professional in maternity wards and helping with guidance on bureaucratic procedures. Understanding the transience of life can help contextualize the loss, appreciating the moments when parents were with their loved one, instead of what they may have been. Differentiating between what we can and cannot control, accepting loss as a natural part of life's cycle and being able to help those who grieve find peace.
The Stoic aphorisms can offer valuable insights into dealing with perinatal grief. Stoicism, focusing on acceptance, resilience and virtue, can offer a philosophical framework for facing and understanding grief and loss.
The study highlights nursing interventions in response to perinatal bereavement, based on stoicism, offering practical and theoretical support for obstetric nurses. The findings point to ways of providing care in a recognized clinical practice challenge, strengthening professional performance and the humanization of care.
No patient or public contribution.
To map and analyse how artificial intelligence technologies interact with and support clinical judgement processes in nursing across practice and educational contexts.
Scoping review.
JBI methodology for scoping reviews.
An electronic search was conducted on 1 July 2025 across MEDLINE, CINAHL, Scopus, Web of Science, and IEEE Xplore to identify studies published since January 2015. Additional sources of grey literature included ProQuest Dissertations & Theses Global, preprint servers (medRxiv and arXiv), and websites of relevant organisations.
Eleven studies were included. Mapped against Tanner's Clinical Judgement Model, AI applications predominantly supported early cognitive phases (noticing and interpreting) through predictive models and decision support systems, while responding and reflecting phases received minimal attention.
Current AI research in nursing concentrates on computational pattern recognition, with the reflective processes central to expertise development remaining largely unexamined. Future research should examine how AI influences nurses' cognitive and interpretative processes across all phases of clinical judgement, with primary studies in nursing education representing a particularly underdeveloped priority.
The integration of artificial intelligence into nursing practice should be guided by a clear understanding of how these technologies support clinical judgement. Artificial intelligence-enabled tools must be rigorously developed, implemented, and evaluated to enhance nurses' reasoning processes while safeguarding patient safety, professional autonomy, and quality of care.
Research on artificial intelligence in nursing rarely employs theoretical frameworks of clinical judgement, limiting understanding of how these technologies interact with cognitive processes central to professional expertise. This review provides a theoretically grounded synthesis, identifying research gaps and implementation priorities for AI development aligned with nursing clinical judgement.
PRISMA-ScR.
This study did not include patient or public involvement in its design, conduct or reporting.
Trial Registration: Protocol registered in Open Science Framework (https://osf.io; DOI: https://doi.org/10.17605/OSF.IO/UH7RA), and subsequently published in a peer-reviewed journal, DOI: https://doi.org/10.62741/ahrj.v2i4.73.
To develop a care-bundle of non-pharmacological strategies with the potential to prevent constipation in people with dementia in Residential Aged Care (RAC).
Mixed-methods intervention development study using Modified Delphi and co-design, informed by evidence, current constipation prevention practices and stakeholder collaboration to define best practice.
The draft bundle was developed using evidence from a scoping review, consultations with aged care professionals and staff at two RAC homes and field observations. It was then refined through expert and lived-experience panels via an online Modified Delphi survey (rating relevance, acceptability and feasibility) and a face-to-face workshop to finalise items for the constipation prevention care-bundle.
Health data, interviews, observations, surveys and workshops.
The draft care-bundle comprised 24 items; 13 reached ≥ 78% agreement in the Modified Delphi, including dietitian consultation, adequate fibre, individualised hydration and toileting plans, beverage cart, constipation risk assessment, privacy during toileting, dementia-friendly signage, toileting positioning, contrasting toilet seat, electronic alerts, staff education and resident/family information.
An evidence-informed and co-designed care-bundle was co-developed with potential to prevent constipation in residents with dementia.
This research has implications for nursing practice by offering an alternative to reliance on pharmacological strategies for preventing constipation in people with dementia.
This co-designed and evidence-informed care-bundle has potential to reduce the incidence of constipation among the growing population with dementia. To ensure sustained use, it was co-designed with stakeholders to be fit-for-purpose.
There were no reporting guidelines for this co-design study identified.
