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Ayer — Diciembre 18th 2025Internacionales

Examining Stroke Symptom Messages Implemented Globally: A Need for Contextually Relevant Stroke Symptom Messaging

ABSTRACT

Background

Stroke is a global health concern. A timely response to a stroke can help reduce morbidity and mortality. However, barriers to timely response include poor recognition of stroke symptoms. Stroke symptom messages are designed to increase stroke recognition and encourage individuals to seek urgent medical assistance. The Face, Arm, Speech, Time (FAST) and Balance, Eyes, Face, Arm, Speech, Time (BE FAST) are commonly used stroke symptom messages shown to improve stroke symptom recognition and response. However, cultural factors and language differences may limit the effectiveness of stroke symptom messages and their acceptability in different countries and contexts. There has not been a comprehensive examination of the stroke symptom messages used worldwide and how these messages have been adapted in various settings.

Aims

We explored what stroke response messages are being used globally, and the contextual factors that influence the adoption of a stroke response mnemonic in different settings.

Methods

A 14-item survey was disseminated by the World Stroke Organization to its networks. The survey contained open- and closed-ended questions and allowed uploading relevant stroke symptom campaign materials. The survey was analyzed using descriptive statistics and a content analysis.

Results

All except one survey respondent used a stroke symptom message. Fifteen respondents (27%) reported they did not translate their stroke awareness messaging. Of these 15 respondents, they used the English versions of FAST (n = 8), BE FAST (n = 4), and both FAST and BE FAST (n = 3). Forty respondents (71%) reported that they/their organization used an acronym to raise public awareness of the signs/symptoms of stroke that was different from FAST or BE FAST (English), many of which were direct or indirect translations or influenced by FAST and BE FAST. Survey responses shared insights and recommendations related to the content, tailoring and dissemination of stroke symptom messages.

Conclusions

Study findings highlight the global use of stroke symptom messages and their contextual adaptations to fit diverse settings and contexts. The challenges in applying universal or commonly used stroke symptom messages to different contexts were highlighted.

Clinical Relevance

Nurses could have a key role in raising awareness of stroke symptoms and the development of locally adapted stroke symptom messages.

Creating a Healthy Work Environment by Balancing Work–Family Conflict Through Ethical Leadership: A Structural Equation Modeling Approach

ABSTRACT

Introduction

Creating a healthy work environment requires balancing organizational goals with ethical responsibilities, where head nurses' ethical leadership can shape staff outcomes by mitigating work–family conflicts and promoting nurses' well-being, retention, and patient safety. This study aims to analyze the mediating role of work–family between head nurses' ethical leadership and nurses' reported errors, turnover intention, and physical and mental health.

Design

Nationwide Multicenter cross-sectional study.

Methods

Validated self-report scales were used to assess nurses' perceptions of head nurses' ethical leadership, work–family conflict, error, turnover intention, physical and mental health. Descriptive and inferential analyses were conducted. Structural equation modeling examined the relationships among these variables based on Della Bella's and Fiorini's framework.

Results

Data from 409 nurses across seven Italian hospitals was analyzed. The structural equation model showed an excellent fit. Head nurses' Ethical leadership was negatively associated with work–family conflicts, turnover intention, and errors, and positively associated with nurses' health. Work–family conflicts were significantly linked to turnover intention, errors, and nurses' health. Work–family conflicts mediate the relation between ethical leadership and turnover intention, errors, and nurses' health.

Conclusion

Promoting healthy work environments is crucial for nurses', patients', and organizations' well-being. Ethical leadership helps achieve this condition by reducing work–family conflicts, fostering nurses' well-being, decreasing turnover intention, and improving care quality. Disseminating ethical leadership programs and integrating with work–life balance policies can therefore strengthen both staff retention and organizational outcomes.

Clinical Relevance

Ethical leadership can foster patient care, reduce turnover intention and errors, and improve nurses' well-being. Therefore, maintaining employee performance and organizational results requires integrating work–life balance policies with ethical leadership development programs.

Reporting Method

The study adhered to The Strengthening the Reporting of Observational Studies in Epidemiology checklist.

