Conectar
Commentary on: Pasere E, O’Hara D, Ballard E, Kilgour C, and Holland L, A narrative review of medical and surgical nurses’ attitudes and perceptions when caring for patients with a secondary diagnosis of mental illness, Nurse Education Today 2025; 151:106 684
The study highlights the importance of education reform in preregistration nurse education to optimise the health outcomes for individuals with a secondary diagnosis of mental illness (SDMI).
Individuals with mental illness experience higher rates of physical health issues compared with those without.
To explore the influences of workplace bullying experiences, witnessing workplace bullying and bystander types on Speaking up for patient safety (SUPS) among hospital nurses.
Cross-sectional study.
A survey was conducted in September 2021 using a structured questionnaire about workplace bullying experiences, witnessing workplace bullying, bystander types, and SUPS. The questionnaire was administered to 200 bedside nurses from two tertiary university hospitals in South Korea.
One hundred and ninety-nine responses were analysed. A hierarchical regression model, incorporating organisational factors, workplace bullying experiences, witnessing workplace bullying, and bystander types explained approximately 44.0% of the variance in nurses' SUPS. Witnessing workplace bullying and the perpetrator-facilitating bystander negatively influenced SUPS, whereas victim-defending bystander had a positive influence on SUPS.
Findings suggest that witnessing workplace bullying and the bystander types of nurses working on patient care units are more impactful on nurses' SUPS than individual experiences of bullying. Notably, the victim-defending and perpetrator-facilitating bystander types were identified as key factors influencing SUPS.
Nurse managers should understand the roles of witnesses and bystanders working on a patient care unit, and how these roles may extend beyond traditional views of perpetrators and victims. Developing strategies to support and effectively manage witnesses and bystanders working on patient care units may promote positive SUPS behaviours among clinical nurses.
What problem did the study address?
Speaking up for patient safety (SUPS) in clinical settings is critical in maintaining and enhancing patient safety. However, a negative work environment, such as one that promotes workplace bullying may hinder nurses' willingness to engage in SUPS. Because many nurses involved in workplace bullying may be witnesses or bystanders rather than direct perpetrators or victims of such situations, this study explored the potential influences of workplace bullying, including the roles of witnesses and bystanders, on SUPS. What were the main findings?
SUPS was influenced more by witnessing workplace bullying and specific bystander types, namely victim-defending and perpetrator-facilitating bystanders, than by workplace bullying experiences. Where and on whom will the research have an impact?
These findings highlight the importance of addressing the roles of witnesses and bystanders in workplace bullying. Nurse managers should broaden their focus beyond perpetrators and victims to include the roles and views of all nursing staff within a department. By effectively managing witnesses and bystander types, they can foster an environment that enhances SUPS behaviours among nurses.
This study adhered to STROBE guidelines.
No Patient or Public Contribution.
To synthesise evidence on nurses' roles in long-term care settings and map their interactions.
Systematic review with network analysis.
Thematic synthesis was used to identify nurses' roles, and network analysis mapped their interactions across domains.
Six databases—Cumulative Index to Nursing and Allied Health Literature, PubMed, Embase, Cochrane Library, Research Information Sharing Service and Database of Periodical Information Academic—were searched for peer-reviewed articles from 2014 to 2024. The Mixed Methods Appraisal Tool assessed study quality.
Fifteen studies were included. Nurses' roles spanned six domains: collaboration, education, leadership, resident-centred care, quality improvement and resource management. Network analysis revealed collaboration and leadership as the most central, each with a degree centrality of five, acting as bridges across domains. Three thematic clusters emerged: collaboration and resource management focused on operational teamwork; leadership and quality improvement centred on systemic care enhancements; and education and resident-centered care emphasised training and resident-focused care. A technological competence gap was identified, alongside barriers like staffing shortages and role ambiguity.
Nurses' interconnected roles are critical for resident-centered care; however, they require systemic support to address barriers and technological gaps.
Enhanced interprofessional training, leadership development and digital skill integration can improve care quality and nurse well-being in long-term care settings.
This study addressed the complexity of nurses' roles in long-term care and their structural interactions, finding collaboration and leadership as pivotal with three role clusters and a technological gap, impacting long-term care nurses, educators and policymakers to inform workforce strategies.
