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This study was an investigation of the key factors influencing nurse retention and attrition focusing on the perspectives of current and former nurses within the context of the ongoing nursing shortage exacerbated by the COVID-19 pandemic.
This descriptive, cross-sectional study was designed to explore the complex dynamics of nurse retention and attrition in a rural and northern academic hospital in northwestern Ontario.
An online survey was administered to current and former nurses to compare the perspectives of those with no intention of leaving the organisation, those contemplating departure within the next year, and those who had reduced their work hours in the past 5 years.
Of the 288 respondents, 47% indicated no intention to leave and 17% reported having already left the organisation. The primary reasons for attrition included excessive workload demands, challenges maintaining a healthy work-life balance and dissatisfaction with management practices and organisational support. Respondents recommended improving leadership effectiveness, increasing staffing levels and implementing retention-focused initiatives to enhance job satisfaction and reduce turnover.
This study underscored the urgent need for strategic interventions tailored to retain nursing staff, particularly in rural and northern communities already facing significant recruitment and retention challenges. By addressing workload pressures, enhancing work-life balance, strengthening leadership and offering retention initiatives, health care organisations can improve job satisfaction and reduce attrition. System-level changes are essential to creating a sustainable and supportive environment for nursing professionals.
The findings highlight the critical need for immediate action to address the nursing crisis in rural and northern health care settings. They emphasise the importance of systemic interventions aimed at improving staffing levels, leadership practices and overall work conditions to safeguard the future of nursing in these underserved regions.
No patient or public contribution.
This research will contribute to the extant literature on the retention and attrition levels of nursing by offering a unique perspective from a rural and northern academ. The findings may help to guide hospital administrators to develop targeted strategies to enhance nurse retention rates within their organisations. By prioritising nurse satisfaction, these efforts will foster positive nurse–patient interactions and improve overall care outcomes.
This study is reported according to STROBE guidelines.
Predicting medical/surgical nurses' delivery of patient pressure injury prevention education within 24 h of hospitalisation.
A cross-sectional sub-study drawn from a larger multisite randomised controlled trial.
A consecutive sub-sample of 300 randomly assigned control group participants was recruited from 20 medical and surgical wards at two major hospitals (July 2020 to August 2023) in Queensland, Australia. Semi-structured observations and chart audit data were collected, including patient education, demographic and clinical data. Binary logistic regression identified hospital site, clinical and patient predictors contributing to pressure injury prevention education delivery by nurses.
Seventeen (5.7%) participants received pressure injury prevention education within the first 24 h of admission. Body mass index was an independent predictor, increasing the odds of nurses delivering patient education.
Few episodes of pressure injury prevention education were observed in this study. As a patient's body mass index rises, they are more likely to receive preventative education from nurses soon after admission.
Our findings underscore the need for standardised inclusive protocols and ongoing nurse training to assess and address education needs beyond single risk factors like body mass index. Further research should explore other factors influencing patient education delivery in hospitals.
This study adhered to STROBE guidelines. Dr. Brett Dyer, statistician, is part of the author team.
No patient or public contribution.
Many frontline essential working mothers returned to work outside of the home after maternity leave during the COVID-19 pandemic. The purpose of this study is to describe the changes in breastfeeding relationships.
A longitudinal descriptive qualitative design was used.
Four open-ended questions were asked to explore breastfeeding experiences at home, mothers' thoughts and feelings during direct breastfeeding, strategies to solve their breastfeeding problems, and workplace breastfeeding support. Data were collected by an online survey at 1, 3, 5 and 6 months between June 2022 and August 2023. Data were analysed using inductive content analysis from 21 mothers in the United States who were directly breastfeeding at least once a day for the first 6 months. The trustworthiness of study results involved coding by consensus, peer debriefing, and maintenance of an audit trial.
The core construct, “Changes in Breastfeeding Relationships When Frontline Essential Working Mothers Return to Work Outside of the Home” explained mothers' experience in four domains: (1) Breastfeeding changes, (2) Changes in sleep arrangements, (3) Social support to continue breastfeeding, and (4) Physical and emotional distress of mothers and infants.