No Patient or Public Contribution

This study did not include patient or public involvement.

Protocol Registration

The study was preregistered on the Open Science Framework https://osf.io/8jk37/overview.

Patient or Public Contribution

This study did not include patient or public involvement in its design, conduct, or reporting.

AnteayerInternacionales

Ensuring racial inclusion in research: the role of research ethics committees and patient and public involvement and engagement

Por: Dube · A. · Ataiyero · Y. · Jones · S.
Introduction

Although the UK is a multicultural society, racially minoritised populations are often under-represented in healthcare research owing to the significant barriers to participation they experience.1 Under-representation of racially minoritised groups in research impacts the quality of evidence and applicability of findings to these groups. This, in part, explains why these communities are more likely to report poorer health and poorer experiences of using healthcare services than their White counterparts,2 given that their cultural and spiritual preferences are often ignored.3 This commentary will explore some of the persistent multifaceted barriers and the role of research ethics committees (RECs) in enabling inclusive healthcare research among racially minoritised communities, given their key responsibility in building public confidence, ensuring ethical conduct and safeguarding research participants. In addition, patient and public involvement and engagement (PPIE) can complement the roles of RECs in embracing diversity in healthcare...

Impact of missed insulin doses on glycaemic parameters in people with diabetes using smart insulin pens

Por: Varma · M. · Campbell · D. J. T.

Commentary on: Danne et al. Association Between Treatment Adherence and Continuous Glucose Monitoring Outcomes in People With Diabetes Using Smart Insulin Pens in a Real-World Setting. Diabetes Care. 2024.47 (6),:995-10031

Implications for practice and research

  • Healthcare providers should emphasise consistent insulin adherence for people with diabetes, as even a few missed doses can worsen overall glycaemia.

  • Future research should identify barriers to consistent usage of insulin and develop strategies to enable patients’ adherence, such as increasing patient engagement with smart insulin pens and continuous glucose monitoring systems.

  • Context

    Diabetes is a widespread chronic disease, with steadily rising prevalence in most countries. In 2019, the global prevalence of diabetes was estimated at 9.3%, affecting 463 million people. This figure is projected to rise to 10.2% by 2030 and 10.9% by 2045.2 All people with type 1 diabetes and many people...

    The Evidence‐Based Practice Mentor: Findings From a Role Delineation Study to Support the Role's Needed Knowledge and Skills

    ABSTRACT

    Background

    The role of the interprofessional evidence-based practice (EBP) mentor is critical to integrate best practices into healthcare and academic environments to improve outcomes and reduce costs for patients, families, providers, students, and faculty. This study aimed to validate the knowledge, skills, and attitudes/beliefs (KSAs) needed for the EBP mentor. This role delineation study (RDS) assessed knowledge about the EBP mentor role and tasks as related to the steps and competencies of EBP.

    Methods

    Interprofessional EBP experts participated in an advisory panel. Focus groups were conducted with the advisory panel members to identify the KSAs needed for expert EBP mentors. The steps of EBP were broken into 11 domains to align with the processes and strategies needed for EBP methodology. The focus group data were analyzed to identify the KSAs for each domain. A role delineation survey was developed. Interprofessional experts were invited to complete the survey to validate the KSAs needed for the EBP mentor role. The online survey included demographic information and 11 sections that aligned with the steps of EBP and the 107 KSA items needing to be validated.

    Results

    A total of 251 interprofessional EBP experts completed the survey (232 nurses, 19 interprofessionals). Healthcare providers comprised 82.5% of the sample, academic/researchers 15.5%, and “worked in both settings” 2%. The results reported strong inter-rater reliability (ranging from 0.836 to 0.955) and strong validity for each of the 11 domains and KSAs.

    Linking Evidence to Action

    Findings from this study support the EBP mentor role and will guide interprofessional EBP education and EBP mentor positions in healthcare systems. The study showed that the tasks of the EBP mentor were consistent across settings, educational degrees, and professional roles. Validity for the tasks/role for an interprofessional Evidence-based Practice Certification was clear and outlined expectations for the EBP mentor role.

