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Commentary on: Freedman B, Li WW, Liang Z, Hartin P, Biedermann N. The prevalence of incivility in hospitals and the effects of incivility on patient safety culture and outcomes: A systematic review and meta-analysis. J Adv Nurs. Published online March 21, 2024. doi:10.1111/jan.16111
Practice: Implement anti-incivility programmes, including training and policies, to improve teamwork, communication and management support, thereby enhancing patient safety culture (PSC). Research: Investigate mediating factors such as conflict handling, psychological resilience and self-efficacy to understand their impact on the relationship between incivility and patient safety, guiding effective intervention development.
Workplace incivility, characterised by low-intensity deviant behaviour, undermines mutual respect,
Commentary on: Lyon, M. E., Fraser, J. L., Thompkins, J. D., et al (2024). Advance Care Planning for Children With Rare Diseases: A Pilot RCT. Pediatrics, 153(6), e2023064557. https://doi.org/10.1542/peds.2023-064557.
Implications for research and practice Having access to advance care planning, despite social and financial constraints is imperative. It is evident that in the population included in this study, advance care planning was invaluable for those below the 2021 financial poverty line. Further research is required to determine if the current medical model in the USA is meeting the requirements of caregivers and children with rare diseases.
Rare diseases in babies, children and young people (children) are often life-shortening, and children can require constant caregiving. Bösch et al
Commentary on: Impact of Crisis Care on Psychiatric Admission in Adults with Intellectual Disability and Mental Illness and/or Challenging Behavior: A Systematic Review—Tai et al.
Implications for practice and research Crisis care should be integrated into community care for this vulnerable and difficult-to-treat population to improve community tenure and reduce healthcare costs. Crisis care versus intensive community care needs to be defined, and standardised models compared, to optimise outcomes in different healthcare jurisdictions.
There is a high prevalence of psychiatric disorders among individuals with intellectual disability. In keeping with deinstitutionalisation, this population has also been moved from hospital to community but not necessarily accompanied by the specialised resources required. Consequently, there are high admission rates, however, this has been associated with traumatic experience (for patients and caregivers), potential neglect and abuse. Community crisis care has been studied for other patient groups but...
Commentary on: Ali MR, Lam CSP, Strömberg A, et al. Symptoms and signs in patients with heart failure: association with 3-month hospitalisation and mortality. Heart. 2023 Dec 1. doi: 10.1136/heartjnl-2023-323295.
Implications for practice and research In primary care consultations, symptoms reported by patients with heart failure (HF) could be valuable in identifying patients at risk of hospitalisation or death. Further research needs to investigate how best can support patients to monitor and report symptoms and test new patient-centred prognostic models including HF signs and symptoms.
Hospitalisation in patients with HF is associated with impaired quality of life, increased mortality and excessive medical costs.
This article on realist reviews is the second in a four-part series on realist research.
Realist reviews (or realist evidence syntheses) are a theory-building, interpretative approach to evidence synthesis. Realist reviews aim to go beyond seeking whether interventions work (ie, are effective), to generating explanations as to...
To generate an in-depth understanding of the perceptions and experiences of individuals with youth-onset type 2 diabetes (T2D) to inform knowledge translation initiatives and clinical care.
Interpretive descriptive qualitative study.
Individuals were eligible to participate if they received a T2D diagnosis on or before 18 years of age, resided in Manitoba, and were between 10 and 25 years of age at the time of data collection. Twenty-two individuals (13 females, 7 males, 2 prefer not to indicate gender; mean age = 19.3 years) participated in 22 semi-structured interviews (mean length: 29:01 min) remotely using Zoom video conferencing software or by telephone. Data were analysed using inductive thematic analysis.
Four themes were generated: (1) Low public knowledge, misconceptions, and stigma impact youth experiences including those of diagnosis, disclosure, treatment, and supports; (2) shared familial experiences impacts perception of the future; (3) mental and emotional wellness is critically important but requires more attention; and (4) T2D carries unanticipated positive and negative impacts for youth.