This study adhered to the PRISMA 2020 guidelines and was preregistered in PROSPERO (CRD42024588422).
This study did not include patient or public involvement in its design, conduct or reporting.
PROSPERO: CRD42024588422
To identify the barriers and facilitators in the implementation of fertility preservation (FP) shared decision-making (SDM) in oncology care.
Qualitative descriptive study.
Qualitative interviews with 16 female patients with cancer and seven healthcare providers were conducted between July 2022 and April 2024. Data were analyzed using directed content analysis, guided by the implementation science framework.
We identified 22 categories comprising 38 codes as barriers to SDM implementation and 17 categories comprising 26 codes as facilitators. Findings revealed that, at the innovation level, accessibility, feasibility, interdisciplinary collaboration, and quality improvement efforts were decisive in the implementation of FP SDM. At the individual level, healthcare providers' awareness and attitudes towards FP and SDM, as well as patients' knowledge, attitudes, and capabilities in FP SDM, were crucial factors in the implementation of FP SDM. In social, economic, and organizational contexts, support from significant others, social awareness about FP, multidisciplinary care, financial assistance, and educational resources were determinants in implementing FP SDM.
Implementing FP SDM among female patients with cancer necessitates a strategic approach that considers barriers and facilitators. Educating and promoting FP SDM among the public and healthcare providers, combined with incentivizing policies, can enhance individual knowledge and awareness while achieving systemic improvements, facilitating its successful implementation.
This study provides insights into barriers and facilitators and proposes strategic approaches to enhancing FP SDM implementation, contributing to improved quality of life for cancer survivors and advancements in clinical practice.
To evaluate the ‘Countdown to Theatre’ intervention, a co-designed nurse-led approach developed using the COM-B framework to address context-specific barriers and facilitators to preoperative fasting practices.
A prospective mixed-method, pre–post study assessed the intervention's impact on fasting adherence and patient experience.
Participants included children booked for a procedure under general anaesthesia. Adherence was assessed through audited fasting duration, and patient experience was evaluated using caregiver/patient surveys. The intervention was implemented and monitored by nursing staff as a part of a structured quality improvement process. Nurses played a central role in embedding the approach into daily workflows and reinforcing fasting timelines
Over 9 months, 901 observations were undertaken from 774 patients. Fasting duration decreased from 7.6 to 5.7 h (mean difference −1.94; 95% CI −3.04, −0.86). Parent-reported patient experience surveys showed improvement in many areas, including an increase in overall satisfaction (from 44.7% to 68.8%).
The intervention successfully reduced prolonged fasting and improved patient experiences, demonstrating the value of co-designed approaches in addressing evidence–practice gaps in perioperative care.
The principles of co-design, structured implementation and the application of the COM-B framework provide a replicable model for addressing similar challenges in healthcare. The study highlights the pivotal role of nurses in improving perioperative practices, supporting both patient safety and satisfaction. Future research should explore the intervention's applicability across diverse settings and patient populations.
Despite evidence-based guidelines, excessive preoperative fasting remains prevalent in practice. This study demonstrates that a structured, nurse-led intervention can successfully reduce fasting durations and enhance patient experience, reaffirming the nursing profession's capacity to lead meaningful change in perioperative care.
Standards for quality improvement reporting excellence (SQUIRE 2.0).
Patients and caregivers contributed to the co-design of the intervention, ensuring that it addressed practical challenges related to preoperative fasting.
To explore mental health help-seeking behaviours among East Asian American dementia caregivers and construct a theory grounded in their behaviour patterns.
Qualitative using constructivist grounded theory design.
We recruited 20 East Asian American dementia caregivers between August 2023 and March 2024 using purposive sampling. We conducted one-on-one interviews and analysed the data using constructivist grounded theory coding.
We constructed a theory including six concepts and 22 categories. While ‘providing care’, caregivers manage caregiving tasks and personal life, experiencing caregiving challenges. ‘Individual capacity’ is a key to perceiving caregiving situations and ‘considering seeking support’. Various factors can affect ‘using support’. Different types of support can be used separately or in combination. When receiving adequate support, caregivers can ‘gain benefits from support’. These benefits, alongside individual capacities, can shape caregivers' ‘outlook on the present and the future’.