    What Can We Learn From Nurses' Experiences of Digital Technology Implementation During the COVID‐19 Pandemic? A Qualitative Study

    ABSTRACT

    Aim

    To explore nurses' experiences of the adoption, implementation, and use of digital technologies during the Covid-19 pandemic in the UK.

    Design

    A qualitative descriptive study.

    Methods

    A qualitative study using two data sources: qualitative responses from 55 respondents to an online survey, and data from in-depth interviews with 21 individuals. The NASSS framework was used to guide data collection and analysis. Data were analysed using framework analysis.

    Results

    Respondents reported using a variety of technologies including video conferencing applications, telemonitoring, systems to support care management and telecommunication systems. The analysis identified a range of reasons why technology had been introduced into services, and a recognition of its value in a situation where otherwise care may not have been able to continue. During the pandemic nurses were expected to change their work practices very rapidly, and we identified situations where organisational infrastructure either supported this effectively or created additional burdens for the nurses' work.

    Conclusion

    Nurses had to adapt to new ways of working rapidly, with digital technology being one of the primary means through which communication and care were delivered. The Covid-19 pandemic provided a unique set of circumstances where layers of governance and many of the existing barriers to technology introduction were reduced.

    Implications for the Profession

    It is important to learn from these experiences, to understand how to sustain innovations that have proved to be successful, as well as the factors that enable nurses to work effectively in this new environment.

    Reporting Method

    This study adheres to the guidance for publishing qualitative research in informatics.

    Patient or Public Contribution

    A public contributor was involved from the beginning of the study conceptualization. They had input into the study approach, were part of the team that acquired the funding for the study and gave input at various stages into the processes for data collection, analysis and writing up the findings. The public contributor is a co-author on this paper and has been involved in the writing and editing of this report.

    Exploring Experiences, Perceptions and Preferences for Exercise in Australians Living With a Stoma: A Cross‐Sectional Survey

    ABSTRACT

    Aim

    (1) Explore the role of core abdominal exercise in people living with a stoma in Australia; (2) determine whether the presence of a parastomal hernia influenced participant symptoms and complications, health status, experiences with different types of exercise, recall advice given by healthcare professionals; (3) determine whether there is an appetite for supervised/supported exercise programs.

    Design

    A cross-sectional, anonymous survey.

    Methods

    Between August and September 2022. The survey included Likert scales and a single free text response. Logistic regression and Cramer's V were used to explore relationships between variables.

    Results

    Approximately half (45.5%) of 105 participants reported a parastomal hernia. Those with a parastomal hernia were less likely to recall having received advice (15.20%) or demonstration (9.40%) pertaining to exercise. Less than a quarter of all participants completed strengthening (23.80%) or vigorous (22.90%) exercise. Fear of vigorous exercise, abdominal exercise and heavy lifting were high in both groups. Relationships between healthcare advice, exercise-related fears and avoidance of heavy lifting were observed.

    Conclusion

    Many Australians living with a stoma are not achieving physical activity recommendations. While exercise behaviours did not differ between people with and without a parastomal hernia, recall of healthcare advice around exercise did. Fear-avoidance relationships were observed.

    Impact

    Most people living with a stoma do not recall advice about core abdominal exercises. Healthcare practitioners need to be aware of fear-avoidance related to lifting among people living with a stoma. This was the first study in Australia, exploring perspectives and experiences regarding exercise; providing foundations for future research particularly exercise programs.

    Reporting Method

    This study adhered to relevant EQUATOR guidelines and the reporting of survey studies (CROSS).

    Patient or Public Contribution

    This study did not include patient or public involvement in its design, conduct, or reporting.

    Evaluation of a Nurse Practitioner Led Procedural Support Service for Children With Procedural Anxiety: An Effectiveness–Implementation Study

    ABSTRACT

    Aim

    To evaluate the clinical effectiveness of a Nurse Practitioner led procedural support service for children with procedural anxiety, and identify facilitators and barriers to its sustained implementation and optimisation.

    Design

    An effectiveness–implementation hybrid type 3 study used a prospective mixed methods evaluation approach.

