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To systematically summarise evidence related to the use of non-sterile gloves when preparing and administering intravenous antimicrobials.
Scoping review.
A rigorous scoping review was undertaken following Arksey and O'Malley's (2005) framework and the modified Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for scoping review guidelines (2018). Five databases and grey literature were included in the search. Literature published between 2009 and 2024 was included.
Five databases (Medline, CINAHL, EMBASE, Scopus and Web of Science) and the grey literature were searched in February 2024.
Three studies were included; however, none directly addressed correct non-sterile glove use during intravenous antimicrobial preparation or administration in clinical practice.
We found no evidence to support the use of non-sterile gloves in intravenous antimicrobial preparation. There is an urgent need for rigorous research to inform the development of clear guidelines on non-sterile glove use to underpin evidence-based decision-making in nursing and other health professional education, improve patient outcomes, reduce healthcare costs and promote environmental sustainability in healthcare.
Inappropriate use of non-sterile gloves for preparing and administering intravenous antimicrobials hinders correct hand hygiene practices and increases healthcare-associated infections, healthcare costs and waste.
A critical gap in the existing evidence was a key finding of this review, highlighting the urgency for evidence-based guidelines to improve patient safety outcomes, reduce healthcare costs and promote environmental sustainability in healthcare.
This scoping review adhered to the relevant EQUATOR guidelines and Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) reporting checklist.
This study did not include patient or public involvement in its design, conduct or reporting.
The protocol was registered on Open Science Framework (https://doi.org/10.17605/OSF.IO/QY4J2).
To determine the association between patient characteristics, techniques, and technologies with first-time peripheral intravenous catheter insertion in paediatric acute care.
Single-centre, prospective cohort study.
Data on patient, provider, and peripheral intravenous catheter insertion characteristics were collected at a large quaternary paediatric hospital in Queensland, Australia. Inpatients aged 0 to ≤ 18 years requiring a peripheral intravenous catheter or who had one inserted in the last 24 h, were eligible. Proportionate stratified random sampling was used. Generalised linear regression with modified Poisson regression assessed associations between patient variables (e.g., age) and first-time insertion success, along with technique (e.g., inserting clinician) and technology (e.g., ultrasound) variables. Models were adjusted for confounding variables identified through direct acyclic graphs.
199 children required 250 peripheral intravenous catheters (July 2022–September 2023). In the adjusted model, each year of age increase and every 5-kg increase in weight were associated with higher first-time insertion success. Children with a history of prematurity had an increased risk of first-time insertion failure. Vascular access specialists were more likely to succeed on the first attempt, as was ultrasound-guidance when adjusted for difficult intravenous access risk.
We identified techniques (expert clinicians) and technologies (ultrasound guidance) that improve first-time insertion success in paediatric patients.
A multi-faceted approach combining technique (clinician), technology (ultrasound guidance), and standardised policy can improve first-time peripheral intravenous catheter insertion. These strategies minimise patient discomfort, trauma, and emotional distress, enhancing the overall healthcare experience for children and their families.
This study emphasises the need to standardise healthcare policies and training, incorporating clinician expertise and ultrasound guidance to improve first-time insertion success, particularly for high-risk patients.
The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE).
No Patient or Public Contribution.
Australia New Zealand Clinical Trials Registry, ACTRN12622000034730
Investigate the perception of male accessibility to the fields of nursing practice by those studying or teaching nursing in England.
Cross-sectional survey.
Online questionnaire with three closed-scale questions and two open-text questions designed to elicit perceptions on the accessibility of men to the fields of nursing practice. The questionnaire was distributed to the staff and students at 61 nursing schools in England. Inferential and descriptive statistics were used to analyse the closed questions data and inductive content analysis was used to analyse open-text questions data.
Students (n = 52) and staff (n = 51) responded to the survey. Adult (Mdn = 6, IQR = 2) and mental health (Mdn = 6, IQR = 2) were perceived as the most accessible fields of nursing practice to men, and child (Mdn = 4, IQR = 2) the least. Specialised practice areas in acute and emergency (Mdn = 6, IQR = 2), education (Mdn = 6, IQR = 2), leadership (Mdn = 7, IQR = 1), prison services (Mdn = 7, IQR = 1), and research (Mdn = 7, IQR = 2) were rated the most accessible to men and neonatal care (Mdn = 3, IQR = 3) the least. Societal stereotyping and stigma were seen as barriers to men entering the nursing profession. The perception that nursing is a feminised profession persists and a distrust of men is associated with child nursing. Men were viewed as progressing to leadership roles with greater ease than women.