Unrestricted direct breastfeeding upon reunion through the night along with co-sleeping was the strategy mothers used to restore breastfeeding relationships with their infants and continue direct breastfeeding. Scheduled feeding and solitary sleep resulted in less direct breastfeeding, had negative consequences such as low milk supply, slow infant weight gain, and maternal distress.
Even though frontline essential working mothers persevered with the complexities of their work during the COVID-19 pandemic, findings highlight challenges mothers faced with their breastfeeding experience. Nurses need to discuss with mothers expected challenges of less frequent direct breastfeeding along with emotional tolls while being separated from their infant and strategies to develop sustainable breastfeeding relationships and continuation of direct breastfeeding.
None.
The aim of this study was to understand the needs of children and young people of a parent with young-onset dementia, to inform the development of a nursing model.
Children and young people of a parent diagnosed with young onset dementia have a range of needs that are subject to change and aligned to their stage of development and growth.
Systematic review.
Searches were conducted in PsycInfo (1806–Jan 2025), Medline (1996–Jan 2025) and CINAHL (1961–Jan 2025); search terms were developed in consultation with an academic librarian.
The Preferred Reporting Items for Systematic reviews and Meta-Analyses was used to assess the trustworthiness and applicability of the findings and the Mixed Methods Assessment Tool to assess quality. The review protocol was registered on PROSPERO (CRD42024534104). Needs identified from the literature were matched with the activities and interventions of a specialist nursing model.
Searches yielded 223 records of which 17 met the inclusion/exclusion criteria, the majority of which used qualitative methods (N = 16). A thematic synthesis approach was used to analyse data to reveal four emergent themes: (1) finding a way, (2) social connection and peer support, (3) preserving childhood and adolescence and (4) practical support, including the needs relating to education. Identified needs: knowledge and information, emotional support, consistency in education and development, maintaining social connections, physical and psychological well-being, and grief and loss were mapped against a specialist nurse role.
Children and young people with a parent diagnosed with young-onset dementia face unique challenges compared to older carers. Despite growing awareness of their needs, this population is often overlooked in national dementia strategies. Developing a specialist nurse role is a positive step, but broader systemic support is essential to safeguard their well-being and future opportunities.
This study adheres to the PRISMA reporting guidelines.
A bespoke Research Advisory Group, consisting of people with young onset dementia, young family carers, clinicians and academics, guided the review.
Research priorities guide research activities, funding and resources within health services. To ensure that research efforts are meaningful and impactful, it is vital that organisational research agendas reflect the priorities of both healthcare consumers and staff, alongside broader national and international research frameworks. This paper outlines a research priority-setting project conducted across two hospitals in Western Australia, aimed at identifying shared research priorities through a collaborative and inclusive approach.
To identify the top ten nursing and allied health research priorities for two hospitals in Western Australia.
A modified James Lind Alliance Priority Setting Partnership approach was used, involving health services users, nurses, allied health professionals, and community members in a co-design approach across three phases. In phase 1, four community conversations were conducted to elicit an initial set of research topics. This data-informed phase 2, a survey to collect diverse views from a wider participant pool. In phase 3, a pre-selected sample of potential research priorities was discussed in a consensus workshop to reach a group consensus of the top ten research priorities. Qualitative data was analysed using multi-step thematic analysis, and quantitative data was analysed using descriptive statistics.
A total of 67, 151 and 18 people participated across study phases 1, 2 and 3, respectively, comprising nurses, allied health professionals, healthcare users, carers, and interested community members. The top ten research priorities reflected three areas: healthcare systems re/design (streamlining care; access to healthcare; patient journey and quality of care), workforce needs (workforce well-being, retention and adequate staffing; workforce training), and specific health issues and needs (dementia and delirium; mental health; caring for carers; Aboriginal and Torres Strait Islander health; palliative care and elderly people).
The research priorities identified in this study for two hospitals in Western Australia reflect the strong desire of nurses, allied health professionals, healthcare users and community members to improve structural issues in healthcare systems. This includes how healthcare systems are designed and integrated with each other, how workforce needs affect service delivery, and a greater focus on holistic service provision for specific health issues and needs.
Healthcare consumers were an integral part of this study. Healthcare consumers were involved in the design of the study, the conduct of the study, and the review of the data analysis.
