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☐ ☆ ✇ Journal of Nursing Scholarship

Quality and Bias in Randomized Controlled Trials Published in Latin American Nursing Journals: A Meta‐Epidemiological Study

ABSTRACT

Introduction

Randomized controlled trials (RCTs) are essential for evidence-based nursing care. However, the quality of reporting and adherence to methodological standards in Latin American nursing journals remains unclear. This study evaluates the characteristics, reporting quality, and potential risk of bias of RCTs published in Latin American nursing journals.

Objective

To assess the reporting compliance and risk of bias of RCTs published in Latin American nursing journals.

Design

Meta-research study.

Methods

A comprehensive handsearch of 29 Latin American nursing journals was performed covering publications from 2000 to 2024. Identified RCTs were assessed for adherence to CONSORT reporting guidelines and evaluated for risk of bias. Outcomes were classified using the COMET taxonomy. A descriptive analysis was performed.

Results

A total of 6377 references were screened, identifying 34 eligible RCTs, most published after 2018. The median CONSORT compliance was 19 reported items (IQR 16–22). High compliance (> 90%) was observed in abstract reporting items, study objectives, and participant selection criteria. However, critical methodological features such as randomization procedures, blinding, and protocol registration showed low adherence (< 40%). Risk of bias was mostly rated as having “some concerns”, largely due to insufficient reporting. According to the COMET taxonomy, the most frequently reported outcome domains were “Delivery of care” and “Physical functioning”.

Conclusions

Reporting compliance and risk of bias of RCTs published in Latin American nursing journals presents significant gaps, particularly in key methodological domains. These shortcomings hinder transparency, reproducibility, and integration into evidence synthesis. Strengthening editorial policies and enforcing reporting standards could enhance the quality and reliability of published research in Latin American nursing journals.

☐ ☆ ✇ Journal of Advanced Nursing

Exploring Individual and Team Resilience Among Dutch Hospital Nurses: A Survey Study

Por: Sharon A. van Stralen · Caroline Schlinkert · Linda van Eikenhorst · Cordula Wagner — Septiembre 25th 2025 at 07:02

ABSTRACT

Background

Nurses confront substantial daily workloads. Coping mechanisms, including resilient behaviours at both individual and team levels, are pivotal in managing these challenges. Factors like work experience can significantly influence individual resilience. Yet, team resilience among nurses remains relatively unexplored.

Aim

Our study examined perceptions of both individual and team resilience among Dutch hospital nurses. Furthermore, we investigated the impacts of hospital type, ward type and work experience.

Methods

The Employee Resilience Scale was used to evaluate individual resilience and adapted for team contexts to assess team resilience. This study was one of three conducted under a governmental research program aimed at improving patient safety in the Netherlands. A paired t-test and correlation analysis were conducted to compare individual resilience with team resilience. A separate t-test assessed the impact of ward type on perceived individual and team resilience. Finally, post hoc analyses were used to examine the effects of hospital type and work experience.

Results

In total, 344 nurses from 25 different wards of 17 Dutch hospitals completed the survey. In general, nurses indicated to act more resilient on the individual level (mean = 3.77, SD = 0.61) compared to the team level (mean = 3.53, SD = 0.65; t = 7.25, p = 0.00). A correlation was found between perceived individual and team resilience (r = 0.53, p = 0.00). No effects of hospital- and ward type were found on both individual or team resilience. Years of work experience did not affect individual resilience but showed a significant effect on team resilience.

Conclusion

Dutch hospital nurses indicated they often act resilient on both individual and team levels. However, with increasing workloads in healthcare, being able to remain resilient will become increasingly challenging and important. Organisations should therefore support employees to maintain resilience by adapting their work environment to meet more employees' needs.

☐ ☆ ✇ Journal of Advanced Nursing

The Perceptions of Male Accessibility to the Fields of Nursing Practice by Those Studying or Teaching Nursing in England: Cross‐Sectional Survey

Por: Daniel Carter · Lucian Hadrian Milasan · Andrew Clifton · George Mcgill · Julian Stribling · Kay De Vries — Septiembre 25th 2025 at 07:02

ABSTRACT

Aims

Investigate the perception of male accessibility to the fields of nursing practice by those studying or teaching nursing in England.