End-users, including frontline staff and older people receiving care, as well as carers of people with dementia, were engaged in the co-design as equal partners in the constipation prevention care-bundle development process.
INCA is a multicentre, prospective, randomised, two-arm superiority trial. 100 adult patients scheduled for primary total knee arthroplasty (TKA) will be randomised 1:1 to one of two locoregional analgesia strategies: group 1 (standard strategy), single-shot adductor canal block (ACB) combined with active surgeon-administered peri-articular infiltration with ropivacaine and participant-facing sham peripheral nerve blocks; group 2 (four-nerve block strategy), single-shot ACB combined with three additional ultrasound-guided nerve blocks (lateral femoral cutaneous, obturator and infiltration between the popliteal artery and capsule of the knee (IPACK) blocks) plus sham surgical infiltration. All patients will receive general anaesthesia and identical systemic multimodal analgesia (paracetamol, non-steroidal anti-inflammatory drugs (NSAIDs), nefopam and rescue opioids) so that any between-group differences can be attributed to the allocated regional strategy. The primary outcome is global recovery at 24 hours, assessed by the Quality of Recovery-15 (QoR-15) questionnaire. Secondary outcomes include postoperative pain scores, opioid consumption, rescue analgesia including any rescue infiltration, motor function and adverse events, range of motion of the index knee, time to first ambulation, postanaesthesia care unit (PACU) stay, hospital length of stay, QoR-15 at 48 hours and Knee Injury and Osteoarthritis Outcome Score-Joint Replacement (KOOS-JR) at 1 month.
INCA is a multicentre, prospective, randomised two-arm superiority trial. 100 adult patients scheduled for primary TKA will be randomised 1:1 to one of two locoregional analgesia strategies: group 1 (standard strategy), single-shot ACB combined with surgeon-administered peri-articular infiltration; group 2 (four-nerve block strategy), single-shot ACB combined with three additional ultrasound-guided nerve blocks (lateral femoral cutaneous, obturator and IPACK blocks) without active infiltration. Participant-facing sham procedures will be used to preserve blinding. All patients will receive general anaesthesia and identical systemic multimodal analgesia (paracetamol, NSAIDs, nefopam and rescue opioids) so that any between-group differences can be attributed to the regional strategy. The primary outcome is global recovery at 24 hours, assessed by the QoR-15 questionnaire. Secondary outcomes include postoperative pain scores, opioid consumption, rescue analgesia including any rescue infiltration, motor function and adverse events, range of motion of the index knee, time to first ambulation, PACU stay, hospital length of stay, QoR-15 at 48 hours and KOOS-JR at 1 month.
The study protocol has been approved by the regional ethics committee (Comité de Protection des Personnes). All participants provide written informed consent. The trial will be conducted in accordance with the Declaration of Helsinki and Good Clinical Practice guidelines. Study results will be disseminated to participants and submitted for publication in a peer-reviewed journal and presented at national and international conferences to inform best practices in TKA analgesia.
Version 4.0 (11 February 2025).
Successful pregnancies with healthy newborns have been reported after all types of solid organ transplantation (SOT). Limited data in young children suggest similar development and health compared with the general population. However, fetal development may be influenced by factors such as immunosuppressive medication and the increased incidence of pregnancy complications, and forthcoming health problems may only become apparent later in the life of the offspring. To allow for better investigation of the long-term health of offspring born after SOT, we designed the Transplantlines Next Generation biobank and cohort study. This study will be the first with detailed data on overall health status at later age in offspring born to mothers after kidney, liver, pancreas (including pancreas islet), heart and lung transplantation (KTx, LiTx, PTx, HTx and LuTx, respectively).
Transplantlines Next Generation is a descriptive, prospective cohort study and biobank. It includes offspring aged≥16 years born after KTx or LiTx. Because of the scarcity of pregnancies after (solo) PTx, HTx and LuTx worldwide, and as a consequence the lack of information about these pregnancies, we want to include all offspring, at any age, born after (solo) PTx, HTx and/or LuTx in the Netherlands. Participants will attend a one-time visit for questionnaires, physical tests (for participants≥16 years including kidney ultrasound and 24-hour ambulatory blood pressure) and biological sample collection (urine, blood, faeces) for participants≥16 years of age for biobanking. Reference values and values from existing birth cohorts will serve as controls. Primary endpoints are cardiovascular and kidney health, assessed through growth charts, physical tests (eg, body composition, blood pressure, kidney ultrasound) and metabolic and kidney function biomarkers. Secondary aims include immunological status, microbiome analysis, quality of life and overall development.
