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AnteayerInternacionales

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.

The Future of Healthcare—Simulation‐Based Learning Curricula and Preparing Future Midwives for Effective Rapport‐Building in Telehealth Settings

ABSTRACT

Aim

To understand student and clinical educator experiences and practices in simulation-based learning curricula linked to rapport-building in midwifery telehealth care interactions.

Design

A qualitative descriptive exploratory design with reflexive thematic analysis.

Methods

A purposeful sample of three educators and seven midwifery graduates who participated in a simulation-based curriculum in telehealth at a South Australian university participated in semi-structured interviews between January and February of 2024. Interviews were transcribed and analysed using woman-centred care as the core conceptual framework and qualitative social sciences research methodology to explore the values, opinions and behaviours of participants.

Results

Four overarching themes impacting graduate preparedness to practise telehealth were identified: understandings of essential concepts, clinical educator training and perspectives, learner experiences and translation into clinical contexts. Analysis showed the impact of disparate definitions of telehealth, inconsistency in the quality and scope of scenarios, ineffective use of simulation-based learning affordances and lack of opportunities to practise telehealth skills in student placements and subsequent clinical roles.

Conclusion

There is scope to improve telehealth education through standardised definitions of telehealth in midwifery care, specific training for clinical educators, focussed scenario development, specific skills training in rapport-building in digital environments and practise in clinical placements.

Impact and Implications

This study shows that effective telehealth education requires specific communicative and technical skills to ensure midwifery students and graduates are equipped to engage positively with technology to build consistent rapport in telehealth consultations. Once fundamental skills are acquired, this can be extended to interprofessional learning and teaching cultural safety.

Contribution to the Wider Global Clinical Community

As telehealth is now part of standard healthcare practice, this timely study offers strategies, which have the potential to be transferable to curricula across all health profession education to ensure rapport building with clients.

Patient or Public Contribution

No patient or public contribution.

Essential competencies of nurses for climate change response in Saudi Arabia: A rapid literature review

Abstract

Aim

Amidst the mounting challenges posed by climate change, the healthcare sector emerges as a vital frontliner, with nurses standing as its linchpins. This review delves into the pivotal role of nurses in combatting the health consequences of climatic alterations, particularly within the nuanced environment of Saudi Arabia.

Design

A rapid literature review.

Method

Drawing from a rigorous analysis of 53 studies, our exploration revolves around the preparedness strategies formulated in response to Saudi Arabia's changing climate. The variables analysed included study design, sample size, focus area, geographical coverage and key findings related to nurse competencies. Data were collected using a structured data extraction form and analysed using thematic content analysis. Employing content analysis, we discerned essential domains: from grasping the health impacts of climate change to customizing care for the most susceptible populations and championing advocacy initiatives.

Findings

Salient findings highlight nurses' profound understanding of both direct and secondary health implications of climate shifts. Additionally, the results emphasize the tailored interventions needed for vulnerable groups, capacity building and disaster readiness. Crucially, our findings spotlight the significance of weaving cultural, ethical and regional threads into nursing strategies. By painting a comprehensive picture, we showcase the delicate balance of environmental evolution, healthcare dynamics and the unique socio-cultural tapestry of Saudi Arabia.

Conclusion

The results of our analysis revealed key competencies required for nurses, including the ability to address immediate health impacts, provide tailored care for vulnerable populations and engage in advocacy and policy formulation. In summation, nurses' multifaceted roles—from immediate medical care to research, advocacy and strategizing—underscore their invaluable contribution to confronting the health adversities sparked by climate change. Our review accentuates the essential contributions of nurses in tackling climate-related health hurdles and calls for more nuanced research, policy adjustments and proactive measures attuned to Saudi Arabia's distinct backdrop.

Fostering Academic Inclusion and Representation: Enhancing Research Capacity for Black Nursing Academics in UK Universities—A Qualitative Multi‐Study Protocol

ABSTRACT

Background

Nursing as a profession remains underrepresented in research leadership, funding success and scholarly authorship globally, which limits its influence on policy and practice. Within this broader context, racially minoritised nursing academics, including Black academics, face additional inequities that further hinder their visibility and progression. Evidence from the United States, Canada and Australia highlights persistent barriers to research careers and leadership opportunities for Black nurses. In the United Kingdom, these disparities are particularly evident: Black nursing academics face barriers to conducting research while in the wider National Health Service workforce, Black nurses are twice less likely than their White counterparts to be promoted. Together, these patterns constrain career progression and hinder the development of culturally competent healthcare education and practice.

Aim

To explore the barriers to conducting research among Black nursing academics working in UK universities that are not traditionally research intensive, and to co-create pragmatic, theory-informed recommendations for enabling supportive and equitable research environments.