Design

Cross-sectional survey.

Methods

Online questionnaire with three closed-scale questions and two open-text questions designed to elicit perceptions on the accessibility of men to the fields of nursing practice. The questionnaire was distributed to the staff and students at 61 nursing schools in England. Inferential and descriptive statistics were used to analyse the closed questions data and inductive content analysis was used to analyse open-text questions data.

Results

Students (n = 52) and staff (n = 51) responded to the survey. Adult (Mdn = 6, IQR = 2) and mental health (Mdn = 6, IQR = 2) were perceived as the most accessible fields of nursing practice to men, and child (Mdn = 4, IQR = 2) the least. Specialised practice areas in acute and emergency (Mdn = 6, IQR = 2), education (Mdn = 6, IQR = 2), leadership (Mdn = 7, IQR = 1), prison services (Mdn = 7, IQR = 1), and research (Mdn = 7, IQR = 2) were rated the most accessible to men and neonatal care (Mdn = 3, IQR = 3) the least. Societal stereotyping and stigma were seen as barriers to men entering the nursing profession. The perception that nursing is a feminised profession persists and a distrust of men is associated with child nursing. Men were viewed as progressing to leadership roles with greater ease than women.

Conclusion

Societal level stereotyping and stigma are perceived as prevalent in nursing practice areas considered less accessible to men entering the nursing profession.

Impact

This study adds insight into the gendered nature of nursing and highlights the barriers to men entering a profession with a workforce crisis.

Reporting Methods

STROBE cross-sectional studies guidelines. COREQ guidelines for content analysis.

Patient or Public Contribution

No patient or public contribution.

☐ ☆ ✇ Journal of Advanced Nursing

Social Representations of Bedside Milk Expression Among Mothers of Preterm Newborns in Neonatal Intensive Care Units

ABSTRACT

Aim

To understand the social representations of bedside milk expression (BME) among mothers of preterm newborns in neonatal intensive care units (NICUs).

Design

Qualitative descriptive study.

Methods

The study was conducted from July to August 2024 in two NICUs of a referral maternity hospital in Fortaleza, Brazil. Nineteen mothers of hospitalised premature newborns participated. Semi-structured interviews were conducted and subjected to thematic content analysis.

Results

Mothers perceived BME as a meaningful act of protection and bonding, though some were unfamiliar with the practice. Emotional ambivalence was common, shaped by prior breastfeeding experiences and the context of prematurity. Discomfort related to privacy and shared spaces was noted. Support from healthcare professionals was essential to promote understanding and adherence.

Conclusion

Social representations of BME are shaped by emotional, social and institutional experiences. Anchored in prior breastfeeding experiences and cultural meanings of maternal care, the practice is objectified through both gestures of affection and tangible barriers.

Implications for the Profession and/or Patient Care

Healthcare professionals, particularly nurses, should receive training to support mothers in BME. Structural improvements, privacy and emotional support are essential for fostering maternal autonomy and confidence.

Impact

This study highlights the barriers to BME, emphasising the role of healthcare support and the need for better infrastructure, privacy and training to enhance maternal confidence and breastfeeding.

Reporting Method

The study followed the Consolidated Criteria for Reporting Qualitative Research checklist.

Patient or Public Contribution

None.

What Does This Paper Contribute to the Wider Global Clinical Community?

This paper highlights the pivotal role of healthcare professional support in overcoming barriers to BME and promoting breastfeeding practices.

What Already Is Known?

Fresh breast milk is considered the gold standard for reducing complications and improving survival in preterm infants. BME is recommended as an effective strategy to ensure the availability of fresh breast milk. Mothers' social representations of this practice remain underexplored within the neonatal intensive care context.

What This Paper Adds?