To develop a structured intervention aimed at enhancing family communication to reduce relapse in adolescents with depression.
This study follows a multi-stage process guided by the Intervention Mapping procedure with the Medical Research Council framework, assessing the layers of complexity. Its design comprises four interrelated stages to construct a family communication intervention, culminating in a pilot randomised controlled trial.
The program has four stages: (1) Identifying family interaction gaps through literature review and expert input; (2) Investigating communication needs of depressed adolescents and their families via a mixed methods study to develop a model intervention; (3) Refining the intervention with focus groups and expert e-Delphi; and (4) Finalising the intervention based on pilot randomised controlled trial outcomes. The research will be conducted in Greater Accra, Ghana.
The process will result in a family communication intervention tailored to the needs of adolescents with depression and their families. It will be pilot tested, and the results will inform a nationwide efficacy trial.
This research integrates qualitative and quantitative data to inform the development of an evidence-based family communication intervention. The program will carefully examine data integration and contextual challenges encountered during its implementation.
The intervention has the potential to enhance family communication, thus playing a crucial role in adolescent depression recovery by reducing relapse rates. Healthcare professionals will benefit from a structured, evidence-based communication tool that can be used in clinical settings.
The study focuses on improving communication between families of adolescents with depression, aiming to develop a family communication package for clinical and community use. This intervention may enhance recovery outcomes and reduce relapse risk for adolescents.
This study adhered to the GUIDED guideline for reporting intervention development studies.
No Patient or Public Contribution.
To co-design an information booklet to support adults living with a peripherally inserted central catheter (PICC) at home.
A sequential, mixed-method approach using Boyd's co-design framework.
A diverse project team led co-design of a PICC booklet based on preferences and PICC management strategies identified through content analysis of interviews with 15 Australian health consumers (January 2022–March 2023) using a qualitative descriptive approach. A draft booklet was developed, reviewed by the team and prototyped, which was evaluated by consumer participants and an external nurse panel, with readability assessed using Flesch Reading Ease and Flesch–Kincaid scores. The project team reviewed feedback, reached consensus on changes and collaborated with designers to produce the final booklet.
Consumer participant strategies were classified into four categories: enhancing coping, taking responsibility and understanding information, modifying life and accessing supports. Two pre-determined categories were included (participant recommendations for PICC education resource content and top tips for living with a PICC). The prototype was evaluated as highly relevant (3.9/4), comprehensive (3.8/4) with an appropriate writing style and visual appeal. Readability scores were 76.1/100 (Flesch Reading Ease) and 6.9 (Flesch–Kincaid grade level). The final booklet contained 13 sections.
A co-design approach successfully created a novel PICC information booklet with positive evaluations.
Provides understanding of consumer information preferences to inform PICC education and offers insight into consumer-developed strategies and knowledge for living with a PICC.
A co-designed PICC information booklet based on consumer knowledge may augment nursing education for people living with a PICC to improve outcomes.
The qualitative component follows the EQUATOR network COREQ guideline. A co-design research reporting standard is not available.
A consumer representative was a member of the project team and contributed to study design, interpretation of findings and development of the booklet and manuscript.
To explore the illness coping experiences of patients with moderate-to-severe burns and provide a reference for healthcare professionals to formulate coping strategies.
Qualitative study using a descriptive phenomenological approach.
From 1 June to 30 September 2024, semi-structured interviews were conducted with 19 patients with moderate-to-severe burns. Colaizzi's seven-step method was used for data analysis.
Seven subthemes and three higher order themes were identified: (1) perception of illness experience; (2) coping with disease threats; and (3) benefits of coping with illness. Most of the participants faced multiple difficulties in their disease experiences, such as increased financial pressure, higher pressure on family caregiving, deformed physical conditions and negative emotions. Positive psychological qualities, family and social support played significant roles in coping with these challenges.
Patients with moderate-to-severe burns experience multiple difficulties during their recovery. Effective coping resources can help them overcome these challenges.
Healthcare professionals should work with patients with moderate-to-severe burns and their families to establish an effective support system that enhances patients' coping abilities and promotes their overall recovery.