    Methods

    From December 2022 to May 2023, data were collected from children, parents and clinicians using a nurse practitioner-led service at a quaternary paediatric hospital in Brisbane, Australia. A prospective audit assessed clinical outcomes, while qualitative interviews explored implementation barriers and facilitators.

    Findings

    The clinical audit (n = 40) confirmed the service was effective and safe, ensuring procedural completion with minimal distress. Descriptive statistics indicated low pain and anxiety scores. There was a moderate negative relationship between pain scores and the use of distraction techniques. Interviews with thirty-three participants showed the service improved access to procedural care, reduced the need for physical restraint and general anaesthesia, and enhanced clinical workflow through preadmission assessments.

    Conclusion

    Utilising a Nurse Practitioner support service represents a safe and effective strategy to enhance access for paediatric patients with procedural anxiety.

    Implications for the Profession and Patient Care

    This study underscores the significance of specialised nursing roles in managing paediatric procedural anxiety, offering a replicable model to enhance procedural outcomes and mitigate medical trauma across healthcare settings.

    Impact

    Minimising pain and distress is important in all clinical encounters with children to reduce the risk of medical-related trauma and the future avoidance of healthcare.

    Reporting Method

    The report of study outcomes was guided by the Standards for Reporting Implementation Studies (StaRI) initiative.

    Patient or Public Contribution

    Patients or the public were not included in the design, conduct or reporting of the study.

    Profiling Healthcare Professionals' Digital Health Competence and Associated Factors: A Cross‐Sectional Study

    ABSTRACT

    Aim

    To assess healthcare professionals' digital health competence and its associated factors.

    Design

    Cross-sectional study.

    Methods

    The study was conducted from October 2023 to April 2024 among healthcare professionals in Italy, using convenience and snowball sampling. The questionnaire included four sections assessing: (i) socio-demographic and work-related characteristics; (ii) use of digital solutions as part of work and in free time, and communication channels to counsel clients in work; and DigiHealthCom and DigiComInf instruments including measurements of (iii) digital health competence and (iv) managerial, organisational and collegiality factors. K-means cluster analysis was employed to identify clusters of digital health competence; descriptive statistics to summarise characteristics and ANOVA and Chi-square tests to assess cluster differences.

    Results

    Among 301 healthcare professionals, the majority were nurses (n = 287, 95.3%). Three clusters were identified: cluster 1 showing the lowest, cluster 2 moderate and cluster 3 the highest digital health competence. Most participants (n = 193, 64.1%) belonged to cluster 3. Despite their proficiency, clusters 2 and 3 scored significantly lower on ethical competence. Least digitally competent professionals had significantly higher work experience, while the most competent reported stronger support from management, organisation, and colleagues. Communication channels for counselling clients and digital device use, both at work and during free time, were predominantly traditional technologies.

    Conclusion

    Educational programmes and organisational policies prioritising digital health competence development are needed to advance digital transition and equity in the healthcare workforce.

    Implications for the Profession

    Greater emphasis should be placed on the ethical aspects, with interventions tailored to healthcare professionals' digital health competence. Training and policies involving managers and colleagues, such as mentoring and distributed leadership, could help bridge the digital divide. Alongside traditional devices, the adoption of advanced technologies should be promoted.

    Reporting Method

    This study adheres to the STROBE checklist.

    Patient or Public Contribution

    None.

    Doctoral Education in Nursing in Ibero‐America: An Analysis of Its Evolution and Perspectives for the Future

    ABSTRACT

    Aim

    To provide an overview of doctoral programs in nursing offered in Ibero-American countries to inform regional collaboration and academic development.

    Design

    This study was a descriptive, document analysis.

    Methods

    A systematic mapping was conducted using data obtained from official university and program websites, national postgraduate databases, and academic documents. The variables analysed included country, institution, year of implementation, number of faculty and students, course duration, delivery modality, costs, scholarship availability, internationalisation activities, and research lines.