Findings illustrate the complex interrelationships between public and personal conceptions of T2D, stigma, and T2D navigation, emphasising the centrality of emotional and mental well-being to participants' T2D experiences and management. This representation of experiences and perceptions of youth onset T2D offers direction for holistic and youth-centred research and care and highlights areas where further mental health and educational resources would be beneficial.
The knowledge translation resource being developed from this study involves input from patient and public partners.
To explore the experiences of significant others of patients with severe burn injury in the intensive care unit. Specifically, how severe burn injury impacted the significant other and their role within their loved one's life.
This qualitative study employed a Narrative Inquiry approach.
Interviews were undertaken during 2021–2022 with 17 participants who were the significant others of a patient with severe burn injury in the Intensive Care Unit. Recruitment occurred in New South Wales, Australia, from two tertiary hospitals providing care for people with major burns. A narrative inquiry approach was utilised, capturing stories through semi-structured interviews.
Significant others experienced necessary changes in their life in response to the catastrophe. These included advocating, being present and ensuring their loved one's needs were met, while often neglecting themselves. Significant others contemplated their future as a carer to their loved one with severe burn injury, and adjusting their own career, finances and lifestyle, often as a long-term measure. The shifting of their role to carer ultimately transformed and redefined their relationships and lives.
Significant others endure immense trauma when a loved one sustains a severe burn injury. They require support but prioritise the patient by virtue of their critical illness. The life of the significant other is changed as they take on the role of carer and provide support. It is, therefore, imperative that the support needs of significant others are recognised, understood and addressed to ensure their well-being while processing the trauma.
With increased understanding of the significant others' experiences, healthcare providers can adopt a consultative approach, where roles and boundaries can be clearly identified. Through this process, healthcare providers can strengthen rapport and provide targeted support for significant others, as they navigate this traumatic life-altering event.
No patient or public contribution.
To better develop and understand the practice of rooming-in in adult care, this study aims to explore the perceptions of the three most important stakeholders: nurses, patients, and family members.
A cross sectional survey study in a university medical centre in the Netherlands.
A convenience sample was drawn from nurses, adult patients, and family members across ten general wards. Data of patients and family members were collected through online questionnaires, developed and validated prior to the study. Their responses were summarised using descriptive statistics. For the nurses, data were obtained by analysing responses to an open-ended question from an existing questionnaire, using thematic analysis.
The sample consisted of 364 nurses, 26 patients, and 35 family members. Thematic analysis of the nursing data revealed four themes: (1) reducing the workload of nurses, (2) optimising patient recovery, (3) unclear policy and inadequate facilities, and (4) complexities for nurses. Regarding the perceptions of patients and family members, more than 75% perceived that rooming-in enhanced patients' sense of safety. Additionally, 54.1% of family members indicated that rooming-in improved their understanding of medical information. For most patients (57.7%) and family members (62.9%), the rules and conditions for rooming-in were not clear. Moreover, 65.7% of family members reported experiencing physical burden. Both patients and family members rated rooming-in with a median of 8 out of 10.
According to nurses, patients, and family members, rooming-in may be beneficial in reducing nurses' workload, enhancing patient safety, and improving family understanding of medical information.
Given the ambiguity surrounding rooming-in policies in adult care, clear guidelines and their implementation are essential for ensuring their success.
Rooming-in can positively contribute to adult care by facilitating family involvement.
STROBE statement.
No patient or public contribution.
Although the positive correlation between self-efficacy and quality of life and the negative correlation between symptom occurrence and self-efficacy are well established in the cancer literature, the underlying mechanism, whether self-efficacy mediates the effect of symptoms on quality of life, remains unclear due to the cross-sectional design of prior studies. Longitudinal investigation is crucial for establishing the causal mechanism of self-efficacy in mitigating the adverse impact of cancer-related symptoms on quality of life.
To examine the longitudinal mediating effect of self-efficacy on the relationship between symptom occurrence and quality of life among 534 cancer patients on treatment with moderate to high symptoms.