Explores mothers' social representations of BME in NICUs, addressing a significant gap in qualitative research. Reveals how emotional, social and institutional factors shape mothers' perceptions, motivations and challenges related to BME. Highlights the need for targeted professional support, improved infrastructure and privacy to enhance maternal autonomy and adherence to milk expression practices.

Implications for Practice

Healthcare professionals, particularly nurses, should receive specialised training to provide technical guidance and emotional support, enhancing mothers' confidence and autonomy in BME. Improving infrastructure and ensuring privacy in NICUs are crucial to creating supportive environments that facilitate milk expression and strengthen maternal–infant bonding. Institutional policies should integrate maternal-centred strategies to support breastfeeding continuity and promote humanised neonatal care.

☐ ☆ ✇ Journal of Advanced Nursing

Women's Experiences of Care and Support Following Postpartum Psychosis: A Meta‐Ethnography

Por: Vimbai Carr · Gill Thomson · Victoria Moran · Gill Strachan — Septiembre 3rd 2025 at 09:38

ABSTRACT

Background

Postpartum psychosis is a psychiatric emergency that occurs following childbirth. Women are often cared for in general psychiatric units or in psychiatric Mother and Baby units. Postpartum psychosis is associated with a significant risk of relapse. There is a need to explore how women perceive care to understand what works well or needs further improvement.

Aims

This review aimed to explore women's experiences of care and support for postpartum psychosis.

Design

A systematic review using meta-ethnographic methods was conducted.

Data Sources

Comprehensive searches were conducted between 4 March 2024 and 4 March 2025 on five databases (CINAHL, EMBASE, MEDLINE, PsycINFO and Web of Science). Backward and forward chain searching was also undertaken.

Review Methods

Critical appraisal was conducted following screening. Reciprocal and refutational translation were used to form the synthesis, and a line of argument was developed. The eMERGe reporting guidelines were used.

Results

Fifteen studies were included within this synthesis. All the studies were conducted in high income countries and included 235 women. Three main themes were developed. ‘Navigating the unknown’ explored women's perceptions of postpartum psychosis as a less well-known condition, and their informational needs. ‘The double-edged sword of care’ found that there were helpful elements of formal mental health care, but that accessing care was sometimes traumatic, stigmatising and conflicting to women's identities. ‘Seeking consolation and recovery’ explored women's need for psychological support and experiences of peer support.

Conclusion

The findings of this review highlighted women's needs in respect to informational support, medication support, psychological support and in-patient care settings. Mother and baby units were strongly preferred by women.

Impact

The findings highlighted a need for specialised care for postpartum psychosis.

Patient or Public Contribution

There were no patient or public contributions.

Trial Registration

Prospero (CRD42024515712)

☐ ☆ ✇ Journal of Advanced Nursing

A Descriptive Qualitative Study of Patient and Carer Perspectives on the Acceptability of Transcatheter Aortic Valve Implantation

Por: Nicola Straiton · Robyn Gallagher · Janice Gullick — Septiembre 3rd 2025 at 09:30

ABSTRACT

Aim

To provide a structured analysis of the acceptability of transcatheter aortic valve implantation to support clinical conversations, decision making and recovery for older adults with aortic stenosis and their carers.

Background

While transcatheter aortic valve implantation is an effective treatment for heart valve disease, its acceptability to patients and caregivers remains unclear. Understanding the acceptability of clinical procedures is key for influencing patient engagement in self-care and guiding the information and support patients and carers need.

Design

A descriptive, qualitative study used deductive content analysis, guided by Sekhon's Theoretical Framework of Acceptability.

Methods

Participants included 18 aortic stenosis patients (mean age 84.2 ± 4.1 years) and 8 carers from three Australian metropolitan hospitals (2018–2020). Semi-structured interviews were conducted 4–6 months post–TAVI and transcribed verbatim. Analysis used Sekhon's Theoretical Framework of Acceptability across three temporal zones, with deductive coding examining affective attitude, burden, ethicality, intervention coherence, opportunity costs, perceived effectiveness and self-efficacy.