Societal level stereotyping and stigma are perceived as prevalent in nursing practice areas considered less accessible to men entering the nursing profession.
This study adds insight into the gendered nature of nursing and highlights the barriers to men entering a profession with a workforce crisis.
STROBE cross-sectional studies guidelines. COREQ guidelines for content analysis.
No patient or public contribution.
To explore the lived experiences of nurses and patients co-producing evidence-based care for long-term conditions, and to understand how they make sense of this process within relational, emotional and organisational contexts.
A qualitative study using the Interpretative Phenomenological Approach.
Semistructured interviews were conducted with 20 participants, comprising 11 registered nurses and 9 adult patients living with at least one Long-Term Condition. Participants were recruited from primary and secondary care settings across the Midlands, England. Data were collected between February and August 2023 and analysed using Interpretative Phenomenological Approach's iterative and inductive framework.
Five experiential themes were identified: (1) weaving together different knowledges, (2) the relational foundations of co-production, (3) organisational pressures and misalignments, (4) shifting identities and power dynamics and (5) emotional and ethical complexity in co-producing care. Participants described co-production as a deeply relational and negotiated process, shaped by trust, vulnerability and shared decision-making.
Co-producing evidence-based care in Long-Term Condition management involves more than implementing guidelines. It is a relational, emotional and contextual practice that requires shared interpretation of evidence, deep listening and responsiveness to individual lives. Findings suggest a need to reframe evidence-based practice as a co-creative process grounded in relational ethics and contextual awareness.
Findings emphasise the centrality of relational competence and organisational flexibility in enabling co-produced care. Findings call for educational and policy reforms that value emotional labour, professional humility and patient knowledge as essential to evidence-based nursing. Internationally, this work provides a grounded model for integrating person-centred approaches into chronic care delivery and policy.
The study offers a relational model of evidence-based practice that moves beyond protocol-driven care to one shaped through dialogue, empathy and contextual negotiation, offering practical insights for transforming professional roles and health systems globally.
Patient representatives contributed to study design, development of interview guides and interpretation of findings to ensure alignment with lived experiences.
This study follows the SRQR guideline.
Advanced cancer not only affects the physical, psychological, and social functions of patients, but it also impacts their adolescent children. There is a dearth of information regarding the understanding of family functioning and specific needs of patients with advanced cancer and their adolescent children.
This qualitative study aimed to explore the experience and needs regarding family functioning of patients with advanced cancer and their adolescent children, as well as understanding potential approaches for maintaining positive family functioning.
A descriptive qualitative study was employed.
This study was conducted at three tertiary hospitals in Changsha, China, from January to September 2023. Purposive sampling was adopted to recruit participants. 17 stage III and IV patients with cancer and 11 adolescent children were interviewed.
Face-to-face individual interviews were conducted among patients with advanced cancer and their adolescent children. The data analysis employed Braun and Clarke's thematic analysis method. The McMaster family functional model theoretical framework was utilised to facilitate the identification and organisation of topics, ensuring a comprehensive analysis of the data.
Six themes were identified: communication challenges; impaired family role functioning; positive/negative feelings; over-involvement; change of behaviour control pattern; Needs for medical and psychological support. Both patients with advanced cancer and their adolescent children expressed collective views and needs regarding family functioning.
The findings of this study reveal an understanding of family functioning and needs among patients with advanced cancer and their adolescent children. The identified themes provide valuable insights for designing and implementing targeted intervention strategies.
Nursing interventions should focus on helping patients with advanced cancer and their adolescent children improve family functioning and communication skills. The findings indicate that communication challenges are a significant aspect of impaired family functioning, necessitating targeted interventions to enhance communication. Healthcare providers should be trained to recognise the diverse communication needs of families, which include providing resources for age-appropriate communication, counselling, and guidance on maintaining family routines. Enhancing the communication skills of patients and their children is crucial for addressing problem-solving needs and mitigating negative feelings, thereby fostering a more supportive family environment.
To explore the prescribing practices and behaviours of Advanced Practice Nurses (APN) and pharmacist prescribers in Singapore, assess their confidence in key prescribing competencies, examine their use of information sources, and understand their views on the consequences of prescribing errors.