This study explains the mental health help-seeking process within East Asian culture, broadening perspectives on diverse populations and highlighting insights into culturally tailored services.
This study offers clinicians and communities insights into the mental health help-seeking process among East Asian American dementia caregivers and highlights strategies to encourage their use of mental health services.
This theory incorporates aspects of East Asian culture, addressing a research gap in studies of Asian Americans. It may enhance understanding of culturally tailored approaches and facilitate future funding for research and services, considering cultural diversity.
The Standards for Reporting Qualitative Research.
No Patient or Public Contribution.
To investigate the impact of parenting stress in both fathers and mothers on the quality of life (QoL) of children with down syndrome (DS) and the mediating effect of family adaptation.
This cross-sectional study was conducted between April 2023 and August 2023.
A total of 106 father–mother dyads of children with DS aged 2–12 years in South Korea were included. The parents independently completed questionnaires assessing parenting stress, family adaptation, and their children's QoL. The Actor–Partner Interdependence Mediation Model was used for the dyadic analysis.
The direct effect of parenting stress on children's QoL was not significant; however, the indirect effect of family adaptation was significant. Fathers' parenting stress indirectly influenced their children's QoL through their own and their mothers' family adaptations. Conversely, mothers' parenting stress indirectly influenced their children's QoL through their own family adaptation, although the mediating effect of fathers was not statistically significant.
Higher family adaptation in both fathers and mothers was associated with an improved QoL in children with DS. The pathways through which parents influenced their children's QoL differed but were interdependent. Therefore, dyadic interventions aimed at improving family adaptation in both fathers and mothers may help improve the QoL of children with DS.
This is the first study to examine parental influence on children's QoL based on dyadic interactions among fathers, mothers, and children with DS. This study highlights the importance of assessing and promoting fathers' and mothers' levels of family adaptation to improve the QoL of children with DS. Nurses should consider effective dyadic interventions for families that include both parents to maximise improvements in the QoL of children with DS.
No patient or public contributions.
This study adhered to the STROBE guidelines for cross-sectional studies.
To explore the impact of international visiting scholars programmes on the academic and professional development of nursing PhD students and to inform future doctoral curriculum design.
Integrative review.
A systematic search was conducted across six databases (Embase, Medline, CINAHL, ERIC, Scopus and Web of Science) in December 2024, with no restrictions on publication year. After removing duplicates, 1300 records were screened by title, abstract and full text. Studies were included if they focused on nursing PhD students participating in international visiting programmes and addressed academic or professional development. Five studies met the inclusion criteria. Data were synthesised using a thematic analysis approach.
Four themes were identified: (1) advancing academic excellence through enhanced research skills and critical thinking; (2) cultivating cross-cultural learning by fostering cultural sensitivity and adaptability; (3) fostering global networks that promote sustained international collaboration; and (4) shaping doctoral education by encouraging structured and sustainable international experiences. These findings suggest that international visiting scholars programmes contribute meaningfully to the academic, cultural and professional growth of nursing PhD students.
International visiting scholars programmes provide a unique platform for doctoral nursing students to strengthen their academic foundations and expand their global outlook. Integrating such experiences into doctoral curricula can better prepare future nursing leaders for international health challenges.
This review addresses a gap in the literature by focusing on the doctoral-level outcomes of international visiting scholars programmes in nursing. The findings offer guidance for educators and policymakers to design curricula that integrate global engagement, build institutional support for mobility programmes and promote equitable access to international academic opportunities in nursing education.
The review adhered to the EQUATOR and PRISMA guidelines for systematic reviews.
No patient or public contribution.
This study aimed to conceptualise ‘function-focused care efficacy’ for direct care workers in long-term care facilities by identifying the domains and attributes of this concept using a hybrid model.
A hybrid model concept analysis was employed in three stages: theoretical, fieldwork and final analysis.
Data were collected in South Korea from December 9 to December 20, 2024, through literature reviews and interviews with long-term care professionals and gerontological experts. The study comprised in-depth interviews with five participants from long-term care facilities. Data were analysed utilising content analysis.