This is a secondary data analysis of the longitudinal mediating effect. A sample of patients with moderate to high symptoms on cancer treatments (N = 534) from a randomised controlled trial was used. We adopted a cross-lagged panel model (CLPM) approach to test the longitudinal mediating effect with three waves. The longitudinal invariance of the measurement was previously tested.
The results showed that cancer-coping self-efficacy predicted the following assessment of symptom occurrence, but not vice versa. Also, cancer-coping self-efficacy had an immediate direct impact on quality of life and the influence sustained to the following assessment. Our mediating analysis showed that cancer-coping self-efficacy totally mediated the relationship between symptom occurrence and quality of life (unstandardized β = −0.008, standardised B = −0.036, p = 0.036, CI95 = [−0.001, −0.016]).
Our findings provide initial evidence supporting the causal mechanism of cancer-coping self-efficacy in interventions that aim for symptom management and quality of life improvement.
This study is the first to test the longitudinal mediating mechanism of cancer-coping self-efficacy in the relationship between symptom occurrence and quality of life among the cancer population. Further testing using a randomised controlled trial of a specifically designed self-efficacy-enhancing intervention is needed.
No patient or public contribution.
Develop and simulate test a digital alert dashboard drawing from existing data to support nurses, care workers and managers in residential aged care.
Participatory action research, co-designing for an Australian 64-bed residential site.
Qualitative data were collected through focus groups and analysed using reflective thematic analysis.
Nursing-theory and evidence-based Nursing Data Domain Standards (NDDS) were developed to support internal triaging of fundamental and clinical care in a non-clinical environment. A co-designed retrospective digital alert dashboard (Aged Care Electronic Dashboard Information Tool—ACED-IT) representing the Standards was created and tested. Twenty aged care nurses, care workers and managers found it had promise in enhancing quality of care, improving resident health and reducing adverse events.
Maximising efficient use of resident-level data with a system that empowers nurse decision-makers is crucial to support effective care design and harm prevention.
ACED-IT has the potential to improve visibility of resident needs, support staff to adjust their workflow based on in-house triage, enhance supervision of staff and quality of care and reduce preventable complications.
Digital systems that enable nursing care escalation and triaging for early intervention are needed in residential aged care settings. The co-designed system was perceived by registered nurses, care workers and managers to have the potential to improve care quality and efficiency. Using an evidence-informed nursing framework to identify day-to-day care indicators can be widely implemented by government regulators, software providers and residential care providers on an international scale to improve resident experience.
This study adhered to the relevant EQUATOR guidelines, specifically the COREQ (Consolidated Criteria for Reporting Qualitative Research) Checklist.
A member of the public participated in the Advisory Group, observed and contributed to the co-design process and reviewed the manuscript.
To identify implementation strategies that effectively facilitate the adoption of social needs care coordination activities using enabling technologies among care management teams serving patients in community-based health centres.
Modified Delphi process.
Discrete, feasible implementation strategies were identified through literature review and semi-structured interviews with care management staff and subject matter experts in clinical informatics, workflow redesign, and product engineering. A modified Delphi was conducted with eight subject matter experts and nine health centre care management staff. Iterative rounds of online surveys were used to achieve consensus on the most relevant implementation strategies and their delivery methods.
The modified Delphi process achieved consensus on nine discrete implementation strategies needed to advance care management teams' ability to screen, refer and track social needs. Prioritised strategies included developing champions, enhancing quality improvement capacity, training staff on using enabling technologies and providing tailored technical assistance for workflow refinement. Consensus was also reached on a monthly cadence for most of the implementation strategies.
Consensus was reached on strategies to enhance care management teams' implementation of social needs screening, referrals and tracking using enabling technologies. These strategies will comprise an intervention to be pilot tested, refined and assessed in a cluster randomised clinical trial.
Findings from this study will inform the development of strategies to further the adoption of enabling technologies to support social needs care coordination.
This work is key to the design of a type 2 hybrid implementation-effectiveness trial that will assess whether user-informed, evidence-based implementation strategies can improve care management teams' adoption of enabling technologies to facilitate social needs care coordination for patients.