Design

A qualitative multi-study design underpinned by Intersectionality Theory and The Silences Framework.

Methods

Two work packages are proposed. Work Package 1 will use semi-structured interviews to explore the experiences and barriers of conducting research among up to 15 Black nursing academics based at UK universities that are not research-intensive. Work Package 2 will adopt a modified Delphi methodology, engaging key collaborators in two rounds of online codesign workshops. Findings from Work Package 1 will inform structured discussions in which collaborators will develop theory-informed, pragmatic recommendations to strengthen research capacity and engagement among Black nursing academics.

Conclusion

This study will address the persistent underrepresentation of Black nursing academics in research. While grounded in the UK, the anticipated outputs will have wider applicability, informing policy, shaping institutional strategies and guiding future research priorities across diverse academic and healthcare systems worldwide.

Implementing the MIRROR‐TCM Randomised Control Trial During the COVID‐19 Pandemic: A Mixed‐Methods Evaluation

ABSTRACT

Aim

To evaluate the implementation of the Transitional Care Model (TCM), an evidence-based, advanced practice registered nurse-led multi-component intervention, as part of a randomised controlled trial during the first year of the COVID-19 pandemic.

Design

Parallel convergent mixed-methods approach.

Methods

Data for this study were collected between June 2020 and February 2021. Data from 78 patients who received the intervention and 68 recorded meetings with system leaders and clinical teams were analysed using descriptive statistics, directed content analysis, and joint display.

Results

Fidelity to delivery of elements of the TCM components was variable, with the Hospital-to-Home visit elements having the widest range (14.3%–100%) and Maintaining Relationships elements having the highest range (97.3%–98.6%). There were 27 identified challenges and 15 strategies for implementing the TCM with fidelity during the pandemic.

Conclusion

The COVID-19 pandemic impacted all aspects of the delivery of the TCM across all sites. This historical event highlighted the need for services and support for patients and caregivers transitioning from the hospital to home.

Implications for Nursing and Patient Care

Evidence-based solutions are needed to enhance healthcare delivery and patient outcomes. Findings will guide nurses in implementing proven transitional care interventions.

Impact

Findings will inform the implementation and scaling of transitional care and other evidence-based interventions across diverse healthcare settings.

Reporting Method

GRAMMS reporting guidelines.

Patient or Public Contribution

No patient or public contribution.

Trial Registration

ClinicalTrials.gov identifier: NCT04212962. https://www.clinicaltrials.gov/study/NCT04212962?titles=NCT04212962&rank=1

Exploring the Causes, Immediate Responses and Preventive Measures of Needle Stick Injuries Among Healthcare Workers: A Qualitative Evidence Synthesis

ABSTRACT

Aim

To combine, synthesise, and interpret qualitative evidence from studies exploring the causes, immediate responses, and preventive measures of needle stick injuries from the perspective of healthcare workers.

Design and Methods

In this qualitative evidence synthesis, the qualitative data from the included studies were synthesised to identify overarching themes. The Preferred Reporting Items for Systematic Reviews and Meta-analysis flowchart, Joanna Briggs Institute tool, and Enhancing Transparency in Reporting the Synthesis of Qualitative Research checklist were used in the meta-synthesis process.

Data Sources

The MEDLINE, Cumulative Index to Nursing and Allied Health Literature, Web of Science, ProQuest, ClinicalKey and Scopus databases were searched between December 14 and December 31, 2024 for studies published between January 2000 and December 2024.

Results

Nine primary research studies were included and the following themes were identified: unpredicted patient movement, casual attitude, recapping, excessive workload, scarcity of article or safety equipment, inadequate training or experience, vigilance, ongoing training, nurturing workplace culture, emotional response, re-living the injury and fear of reprimand.

Conclusion

Needle stick injuries result from a complex interplay of individual, administrative, engineering, and environmental factors, but there are potential solutions to address these issues.

Implications for the Profession and/or Patient Care

Policymakers in healthcare settings would benefit greatly from an understanding of the causes, immediate responses, and preventive aspects of needle stick injuries. These findings can direct the creation of focused interventions and safety procedures by identifying important risk variables and useful coping mechanisms.

Impact

The causes, immediate responses, and preventive measures of needle stick injuries were explored. Findings can help develop protocols to lower needle stick injury rates and increase worker safety.

Reporting Method

ENTREQ guidelines.

Patient or Public Contribution

This research is a systematic review of published peer-reviewed studies.

Clinical Registration

PROSPERO registration number: CRD42024620673.

Collaging Integration Procedure for Integrating Literature, Theory, and Research Data in Mixed Methods Research

ABSTRACT

Aims

To propose the collaging integration procedure for linking literature and theory to research data in mixed methods research (MMR) and illustrate its application in two mixed methods studies.