Cross-sectional national survey.
A census survey of all registered APN and pharmacist prescribers in Singapore was conducted from February to May 2024 using a validated 96-item instrument. The survey assessed prescribing practices, confidence in prescribing competencies, use of information sources, and prescribing safety. Descriptive statistics were used for analysis.
Ninety-one prescribers (54 APNs, 37 pharmacists) responded (32% response rate), most of whom worked in public medical/surgical settings. Prescribing comprised a median of 75% of their practice. Most time was spent prescribing continued medications, with less on initiating new medicines. Participants reported high confidence in communication, therapeutic partnerships, and working within professional standards. Greatest confidence was seen in educating patients, legal prescribing, and monitoring treatment response. Lower confidence was noted in complementary medicine-related tasks. Professional literature and colleagues were the most valued information sources. Most participants acknowledged the serious consequences of prescribing errors, though many believed such errors would likely be intercepted.
APNs and pharmacists demonstrate strong competencies in safe, holistic prescribing. However, cultural factors may limit patient engagement, highlighting the need to strengthen shared decision-making and collaborative practice.
Refining governance structures, adopting tiered prescriber autonomy, and enhancing training in complex prescribing are essential. Standardising deprescribing, improving access to decision-support tools, and promoting interprofessional collaboration and patient involvement can strengthen care quality and team-based delivery.
This study offers the first national insight into Singapore's Collaborative Prescribing Framework and informs training, policy, and workforce development for non-physician prescribers locally and in similar international contexts.
STROBE checklist.
This study did not include patient or public involvement in its design, conduct, or reporting.
The purpose of this study was to describe the strategies older adults use to maintain their balance and prevent themselves from falling in the hospital.
The Expanded Health Belief Model served as the theoretical framework for this qualitative descriptive study.
Audio-recorded, semi-structured interviews were conducted with 15 (N = 15) older adults (female 53.3%), mean age of 77 (SD 9.9) admitted to a rural community hospital in the United States. Each transcript was analysed independently by two researchers using content analysis before reaching consensus. Sample size was guided by thematic saturation. Trustworthiness was ensured by using the criteria outlined by Lincoln and Guba.
Four main themes emerged: My Balance Problem is My Personal Responsibility, Self-efficacious Common-Sense Balance Management Strategies, Hospital Staff as Contributors or Disruptors of My Balance Management, and My Needs for Balance Management Support. The older adults used extensive mental efforts in planning and executing personal strategies to maintain balance and viewed this as their personal responsibility. Their self-efficacious balance management strategies included observing the environment, assessing furniture and equipment, staying focused, and moving slowly. Assistance from hospital staff members either supported or disrupted the older adults' balance management efforts. The older adults desired to learn more about fall prevention in the hospital. The older adults found physical guidance, demonstration and verbal guidance to be the preferred method of learning.
Rurally hospitalised older adults employ independent, self-efficacious balance management strategies.
Older adults' personal balance management strategies must be recognised by healthcare workers.
Future inpatient fall prevention interventions and policies must focus on exploring hospitalised older adults' optimal and suboptimal balance management behaviours to develop patient-centred fall prevention interventions to decrease inpatient falls among older adults.
The Consolidated Criteria for Reporting Qualitative Research.
No patient or public contribution.
Delay in detecting acute deterioration in older adults in care homes is associated with avoidable hospitalizations and adverse outcomes, including premature death.
Underpinned by the Knowledge to Action Framework, this study aimed to understand the barriers and enablers to direct care staff detecting and responding to the early signs of acute deterioration in care home residents.
Online focus groups or interviews with regulated (registered and enrolled nurses) and unregulated (assistants in nursing and personal care workers) direct care staff from participating care homes were conducted. Homes were recruited using disproportionate stratified random sampling to include metropolitan, inner regional, and outer regional care homes. Interview and focus group recordings were transcribed verbatim and analyzed using inductive thematic analysis.
Eighty direct care staff (n = 48 regulated; n = 32 unregulated) from eight care homes participated. Fifteen focus groups (n = 7 unregulated staff, n = 8 regulated staff) and two interviews (n = 1 regulated staff, n = 1 unregulated staff) were conducted between July 2021 and October 2022. Four themes related to the barriers and enablers of detecting and responding to acute deterioration were generated: decision-making within the scope of practice; resource availability; streamlined communication; and teamwork.