Patients with moderate-to-severe burns face diverse challenges. However, their experiences and coping processes during recovery remain unclear. This study provided valuable insights into their illness experiences and coping strategies. The findings highlighted multiple difficulties, such as a significant increase in financial pressure and dependence on family caregiving, painful and deforming physical conditions and various negative emotions. Positive psychological qualities, family and social support play an important role in coping with these challenges. Healthcare professionals should work with patients and their families to establish effective support systems to promote overall recovery.
No patient or public involvement.
To determine the application rate of the preventive measures, alternate air anti-decubitus mattress and postural changes in patients who develop hospital-acquired pressure injury (HAPI) on the basis of their preventive or reactive temporality.
This is an ambispective observational study that included adult patients without pressure injuries admitted to Mancha Centro Hospital (Spain) who developed at least one HAPI during hospitalisation (August 2022 to March 2023).
The main variables were the implementation of preventive measures and the time of their application. Other variables were comorbidities, sociodemographic and clinical variables, Braden and Barthel scale, variables related to the application of preventive measures and information to characterise HAPI.
180 patients who developed 276 HAPI during their admission were included; 73.9% of the patients received a risk assessment upon admission, and 53.9% were re-evaluated. At some point during admission, an anti-decubitus mattress was placed in 73.3% of the patients, and 76.1% received postural changes.
Among the patients at risk at the time of HAPI onset, 49.4% had received anti-decubitus mattress preventively, 23.9% had received it reactively, and 26.7% did not receive it. Among the patients without contraindication for postural changes, 51.4% received them before the lesions appeared, 33.6% received them after the lesions appeared, and 13.6% did not receive them.
We detected a significant association between the preventive application of anti-decubitus mattress and postural changes with the Braden reassessment; admission to the intensive care unit; mechanical ventilation, vasopressors, nasogastric tube; mental state confused; hospital isolation; low Barthel and Braden scores; impaired mobility; inability to perform postural changes; diaper; urinary/faecal incontinence; and sedatives.
Only approximately half of the patients received preventive measures. Although patients with a more unfavourable clinical profile were more likely to receive these measures, increased awareness and training among healthcare professionals are necessary to ensure broader and more consistent implementation of preventive strategies.
This study explores the real-world use of preventive measures in hospitalized patients who develop HAPI. In half of the patients, these measures were applied reactively, highlighting the need to introduce strategies that facilitate the implementation of evidence-based practices.
This study was reported following the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist for cross-sectional studies.
In the present study, data from patients have been obtained, but the patients or caregivers have not contributed to the development of the manuscript.
To design and develop a novel co-produced intervention tool aimed at facilitating discussions that lung cancer nurses have with lung cancer patients about clinical trial opportunities; and promote trial recruitment.
A multi-phase qualitative focus group (phase 1) and co-production (phase 2) study.
The rigorous design and content of the intervention tool was informed by qualitative data from seven focus groups with lung cancer healthcare professionals (n = 38) and patients and their carers (n = 22) to establish barriers and facilitators to clinical trial participation. Data collection took place across England and Scotland between October and December 2023. Findings from a previously published systematic review were also incorporated to inform intervention tool design. The tool was developed through an extended co-production workshop comprising lung cancer nurses (n = 7), lung cancer patients (n = 2) and health researchers (n = 4). The COM-B model of behavioural change underpinned both phases of the project to guide tool development.
Phase 1 focus groups identified the need for a tool to provide basic trial information to patients, and to support lung cancer nurses in discussing trials with patients, thus improving nurses' knowledge, confidence, and awareness of trials. The phase 2 coproduction workshop identified that the tool should consist of two elements: a patient-facing information pamphlet and a large poster for nurses to assist them in discussing trial opportunities.
The study results demonstrate how nurses can be supported to discuss clinical trial opportunities with patients, with the potential to increase long-term recruitment to clinical trials.
Lung cancer nurses often lack confidence to support patients to make informed choices about trial enrolment. By addressing this issue, participation in lung cancer clinical trials can be significantly improved to benefit patient outcomes and trial participation rates.
The tool has the potential to be used across a range of different cancer settings and sites to increase recruitment to clinical trials.
The COREQ checklist was utilised to ensure that robust processes were followed and reported on.
