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Ayer — Diciembre 18th 2025 Journal of Advanced Nursing

How Government Policies and Organisational and Sectoral Circumstances Influence Nurse Practitioner and Physician Assistant Employment and Training: A Realist Analysis Using Surveys

ABSTRACT

Aims

To explain how government policies affected decision-making on Nurse Practitioner and Physician Assistant employment and training within Dutch healthcare organisations, and how organisational and sectoral circumstances were influential.

Design

An online, cross-sectional survey study.

Methods

A literature- and interview-based program theory was tested using surveys. Respondents from hospital care, (nursing) home care, primary care, and intellectual disability services were recruited using convenience sampling. Data analysis used descriptive statistics and inferential tests. Open-ended responses were analysed using thematic synthesis techniques. Survey results were clustered to assess verification, falsification, or refinement of program theory elements.

Results

A total of 568 experts in hiring and training healthcare professionals participated. Respondents indicated that most government policies promoted employment and training. Organisational and sectoral circumstances caused significant variations in Nurse Practitioner and Physician Assistant deployment across healthcare sectors, shaping how decision-makers interpreted and acted on government policies. Specific circumstances within primary care hampered deployment.

Conclusion

Government policies stimulated training and employment by: (1) removing practice restrictions (scope of practice expansion, legal acknowledgment), (2) facilitating cost-effective training and deployment (training grants, billing options), (3) providing sectoral knowledge on deployment, training, and healthcare outcomes (funding research and a sectoral knowledge center), and (4) establishing sectoral agreements (on apprenticeships). Organisational and sectoral circumstances significantly influenced outcomes. Key circumstances included flanking policies, stakeholder support, labor market capacity, healthcare demand, organisational resources and aims, and type of decision-makers (medical doctor or manager/director). Familiarity with the professions stimulated deployment.

Impact and Implications

The refined and verified program theory supports designing effective skill-mix policies and facilitating Nurse Practitioner and Physician Assistant employment and training. Tailoring skill-mix policies can optimise outcomes. This offers opportunities for governments, healthcare funders, organisations, and professionals to contribute to healthcare quality, cost efficiency, and patient satisfaction.

Patient or Public Contribution

Healthcare professionals were part of the study population.

The Key Role of Nurse–Patient Mutuality in Shaping Professional Quality of Life Among Nurses: A Bayesian Path Analysis

ABSTRACT

Aim

To examine the association between nurse–patient mutuality (i.e., a good quality of the relationship between the nurse and the patient) and nurse professional quality of life.

Design

A cross-sectional, multi-centre study was conducted across four tertiary hospitals in Italy.

Methods

Data collection took place from November 2023 to June 2024, enrolling 517 nurses. Both medical and surgical departments, as well as inpatients and outpatients departments were included. Data were collected on nurses caring for patients with chronic illness. Mutuality was measured with the Nurse–Patient Mutuality in Chronic Illness scale, which includes three dimensions: Developing and Going Beyond, Being a Point of Reference, Deciding and Sharing Care; Professional Quality of Life was measured with the Professional Quality of Life version 5, which includes three dimensions: Compassion Satisfaction, Secondary Traumatic Stress, Burnout. A Bayesian path analysis was employed to evaluate the contribution of mutuality dimensions to the dimensions of professional quality of life.

Results

Nurses' sample consisted of 517 participants. The three dimensions of mutuality showed different associations with the three dimensions of professional quality of life. Specifically, Being a Point of Reference, along with Deciding and Sharing Care, was significantly associated with Compassion Satisfaction. The dimensions Developing and Going Beyond and Deciding and Sharing Care were significantly and negatively associated with Secondary Traumatic Stress. Additionally, Deciding and Sharing Care was significantly and negatively associated with Burnout.

Conclusions

As all the dimensions of mutuality were significantly associated with different aspects of professional quality of life, future interventions to improve nurses' professional quality of life may also consider nurse–patient mutuality.

Implications for the Profession

Nurse–patient mutuality may be a novel area of research to enhance nurses' professional quality of life, with implications for clinical practice and organisational development.

Impact

Nurse–patient mutuality is a key indicator of a high-quality relationship, enabling shared goals and shared decision-making. Nurses' professional quality of life is one of the most important factors that influence their intention to leave. Little is known about the association between nurse–patient mutuality and nurses' professional quality of life. Mutuality influences nurses' and patients' outcomes. Understanding mutuality could enhance the professional quality of life for nurses, improving their compassion satisfaction and reducing their burnout.

Reporting Method

We adhered to STROBE guidelines.