The final conceptualisation identified six domains and 13 attributes across three dimensions: plan, action and evaluation. The plan dimension encompassed personalised care (identifying residual function and designing tailored care plans) and collaborative care (communication among staff, multi-team approach and cooperation with family). The action dimension covered daily care (supporting daily activities and integrated care), motivational care (encouraging and praising) and ethical care (positive attitude and respect). The evaluation dimension focused on function evaluation (observing and documenting functional changes).
This study conceptualises function-focused care efficacy as the belief that direct care workers can effectively plan personalised and collaborative care, motivate older adults to maintain independence, provide integrated care in daily activities, deliver ethical care with respect and positive attitudes and assess functional changes. These findings can inform a measurement instrument and training programmes to enhance care workers' efficacy in function-focused care.
Enhancing function-focused care efficacy can potentially improve the quality of care provided to older adults, promoting their independence and well-being.
The study aimed to conceptualise function-focused care efficacy among LTCF direct care workers. It identified six domains and 13 attributes across planning, action and evaluation dimensions. This framework can guide the development of efficacy measurement tools.
N/A.
No patient or public contribution.
This study aimed to investigate factors influencing the acceptance of smartphone applications among high-risk pregnant women in the Lao People's Democratic Republic to support continuous care.
An explanatory sequential mixed-methods design.
The quantitative phase included 167 high-risk pregnant women recruited from four tertiary hospitals in Vientiane, Lao PDR. Validated questionnaires were used to measure demographics, digital technology usage, eHealth literacy and anxiety. Data were analysed using descriptive statistics and multiple regression analysis. In the qualitative phase, in-depth interviews with 20 women were conducted to further explore experiences, perceptions and barriers related to smartphone application usage. Interviews were analysed via direct content analysis.
Quantitative findings indicated that smartphone application acceptance was significantly predicted by eHealth literacy (B = 1.53, 95% CI 1.22–1.84, p < 0.001) and pre-existing non-communicable diseases (B = 4.39, 95% CI 1.05–7.73, p = 0.010). Anxiety negatively impacted acceptance (B = −0.28, 95% CI −0.51 to −0.05, p = 0.019). The model explained 53.9% of the variance in smartphone application acceptance (R 2 = 0.539). Qualitative findings highlighted four key themes: awareness of pregnancy risks, unclear health information, perceived benefits of smartphone applications including accessibility and emotional reassurance and practical barriers such as internet costs and limited digital literacy.
Positive perceptions of smartphone applications regarding accessibility and reassurance were observed, alongside significant barriers, such as limited digital literacy and internet costs. Addressing these factors may enhance the adoption and effective utilisation of digital health technologies among high-risk pregnant populations.
No patient or public contribution.
To systematically synthesise nurses' perspectives on dignified death, providing a culturally informed and comprehensive understanding.
Meta-ethnography.
This study was conducted using Noblit and Hare's approach, which included reciprocal translation, refutational synthesis, and line-of-argument synthesis. Methodological rigour and credibility were evaluated using the Critical Appraisal Skills Program (CASP) checklist. The review included peer-reviewed qualitative studies published in English or Korean that focused on nurses' or nursing students' views on dignified death in end-of-life care.
A systematic search was conducted in MEDLINE, EMBASE, CINAHL, and the Web of Science in August 2023, with an updated search in August 2024. Seventeen qualitative studies published between 2010 and 2024 met the inclusion criteria.
Four interconnected themes emerged: A death that embraces humanity, a death that preserves personal identity, a death that facilitates connection and reconciliation, and a death that affirms acceptance and spiritual serenity. These themes, including eight sub-themes, highlight cultural influences shaping nurses' approaches to dignified death.
The findings emphasise the influence of cultural context in shaping end-of-life care and support the development of culturally sensitive nursing education and guidelines to enhance care quality.
This research provides culturally grounded strategies to improve end-of-life care and strengthen nurses' competencies in delivering holistic support.
This study highlights cultural variations in nurses' approaches to balancing autonomy, family expectations, and spiritual needs, offering practical insights for holistic, patient-centred, and culturally sensitive care.
This review complies with the Equator and improving reporting of meta-ethnography (eMERGe) guidelines.
No patient or public contribution.