Patients and members of the public were involved in all study processes and contributed to the study design, interpretation of the data, and intervention design. Their contributions included reviewing focus group topic guides, reviewing data analysis, the co-production of the intervention tool, and co-authoring this paper, ensuring the research addressed the needs and priorities of lung cancer patients when making an informed choice about clinical trial participation.
The aim of this study was to explore the digital health technology readiness of nurses, nursing students, nurse-academics, and nurses in leadership roles. Workforce digital readiness impacts the adoption of digital health technologies and quality and safety outcomes. This study sought to identify key factors affecting nurses' readiness for specific digital health technologies and provide recommendations to accelerate readiness levels in alignment with rapidly advancing digital health technologies.
Cross-sectional multi-method study.
An online survey was followed by semi-structured interviews. Survey data (N = 160) were analysed using descriptive and inferential statistics, whereas qualitative responses (N = 8 interviews, 43 open-ended responses) were thematically analysed.
Participants were confident regarding openness to innovation, reporting highest confidence Levels around telehealth, wearable devices, and information technology. The lowest confidence scores were seen in health smart homes technology, followed by health applications, social media, patient online resources, and EHRs. Four themes were developed from the qualitative interviews including ‘opportunities for efficient ways of working’, ‘digital technology turning experts into novices’, ‘disillusionment between expectation and reality’ and ‘shared responsibility for development of digital expertise’. Open-ended data was focused on the need for comprehensive education, ongoing support, and infrastructure improvements to prepare healthcare professionals for digital health environments.
Notable findings include age-related differences, the need for shared responsibility in workforce preparation, and a link between problem-solving ability and help-seeking.
Low confidence among nurses around the use of digital health technologies such as electronic health records, in-home monitoring technology, and other wearable technologies could impact adoption readiness. Because patient safety is increasingly and inextricably linked to digital health technologies, nurses must not only be digital health literate but also included in the design and implementation process of these technologies.
This study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines for the reporting of cross-sectional survey research, and the Consolidated Criteria for Reporting Qualitative (COREQ) research guidelines.
Limited patient and public involvement was incorporated, focusing on feedback from digital health researchers and practitioner-academics during the academic peer review process. Their insights informed the clarity and relevance of the survey design and data interpretation, ensuring alignment with real-world workforce development priorities in nursing.
To identify and synthesise the ethical, feasibility and acceptability challenges associated with implementing eye-tracking research with clinicians in acute care settings and to explore strategies to address these concerns.
Scoping review using the Joanna Briggs Institute methodology.
Six databases (MEDLINE, CINAHL, EMBASE, Web of Science, APA PsycInfo and ProQuest Dissertations & Theses Global) were searched for peer-reviewed articles. Reference lists of included studies were also hand-searched.
Eligible studies involved clinicians using or interacting with eye-tracking devices in acute care environments and addressed at least one ethical, feasibility, or acceptability consideration. Data were extracted and thematically analysed. Knowledge users, including clinicians, ethicists and a patient partner, were engaged during protocol development and findings synthesis.
Twenty-five studies published from 2010 to 2024 were included. Seven challenges were identified: obtaining ethical approval, managing consent, privacy and confidentiality concerns, collecting data in unpredictable environments, interference with care, participant comfort and data loss or unreliability. Knowledge users highlighted the importance of early institutional engagement, clear protocols, continuous consent and context-sensitive ethical reflection.
Eye-tracking offers valuable insights into clinician behaviour and cognition, but its implementation in acute care raises complex ethical and methodological issues. Responsible use requires anticipatory planning, stakeholder engagement and flexible yet rigorous protocols.
By informing the development of ethically sound study protocols and consent practices, this work contributes to safer, more transparent and patient-centred research that respects participant autonomy and protects clinical workflows.
The protocol was registered with the Open Science Framework (https://osf.io/jn4yx).
Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA; Page et al., 2021) and its Extension for Scoping Reviews (Tricco et al., 2018).
A patient partner was involved in protocol development, interpretation of findings and development of study recommendations. Their contributions included participating in advisory groups and providing feedback alongside clinicians and ethicists during focus groups. This input helped ensure the research addressed patient-relevant priorities and informed the development of ethically responsible practices for conducting eye-tracking research in clinical care settings.