    Results

    A total of 94 active nursing doctoral programs were identified. Brazil emerged as the pioneer, launching the first doctoral program in 1982, and remains the regional leader, accounting for 43 programs. Most programs are offered by public institutions (76.6%), delivered primarily in face-to-face format (64.1%), and emphasise research (90.4%). There has been a consistent upward trend in the establishment of programs since 2000, with notable expansion between 2011 and 2025. Despite this progress, regional disparities persist, along with a lack of data standardisation and a limited presence of professional doctorates. While 69.1% of programs reported international activities, few offer joint or dual degrees. The most common thematic axis, “Health Care and Nursing,” proved to be broad and non-specific.

    Conclusion

    The study reveals the expanding landscape of nursing doctoral education in Ibero-America, while also exposing persistent challenges regarding access, curricular clarity and regional articulation.

    Implications for the Profession and/or Patient Care

    Doctoral programs are essential for developing research capacity, academic leadership and evidence-based care. Strengthening these programs could enhance nursing responses to local health needs and promote scientific progress in care delivery.

    Impact

    This study provides the first comprehensive mapping of nursing doctoral programs in Ibero-America, highlighting regional disparities and areas for academic collaboration, with potential impact on policy-making, curriculum development, and the strengthening of research capacity in nursing education.

    Reporting Method

    STROBE (Strengthening the Reporting of Observational Studies in Epidemiology).

    Patient or Public Involvement

    No patient or public contribution.

    Exploring the Service Features of Telephone Cancer Information and Support Services From Callers' Experiences: A Qualitative Evidence Synthesis

    ABSTRACT

    Aim

    This study aims to synthesise evidence on users' experiences of telephone cancer information and support services (CISS) to identify important service features and inform service development.

    Design

    A qualitative evidence synthesis.

    Methods and Data Sources

    OVID MEDLINE, EMBASE, CINAHL, PsycINFO and SocINDEX databases were searched for peer-reviewed qualitative literature fitting the inclusion criteria from database inception to 30 March 2023. The included articles were double-screened, and quality appraised using the CASP checklist. GRADE-CERQual was used as a tool to assess the confidence of review findings. Content synthesis combined the qualitative data with the Loiselle cancer experience measurement framework guiding analysis. This paper is reported as per the equator network recommended SRQR checklist.

    Results

    Of the 607 articles screened, seven studies were included. Four main themes and 14 sub-themes about CISS aspects were identified: psychological well-being (managing emotions/coping, hope/reassurance, supporting close others and a reluctance to call the CISS); knowledge is power (information seeking, the burden of knowledge and empowerment); truth and clarity (adjunct support, credible source and improved understanding and confidence); and service adequacy (operators' ability to connect with users, convenience, service provision and awareness, and the cancer journey).

    Conclusion

    Findings suggest people with cancer and their carers accessing a CISS value emotional support combined with trusted information, topic expertise and a connection with the service operator. future service provision should address the lack of awareness regarding the range of services and the convenience extended operating hours may offer.

    Implications for Patient Care

    The results add to our understanding of CISS service provision. However, knowledge gaps remain regarding preferences among service features and the hierarchy of CISS characteristics to be prioritised to enhance services.

    Impact

    Focused CISS awareness campaigns will inform communities and healthcare professionals of the available resources to improve the lives of those affected by cancer. Ongoing service review will enable resources to be tailored to callers' needs, potentially easing the burden on existing services that are overwhelmed and under-resourced.

    Patient or Public Contribution

    This qualitative evidence synthesis did not directly involve patient or public contribution to the manuscript.

    Trial Registration

    Systematic Review Registration Number (PROSPERO): CRD42023413897

    Consultations Within School Health Services: A Cross‐Sectional Observational Study

    ABSTRACT

    Aim

    This study aims to (1) describe the content of consultations within school health services, (2) outline school nurses' assessments, and (3) identify factors that influence the duration of consultations.

    Design

    A cross-sectional observational study was conducted.

    Methods

    The data were collected in Norway during November 2023 using a self-report form by school nurses (n = 96). Consultations (n = 382) were registered and analysed using descriptive statistical methods and multiple linear regression analyses to identify factors influencing the duration of consultations.