Patient or Public Contribution

Patients were not included in the sample. Health workers were involved in the study.

Anteayer Journal of Advanced Nursing

A Descriptive Evaluation of Evidence‐Based Rounds in Critical Care Using Mixed Data Types

ABSTRACT

Objectives

To pilot and evaluate the implementation of a structured Evidence-Based Rounds (EBR) education model in critical care.

Design

A mixed data type design was used to evaluate Evidence-Based Rounds in a critical care setting. Structured observational data were captured and open-ended survey responses were submitted by attendees. Content analysis and descriptive statistics were used to analyse survey findings.

Results

Seventeen rounds were completed between March 2023 and January 2024 with a total of n = 83 clinical staff members. From these, n = 55 staff completed and submitted evaluation surveys. Rounds were most frequently attended by nurses of all bandings including senior clinical nurses, support workers and student nurses. Evidence-Based Rounds were globally perceived as a positive and useful education strategy and staff were very willing to attend future sessions. Patient outcomes were not directly assessed and rounds specifically facilitated three outcomes: (1) helping staff apply evidence to practice, (2) building staff confidence in presenting clinical information and (3) supporting staff in identifying local improvements to patient care.

Conclusion

Evidence-Based Rounds are an adaptable effective model of bedside education within critical care. In our setting, staff perceived that this model facilitated the application of evidence in clinical practice and positively influenced feelings of confidence. Importantly, this education strategy empowered nurses to explore and identify improvements locally to patient care. Whilst this model offers a practical education approach to address some of the key critical care workforce issues, such as an expanding curriculum and loss of senior staff, it could also be widely adopted to other clinical areas.

Implications for the Profession

Evidence-Based Rounds are perceived by staff as a successful bedside education model that facilitates nurses to apply evidence in practice. It is feasible that this strategy is a potentially sustainable, low-cost model for continuing professional development centred around routine clinical work.

Patient and Public Contribution

No patient or public contribution.

Exploring Individual and Organisational Factors Related to Inclusive Leadership Among Healthcare Professionals: A Systematic Review and Meta‐Analysis

ABSTRACT

Aim

To offer a comprehensive overview of the individual and organisational factors related to inclusive leadership among healthcare professionals.

Design

Systematic review and meta-analysis.

Methods

The review was conducted following the Joanna Briggs Institute methodology for systematic reviews of effectiveness. Findings were synthesised using meta-analysis, a random effects model and narrative synthesis.

Data Sources

In January 2025, a systematic search was conducted with no time or geographical limits in the CINAHL, MEDLINE (PubMed), Mednar, ProQuest and Scopus databases. Studies in English, Swedish and Finnish were included.

Results

A total of 34 studies were included. The meta-analysis revealed a statistically significant positive relationship between inclusive leadership and psychological safety among healthcare professionals (n = 10). The narrative synthesis further identified individual and organisational factors related to inclusive leadership. Individual factors consisted of well-being at work, performance and productivity, social behaviour, innovativeness and creativity and psychological capacity. Organisational factors revealed work community cohesion and citizenship, as well as organisational fairness and appreciation.

Conclusions

Inclusive leadership is a promising leadership behaviour, with positive outcomes for healthcare professionals and organisations. By enhancing psychological safety, inclusive leadership offers broader benefits for individuals and organisations. As such, it could improve the retention of professionals and the attractiveness of organisations in the healthcare sector.

Implications for Healthcare Management

To strengthen the functioning of healthcare organisations, leaders should be educated in inclusive leadership and its practical benefits. Training should focus on developing inclusive leadership behaviours that foster belonging, value individual uniqueness and encourage participation across all professional groups, creating an environment where both individuals and organisations can thrive.

Reporting Method

The Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines were used to report the results.

Patient or Public Contribution

No patient or public contribution.

Trial Registration

The protocol was registered in the International Prospective Register of Systematic Reviews PROSPERO (ID: CRD42024503861)

Exploring Experiences, Perceptions and Preferences for Exercise in Australians Living With a Stoma: A Cross‐Sectional Survey

ABSTRACT

Aim

(1) Explore the role of core abdominal exercise in people living with a stoma in Australia; (2) determine whether the presence of a parastomal hernia influenced participant symptoms and complications, health status, experiences with different types of exercise, recall advice given by healthcare professionals; (3) determine whether there is an appetite for supervised/supported exercise programs.

Design

A cross-sectional, anonymous survey.

Methods

Between August and September 2022. The survey included Likert scales and a single free text response. Logistic regression and Cramer's V were used to explore relationships between variables.