To explore nursing professionals' perceptions of the intersectional positioning of their profession within healthcare and society, examining how axes of oppression shape healthcare responses and resource management.
A qualitative study framed in critical theory paradigm employing constructivist grounded theory, as outlined by Charmaz.
The study was conducted in Catalonia, Spain, between 2022 and 2023. A total of 26 nursing professionals participated, representing a range of professional roles and settings. Theoretical sampling guided participant recruitment and was saturated after 17 in-depth interviews and 2 thematic focus groups. Interviews and focus groups were transcribed verbatim. Thematic analysis, informed by Charmaz's approach, was applied to identify key dimensions and themes. Intersectionality theory was used as a critical analysis framework.
A predominant theme emerged from data identified as ‘intersectional disempowerment of nursing profession’. Four categories shape this positioning: (1) symbolic and historical undervaluation of care, rooted in nursing's feminization and patriarchal norms; (2) patriarchal influence on professional leadership, manifested by men disproportionately occupy leadership roles, reinforcing vertical segregation; (3) intra-professional hierarchies and technocratic influence, forcing prestige disparities within nursing and promoting horizontal segregation; and (4) internalised barriers among nurses regarding professional prestige, authority and recognition which combined undermine nursing's visibility, legitimacy and influence within healthcare.
Nursing cannot be understood as a neutral profession. Its societal positioning is deeply shaped by structural inequities, gendered assumptions and entrenched hierarchies, which collectively undermine its potential for autonomy and recognition.
This study highlights the need to challenge intersectional hierarchies in nursing, promoting equitable recognition, policy reforms and leadership opportunities to enhance nurses' authority, visibility and professional empowerment within healthcare systems. Addressing these challenges requires systemic policy reforms and a critical re-evaluation of societal perceptions. What problem did the study address? Nursing's social image is strongly shaped by biomedical, technocratic and social views. The gap between nursing's public image and identity limits professional growth and recognition. Analysing how power relations intersect in nursing's social position is essential. What were the main findings? Nursing's role is shaped by the intersection of gender, prestige, socioeconomic status and social recognition. Nurses' empowerment must be tied to transforming unjust institutions and systemic structures. Where and on whom will the research have an impact? This study provides a critical analysis of the intersectional positioning of the nursing profession. The findings have implications at multiple levels: micro, by offering nurses a critical perspective on their professional positionality; meso, by providing healthcare managers with insights into the underlying factors contributing to nursing's undervaluation; and macro, by fostering reflection within the broader healthcare community on the power dynamics shaping interprofessional relationships.
This study did not include patient or public involvement in its design, conduct, or reporting.
The manuscript is based on the Consolidated Criteria for Reporting Qualitative Research (COREQ).
To discuss how shared decision-making (SDM) is currently practised in hospitals, to highlight the essential—yet often underacknowledged—contribution of nurses to inclusive SDM in life-prolonging treatment decisions, and to propose a five-step implementation plan to strengthen the role of patients in the SDM process.
A position paper on current SDM practices.
To take a position, we drew on knowledge gained from six empirical studies conducted by our research group and evaluated these findings in light of the most recent literature.
A five-step implementation plan to stimulate SDM: (1) Clarify roles, (2) Organisational alignment, (3) Comprehensive training, (4) Tailored implementation plans, and (5) Sustainable integration.
The plan is ambitious, yet it offers a clear and actionable path forward for healthcare organisations and professionals. It provides a concrete opportunity for collaboration to embed SDM in daily clinical practice. Ultimately, our shared objective is to achieve optimal patient outcomes—an aim that unites all stakeholders.
Integrating nurses into SDM processes will enhance the quality of support for treatment decision-making. However, to realise truly inclusive, high-quality, patient-centred care, coordinated action at multiple organisational levels is essential.
The proposed plan is not only relevant to treatment decisions at the end of life in hospital settings, but also presents broader opportunities to advance SDM across healthcare sectors. It offers nurses a clearly defined and meaningful role in SDM and provides a practical blueprint for implementation at all levels of the organisation—transforming long-standing ambitions into tangible practice.
To clarify the concept of disempowerment in adults with chronic illness.
The Walker and Avant approach to concept analysis was used.