Ethical approval has been obtained from the local medical ethical committee; the Institutional Review Board METc UMC Groningen (METc 2023/610). The study will be conducted according to the Declaration of Helsinki and in accordance with the Medical Research Involving Human Subjects Act and other guidelines, regulations and Acts including the General Data Protection Regulation (GDPR). All participants will give written informed consent upon enrolment. TransplantLines Next Generation is designed to deliver pioneering insights into the health of offspring born after SOT. This knowledge will help optimise care and available information for families with a pregnancy wish after SOT and provide a rationale for future studies. The results of this study are planned to be submitted for publication in relevant peer-reviewed journals and will be presented at national and international conferences.
Advance care planning is a complex process and requires a culturally sensitive communication approach. Competence in initiating advance care planning requires specific education and training for healthcare providers. This qualitative descriptive study aims to explore the experiences and perspectives of healthcare providers across 12 Regional Health Sectors in Thailand regarding impacts of communication training on advance care planning implementation.
A qualitative descriptive study.
The participants were healthcare providers who had attended the communication training workshop and engaged in advance care planning from across 12 Regional Health Sectors in Thailand. Focus group discussions were conducted and transcriptions were analyzed following the qualitative framework approach. Several strategies were used to enhance trustworthiness.
Sixty healthcare providers participated in the study. Two main themes were identified: (1) a ripple effect of communication training; and (2) key components for successful advance care planning implementation. The communication training enhanced participants' knowledge and skills, and participants gained more confidence to initiate conversations with patients who had serious illnesses and families. The participants shared knowledge with and mentored junior nurses on conducting advance care planning. The participants also extended services to other advanced chronic diseases and advocated for early advance care planning. Finally, the participants took proactive action to raise public awareness of advance care planning in communities. The participants identified key components for successful advance care planning implementation. These included healthcare providers' knowledge, skills, and attitudes towards palliative care, knowing the patients, sufficient and dedicated time, continuity of care and institutional support.
The communication training had a ripple effect, enhancing health professionals' competence and efficacy. The effects are beyond individual benefits. The training transformed clinical practices and extended to raise public awareness on advance care planning. Essential components for successful advance care planning should be used as a framework to guide clinical practice.
Accurate chronic wound classification is essential for appropriate management, yet diagnostic variability persists in routine practice. Transparent, rule-based decision-support tools may improve standardisation but require validation against expert judgement under clearly defined conditions. To evaluate inter-expert agreement, agreement between a rule-based algorithm and an expert-consensus reference standard, diagnostic accuracy as a complementary measure, exploratory comparison with a non-expert nurse, and expert agreement with algorithm-generated therapeutic recommendations. Thirty anonymised standardised clinical cases were classified by the algorithm and one non-expert nurse. Thirty wound-care experts, including 26 nurses, three physicians, and one researcher, were organised into six independent panels of five and classified case subsets, yielding 150 ratings. A consensus reference diagnosis was defined a priori as agreement by at least 3/5 experts. The primary outcome was algorithm–consensus agreement using Cohen's κ. Expert reliability was assessed using Krippendorff's α and Fleiss' κ. Recommendation agreement was dichotomised and analysed exploratorily. Expert agreement was low to moderate (Krippendorff's α = 0.26–0.60), highest for pressure ulcers/injuries and venous leg ulcers, and lowest for mixed or unknown leg ulcers and diabetic foot ulcers. Consensus was reached in 29 of 30 cases. The algorithm achieved 86.2% accuracy (25/29) and substantial agreement (κ = 0.70, 95% CI 0.46–0.94). Nurse accuracy was 72.4% (21/29, p = 0.219). Experts endorsed 85.2% of therapeutic recommendations. The algorithm showed promising agreement under controlled conditions, supporting further prospective validation in larger, balanced real-world datasets.