Results

Approximately half (45.5%) of 105 participants reported a parastomal hernia. Those with a parastomal hernia were less likely to recall having received advice (15.20%) or demonstration (9.40%) pertaining to exercise. Less than a quarter of all participants completed strengthening (23.80%) or vigorous (22.90%) exercise. Fear of vigorous exercise, abdominal exercise and heavy lifting were high in both groups. Relationships between healthcare advice, exercise-related fears and avoidance of heavy lifting were observed.

Conclusion

Many Australians living with a stoma are not achieving physical activity recommendations. While exercise behaviours did not differ between people with and without a parastomal hernia, recall of healthcare advice around exercise did. Fear-avoidance relationships were observed.

Impact

Most people living with a stoma do not recall advice about core abdominal exercises. Healthcare practitioners need to be aware of fear-avoidance related to lifting among people living with a stoma. This was the first study in Australia, exploring perspectives and experiences regarding exercise; providing foundations for future research particularly exercise programs.

Reporting Method

This study adhered to relevant EQUATOR guidelines and the reporting of survey studies (CROSS).

Patient or Public Contribution

This study did not include patient or public involvement in its design, conduct, or reporting.

Older Persons' Participation in Life‐Enhancement Activities in a Long‐Term Care Facility: A Mixed‐Methods Observational Study

ABSTRACT

Aim

To examine older persons' experiences and participation in life-enhancement activities in a long-term care facility.

Design

Convergent mixed-methods design.

Methods

Naturalistic observations of 20 life-enhancement activity sessions were conducted in a single long-term care facility that includes 111 older persons in September 2024. Data were collected through guiding questions and fieldnotes for systematic observation. We used Kruskal-Wallis and Mann–Whitney U tests for quantitative analysis. Fieldnotes were analyzed using a six-phase reflexive thematic analysis approach.

Results

Engagement levels (self-initiative, assistance-seeking frequency, and social interaction frequency) significantly differed across 16 different life-enhancement activities. Social interaction frequency also varied by mobility status (wheelchair, walker, independent). Participants displayed significantly more distractions in the TV Room than in the Activity Room. Four themes emerged from thematic analysis: (1) participation barriers, (2) activity contextual factors, (3) facilitator support strategies, and (4) social interactions and emotional well-being.

Conclusion

Structural elements (purposefully designed rooms, activity design and complexity, and the resident-preferred music), relational elements (facilitators' hands-on support, conflict resolution, and positive reinforcement), and individual factors (mobility status) influence older persons' participation in life-enhancement activities. Life-enhancement activities benefit older persons when they are provided with choices and adaptive equipment.

Implication

Findings support allocating distraction-free spaces for life-enhancement activities, incorporating resident-preferred music and game-layered physical exercises, and providing facilitator training in adaptive coaching, hands-on support, and conflict resolution.

Impact

Life-enhancement programs can promote psychosocial well-being among older persons in long-term care facilities by transforming routine recreational activities into personalized and socially engaging experiences that may reduce feelings of loneliness.

Reporting Method

Journal Article Reporting Standards for Mixed Methods Research.

Patient or Public Contribution

No Patient or Public Contribution.

Evaluation of a Nurse Practitioner Led Procedural Support Service for Children With Procedural Anxiety: An Effectiveness–Implementation Study

ABSTRACT

Aim

To evaluate the clinical effectiveness of a Nurse Practitioner led procedural support service for children with procedural anxiety, and identify facilitators and barriers to its sustained implementation and optimisation.

Design

An effectiveness–implementation hybrid type 3 study used a prospective mixed methods evaluation approach.

Methods

From December 2022 to May 2023, data were collected from children, parents and clinicians using a nurse practitioner-led service at a quaternary paediatric hospital in Brisbane, Australia. A prospective audit assessed clinical outcomes, while qualitative interviews explored implementation barriers and facilitators.

Findings

The clinical audit (n = 40) confirmed the service was effective and safe, ensuring procedural completion with minimal distress. Descriptive statistics indicated low pain and anxiety scores. There was a moderate negative relationship between pain scores and the use of distraction techniques. Interviews with thirty-three participants showed the service improved access to procedural care, reduced the need for physical restraint and general anaesthesia, and enhanced clinical workflow through preadmission assessments.

Conclusion

Utilising a Nurse Practitioner support service represents a safe and effective strategy to enhance access for paediatric patients with procedural anxiety.

Implications for the Profession and Patient Care

This study underscores the significance of specialised nursing roles in managing paediatric procedural anxiety, offering a replicable model to enhance procedural outcomes and mitigate medical trauma across healthcare settings.