A systematic literature search was performed on 14 February 2024, using the following databases: CINHAL, PubMed, PsycINFO, Sociological Abstracts and ProQuest Dissertations & Theses Global A&I: The Humanities and Social Sciences Collection. Studies examining adults' experience of individual disempowerment stemming from chronic illness were included. Definitions and descriptions of the concept in the included studies were extracted and synthesised into defining attributes, antecedents, and consequences.
Forty-five articles were included. Two defining attributes were identified: (1) diminishing opportunities to take control and (2) clients' dissatisfaction with diminishing control. Antecedents were changes in health status related to chronic illness and expectation mismatch within the client, or between clients and their care partners. The consequence of disempowerment was disengagement in the context of disempowerment.
Disempowerment was found as the state of dissatisfaction with diminishing opportunities to control personal lives, which stems from changes in health status and expectation mismatch and leads to disengagement in the context of disempowerment. Contrary to prior studies, where disempowerment was often considered an outcome of an imbalanced relationship between clients and care partners, the present findings showcased disempowerment as a holistic illness experience, involving changes in health status. The understanding of disempowerment as the dissatisfaction with the situation of diminishing opportunities to take control differentiates this concept from the opposite of empowerment, which is conceptualised as clients' ability to make decisions or manage diseases. Findings further highlight the importance of understanding clients' illness experience comprehensively and providing care in a manner that is matched with clients' abilities, expectations and needs. It is suggested that operationalising the concept based on this understanding is necessary in order to understand correlations between disempowerment, its causes and consequences.
Disempowerment has been applied to describe interruptions in their states of being, perceived role performances, and independence in adults with chronic illness from diverse perspectives in the extant literature, such as the opposite of empowerment, action to take away control over personal lives and a state of diminishing ability to tackle problems. Through clarifying the concept, this article will guide the communication, measurement tool development and response in clinical practice.
No patient or public contribution.
To investigate factors influencing the implementation of advanced practice nursing roles within healthcare organisations in seven European countries from the perspective of advanced practice nurses.
A cross-sectional survey was conducted between September 2021 and December 2022, involving advanced practice nurses from Belgium, Finland, Germany, Iceland, Ireland, Spain and the Netherlands. The countries were selected to represent different stages of implementing advanced practice nursing roles, from emerging to well-established.
A self-administered questionnaire was used to address five domains: patient care, practice patterns, policy and legal, educational and workforce-related factors. Descriptive statistics, chi-squared tests and correspondence analysis were employed to identify patterns and country-specific differences across these domains of implementation factors.
A total of 491 advanced practice nurses participated in the study. While almost three-quarters of the participants indicated satisfaction with their job, the study highlighted multifaceted factors influencing the implementation of advanced practice nursing roles across countries. The Netherlands, Ireland and Belgium reported mainly facilitators, whereas Finland, Iceland and Germany noted barriers or a lack of knowledge. Spain mostly reported neutral or moderate positions. Key challenges included role ambiguity, interprofessional collaboration gaps, limited managerial support, workload imbalances, limited mentorship and underutilised competencies. Results also indicated that advanced practice nurses are partially hindered by operating in isolation from other professions.
The findings emphasise the need for robust organisational support, interprofessional collaboration and clear role definitions to facilitate the integration of advanced practice nursing roles. Addressing professional isolation through networking and mentorship is crucial to sustaining the advanced practice nursing workforce.
Policy should prioritise support for advanced practice nursing, including structured mentoring and networking opportunities. Further research on advanced practice nurses' well-being and long-term role sustainability in Europe is recommended.
What problem did the study address? What were the main findings? Where and on whom will the research have an impact?
This study reported factors influencing advanced practice nurse role implementation across seven European countries with different levels of role development. Key challenges included role ambiguity, interprofessional collaboration gaps and limited support. The findings can guide healthcare managers and policymakers on the key factors to consider when integrating advanced practice nursing roles into their teams.
To analyse the impact of the COVID-19 pandemic on the sustainability of a breastfeeding (BF) clinical practice guideline (CPG) for women without COVID-19, throughout the 5 waves of the pandemic.
A mixed-methods design was utilised.