Results

Participants described high prospective, concurrent and retrospective acceptability of transcatheter aortic valve implantation. Perceived prospective acceptability framed the procedure as lifesaving. Peri-operatively, participants found the procedure simple, low-risk and minimally disruptive, ensuring high concurrent acceptability. Post-procedure, patient participants described a slow but gradual return to normal, growing confidence and a reengagement with their valued pastimes. The absence of structured rehabilitation advice led to self-designed recoveries and uncertainty about safe limits.

Conclusion

Transcatheter aortic valve implantation was perceived as a highly acceptable intervention that helped this group of mostly older adults achieve their personal goals.

Relevance to Clinical Practice

Despite the minimally invasive nature of transcatheter aortic valve replacement, optimising recovery and rehabilitation requires a holistic approach that addresses both clinical needs and patient goals.

Patient and Public Contribution

None in the conceptualisation or design.

☐ ☆ ✇ Journal of Clinical Nursing

Preventing Child Maltreatment in Early Childhood: The Clinical Role of Public Health Nurses in Primary Care

ABSTRACT

Aim and Objective

To explore how public health nurses at child and family health clinics work to prevent maltreatment and the experiences of public health nurses in the maltreatment prevention efforts.

Background

Child maltreatment is a serious societal issue with major consequences. Preventive efforts are increasing and have broad political support. A key objective of the child and family health clinic services is to prevent, identify, and stop maltreatment, abuse, and neglect. National clinical guidelines outline, in general terms, how such work should be conducted. However, limited research exists on how public health nurses prevent maltreatment and the effectiveness of their methods.

Design and Method

A qualitative and explorative design was used, based on semi-structured interviews with 14 public health nurses conducted as part of the project ‘Public Health Nurses in Child and Family Clinics' Role in Preventing and Detecting Child Maltreatment’ at Oslo Metropolitan University. The interviews were carried out between August and November 2021. We used qualitative content analysis with an inductive approach to analyse the data.

Result

Three main categories were developed: 1. Structure and system: weaving prevention into daily practice; 2. To dare and endure: a negotiation of courage and understanding, and 3. To empower and uphold: the goal of strengthening and supporting parents. The results show the importance of early intervention, barriers to discussing maltreatment with parents, and the importance of building trust and empowering parents.

Conclusion

Preventing maltreatment is a key part of public health nurses' clinical work, focusing on early risk identification and parental guidance. While building trust with families is prioritised, structural, resource, and guideline-related challenges persist.

Implications for Practice

This study provides knowledge about Norwegian public health nurses clinical work with child maltreatment at the child and family health clinics, which can serve as a valuable foundation for further research as well as for collaborating services.

Reporting Method

EQUATOR guidelines were followed, using the COREQ checklist.

Patient or Public Contribution

No patient or public contribution.

☐ ☆ ✇ Journal of Clinical Nursing

The Effectiveness of Family Health Conversations Delivered by Nurses: A Systematic Review

ABSTRACT

Aim

To extract and interpret quantitative data exploring the effectiveness of family health conversations (FHCs) on family functioning, perceived support, health-related quality of life, caregiver burden and family health in families living with critical or chronic health conditions.

Background

Addressing the health of families affected by critical or chronic illnesses requires focused attention. The effective integration of FHCs is hampered by a scarcity of rigorous quantitative studies that provide solid evidence on best practices and outcomes.

Design

A systematic review following the Joanna Briggs Institute guidelines.

Methods

The review is reported according to the PRISMA 2020 checklist. Appropriate studies were searched in PubMed, CINAHL, PsycINFO, Scopus and Cochrane Databases. Results of the search were imported into the Covidence web-based program. Included were studies with a quantitative research design, delivered to families with critical or chronic health conditions, describing FHCs based on the Calgary Family Assessment Model and/or the Calgary Family Intervention Model, and/or the Illness Beliefs Model, using reliable and validated instruments, published between 2008 and 2023, and written in English.