Impact

Minimising pain and distress is important in all clinical encounters with children to reduce the risk of medical-related trauma and the future avoidance of healthcare.

Reporting Method

The report of study outcomes was guided by the Standards for Reporting Implementation Studies (StaRI) initiative.

Patient or Public Contribution

Patients or the public were not included in the design, conduct or reporting of the study.

Profiling Healthcare Professionals' Digital Health Competence and Associated Factors: A Cross‐Sectional Study

ABSTRACT

Aim

To assess healthcare professionals' digital health competence and its associated factors.

Design

Cross-sectional study.

Methods

The study was conducted from October 2023 to April 2024 among healthcare professionals in Italy, using convenience and snowball sampling. The questionnaire included four sections assessing: (i) socio-demographic and work-related characteristics; (ii) use of digital solutions as part of work and in free time, and communication channels to counsel clients in work; and DigiHealthCom and DigiComInf instruments including measurements of (iii) digital health competence and (iv) managerial, organisational and collegiality factors. K-means cluster analysis was employed to identify clusters of digital health competence; descriptive statistics to summarise characteristics and ANOVA and Chi-square tests to assess cluster differences.

Results

Among 301 healthcare professionals, the majority were nurses (n = 287, 95.3%). Three clusters were identified: cluster 1 showing the lowest, cluster 2 moderate and cluster 3 the highest digital health competence. Most participants (n = 193, 64.1%) belonged to cluster 3. Despite their proficiency, clusters 2 and 3 scored significantly lower on ethical competence. Least digitally competent professionals had significantly higher work experience, while the most competent reported stronger support from management, organisation, and colleagues. Communication channels for counselling clients and digital device use, both at work and during free time, were predominantly traditional technologies.

Conclusion

Educational programmes and organisational policies prioritising digital health competence development are needed to advance digital transition and equity in the healthcare workforce.

Implications for the Profession

Greater emphasis should be placed on the ethical aspects, with interventions tailored to healthcare professionals' digital health competence. Training and policies involving managers and colleagues, such as mentoring and distributed leadership, could help bridge the digital divide. Alongside traditional devices, the adoption of advanced technologies should be promoted.

Reporting Method

This study adheres to the STROBE checklist.

Patient or Public Contribution

None.

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.

Nurses' Experiences of Psychological Safety in Ad Hoc Teams During Emergency Care: An Interview Study

ABSTRACT

Aim

To investigate specialist nurses' experience of psychological safety in ad hoc teams during emergency care.

Design

Interpretive descriptive qualitative study.

Methods

Semi-structured interviews with nine specialist nurses were conducted in Sweden from May to June 2024 and analysed using reflexive thematic analysis (Braun & Clarke).

Results

Four themes were identified: Interpersonal skills: implications for psychological safety; Individuality and team dynamics; Confidence, competence and collaboration; and Organisational responsibility for promoting psychological safety.

Conclusion

Psychological safety in ad hoc emergency care teams is a fragile and multifaceted phenomenon, shaped by interpersonal skills, leadership and organisational culture. Supportive environments characterised by open communication and proactive leadership enable specialist nurses to collaborate confidently and safely, even under acute stress. Targeted efforts to strengthen these factors are essential for optimising teamwork and patient outcomes.

Implications for the Profession

The psychological safety implications for specialist nurses in ad hoc teams during emergency care are profound. Psychological safety fosters an environment that empowers nurses to leverage clinical expertise, collaborate in ad hoc teams and improve patient outcomes. Promoting psychological safety ensures specialist nurses feel respected, valued and secure, leading to better care and a more resilient workforce.

Impact

This qualitative study investigated specialist nurses' experience of psychological safety in ad hoc teams in acute care. The results will influence the awareness of nurses, specialist nurses, other professions, managers and organisations about the importance of feeling psychologically safe.

Reporting Method

Presentation follows COREQ 32-item checklist.

Patient and Public Involvement

No patient or public involvement.

Contribution to Global Community

Shows that psychological safety helps nurses perform in ad hoc emergency teams. Identifies key factors that affect teamwork and patient care.

Structural Vulnerability in Health Research: A Systematic Mixed Studies Review

ABSTRACT

Aims

To systematically examine how structural vulnerability has been defined and operationalised in United States-based health research, identify conceptual consistencies and methodological gaps, and propose core dimensions of structural vulnerability along with implications for future application in health research.

Design

A systematic mixed-studies review using a parallel-results convergent synthesis design.