For the quantitative approach, an interrupted time series design was utilised, as well as the analysis of CPG sustainability reports as a qualitative approach. The study setting was in a health area in the Spanish health system from April 2019, until October 2021. The sample was composed of 2239 mother–infant dyads.
The exclusive-BF rate at hospital discharge obtained values between 90% and 94.8%, without statistically significant changes. A significant increase in the risk of not starting BF in the first feeding was observed (adjusted odds ratio = 9.36; 95% CI: 1.04–84.13), between the pre-pandemic period and the first wave. Skin-to-skin contact (SSC) decreased in the first wave to 82.20%, and the oscillations observed throughout the pandemic were not statistically significant. In general, the qualitative indicators were maintained. A decrease was observed in the spaces used for postpartum care due to the re-assigning to the intensive care unit. Also, the acquisition of materials and equipment decreased.
The measures implemented for the sustainability of the BF CPG during the 5 waves of the pandemic were positive. The programmes of implementation of BF guidelines were shown to resist the COVID-19 pandemic.
Our findings contribute to the understanding and evolution of the main indicators of the sustainability of a BF CPG on COVID-19 context, providing details on the magnitude of the effect and the process of change.
The Preferred Reporting Items for observational studies (STROBE) checklist was followed.
No Patient or Public Contribution.
To describe and compare the Evidence-Based HealthCare (EBHC) competence of Advanced Practice Nurses (APNs), and the factors associated with it in Finland and Singapore.
A descriptive and analytical cross-sectional study.
Data were collected from APNs working in healthcare in Finland (n = 157) or Singapore (n = 99) between May 2023 and October 2023 using a self-assessment instrument to measure EBHC competence (EBHC-Comp-APN) and an EBHC knowledge test. The data were analysed using descriptive statistics, analysis of variance, K-mean cluster and multivariate analyses.
The self-assessments of APNs working in Finland and Singapore regarding their EBHC competence level varied and three distinct profiles of APNs' EBHC competence were identified in both countries. The strongest EBHC competence was in ‘The Knowledge Needs Related to Global Health’, while the weakest in ‘Evidence Synthesis and Transfer’. The country-specific differences were identified in factors associated with EBHC competence.
The EBHC competencies of APNs vary widely and require planned and needs-driven development. In connection with the development of EBHC competence, the factors related to competence should be considered country-by-country.
The APN's EBHC competence should be systematically developed considering the factors associated with and the current level of EBHC competence.
The level of EBHC competence of APNs and associated factors should be identified when developing their competence and role in collaboration with APNs, leaders of healthcare and education organisations and policy makers. In addition, research into APNs' EBHC competence should continue.
The STROBE checklist was used in the reporting of the study.
No patient or public contribution.
The purpose of this integrative review was to identify effective diabetes self-management education and support for increasing adult primary care referrals, participation rates and improving health outcomes for persons with diabetes.
Integrative review.
A systematic literature search of PubMed/MEDLINE, Embase and CINAHL was performed by applying the PRISMA guidelines. Following Whittemore and Knafl's method, 11 papers were included for review.
Integration of diabetes self-management education and support in primary care clinics and a multifaceted approach resulted in improved referral and participation rates, ameliorated glycated haemoglobin A1C and boosted patient, provider and staff satisfaction.
Patient-centred multifaceted interventions can boost current diabetes self-management education referrals and participation rates and enhance health outcomes for persons with diabetes. Nurses in their role as primary care providers, diabetes educators and clinic staff are well-positioned to undertake this intervention. Further investigation is needed to explore the impact of these interventions among individuals with type 1 diabetes, gestational diabetes and those living across various global regions.
Along with other healthcare providers, nurses are qualified to advocate for, and lead programmes that increase referrals for persons with diabetes to improve health outcomes. Additionally, as primary care providers, nurse practitioners are well placed to positively impact the outcomes of individuals with diabetes by referring them to diabetes self-management education. Nurses, as diabetes educators, are well positioned to implement diabetes self-management education which can improve patient outcomes.
Improved referral of persons with diabetes to diabetes self-management education and increased participation have the propensity to contribute to the achievement of positive health outcomes for individuals living with Type 2 Diabetes.
There is no patient or public contribution for this review.
FreshRSS 