Findings highlight the challenges direct care staff encounter in being able to detect early signs of acute deterioration and implement appropriate care pathways. Perceived barriers and enablers highlighted in this study need to be considered when developing and implementing programs to optimize the timely detection of, and response to, acute deterioration in care homes.
Workforce knowledge, experience, and confidence deficits are significant barriers to detecting acute deterioration, while the unique workforce mix in care homes poses additional challenges for the accurate detection of early signs of acute deterioration. Knowing the resident, working as a team, and valuing the contribution of aged care staff and families in managing acute deterioration are enablers to achieving better outcomes for residents experiencing acute deterioration.
To provide a description of nurses' experiences related to moral injury, including Potentially Morally Injurious Events and factors related to the impact of those events.
Reflexive thematic analysis of nurse interviews.
Nurses were recruited from an ongoing study within a large academic medical centre. Nurses who enrolled in the present study participated in semi-structured individual interviews using an interview guide based on Litz's conceptualisation of moral injury. Themes were identified in the recorded and transcribed interviews.
Interviews were conducted with 12 nurses in May and June 2023 and coded for themes within three broad categories: (a) Nursing Values, (b) Experiences of Potentially Morally Injurious Events and (c) Stressors and Supports. Within these categories, we pinpointed 8 themes and 3 subthemes, which highlight the nurses experience of potentially morally injurious events related to challenging care, strained relationships with physicians, and treatment inequity, which conflict with their nursing values. We identified team and organisational factors, including senior leadership behaviours, team dynamics and access to resources that appear to intensify or lessen the impact of these events.
Potentially Morally Injurious Events contribute to the occupational stress experienced by nurses, particularly when systemic organisational factors and demands prevent them from providing the value-driven and ethically necessary healthcare. Limiting Potentially Morally Injurious Events and providing supportive environments following stressors requires organisational-level changes within healthcare environments to prevent and alleviate nurses' occupational stress.
This research highlights the need for healthcare organisations to implement systemic interventions aimed both at reducing Potentially Morally Injurious Events and creating system and team-level supports to lessen the impact of unavoidable events. These results pinpoint specific areas for prevention, intervention and support.
No Patient or Public Contribution.
This study aimed to evaluate the impact of the Community Care Program, which was the amalgamation of three outreach services—post-acute care, Residential In-Reach, and the Hospital Admission Risk Program—into a single integrated care model. Specifically, we assessed its effects on unplanned hospital readmissions and emergency department re-presentations at 30-, 60- and 90-days post-enrolment.
A pragmatic, real-world, population-based observational study was conducted using an interrupted time series analysis. The study included 4708 adult patients across two periods: pre-amalgamation (November 2014–October 2016), and post-amalgamation (May 2017–October 2018). Data were sourced from the National Centre for Healthy Ageing Data Platform, with statistical analyses conducted using Generalised Least Squares models to account for autocorrelation.
The study observed a significant increase in quarterly program enrolments post-amalgamation, from 578 to 1011 per quarter. The 30-day readmission rate decreased from 11.8% to 8.52% post-amalgamation. However, interrupted time series analysis revealed no statistically significant changes in the slopes of readmission and emergency department re-presentation rates after the program's amalgamation. The program did not result in significant changes in 60- or 90-day outcomes.
The amalgamation of post-acute care, Residential In-Reach, and the Hospital Admission Risk Program into the Community Care Program led to increased service utilisation without a significant impact on reducing unplanned hospital readmissions or emergency department re-presentations. Although the program amalgamation demonstrated improved accessibility, its longer-term impact remains inconclusive, highlighting the need for continuous refinement and further evaluation to optimise system efficiency. No patient or public contribution occurred in this study.
This study adhered to the STROBE guidelines for observational research.
To determine patient and nursing factors associated with peripheral intravenous access success among hospitalised adults on medical-surgical units.
A prospective, cross-sectional, correlational design was guided by STROBE.
Within a quaternary care hospital with multiple medical-surgical units, nurses who attempted intravenous access completed case report forms and medical records were reviewed to record 38 factors associated with intravenous access success. After identifying factors associated with first attempt and overall intravenous access success in univariate analyses, prediction models were fit and calibration (based on plots) and discrimination (using the C-statistic) were evaluated using bootstrap sampling.