Data Sources

PubMed, Embase, Scopus and CINAHL were searched from first publication through 2024 using the terms ‘structural* vulnerab*’ AND health.

Review Methods

Peer-reviewed English-language empirical studies conducted in the United States that applied the concept of structural vulnerability were identified. The Mixed Methods Appraisal Tool was used to assess study quality. Study content was analysed to identify how structural vulnerability was defined and operationalised.

Results

Thirty-seven predominantly high-quality studies published between 2011 and 2024 met inclusion criteria. Structural vulnerability was consistently defined through two interrelated dimensions: as a social positionality (characterised by constrained resilience, limited agency and imposed risks rooted in systemic discrimination and social hierarchies) and as a critical analytic framework for examining structural determinants of health. Quantitative studies predominantly used individual-level indicators (e.g., income, housing) and cross-sectional designs. Qualitative studies focused on experiences of structural vulnerability in relation to health outcomes and infrequently translated findings into structural interventions. The most frequently studied outcomes were infectious disease, substance use and mental health.

Conclusion

Structural vulnerability, as a conceptual and empirical lens, reveals how systems produce—and can potentially reduce—health risks. Findings underscore the need for geographically diverse and longitudinal studies, as well as multidimensional measures. Advancing health equity demands critiquing systemic causes of inequities and pursuing justice-oriented interventions.

Implications for the Profession

Nursing, positioned at the intersection of public health, social sciences and policy, is uniquely equipped to engage structural vulnerability as a critical analytic tool to address health inequities, design interventions and advocate for policy reform.

Impact

What problem did the study address? This study addressed a lack of clarity in the definition and operationalization of structural vulnerability in health research.

What were the main findings? The definition of structural vulnerability is consistent across quantitative and qualitative studies, but there are marked variations in its operationalization. Quantitative studies predominantly rely on individual-level indicators, while qualitative studies use it as a theoretical framework to guide analysis, interpret findings and examine structural determinants of health.

Where and on whom will the research have an impact? This review offers a clear framing for integrating structural vulnerability in health research in efforts to advance health equity.

Reporting Method

PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) reporting guideline.

No Patient or Public Involvement

This study did not include patient or public involvement in its design, conduct or reporting.

The Associations Between Nurses' Perceived Adequacy of Staffing and Quality of Nursing Care and Job Enjoyment: A Multilevel Modelling Approach

ABSTRACT

Aim

To explore the associations of (1) shift-to-shift Nurse Perceived Adequacy of Staffing Scale (NPASS) scores and (2) the relative contribution of individual NPASS items to nurse-perceived quality of care (NPQoC) and job enjoyment.

Design

Multihospital prospective observational study.

Methods

The study was conducted across 15 medical, surgical or acute admission hospital wards in three teaching hospitals in the Netherlands. Vocationally and bachelor-trained nurses conducted 1550 measurements of perceived adequacy of staffing using the NPASS, NPQoC and job enjoyment in 797 shifts. Multilevel models were used to assess associations between NPASS scores and NPASS items and the outcome variables.

Results

Higher NPASS scores were significantly associated with improved NPQoC and job enjoyment. An increase in 1.0 point NPASS score leads to an increase of 0.97 points in NPQoC and 1.04 points in job enjoyment. Of the NPASS items, energy level, adherence to protocols and the opportunity for adequate breaks had the most positive effect on both outcomes.

Conclusion

Perceived adequacy of staffing as measured by the NPASS is highly relevant for improvements in both NPQoC and job enjoyment.

Implications for the Profession and/or Patient Care

Decision-makers on nurse staffing should incorporate the NPASS in staffing methods to ensure adequate staffing and the associated benefits. Policies that ensure adequate breaks, adherence to protocols and maintenance of nurses' energy levels during the shift should be implemented with special attention.

Impact

This study provides supportive evidence for incorporating nurses' perceived adequacy of staffing, as measured by the NPASS, to ensure adequate staffing. This is crucial for nurse retention, and therefore vital to maintaining accessible healthcare given the global nursing shortages.

Reporting Method

The STROBE checklist was used to conduct and describe the study.

Patient or Public Contribution

This study did not include patient or public involvement in its design, conduct or reporting.

‘Giving and Receiving’—Peer Volunteers' Experiences of Online Perinatal Support: A Qualitative Study

ABSTRACT

Aim

To explore peer volunteers' experiences of delivering online support through SMART to at-risk mothers during the perinatal period, to inform future improvements to mobile-health-application (mHealth app) based peer-support interventions.

Design

Descriptive qualitative research.