Design

Discussion paper/research methodology.

Data Sources

The collaging technique was used and developed based on two exploratory sequential nurse-led mixed-methods studies.

Results

The collaging technique entails using multiple artefacts (data fragments, figures and textual information) within one figure. Collaging can generate relevant pre-post linkages, create meaning and refine inferences and meta-inferences.

Conclusion

This paper offers a novel integration technique for meaningful integration of the literature review and theoretical dimensions in the integration trilogy.

Implications for Nursing

Nurse researchers can use the collaging integration procedure for effective integration for conducting rigorous mixed-methods research. Collaging is a straightforward yet effective technique for enhancing integration in the literature review and theoretical dimensions in MMR.

Impact

Linking literature review, theory and research data facilitates a more meaningful interpretation of research findings. While researchers may be able to create a more fully integrated MMR design by integrating multiple dimensions of the study, to date, most of the empirical and methodological literature on MMR has focused on integration at the design, fieldwork, analysis and interpretation dimensions, ignoring others, such as the literature review and theoretical dimensions. Collaging enables intensive analysis of the raw data and embeds the insights gained from literature and theory throughout the data analysis and presentation, thereby avoiding neglecting insights which could have been gained by back-and-forth comparison and integration of literature review and theoretical underpinnings.

Patient or Public Contribution

No direct patient or public contribution.

Factors Influencing Mistriage Based on the Korean Triage and Acuity Scale: A Retrospective Cross‐Sectional Study

ABSTRACT

Introduction

Mistriage is important because of its potential for serious consequences, notwithstanding the beneficial effects of the emergency patient classification system employed to alleviate overcrowding in emergency departments (EDs). This study aimed to assess mistriage using the Korean Triage and Acuity Scale (KTAS) and identify factors influencing it.

Design

Retrospective cross-sectional study.

Methods

We examined the factors influencing mistriage in the KTAS and rates of under- and over-triage. Participants were obtained by combining electronic health records with registry data from the National Emergency Department Information System. We assessed the eligibility of patients aged ≥ 15 years who visited the ED between July 1, 2022, and June 30, 2023. Using the KTAS classification criterion, two experienced experts determined the final acuity level. We employed multivariate logistic regression analysis to evaluate the factors that predict under- and over-triage.

Results

Of 53,947 ED encounters, 1110 participants were enrolled in this study. Mistriage occurred in 207 (18.6%) patients: 88 (7.9%) had under-triage, and 119 (10.7%) had over-triage. In adjusted analyses, under-triage was associated with lower mean arterial pressure (odds ratio [OR], 5.42; 95% confidence interval [CI], 1.45–20.32) and presenting complaints of immunity or fever (OR, 3.41; 95% CI, 1.38–8.45), while over-triage was associated with advanced age (OR, 0.52; 95% CI, 0.28–0.98), pain (OR, 1.96; 95% CI, 1.18–3.25), lower KTAS experience (OR, 1.95; 95% CI, 1.08–3.51), and several specific present complaints.

Conclusions

By improving mistriage, the quality of emergency medical services may be enhanced through reduced costs, increased operational efficiency, and improved patient safety and satisfaction. Implementation of standardized criteria, validated triage tools, and enhanced provider training is crucial for achieving more accurate emergency triage. Additionally, establishing regulatory and financial incentives and developing realistic standards for mistriage management will optimize triage processes and ensure prompt, prioritized care.

Empirical Testing of a Middle‐Range Theory for Ineffective Breathing Pattern in Children With Congenital Heart Disease

ABSTRACT

Aim

To test a middle-range theory (MRT) for the nursing diagnosis of ineffective breathing pattern in children with congenital heart disease (CHD) based on analysis of two general propositions.

Methods

This cross-sectional study is guided by STROBE. The propositions represent hypotheses about the relationships between the concepts of this MRT to be tested empirically, and thus, log-linear models were used to verify the structure of the proposition related to the stimuli. Diagnostic accuracy measures, univariate logistic regressions and the Mann–Whitney test were used to analyse the structure of the propositions related to behaviours.

Results

The analysis of the propositions related to the stimuli (eight concepts, four of which were classified as focal stimuli and four as contextual stimuli) suggested a reclassification of the stimulus “deformities in the thoracic wall” which became too focal. In the analysis of the propositions related to behaviours (17 concepts, five of which were classified as acute confirmatory, nine as acute clinical deterioration and three classified as chronic), guided changes in the operationalisation of concepts were suggested after comparing clinical findings; thus, acute confirmatory behaviours now have 10 concepts, while acute clinical deterioration behaviours and chronic behaviours continued with nine and three concepts, respectively, but with reclassifications between them.