The research team includes a patient advisor with community-based nursing expertise and a nurse practitioner-clinical informaticist leader who was involved in data collection and interpretation of findings.
Trial registration: Clinicaltrials.gov registration # NCT06489002. Registered July 5, 2024, https://clinicaltrials.gov/study/NCT06489002?term=NCT06489002&rank=1.
To explore how nursing teams (co)organise their work environment by going beyond caregiving.
A descriptive qualitative study with a phenomenological approach.
Semi-structured group interviews were conducted in 2022 with nurses and managers from 18 nursing teams in a general hospital located in the Netherlands. In each group interview, 2–3 participants per team took part. The interviews were audio-recorded, transcribed verbatim, and analysed using thematic analysis.
The analysis identified four main themes contributing to a more supportive work environment: (1) embracing diversity, (2) stretching nursing roles, (3) raising voices, and (4) aligning nurses and managers. These themes show how nursing teams go beyond caregiving and actively shape and co–organise their work environment.
Teams that extend their roles create more supportive work environments, enhancing patient care and professional development. These findings contribute to the understanding of organising professionalism in nursing and provide insights for nursing teams striving to improve their work environments.
Nursing teams can use the four themes—as team features—to reflect upon their organising roles and engagement with their work environment. Our findings offer practical insights for nurses with responsibilities in areas such as team development and leadership. They can focus on team diversity, voicing, stretching roles, and organisational alignment, and facilitate their teams to become more assertive.
The Consolidated criteria for Reporting Qualitative research guideline was followed.
No patient or public involvement.
To synthesise the evidence on implementation strategies used to implement transitional care interventions for adult surgical patients.
Scoping review.
Medline, CINAHL and EMBASE were searched in August 2023 and updated June 2025, followed by citation searches. Studies were screened independently by two researchers, and one extracted data, another verified its accuracy. Studies about transitional care interventions for adult surgical patients were coded according to the ‘Five classes of implementation strategies’ and the ‘Patterns, Advances, Gaps, Evidence for practice and Research recommendations’ framework, to illuminate the review findings.
Based on 27 studies included in the scoping review, staff education, changes to staffing and electronic systems, and change management techniques were frequently used implementation strategies. Implementation strategies were mostly used with patients undergoing colorectal and cardiac surgery in Asia and the United States. Scale-up strategies and capacity-building initiatives for people in charge of spearheading the change initiatives were less common.
To further the field, future research could focus on capacity-building and scale-up strategies, fidelity reporting, and financial implications of implementation in a wider range of surgical populations and settings. Work is needed to effectively implement surgical transitional care interventions in real-world settings.
Our findings provide strategies for hospital leaders to adopt when implementing transitional care interventions for surgical patients.
Scoping Reviews (PRISMA-ScR) checklist.
Determined review focus, interpreted findings, and contributed to manuscript.
The Open Science Framework.
To review the evidence on the experiences and perceptions of culturally and linguistically diverse informal carers supporting older adults during transitions from hospital to home, including their interactions with transitional care interventions.
Scoping review guided by Arksey and O'Malley's framework.
We searched CINAHL, MEDLINE, Embase, Emcare, AMED, PsycINFO, Global Health, Social Work Abstracts, JBI EBP, Scopus, Web of Science Core Collection, ProQuest and Informit for studies published between January 2010 and November 2024.
Two reviewers independently screened studies and extracted data. Analysis followed the Patterns, Advances, Gaps, Evidence for Practice and Research recommendations framework.
Seventeen studies involving 1275 carers were included. Carer experiences were summarised into four themes: (1) cultural and communication barriers; (2) role ambiguity and practical challenges; (3) limited involvement in discharge planning and (4) barriers to accessing support and services. Perceptions of transitional care interventions were mixed. While some interventions improved carer preparedness and reduced stress, most lacked cultural tailoring and did not address carers' psychosocial and communication needs.
Culturally and linguistically diverse informal carers face challenges navigating transitional care. While involving them in care planning improves outcomes, implementation remains inconsistent. Emotional support and culturally tailored services are insufficient.