    Results

    Nearly 30% of the pupils had to wait for a consultation and 29% of the registered consultations were drop-in. School nurses had to prioritise due to limited time in 41% of the consultations. Mental health was the predominant theme. Several adverse factors, such as interruptions during consultations, affected the time spent.

    Conclusion

    This study provides knowledge about the content of consultations within school health services in Norway, contributing to the enhancement of this activity within these services.

    Implications for Profession and/or Patient Care

    The insights from this study may serve as a foundation for developing guidelines for consultations, helping to ensure equitable support for all children and adolescents.

    Impact

    To our knowledge, this is the first study that gives a broad insight into consultations within the Norwegian school health services. Having enough resources is essential for providing good services. Politicians and central authorities need to consider this when deciding on budgets.

    Reporting Method

    This study adhered to STROBE guidelines for reporting cross-sectional studies.

    Patient or Public Contribution

    No patient or public involvement.

    Understanding Digital Health Equity: A Conceptual Analysis

    ABSTRACT

    Aim

    The purpose of this concept analysis is to clarify the meaning of digital health equity beyond a simplistic definition, obtaining a richer meaning that can guide the digital healthcare landscape.

    Background

    With the growing spread of digital health, digital health equity should be at the center of healthcare. Health outcomes for equity-deserving groups may be compromised without a clear understanding of digital health equity. Although the concept of ‘health equity’ has been analysed before; no concept analysis has been completed for the concept of ‘digital health equity’.

    Design

    Concept analysis using Walker and Avant's method.

    Data Sources

    Articles from PubMed, Scopus and Google Scholar with no limitation on the period of data collection.

    Methods

    Walker and Avant's concept analysis method was used to outline attributes, antecedents, consequences, and empirical referents of the concept digital health equity.

    Results

    The main attribute of digital health equity is digital health technology that benefits everyone fairly. The antecedents include: (1) appropriate infrastructure; (2) cognitive abilities including digital literacy; (3) intersectionality of multiple vulnerabilities; (4) presence of the core ethical principles in healthcare; (5) digital accessibility with careful consideration of the social determinants of health; and (6) co-creation of digital health technologies. The main consequences are improved patient health outcomes and elimination of the digital divide.

    Conclusion

    This analysis explored the concept of digital health equity as a means to promote positive health outcomes for equity-deserving groups, highlighting the critical role of nursing practice and research in addressing digital health disparities.

    Impact Statement

    This paper can have an impact on nursing practice, education and wider social and economic issues. First, various barriers encountered by patients when utilising digital health technologies can be understood. Second, clinicians can be encouraged to assess digital health equity, improve interventions for equity-deserving groups, and evaluate the effectiveness of digital health interventions to ensure they are equitable. In the context of educational implications, the understanding of digital health equity can be used to facilitate the creation of appropriate education materials for clinicians. Finally, on a wider social and economic scale, understanding digital health equity can aid in the creation of policies to enable equitable digital health technologies.

    Patient or Public Contribution

    No patient or public contribution because this paper is a concept analysis.

    Timely Implementation of Patient‐Reported Outcomes in Clinical Care: Insights From Clinicians and Health Informatics Experts

    ABSTRACT

    Aim

    To explore the optimal timing of patient-reported outcome assessment, defined as the collection and use of patient-reported outcomes at clinically meaningful points such as before or during encounters, treatment initiation and follow-up, and to identify the facilitators and barriers to timely use.

    Design

    A qualitative analysis of semi-structured interviews with healthcare professionals across diverse US health systems.

    Methods

    Thematic analysis was used to identify key themes related to the timing and implementation of patient-reported outcomes assessments. Interviews were analysed iteratively to develop a coding framework and synthesise overarching themes.

    Results

    Fourteen healthcare professionals, including nurse practitioners, cardiologists and health informatics experts across seven U.S. health systems from academic and community hospitals, were interviewed in February 2024. Three major themes emerged: (1) value proposition of timely patient-reported outcome data collection (2) key facilitators for timely implementation and (3) multilevel barriers. The value proposition focused on the use of patient-reported outcomes for prevention and active disease management. Critical facilitators for the timely implementation of patient-reported outcomes included the involvement of research and clinical coordinators, strategies for pre-visit and on-site patient-reported outcome collection, the use of standardised templates within EHRs and the alignment of patient-reported outcome collection with patients' long-term treatment goals. Finally, multilevel barriers included time constraints, patient-level challenges (e.g., fatigue, literacy, language) and systemic issues (e.g., technical limitations, lack of reimbursement and unclear guidelines).