This study aimed to address two objectives: (1) To analyse the meal support behaviours of direct care workers in long-term care facilities in South Korea and (2) to explore associations between mealtime support behaviours and caregiver characteristics.
Secondary analysis of behavioural coding of cross-sectional video recordings.
Positive and negative staff behaviours at mealtimes were coded using the Mealtime Engagement Scale and Cue Utilization and Engagement in Dementia tool, respectively. Statistical analyses, including t-tests and analysis of variance, were used to examine differences in mealtime support behaviours based on caregiver characteristics.
The average mealtime duration of residents was 19.03 ± 5.30 min. Positive meal support behaviours accounted for 91.1% of the observed interactions, whereas negative interactions accounted for 8.9%. The most frequent positive behaviour observed was ‘providing one-on-one assistance’, whereas the most frequent negative behaviour was ‘leaving the resident alone’. Positive meal support behaviours were observed at significant higher frequencies among caregivers working during day shifts than those working during rotating shifts. Additionally, positive behaviours were associated with a higher carer-resident ratio.
Positive mealtime support behaviours were frequently observed but were concentrated in a few specific actions. Negative behaviours, such as leaving the resident alone, were still observed in a considerable portion of mealtime interactions. Training programmes focusing on diverse positive mealtime support behaviours should be developed to improve the quality of dementia care in long-term care facilities.
The findings emphasise the need for targeted training programmes to improve mealtime support and overall care quality in long-term care facilities. This approach signals a transformative shift in caregiver training, fostering more personalised and effective care for older adults with dementia.
This study quantified positive and negative mealtime support behaviours. These findings contribute to understanding caregiver behaviours during mealtimes in dementia care, offering evidence-based insights for developing targeted training programmes and improving quality of care in long-term care facilities.
We adhered to the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines.
No patient or public contribution.
To explore how adults with congenital heart disease (ACHD) experience and express grit in the workplace.
Qualitative study using Husserl's descriptive phenomenology.
Between March 2022 and June 2023, semi-structured interviews were administered to 18 ACHD recruited from two medical centre outpatient departments. The collected data underwent analysis utilising Colaizzi's 7-step analysis method, coupled with Lincoln and Guba's framework, to ensure credibility and trustworthiness.
The analysis revealed five prominent themes derived from the data: (a) career choices amid constraints; (b) adjustments to one's work environment for reasons of fatigue; (c) crises in the workplace arising from exceeding one's physical limits; (d) supportive networks for better health and job stability; (e) resilience at work for balance and fulfilment in life.
Grit significantly influences life satisfaction and job performance among adults with congenital heart disease, highlighting its profound impact on their experiences. Patients exhibit perseverance in job pursuits, adapt work methods to manage physical fatigue, confront challenges during work crises, value family and societal support and aim for self-satisfaction. These findings highlight the impact of grit and mental health on ACHD's lives and work, providing insights for better psychological support and interventions.
This study clarifies the need for healthcare professionals to incorporate workplace grit training and assessment into ACHD care.
Recognising grit as a key factor in ACHD patients' lives informs holistic care, workplace inclusivity and policies that enhance their long-term well-being.
This study was performed in accordance with the COREQ guidelines.
No patient or public involvement.
Socially assistive robots (SARs) have been used in group interventions for older adults; however, their effectiveness remains unclear. This systematic review aimed to synthesize evidence on the efficacy of group interventions with SARs on various outcomes (physical, cognitive, psychological, quality of life, therapeutic engagement, and sociality) for older adults, and the factors that influence their effectiveness.
A literature search was conducted using five databases (Web of Science, PubMed, Scopus, PsycINFO, and MEDLINE) in October 2024. The research team selected and analyzed the studies applying a narrative synthesis.
In all, 25 articles were identified, 15 of which were deemed of good quality. We found that companion robots are commonly used in group interventions for older adults that consist of physical, cognitive, and combined physical and cognitive activities. Insufficient evidence was identified on the effectiveness of physical interventions and groups with physical and cognitive activities on health outcomes (i.e., physical, cognitive, psychological, and quality of life). Regarding the cognitive group interventions, positive physical outcomes (i.e., improved sleep quality, decreased pulse rate, and increased pulse oximetry), improved cognitive function, positive psychological outcomes (i.e., decreased agitation, depression, anxiety, and loneliness, and increased positive emotions) were found; however, the positive effects in terms of cognitive level and certain psychological outcomes were comparable to the control groups. Mixed results were reported for quality of life in older adults. Across the three types of interventions, robots facilitated engagement and increased the sociality of most older adults. The effectiveness depended on the cognitive function of the older adults, the presence of staff, the type of robot, and the schedule of the interventions.