Methods

The study was conducted between February 2024 and June 2025 in a tertiary public healthcare institution in Singapore. Twenty peer volunteers were recruited via convenience and snowball sampling and participated in individual semi-structured interviews. Interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis.

Results

Four themes were identified: (a) Giving and receiving: the inner world of peer volunteers; (b) Navigating relational complexity in digital peer support; (c) Facilitating connection and continuity in digital peer support; and (d) Building better connections through supportive ecosystems.

Conclusion

Peers reported experiencing reciprocal benefits, such as a sense of fulfilment and achievement, while supporting mothers. Shared experiences and psychosocial vulnerabilities enhanced relatability, reassurance and rapport, which sustained supportive relationships. Challenges encountered by peers highlighted the need for strengthening both intervention design and peer training.

Implications for Patient Care

Regular check-ins by programme facilitators, alongside clear information, flexible guidelines and reassurance, can improve peer volunteers' motivation and resilience, thereby ensuring consistent and sustainable support for at-risk mothers.

Impact

Examined peer volunteers' experiences in providing online perinatal support to mothers with diverse psychosocial vulnerabilities. Peers offered emotional, informational and practical support, while mothers benefited from learning how peers had coped with their psychosocial vulnerabilities. Shared experiences fostered confidence and reassurance among mothers that they, too could overcome similar adversities. Valuable in providing both medically accurate perinatal information and meaningful social support to perinatal mothers.

Reporting Method

The reporting of the study adheres to the standards outlined in the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist.

Patient or Public Contribution

Mothers and peer volunteers contributed valuable insights and suggestions that helped in the design of the intervention.

Timely Implementation of Patient‐Reported Outcomes in Clinical Care: Insights From Clinicians and Health Informatics Experts

ABSTRACT

Aim

To explore the optimal timing of patient-reported outcome assessment, defined as the collection and use of patient-reported outcomes at clinically meaningful points such as before or during encounters, treatment initiation and follow-up, and to identify the facilitators and barriers to timely use.

Design

A qualitative analysis of semi-structured interviews with healthcare professionals across diverse US health systems.

Methods

Thematic analysis was used to identify key themes related to the timing and implementation of patient-reported outcomes assessments. Interviews were analysed iteratively to develop a coding framework and synthesise overarching themes.

Results

Fourteen healthcare professionals, including nurse practitioners, cardiologists and health informatics experts across seven U.S. health systems from academic and community hospitals, were interviewed in February 2024. Three major themes emerged: (1) value proposition of timely patient-reported outcome data collection (2) key facilitators for timely implementation and (3) multilevel barriers. The value proposition focused on the use of patient-reported outcomes for prevention and active disease management. Critical facilitators for the timely implementation of patient-reported outcomes included the involvement of research and clinical coordinators, strategies for pre-visit and on-site patient-reported outcome collection, the use of standardised templates within EHRs and the alignment of patient-reported outcome collection with patients' long-term treatment goals. Finally, multilevel barriers included time constraints, patient-level challenges (e.g., fatigue, literacy, language) and systemic issues (e.g., technical limitations, lack of reimbursement and unclear guidelines).

Conclusion

Timely collection and use of patient-reported outcomes is critical for improving symptom monitoring and supporting patient-centered clinical decision-making. However, multilevel barriers hinder consistent implementation across health care settings.

Implications for the Profession and/or Patient Care

Integrating patient-reported outcomes into clinical workflows can improve the patient-centeredness of patient-healthcare professional interactions, and provide a more holistic picture of a patient's health status. Addressing barriers to patient-reported outcome implementation, including lack of time, poor health literacy and workflow integration barriers, is crucial for improving clinical outcomes.

Reporting Method

This study adhered to the COREQ (Consolidated Criteria for Reporting Qualitative Research) checklist, in accordance with EQUATOR Network guidelines.

Patient or Public Contribution

No patient or public involvement: This study did not include patient or public involvement in its design, conduct or reporting.

Using a Socio‐Technical Strategy to Identify the Use and Implications of Generative Artificial Intelligence Tools on Nursing Education and Practice

ABSTRACT

Aim

Use a socio-technical strategy to identify the use and implications of generative artificial intelligence (GenAI) tools on nursing education and practice.

Design

Descriptive qualitative study.

Method

Online interviews with 32 nursing students, faculty and practitioners between February and April 2024. Data were analysed using the Framework Method.