Results

In total, 24 papers met the inclusion criteria. Sixteen papers used a quasi-experimental design, eight of which included a control group. Two papers used a mixed methods design, and six papers were randomised controlled trials (RCTs). A statistically significant effect of FHCs on family functioning was reported in two RCTs and three quasi-experimental papers. We also found that a statistically significant effect of FHCs was reported on perceived support in 9 of 15 papers, quality of life in 4 of 11 papers and caregiver burden in 1 of 3 papers.

Conclusion and Implications for Clinical Practice

The interventions reviewed revealed variability and partial results concerning the effectiveness of FHCs on family functioning. More rigorous research about short-term, intermediate- and long-term effectiveness is needed before conclusions can be drawn.

Reporting Method

The study is reported according to the PRISMA 2020 (Preferred Reporting Items for Systematic reviews and Meta-Analyses) (File S1).

Patient or Public Contribution

No patient or public contribution. Data were gathered from previously published studies.

☐ ☆ ✇ Journal of Advanced Nursing

Nursing at the Intersection of Power and Practice: A Grounded Theory Analysis of the Profession's Social Position

ABSTRACT

Aim

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.

Design

A qualitative study framed in critical theory paradigm employing constructivist grounded theory, as outlined by Charmaz.

Methods

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.

Results

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.

Conclusions

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.

Impact

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.

Patient or Public Contribution

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

Reporting Method

The manuscript is based on the Consolidated Criteria for Reporting Qualitative Research (COREQ).

☐ ☆ ✇ Journal of Advanced Nursing

A Realist Evaluation of the Implementation and Use of Patient‐Reported Outcomes in Four Value‐Based Healthcare Programmes

Por: Mayara S. Bianchim · Ellie Crane · Leah McLaughlin · Carys Stringer · Gareth Roberts · Adele Cahill · Jane Noyes — Julio 28th 2025 at 09:00

ABSTRACT

Aim

To investigate what works when using Patient-Reported Outcome Measures (PROMs), for whom, in what contexts, and why in four Value-Based Healthcare (VBHC) programmes.

Design

Realist evaluation.

Methods

Evaluation of Heart Failure, Parkinson's Disease, Epilepsy and Cataract surgery programmes using data from a scoping review, documentary analysis, questionnaires, quantitative routinely collected data and semi-structured interviews with staff, patients and carers (July 2022–August 2023). Programme theories and logic models were developed, tested and refined.

Results

We conducted 105 interviews (67 patients, 21 carers and 17 staff) and collected data from 230 patients (66 Epilepsy, 140 Heart Failure and 24 Parkinson's Disease) and 14 staff via questionnaires. Clinicians used PROMs data to regularly monitor patients with Heart Failure and Epilepsy, which resulted in better triage and tailoring treatment, prioritisation of access based on the urgency of need, and facilitation of referral to relevant professionals. In Heart Failure, this further resulted in a more efficient provision of care and better use of resources, care closer to home, improved health outcomes (e.g., better symptom management) and service redesign. The same was not observed in Epilepsy, as patients who required mental health treatment had to be referred, but they were not always able to access specialist services. PROMs were discontinued in Cataract surgery services mainly due to the lack of integrated IT systems, which caused an increased workload and staff resistance. In Parkinson's Disease, patients were asked to complete PROMs even though the information was not consistently being used.

Conclusions

Findings challenge the orthodoxy that implementing PROMs is universally good and brings about real improvements in patient outcomes in a VBHC context. PROMs are generally ill-suited for long-term use with patients in routine care without further adaptation. Greater staff and patient involvement are imperative to enhance the acceptability and relevance of the programmes.

Implications for the Profession and/or Patient Care

Patient-Reported Outcome Measures can improve care when embedded in well-supported systems. Implementation must be realistic, involve staff and patients, and be underpinned by clear leadership and robust digital infrastructure. Co-designed patient-facing tools can improve accessibility and engagement.

Impact

What problem did the study address? There is limited evidence on how Patient-Reported Outcome Measures function across different routine healthcare contexts. What were the main findings? Patient-Reported Outcome Measures improved care in Heart Failure but not in other services, largely due to contextual barriers. Where and on whom will the research have an impact? Findings are relevant for clinicians, service designers, and policymakers seeking to implement meaningful person-centred outcome measurement in long-term conditions.