Conclusion

Changes in the operationalisation of the classification of the elements of the two propositions occurred after comparing the clinical findings with the theoretical model.

Relevance to Clinical Practice

By establishing precise causal relationships and describing how IBP manifests itself over time in children with CHD, empirical testing of this MRT helps nurses understand clinical reasoning based on temporal logic and spectral interaction between diagnostic components, which in turn will improve the use and accuracy of nursing diagnoses.

Patient Contribution

Children and adolescents with CHD were recruited for this study sharing their clinical history and physical lung examination.

Nursing home nurses' opinions on the potential evolution of their role in antibiotic stewardship: A French national cross‐sectional survey

Abstract

Aims

To assess French nursing home nurses' opinions on the potential evolution of their antibiotic stewardship role, facilitators and barriers, and nurses' characteristics associated with their opinion toward new roles regarding antibiotic prescribing.

Design

We conducted a cross-sectional study in French nursing homes with ≥20 beds and for which an email address was available in a national database managed by the French government between May and June 2022.

Methods

A self-administered internet-based questionnaire of 43 closed-ended Likert items was sent to directors of eligible nursing homes by email asking them to forward the link to the questionnaire to the nurses and head nurses of their institution. Data analysis included descriptive statistics and χ2 tests.

Results

7215 nursing homes were sent the online questionnaire; 1090 participants completed it partially or totally and 923 fully filled in the questionnaire. A majority of nurses supported strengthening and expanding their antibiotic stewardship role. Regarding new roles, over 70% agreed that nurses could collect urine samples to perform a urine culture on their own initiative, prescribe microbiological laboratory tests, and change the drug formulation or the administration route of the antibiotic prescribed by the general practitioner.

One-third declared that they could initiate antibiotics for some infections and/or change the empirical antibiotic treatment prescribed by the general practitioner. Nurses from public nursing homes with connection to a hospital (27.5% vs. >35% for other status) and with recent experience in nursing homes (31% for <5 years of practice vs. 41% for 10 years or more) were less likely to agree to prescribe antibiotics.

Conclusions

This quantitative questionnaire survey identified potential new nurses' roles in antibiotic stewardship that seem to be acceptable and feasible for participants. These new nurses' roles need to be explored in future experimentations before considering implementation.

Reporting Method

The study adhered to relevant EQUATOR guidelines and followed the STROBE reporting guidelines.

Patient or Public Contribution

A self-administered internet-based questionnaire was sent to directors of eligible nursing homes by email asking them to forward the link to the questionnaire to the nurses and head nurses of their institution. Nurses and head nurses who were interested and willing could complete the questionnaire online partially or fully.

Trial and Protocol Registration

This study is not a clinical trial and is not eligible for trial registration. We used another suitable study registration site, the Center for Open Science.

The relationship between perception of COVID‐19, fear of COVID‐19 and self‐care management in individuals with chronic diseases during the pandemic process in Turkey

Abstract

Aims

To determine the relationship between perception of COVID-19, fear of COVID-19 and self-care management in individuals with chronic diseases during the pandemic process.

Background

Individuals with chronic diseases are a sensitive group during the COVID-19 pandemic process; it is thought that self-care management may be adversely affected as a result of their more intense exposure to the psychological, physiological and economic effects of the pandemic. In the literature, there is no study examining the effect of perception of COVID-19 and fear of COVID-19 on self-care management in individuals with chronic diseases.

Design

Descriptive study.

Methods

The study was conducted with 322 individuals who applied to the internal medicine outpatient clinics of a university's Health Practice and Research Center, met the inclusion criteria, agreed to participate in the study and had a chronic disease. Questionnaire form, Perception of COVID-19 Scale (P-COVID-19), The Fear of COVID-19 Scale (FCV-19S) and Self-Care Management Process in Chronic Illness Scale (SCMP-G) were used to collect data. STROBE checklist was used to report the present study.

Results

In the study, it can be stated that individuals with chronic diseases had a moderate to the high perception of contagiousness and dangerousness of COVID-19, they had a moderate-high level of fear of COVID-19 and their self-care care management was above moderate level. There was a significant positive correlation between P-COVID-19, FCV-19S and SCMP-G in the study.

Conclusions

It was found that the perception of COVID-19 contagiousness and the fear of COVID-19 had a positive effect on the self-care management of individuals with chronic diseases.

Relevance to clinical practice

Determining the level of COVID-19 perception and fear of COVID-19 and their effects on the life of the individual, and evaluating self-care management during the difficult pandemic process will increase the success in the holistic nursing care and management of chronic diseases.

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