Results

Theme 1 described participants' use of eight GenAI tools across seven use cases. Theme 2 describes the implications of using GenAI tools on nursing education. The subthemes include (2.1) facing a new pedagogical reality, (2.2) negative sentiments on using GenAI tools in nursing education and (2.3) opportunities to improve nursing education with GenAI tools. Theme 3 describes the implications of using GenAI tools on nursing practice. Subthemes include (3.1) embedding in patient care, (3.2) nursing workflow integration and (3.3) organisational support. Theme 4 describes GenAI capacity-building. Subthemes include (4.1) to develop an AI-ready workforce, (4.2) to promote responsible and ethical use and (4.3) to advance the nursing profession.

Conclusion

Although GenAI tools initially disrupted nursing education, it is only a matter of time before they disrupt nursing practice. Nurses across education and practice settings should be trained in the responsible and ethical use of GenAI tools to mitigate risks and maximise benefits.

Implications for the Profession and/or Patient Care

GenAI tools will profoundly impact how nurses of today and tomorrow learn and practice the profession. It is crucial for nurses to actively participate in shaping this technology to minimise risks and maximise benefits to the nursing profession and patient care.

Impact

This study revealed the socio-technical intricacies of using GenAI tools in nursing education and practice. We also present wicked problems that nurses will face when using GenAI tools.

Reporting Method

COREQ.

Patient or Public Contribution

This study did not include patient or public involvement in its design, conduct or reporting.

Patient Preferences for Cancer Nurses as Care Providers: A Systematic Review of Discrete Choice Experiments

ABSTRACT

Background

Limited literature has focused on people with cancers' preference for care providers in scenarios where trade-offs may have to be made.

Aim

To report the results of a comprehensive search and synthesis of discrete choice experiments or best-worst scaling studies (± willingness to pay estimates) in scenarios involving cancer nurses, with a focus on: (1) preferred care provider; and (2) relative importance of attributes of care provision for people with cancer.

Methods

A search was conducted across: CINAHL, Cochrane Central Register of Controlled Trials, EconLit, Medline, PsycINFO, Scopus, Web of Science Core Collection, and Google Scholar for discrete choice experiments published between January and July 2025. Data were extracted and appraised by two authors. Results were narratively synthesised.

Results

Of 461 studies screened, 11 were included, published in Australia (n = 3), UK (n = 3), and China (n = 5) including people with breast (n = 4), gastric (n = 4), prostate (n = 1), or mixed cancers (n = 2). In six studies exploring scenarios of follow-up care (i.e., survivorship/surveillance), cancer medical specialists were the preferred care provider, followed by cancer nurses, and then general practitioners. In four of the five studies of supportive care scenarios (i.e., diet and exercise advice, anxiety and depression screening), cancer nurses were the preferred care provider, followed by allied health professionals, then cancer medical specialists. The highest WTP estimate was $US226.15 for a medical specialist to provide follow-up care. For supportive care, the highest WTP was $US137.52 for a cancer nurse to provide diet-based lifestyle advice post-treatment for breast cancer.

Conclusion

Cancer nurses are highly valued by people with cancer, particularly for supportive care provision. Opportunities exist for an increase in cancer nurse specialists with expanded scope of practice, to support the preference of people with cancer to have cancer medical specialists, or cancer nurse specialists provide expert cancer follow-up care.

Patient or Public Contribution

Employees of a cancer patient advocacy group were involved in the design of the study, interpretation of the data, and the preparation of the manuscript. No patients were involved in this work. However, this systematic review prioritized patient voices by including studies that reported on the preferences of people with cancer.

Suicide Risk and Protective Factors in Nursing Students in the United States

ABSTRACT

Aim

This study examined cultural, contextual and psychological risk and protective factors for suicide risk (i.e., suicide ideation, planning and attempting in the past year) in a cross-sectional sample of nursing students in the United States.

Design

A cross-sectional study design was employed.

Methods

Nursing students (n = 9871) were selected from the national 2020–2021 Healthy Minds Study (HMS). Students reported their demographics, suicidality and non-suicidal self-injurious behaviour (NSSIB). They also completed validated self-report measures of depression, belonging and flourishing.

Results

Logistic regressions revealed that racial minority nursing students were at risk for suicidal ideation and attempts, and sexual minority students were at risk for suicidal ideation. Nursing students with a history of mental illness severe enough to seek treatment and those who reported more NSSIB also evidenced greater odds of reporting all forms of suicide risk. Specifically, the odds of suicidal ideation and attempts were more than three times greater for nursing students who reported NSSIB. Additionally, positive elements of flourishing only marginally protected against suicidal ideation, and belonging was not associated with any form of suicide risk.