There is a need for culturally and linguistically tailored transitional care programmes that prioritise carer education and communication support. Key areas for improvement include: (1) health literacy and system navigation; (2) involvement in care planning; (3) communication with providers; (4) psychosocial and emotional support and (5) culturally appropriate services. Future research should explore the unique emotional and psychosocial needs of these carers to inform targeted support strategies.
This review follows the PRISMA guideline for reporting.
No patient or public contribution.
This study sought to understand the experience of women veterans transitioning from military to civilian life.
A community-based research design and Ricoeur's hermeneutic phenomenology guided the philosophical framework.
Seventeen women veterans were recruited from a non-profit organisation. Data was collected in six virtual focus groups using Zoom in the fall of 2022 using dialogical engagement. Analysis of the data was done using hermeneutic phenomenology. Five participants in the research validated the data and recommended changes to their peer-to-peer support group.
The veterans described their environment as service to confusion and from pride to embodied shame. The phenomenology of this experience was screaming in silence, harsh reality, creating a village, and taking the high road. Lists of deployment and military sexual trauma triggers were created.
There are many obstacles for women transitioning from military to civilian life. Some veterans suffer more than others. For those who are challenged by living in civilian life, this study strongly emphasised that veterans are often their own best source of support. Peer-to-peer support groups for women veterans were highly encouraged as a vital part of their well-being.
The data obtained in this study provided us with rich information for nursing practice, including an understanding of the way of being of women veterans, suicide, military sexual trauma, and homelessness assessment, significant community resources, the significance of having peer-to-peer support groups, and the policies and research needed.
Consolidated criteria for reporting qualitative research.
This study did not include patient or public involvement in its design, conduct, or reporting.
To explore the direct relationship between financial stress and mental health and wellbeing of nursing students and characterise the effectiveness of available support mechanisms.
Systematic integrative review.
Academic Search Complete, CINAHL, Education Research Complete, MEDLINE, ProQuest Central, PsycNET, Scopus and Web of Science were searched in January and October 2024.
Studies reporting a direct relationship between financial stress and mental health and wellbeing in nursing students were included. Data related to sources of financial stress, mental health impacts, and support mechanisms were extracted, synthesised narratively, and reported thematically.
Findings from nine studies reveal that financial stress significantly affects nursing students' mental health and wellbeing, contributing to emotional distress and reduced quality of life. Financial stress arises from personal, academic and clinical sources, with the intensity varying based on individual demographic profiles and fluctuating throughout their educational journeys. Marginalised and underserved groups experience greater impacts due to pre-existing disadvantages. Current support mechanisms are largely reactive, providing only short-term relief and failing to address root causes. Additionally, students' efforts to alleviate financial stress in one domain often exacerbated it in another.
This review highlights the multifaceted and compounding effects of financial stress on nursing students' mental health and wellbeing. Proactive strategies, including structured employment programs, embedded financial literacy education, and transparent pre-enrolment information offer promising solutions.
While financial stress cannot be fully eradicated, targeted support for at-risk students can mitigate its impacts, improving their mental health and educational outcomes.
This review addresses the critical issue of financial stress among nursing students, highlighting its disproportionate impact on marginalised and underserved groups. It underscores the need for proactive interventions and systemic reform to improve educational experiences globally.
Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 Statement.
No patient or public contribution.
Trial Registration: PROSPERO: CRD42024514262
Background
Chronic pain is a major cause of distress and disability, and biomarkers may aid in the assessment and treatment of it. Urine metabolites may be valuable bioindicators that can provide biological insight regarding chronic pain.
Objectives
To investigate the relationship between a multimarker composite measure of metabolites and patient-reported outcomes scores in adults with chronic pain, using data from a pragmatic clinical trial with a sequential, multiple-assignment randomized trial design.