    Conclusion

    Timely collection and use of patient-reported outcomes is critical for improving symptom monitoring and supporting patient-centered clinical decision-making. However, multilevel barriers hinder consistent implementation across health care settings.

    Implications for the Profession and/or Patient Care

    Integrating patient-reported outcomes into clinical workflows can improve the patient-centeredness of patient-healthcare professional interactions, and provide a more holistic picture of a patient's health status. Addressing barriers to patient-reported outcome implementation, including lack of time, poor health literacy and workflow integration barriers, is crucial for improving clinical outcomes.

    Reporting Method

    This study adhered to the COREQ (Consolidated Criteria for Reporting Qualitative Research) checklist, in accordance with EQUATOR Network guidelines.

    Patient or Public Contribution

    No patient or public involvement: This study did not include patient or public involvement in its design, conduct or reporting.

    A Mixed‐Methods Exploration of Staff Needs for Coping With Grief and Loss in Residential Aged Care

    ABSTRACT

    Aims

    To examine residential aged care staff's experience of death and grief, and their support needs.

    Methods

    A mixed-methods sequential explanatory design, using an online cross-sectional survey that included the Texas Revised Inventory of Grief and the Grief Support in Health Care Scale. Followed by semi-structured interviews with direct care workers and managers working in residential aged care homes were conducted.

    Results

    Over 60% of participants experienced five or more resident deaths in the previous 12 months. Although, different levels of grief were experienced among different roles, the importance of open communication and opportunities for farewells after resident death was highlighted. Participants suggested support and education to normalise grief and promote self-care.

    Conclusion

    Recognising staff grief following the resident death is important. Providing support and education may help improve staff wellbeing and contribute to the delivery of high-quality care for both residents and their families.

    Implication for the Profession and/or Patient Care

    Staff grief after a resident death needs to be recognised, and continuing education and support are required for their wellbeing.

    Reporting Method

    The STROBE and SRQR checklists were applied.

    Patient or Public Contribution

    No Patient or Public contribution.

    Using a Socio‐Technical Strategy to Identify the Use and Implications of Generative Artificial Intelligence Tools on Nursing Education and Practice

    ABSTRACT

    Aim

    Use a socio-technical strategy to identify the use and implications of generative artificial intelligence (GenAI) tools on nursing education and practice.

    Design

    Descriptive qualitative study.

    Method

    Online interviews with 32 nursing students, faculty and practitioners between February and April 2024. Data were analysed using the Framework Method.

    Results

    Theme 1 described participants' use of eight GenAI tools across seven use cases. Theme 2 describes the implications of using GenAI tools on nursing education. The subthemes include (2.1) facing a new pedagogical reality, (2.2) negative sentiments on using GenAI tools in nursing education and (2.3) opportunities to improve nursing education with GenAI tools. Theme 3 describes the implications of using GenAI tools on nursing practice. Subthemes include (3.1) embedding in patient care, (3.2) nursing workflow integration and (3.3) organisational support. Theme 4 describes GenAI capacity-building. Subthemes include (4.1) to develop an AI-ready workforce, (4.2) to promote responsible and ethical use and (4.3) to advance the nursing profession.

    Conclusion

    Although GenAI tools initially disrupted nursing education, it is only a matter of time before they disrupt nursing practice. Nurses across education and practice settings should be trained in the responsible and ethical use of GenAI tools to mitigate risks and maximise benefits.

    Implications for the Profession and/or Patient Care

    GenAI tools will profoundly impact how nurses of today and tomorrow learn and practice the profession. It is crucial for nurses to actively participate in shaping this technology to minimise risks and maximise benefits to the nursing profession and patient care.

    Impact

    This study revealed the socio-technical intricacies of using GenAI tools in nursing education and practice. We also present wicked problems that nurses will face when using GenAI tools.