Conclusion

Findings highlight the high number of nursing students at risk for suicidality and highlight potential demographic and psychological targets for suicide interventions. Impact: Early intervention during nursing school could impact suicide risk throughout a nurse's educational and professional journey. Thus, nurse educators should consider implementing suicide and mental health interventions in their programmes.

Patient or Public Contribution

No direct patient or public contribution.

Underrepresentation of Nurses in Croatian Graduate Nursing Programs: Implications for Academic Equity in Nursing Education

ABSTRACT

Aim

To examine the representation of nurses in Croatian graduate nursing programs and to explore its implications for academic equity, professional development, and nursing leadership.

Design

Cross-sectional descriptive study using document analysis.

Methods

Data on lecturers and course leaders for the 2022/2023 academic year were retrieved from all graduate and specialist nursing programs in Croatia. A total of 694 lecturers and 545 course leaders were analysed by professional background.

Results

Nurses accounted for 19% of lecturers in university graduate programs and 14% in specialist studies. As course leaders, they represented 11% in specialist studies and only 4% in university graduate programs. Thirty courses lacked assigned lecturers. The findings demonstrate a strong dominance of medicine and other professions in teaching roles.

Conclusion

Nurses remain markedly underrepresented in academic positions, which may limit their ability to shape curricula, influence educational standards and strengthen professional identity.

Implications for the Profession and/or Patient Care

Improving the academic presence of nurses could be important for advancing leadership capacity, curriculum relevance and professional equity. Stronger representation may help enhance the profession's authority and indirectly benefit patient care.

Impact

What problem did the study address?: The study explored limited nurse representation in graduate nursing education and its implications for equity and autonomy. What were the main findings?: Nurses are a small minority in lecturer and course leader roles, with most positions occupied by non-nursing professionals. Where and on whom will the research have an impact?: The findings are relevant to educators, regulators and policymakers in Croatia and internationally, particularly in countries where nurses face barriers to academic participation. The study supports ongoing policy efforts to strenghten nurses' academic representation and leadership in higher education.

Patient or Public Contribution

No patient or public contribution. This study relied exclusively on publicly available academic data and did not involve patients, service users or members of the public.

Climate change effects in older people's health: A scoping review

Abstract

Background

Climate change has serious consequences for the morbidity and mortality of older adults.

Objective

To identify the effects of climate change on older people's health.

Methods

A scoping review was conducted following the Joanna Briggs Institute guidelines and the PRISMA-ScR checklist. Quantitative research and reports from organizations describing the effects of climate change on older people were selected.

Results

Sixty-three full-text documents were selected. Heat and air pollution were the two factors that had the most negative effects on cardiovascular and respiratory morbidity and mortality in older people. Mental health and cognitive function were also affected.

Conclusions

Climate change affects several health problems in older individuals, especially high temperatures and air pollution. Nursing professionals must have the necessary skills to respond to the climate risks in older adults. More instruments are required to determine nursing competencies on climate change and the health of this population group.

Patient of Public Contribution

No patient or public contribution.

Understanding the Long‐Term Relationship in Dyads of Parental Live Liver Donors and Adolescent Young Adults

ABSTRACT

Aim

This qualitative study aimed to understand how dyads of parental donors and adolescent young adult recipients make sense of living donor liver transplantation from donation to adolescence.

Design

This qualitative study used a focused ethnographic design.

Methods

Twelve dyads of parental liver donors and their adolescent young adults were interviewed together using a semi-structured interview guide. Data was collected from April 16 to July 30, 2019. All of the interviews were audiotaped and transcribed. The theoretical framework of sensemaking was implemented. Thematic analysis was used, concepts were categorised, connections were made and references to the coding were conducted.

Results

Thematic analysis contributed to the emergence of three categories: connections, reflections and life transitions, and the overarching theme of gratitude for being given or giving the gift of life.

Conclusion

The dyads' gratitude increased over time through the social process of sensemaking.

Implications for the Profession and Patients

As living donor liver transplantation in the paediatric population enters its third decade, understanding how it shapes relationships in dyads of parental donors and adolescent young recipients over time can provide new insights for nurses who work in paediatric transplantation.

Impact

This study's findings address the current gap in the literature on the long-term impact of living donor liver transplant dyads and highlight the role of nurses who provide care and guidance at the time of evaluation and surgery to the ongoing support during the years that follow.

Reporting Method

This qualitative study followed EQUATOR guidelines and adhered to the COREQ checklist for qualitative studies.

Patient or Public Contribution

No patient or public contribution.

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