Methods
Self-reported measures and urine samples from 169 active-duty service members with chronic pain were collected. Urine was analyzed using a preestablished panel of metabolites, including four previously identified biomarkers of pain: kynurenic acid, pyroglutamic acid, ethylmalonic acid, and methylmalonate. Multivariable linear regression models—adjusted for participant characteristics such as age and sex—were used to cross-sectionally examine the relationship between 11 patient-reported outcomes (fatigue, sleep-related impairment, anxiety, depression, anger, pain catastrophizing, physical function, pain interference, satisfaction with participation with social roles, pain intensity, and pain impact score) and the four urine metabolites both individually and as a composite (urine metabolite pain indicator, or UMPI). Given the study’s small sample size and exploratory nature, a significance threshold of p ≤ .10 was used for all analyses.
Results
The UMPI showed statistically significant associations with five self-reported measures (fatigue, anxiety, depression, physical functioning, and pain impact score); adjusted Pearson correlations ranged from .18 to .25. Individual metabolite analyses supported these findings, with all relationships between individual metabolites and self-reported measures showing positive associations. Kynurenic acid and ethylmalonic acid showed the strongest associations, each having statistically significant relationships with four individual self-reported measures, while pyroglutamic acid had statistically significant relationships with three self-reported measures and methylmalonate with none. The UMPI demonstrated feasible reliability.
Discussion
Our finding of associations between the UMPI and components of the self-reported measures supports the development of the UMPI and these four urine metabolites as biomarkers for chronic pain outcomes. Further research is planned and will be essential for establishing mechanistic insight and guiding biomarker development within the context of pain management. Nursing well-being is foundational to the specialties workforce and broader healthcare industry worldwide. Despite frequent reports and descriptions of activities that support nurses' well-being, most reports describe singular activities and programs that lack science-based structures contextualized within academic healthcare systems (AHS) with validated impact.
To evaluate and synthesize the existing national and international literature on nurse well-being initiatives offered in AHS.
Over 18 months, an 8-member interprofessional team conducted a scoping review adhering to PRISMA-ScR reporting guidelines. Five databases were searched, and results were screened in a multistep process by researcher pairs. Discrepancies were resolved by a third team member's review. Citations were reviewed uniquely three times to ensure methodological rigor. A final set of 54 articles was extracted for key data elements pertinent to the research question describing setting, population, study design, intervention, and other subsidiary fields. Reviewers additionally analyzed publication quality indicators and trends for additional implications for research and practice.
Among the 54 eligible articles, 72% were research and 28% were evidence-based practice, quality improvement, or doctoral dissertations. The concepts studied were psychosocial (e.g., resiliency) and physical (e.g., sleep). The number of instruments used per study ranged from 1 to 11. Thirty percent of studies utilized a framework from various disciplines that included nursing, social and behavioral sciences, and safety science principles. Nurses were included as authors 67% of the time, and 35% received funding from either the public or private sector.
Commentary on: García-Hermoso A, López-Gil JF, Izquierdo M, et al. Exercise and insulin resistance markers in children and adolescents with excess weight: a systematic review and network meta-analysis. Jama Pediatrics. 2023;177(12):1276–84.
Resistance exercises with aerobic training and high-intensity interval training reduced insulin resistance markers in 5–18 years old children with excess weight if done at least two to three times/week. Low to moderate certainty of evidence in this meta-analysis
The prevalence of childhood excess weight continues to grow, adding to risk of metabolic syndrome and type II diabetes.
Commentary on: Kim MR, Chae SM. Experiences of trust in mothers of hospitalized children toward pediatric nurses. J Child Health Care. 2023 Oct 17:13674935231206214. doi: 10.1177/13674935231206214. Epub ahead of print.
The ability to develop a trusting relationship with families and carers of hospitalised children is an important skill for paediatric nurses as it can facilitate emotional support and parental empowerment Future research in this area requires the development of tools which can objectively measure trust; these must be culturally sensitive and acknowledge the culturally diverse experiences of parents, caregivers and healthcare professionals
Developing a trusting relationship with parents and caregivers is an essential component of paediatric nursing. Previous studies in this area have been largely conducted in western cultures and as such, the experiences of other cultures are not well understood. This study
FreshRSS 