Point-of-care technologies (POCTs) are essential to providing clinical care for patients, with their potential for rapid and accurate results on site supporting efficient clinical decision-making.
To understand the current key needs, barriers and challenges of POCT developers for effective development and implementation of POCTs across diverse settings particularly in the domain of cancer, nutrition and infections.
A qualitative semi-structured focus group discussion (FGDs) was employed. The FGDs were guided by the needs assessment process and the Phase Gate Framework. The qualitative data were coded and analysed in NVivo and refined into various themes.
The study was conducted in person at Cornell Tech Campus in May 2024, New York, USA.
24 participants were purposively sampled from the PORTENT (Point-of-Care Technologies for Nutrition, Infection and Cancer) network. Participants included technical developers (eg, engineers, scientists, startup leads) and expert stakeholders (eg, funders, policy advisors, clinicians and academic partners) involved in POCT development, evaluation and implementation.
A total of 24 participants participated in the in-person FGDs in New York (n=24). Key themes identified included gaps in stakeholder engagement, limited regulatory preparedness, insufficient market analysis, challenges in scaling and manufacturing and the need for context-specific adaptation in low- and middle-income country (LMIC) settings. Participants emphasised the importance of user-centred and context-responsive design, strategic partnerships and early planning for regulatory and implementation pathways.
Technical developers and expert stakeholders in the POCT landscape face various barriers to efficient and effective development and implementation of POCTs. It is important to consider their needs when adapting POCTs in LMICs and diverse settings.
The literature on sustainability performance frameworks for healthcare organisations varies in its applicability to different types of organisations and settings, functions and activities, and definitions and dimensions of sustainability. This fragmentation creates implementation barriers which may be overcome by consolidating existing evidence in a format that can be linked directly to organisations’ business models. This protocol proposes a scoping review to assess the extent of the literature on frameworks for monitoring and evaluating the multidimensional sustainability performance of healthcare organisations and to assemble a consolidated framework in an operationally relevant format to support progress towards sustainable healthcare organisations.
The search strategy will be applied across Semantic Scholar, Google Scholar, Web of Science, MEDLINE, Embase, Academic Search Premier, CINAHL and Business Source Premier databases. Search results from 2009, coinciding with the publication of the WHO’s ‘Healthy Hospitals, Healthy Planet, Healthy People’ report, will be considered. The scoping review will include studies reporting on multidimensional sustainability monitoring or evaluation frameworks applied or developed for use at the level of healthcare delivery organisations. Studies relating to operational units within organisations or to healthcare systems will be excluded. The review’s context will be restricted to operational sustainability and will not consider the literature on sustainable design planning and construction of new facilities. No specific exclusion criteria will be applied to the types of healthcare delivery organisations nor participants implicated in the frameworks. Title and abstract screening against the inclusion and exclusion criteria, followed by full-text assessment of remaining articles, will be performed by two reviewers. Data from included studies will be extracted using a custom-designed extraction tool, analysed using topic or thematic analysis to consolidate themes and presented within the triple-layered business model canvas.
Only publicly available sources will be used; research ethics approval is not required. Findings will be submitted to a peer-reviewed journal and presented at scientific meetings.
Dental caries is the most prevalent chronic condition among Argentine children, with distribution and severity strongly shaped by social and territorial inequalities. This study evaluated caries treatment needs and their spatial and socio-economic associations among preschool children in Buenos Aires.
An ecological population study was conducted among 54 337 6-year-old children attending public schools in Buenos Aires. Caries severity was measured using the Caries Treatment Needs Index (CTNI) by calibrated examiners.
Socio-economic indicators included individual health coverage, neighbourhood housing prices, distance to the nearest primary health centre, population density and the proportion of households with unsatisfied basic needs. Analyses comprised descriptive statistics, multivariate regression, ORs and spatial autoregressive models.