Of 394 adults, 244 (61.9%) had first attempt and 323 (82.0%) had overall intravenous access success. Ultrasound was used in 227 (57.6%) intravenous access attempts and use was associated with less vein visibility and palpability and higher nurse perception of difficult intravenous access. In multivariable modelling, four factors were associated with first attempt intravenous access success: using a wrist vein, higher nurse expertise in intravenous access, nurse use of an ultrasound in patients with high-risk vein characteristics, and higher nurse confidence in first attempt success; model goodness of fit was good. Seven factors were associated with overall intravenous access success: shorter patient hospital length of stay, no history of diabetes, higher patient anxiety level, nurse use of an ultrasound in patients with high-risk vein characteristics, higher nurse expertise in intravenous access, higher nurse confidence in first attempt success, and nurse prediction of difficult intravenous access was low; model goodness of fit was strong.
Patients' vein characteristics and nurses' confidence in first attempt intravenous access success were predominant characteristics of intravenous access success.
Factors of importance in achieving intravenous access can be easily assessed prior to first attempt and may enhance first attempt and overall success.
Authors adhered to relevant EQUATOR guidelines and used the following reporting method: STROBE (The Strengthening the Reporting of Observational Studies).
Background
There is a dearth of research inclusive of African American adults living with obstructive sleep apnea (OSA) despite differences in symptom presentations compared to non-Hispanic White patient populations. Less is known regarding the potential effect of comorbidities, including hypertension, on commonly reported symptoms, such as fatigue, and their association with inflammatory biomarkers.
Objective
This longitudinal pilot study aimed to characterize fatigue symptom presentations among African American adults newly diagnosed with OSA and discern peripheral blood analytes linked to symptoms while accounting for co-occurring hypertension.
Methods
African American adults newly diagnosed with OSA with and without co-occurring hypertension were approached by study staff and recruited following their diagnostic visit with sleep medicine clinicians at two health systems and followed over 6 months after commencing continuous positive airway pressure treatment. Patient-Reported Outcomes Measurement Information System Fatigue surveys and plasma were collected every 3 months from 29 participants. Mixed-effects models examined changes in fatigue symptom presentations over time while accounting for plasma-based analytes and hypertension status.
Results
Despite higher fatigue symptom severity upon diagnosis, participants with co-occurring hypertension reported greater improvements in fatigue scores after commencing continuous positive airway pressure treatment for up to 6 months than those without hypertension. Inverse correlations were observed between fatigue scores, C-reactive protein, matrix metalloproteinase-8, and osteoprotegerin analyte levels among participants with/without hypertension. Across all participants, changes in interleukin-6 were associated with changes in fatigue scores in the first 3 months after diagnosis.
Discussion
Findings indicate that hypertension is linked to increased fatigue upon diagnosis of OSA in this sample of African American adults. Fatigue in persons with hypertension improved after treatment in this sample. These hypothesis-generating findings can inform future interventional studies aimed at improving fatigue among persons with OSA while leveraging markers linked to fatigue symptom severity as potential objective markers of improvements. Further research on the role of inflammatory markers, such as IL-6, on fatigue symptom presentations is warranted in persons with OSA. To survey registered nurses' familiarity with delegation standards and confidence to delegate to unlicenced workers within their practice.
Cross-sectional exploratory survey design.
The survey focused on Australian registered nurses (n = 420). Initial descriptive analysis was undertaken. Additionally, inferential analysis was undertaken between two independent variables focused on familiarity of delegation policy, and confidence to delegate, and several demographic and workplace variables. Stepwise linear regression was undertaken to determine predictors of the two delegation variables. The cross-sectional study was undertaken according to the STROBE reporting checklist.
The majority of respondents were somewhat familiar, or not familiar at all with delegation standards. This pattern was followed for results relevant to confidence delegating to unlicenced workers. Nurses working in adult acute, intensive care and emergency department reported the lowest levels of familiarity with delegation. Additionally, intensive care nurses were significantly less likely to feel very confident delegating to unlicenced support workers. Stepwise regression revealed identifying as male, and working in the public sector were less likely to be confident delegating. Nurses working in the acute setting and public sector were less familiar with delegation standards.
The findings of this study highlight the nuanced nature of delegation to unlicenced workers in Australian nursing settings, with nurses from certain contexts being far less likely to be familiar with or confident undertaking the practice.
The findings of this study have significant implications to increase understanding of nurses diverse contexts of practice and how delegation standards might not be implemented in practice in a confident manner.
FreshRSS 