Research gaps have been identified, and more rigorous studies investigating the effectiveness of different types of group interventions in older adults are needed before applying SARs in group interventions on a large scale.
Given the importance of group interventions in nursing care of older adults, healthcare professionals can use socially assistive robots in such interventions to assist in caring for older adults.
Delirium is a frequent, yet often underdiagnosed, condition in intensive care units (ICUs), especially in postoperative patients. It has three subtypes: hyperactive, hypoactive and mixed, each with distinct clinical manifestations and outcomes. A deeper understanding of each subtype's prevalence and risk factors is essential for improving ICU patient care. This study aims to figure out the prevalence of each type of delirium and risk factors associated with each subtype of delirium.
This retrospective study included 4234 postoperative patients admitted to the surgical ICU between January 2017 and June 2019. Delirium was diagnosed using the Confusion Assessment Method for the ICU, and subtypes were determined using the RASS score. Multivariate logistic regression analysis was used to identify the risk factors associated with each delirium subtype. This study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist.
The prevalence of delirium was 8.7%, with mixed delirium being the most common subtype (47.7%), followed by hypoactive delirium (40.3%) and hyperactive delirium (12.0%). Each subtype was linked to different risk factors: hypoactive delirium was correlated with shorter ICU stays and pH and O2 imbalances, hyperactive delirium was associated with physical restraints and mixed delirium was linked to sedative medication and restraint use.
Among postoperative ICU patients, mixed delirium was the most prevalent subtype, followed by the hypoactive and hyperactive forms. Identifying the unique risk factors for each subtype highlights the need for targeted prevention and management approaches in ICU. Further research is warranted to investigate the underlying mechanisms and to develop effective interventions tailored to each delirium subtype.
This study is distinct from previous research in that it comparatively analysed the risk factors for delirium according to subtype. By distinguishing between the subtypes of delirium and identifying their incidence and risk factors, it is possible to enhance the overall understanding of delirium, particularly given that some of the known risk factors are more strongly associated with certain types of delirium. Identifying risk factors according to the type of delirium can facilitate the planning of proactive interventions based on risk factors. Furthermore, it can serve as a valuable resource for the development of tools for predicting different types of delirium to provide more tailored and evidence-based care for patients with delirium.
No patient or public contribution.
The interaction between dementia and changes in health status accelerates the progression of dementia and health deterioration. Although health indicators exist for older adults, comprehensive ones for dementia are lacking.
To (1) establish core health indicators for older adults with dementia, (2) develop an integrated health assessment toolkit for older adults with dementia, and (3) test the feasibility and applicability of the integrated health assessment toolkit.
This study involved two phases. In the first phase, using the Delphi method, opinions from 10 experts were synthesized to establish core health indicators for older adults with dementia. In the second phase, with a descriptive research approach, an integrated health assessment toolkit was developed, evaluated by 10 daycare case managers for feasibility, and then pilot tested with 50 older adults with dementia across three daycare centers.
The core health indicators for older adults with dementia covered 18 indicators in five domains: (1) cognitive and behavioral impairment, (2) sensory and perceptual impairment, (3) disease and dysfunction, (4) functional fitness deterioration, and (5) social isolation. After two rounds of assessments, experts rated the criteria's importance and clarity at 0.94 and 0.89 on the scale-level content validity index/universal agreement (S-CVI/UA), respectively. In the second phase, the integrated health assessment toolkit was developed, which integrated five observational assessment scales and six physical function measures. The average applicability scores ranged from 7.80 to 9.90 out of 10. In the pilot test, the assessment process proceeded smoothly without any adverse events. However, 10 participants did not comply with wearing the actigraphy device.
The core health indicators and the corresponding health assessment toolkit are feasible to assess the health of older adults with dementia that could provide valuable insights and guide future interventions to enhance their well-being.
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