    Reporting Method

    COREQ.

    Patient or Public Contribution

    This study did not include patient or public involvement in its design, conduct or reporting.

    Competencies Required for Hospital‐Based Wound, Ostomy, and Continence Nurses to Provide PI Care in Home Care in Japan: A Mixed‐Methods Study

    ABSTRACT

    Aim

    To identify the competencies required for hospital-based WOC nurses to provide direct pressure injury (PI) care in home care settings in Japan.

    Design

    Mixed methods convergent design.

    Methods

    The qualitative strand used a descriptive design to explore competencies for overcoming barriers faced by hospital-based WOC nurses when providing PI care at home. The quantitative strand used a cross-sectional design to assess competencies in organising the hospital PI management system.

    Results

    Six competencies were identified: (1) Establish relationships with home healthcare professionals; (2) Promote hospital-based WOC nurse's expertise to home healthcare professionals; (3) Collaborate with the regional medical liaison office in WOC nurse's hospital; (4) Involve hospital administrators in home PI management; (5) Utilise social media/Information and Communication Technology for patient or home-visiting nurse communication; and (6) Utilise public or academic support projects to facilitate home-based activities. The median scoring rate for each medical staff domain on the revised Collaboration Competency Scale for WOC Nurses ranged from 80% to 91%.

    Conclusion

    The results of this study can serve as a practical resource to help WOC nurses expand their activities into home-care settings.

    Implications for the Profession

    Their ability to coordinate with staff and manage PI care within hospitals supports active engagement in home care, improving continuity and quality.

    Impact

    This study addressed the issue that many hospital-based WOC nurses cannot visit patients at home. The competencies identified may enable these nurses to expand their role into home care.

    Reporting Method

    This study followed EQUATOR guidelines, with the STROBE Statement applied to the quantitative part and the COREQ checklist to the qualitative part.

    Patient or Public Contribution

    Patients or the public were not involved in the study's design, conduct, or reporting.

    Nurses' Self‐Perceived Patient Safety Competencies: Associations With Work‐ and Education‐Related Factors in a Cross‐Sectional Study

    ABSTRACT

    Aim

    To describe nurses' self-perceived confidence in patient safety competencies and examine how work- and education-related factors influence this confidence.

    Design

    A descriptive, explorative, cross-sectional survey design.

    Methods

    The Health Professional Education in Patient Safety Survey (H-PEPSS) was administered to a convenience sample of practising nurses and master's degree students in Estonia between May and September 2023. The following background variables were included: work experience, workplace, educational level and prior patient safety training. A total of 376 respondents completed the survey. Data were analysed using descriptive statistics and multivariable logistic regression, which returned the odds ratios for associations between background factors and confidence in patient safety.

    Results

    Nurses perceived the highest confidence in understanding human and environmental factors, and the lowest confidence in teamwork. Having longer work experience was found to demonstrate a positive association with nurses' confidence in teamwork (OR = 1.03, 95% CI = 1.01–1.05) and safety culture (OR = 1.02, 95% CI = 1.00–1.04), compared to nurses with less experience. Nurses in smaller hospitals felt more confident managing safety risks (OR = 2.19, 95% CI = 1.14–4.21), compared to nurses from bigger hospitals. Master's degree students showed significantly higher confidence in responding to adverse events and safety culture than other respondents. Prior patient safety training was associated with greater confidence across several domains.

    Conclusions

    Confidence in patient safety competencies varies by domain and was found to be noticeably shaped by experience, education and workplace context. As such, targeted training and supportive environments are essential to ensuring high levels of competence among nursing professionals.

    Implications for the Profession and Patient Care

    The findings underscore how improvements in training and organisational support can strengthen patient safety. Furthermore, retaining experienced and diversely educated nurses is key to building confidence and ensuring a competent workforce. The finding that respondents assess their confidence in teamwork as weak means that new educational interventions need to be designed and implemented to target this aspect of nursing care.

    Reporting Method

    This study followed the STROBE guidelines for cross-sectional research.

    Patient or Public Contribution

    No patient or public contribution.

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