Overall, 67.9% of children had treatment needs (CTNI >2) and 17.5% had high needs (CTNI >10), with significant heterogeneity across municipalities (p
Caries treatment needs in Buenos Aires follow a clear socio-economic and spatial gradient, with both individual and neighbourhood disadvantage independently associated with increased needs and highlighting the need for targeted, territorially focused public health strategies.
Chronic kidney disease (CKD) is highly prevalent in Thailand and imposes a growing burden on the health system, driven by limited nephrology capacity and high rates of unplanned dialysis. The kidney failure risk equation (KFRE) estimates the risk of progression to kidney failure (KF) on age, sex, estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio. This study aims to validate and, if required, recalibrate the four-variable KFRE for the Thai population and to assess the potential impact of KFRE-guided referral strategies on clinical care and health system performance.
We will conduct a retrospective cohort study using linked, de-identified national health databases covering approximately 70% of the Thai population. Adult patients with CKD stages 3–5 will be included. KFRE performance will be evaluated at 2 and 5 years for discrimination and calibration. If miscalibration is identified, the model will be recalibrated using Cox-based methods. Simulations (1000 iterations) indicated that approximately 920 KF events by 5 years would be required to achieve the target standard errors for the calibration slope. A subsequent impact analysis will compare KFRE-guided referral with current Thai CKD guideline criteria and real-world practice using a decision-tree and Markov modelling framework.
Ethical approval was obtained from the Ethics Committee of the Institute for the Development of Human Research Protections, Thailand (COA No. IHRP2025110), Imperial College London and the London School of Hygiene and Tropical Medicine. The requirement for informed consent was waived due to the use of anonymised secondary data. Findings will be disseminated through peer-reviewed publications, conferences and policy briefs to supplement evidence-based referral strategies and health system planning.
Thalassaemia, a genetic blood disorder, is a major public health burden. Most affected individuals reside in low-and-middle-income countries (LMICs). Screening programmes can reduce incidence, but in resource-constrained settings cost-effectiveness is important. This work aimed to investigate how economic evaluations of thalassaemia screening programmes have been conducted globally, to identify best practices for future evaluation suited to a LMIC context.
Systematic literature review.
The original review was undertaken between May and July 2023; an update was completed between November and December 2025. Electronic databases (MEDLINE, Embase, National Health Service Economic Evaluation Database, Health Technology Assessment Database, Cochrane Database of Systematic Reviews), economic databases (Cost-Effectiveness Analysis Registry) and grey literature (including conference proceedings) were searched. Additional validation searches were conducted in Google Scholar to identify relevant studies not indexed in the electronic databases.
Studies were screened against pre-specified criteria by two independent reviewers. Eligible articles reported an economic evaluation of a thalassaemia screening programme for pregnant women or children aged 2 years or younger in any geographic setting.
Data extraction for each included article was performed by one author and verified by a second. Findings were interpreted within the context of LMICs, given the high prevalence and resource limitations in these settings. The quality of each article was assessed using the Critical Appraisal Skills Programme Economic Evaluation Checklist; quality assessment for each article was performed by one author and verified by a second.
Of 2112 publications identified from database searches, ten were ultimately included: three cost-effectiveness analyses (CEAs), six cost-benefit analyses (CBAs) and one cost-utility analysis. Study quality varied widely, with most not reporting methodological details such as discounting rates and time horizon. Additionally, no studies employed standard cost-effectiveness metrics, such as quality-adjusted life-years. Seven studies adopted simplified approaches to evaluating thalassaemia screening programmes, relying on basic cost comparisons without formal modelling. Three studies used a decision tree model structure based on the chronological sequence of steps during the screening process. Of these, two Thailand-based studies were notable, given their robust decision tree model, explicit adoption of a lifetime time horizon, application of a discounting rate in line with Thai Health Technology Assessment Guidelines, and performance of sensitivity analyses using recognised methods.
The frequent use of simple cost comparisons likely reflects the complexities surrounding modelling of thalassaemia screening programmes. While traditional CEAs are predominantly used in cost-effectiveness research, practical and ethical challenges associated with calculating health utility differences in this context may limit their use. However, the absence of standard metrics does not preclude a robust economic evaluation, as evidenced by the two high-quality Thailand-based studies. The methods outlined in these papers can be used as a starting point for future economic evaluations, provided the evaluation is further tailored to the local setting. If development of a model is not possible, a simpler CBA with a robust, comprehensive approach could be used. In any case, it is vital to capture the societal benefits of screening programmes; any future evaluation within this context should therefore include a broad societal perspective.
CRD42023445001.
Doctoral research in nursing is central to advancing scientific knowledge, strengthening professional identity, and informing evidence-based practice, education, and health policy. Analyzing the thematic content of doctoral theses offers insight into research priorities and national variations in nursing scholarship. Yet, no systematic cross-country analysis has examined the thematic focus of such work.
To explore and describe the diversity and scope of doctoral nursing research themes across eight countries in the Sigma Europe Region, identifying key areas of scholarly focus and shared priorities.
A document-based qualitative study using reflexive thematic analysis, as outlined by Braun and Clarke, to examine patterns of meaning within thesis summaries.
The study included doctoral nursing thesis summaries defended between January 2020 and December 2023, sourced from national and institutional repositories in eight countries of the Sigma Europe Region. A total of 15 repositories (4 national, 11 institutional) were systematically searched, and additional summaries were obtained via direct contact with universities offering doctoral nursing programmes.
Data were collected between September 2024 and February 2025 using predefined inclusion and exclusion criteria. In total, 431 eligible thesis summaries were analyzed following Braun and Clarke's six-phase framework, supported by MAXQDA software for data management and coding.
Thematic analysis identified three overarching domains: (1) foundations of nursing practice and care philosophy, (2) systemic and organizational dimensions of nursing, and (3) clinical innovation and public health impact. Ten interrelated themes emerged, including holistic and patient-centred care; emotional, psychological, and quality-of-life dimensions; communication in healthcare; workforce challenges; transforming nursing practice; maternal, neonatal and pediatric health; digital and virtual health innovations; public health and chronic disease management; and disease management, caregiving, and outcomes. Cross-cutting elements such as cultural sensitivity and resilience spanned multiple themes.
This cross-national synthesis demonstrates the breadth and depth of doctoral nursing research in the Sigma Europe Region. Findings highlight nursing's pivotal role in addressing healthcare needs through innovative, person-centred, and evidence-informed solutions, and underscore the value of international collaboration in shaping resilient, equitable, and future-ready healthcare systems.
To explore how critical care nurses access, negotiate and apply knowledge in high-pressure clinical environments, focusing on organisational, cultural and leadership factors influencing evidence-based practice implementation in acute hospital settings.
A focused ethnographic collective case study was conducted across two contrasting critical care units in England.
Methods included non-participant observation (56 sessions), semi-structured interviews (36 participants) and document review. Spradley's Developmental Research Sequence guided data generation and analysis. Data were collected over an eight-month period (February to September 2022).
Five major themes were identified: sources of knowledge and acquisition strategies; institutional and hierarchical influences on knowledge use; role of experiential knowledge and clinical intuition; challenges to evidence-based practice implementation; and strategies for integrating knowledge into practice. Organisational structures, leadership engagement, mentorship and access to updated digital resources were key enablers of evidence-based practice. Barriers included workload pressures, inconsistent guideline dissemination and hierarchical cultures. Adaptive blending of formal evidence, clinical experience and intuition characterised effective knowledge negotiation at the bedside.
Knowledge use in critical care nursing is a dynamic, relational process shaped by leadership, organisational culture and systemic pressures. The availability of evidence alone is insufficient; visible leadership, peer learning, protected educational time and valuing of experiential knowledge are critical to embedding evidence-based practice into routine practice.
Strengthening organisational systems, investing in nurse manager development, expanding simulation-based learning and legitimising experiential knowledge are vital strategies to enhance evidence-based critical care.
This study provides actionable insights for healthcare leaders, educators and policymakers seeking to optimise evidence-based practice adoption in high-acuity clinical environments and improve patient outcomes.
The Consolidated Criteria for Reporting Qualitative Research checklist guided reporting.
Patients and the public were not involved in the design, conduct, reporting or dissemination of this research.
FreshRSS 