Reporting Method

We adhered to Realist and Meta-narrative Evidence Syntheses: Evolving Standards II guidance and to the Guidance for Reporting Involvement of Patients and the Public.

Patient or Public Contribution

The study was developed alongside a wide range of patient and public stakeholders involved in the Aneurin Bevan University Health Board Value-Based Healthcare programme, third sector and specific individuals and groups representing the four included services (i.e., St. David's Hospice Care, British Heart Foundation, Digital Communities Wales, Epilepsy Action, Digital Communities Wales, Parkinson's UK Cymru, Race Equality First, Aneurin Bevan Community Health Council, Value- Based Healthcare Patient Reference Group and Wales Council of the Blind). A total of 10 virtual meetings were strategically planned to address gaps, assist in the interpretation of findings, and ensure that outcomes were pertinent and accessible to the specific needs and circumstances of under-represented or vulnerable groups.

☐ ☆ ✇ Journal of Advanced Nursing

Person‐Centred Learning: Enabling Development of Clinical Competence in Nursing Students Following Initial Failure During Clinical Education—A Grounded Theory Study

ABSTRACT

Aim

To explore the learning processes and prerequisites for nursing students to develop and achieve passing clinical competence, following an initial failing grade in their clinical education.

Design

A constructivist grounded theory study was employed.

Methods

Data were collected between January 2022 and June 2024 through individual interviews with seven undergraduate nursing students retaking their clinical education in the final semester at a university in Sweden. In addition, individual interviews were conducted with four teachers in higher education and two focus group discussions, one with four teachers in higher education and another with a clinical teacher and a supervisor. The data analysis was conducted using an iterative process of constant comparison of data in different phases.

Results

The analysis resulted in a theoretical model of person-centred learning which illustrates nursing students' learning processes and the prerequisites for them to develop and achieve clinical competence in clinical education. The model's core learning processes involve tailoring clinical education to students' needs: acknowledging one's own learning needs, receiving supervision which addresses their specific needs and having an educational institution which meets these needs are the three main learning processes that define student development. Students' acknowledgement of their personal learning needs itself entails three learning processes: trusting one's own knowledge, reflecting on and applying the nursing process, and reflecting on one's own learning. For students to progress in the learning process, prerequisites related to supervision and an educational institution meeting the students' needs must be in place.

Conclusion

The study provides evidence for a person-centred model which promotes nursing students' learning and development of clinical competence during clinical practice at the end of their nursing education.

Implications for the Profession

This model can provide support to coordinators and supervisors in nursing education with regard to planning and implementing clinical education.

Impact

This grounded theory study provides a theoretical model for nursing students' learning and development of clinical competence during their clinical education in their final year of nursing education. A person-centred learning approach in clinical education can provide learning prerequisites for students to successfully achieve learning objectives and develop safe competences for the profession. The findings of the study can offer valuable support and direction to nursing students, educators, and clinical practice supervisors in the planning and implementation of clinical education.

Reporting Method

The study adhered to the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist and the Guideline for Reporting and Evaluating Grounded Theory Research Studies (GUREGT).

No Patient or Public Involvement

This study did not include patient or public involvement.

☐ ☆ ✇ Worldviews on Evidence-Based Nursing

Development of Core Health Indicators and Integrated Health Assessment Toolkit for Older Adults With Dementia

Por: Hsiao‐Ting Tung · Kuei‐Min Chen · Frank Belcastro — Julio 10th 2025 at 05:48

ABSTRACT

Background

The interaction between dementia and changes in health status accelerates the progression of dementia and health deterioration. Although health indicators exist for older adults, comprehensive ones for dementia are lacking.

Objective

To (1) establish core health indicators for older adults with dementia, (2) develop an integrated health assessment toolkit for older adults with dementia, and (3) test the feasibility and applicability of the integrated health assessment toolkit.

Methods

This study involved two phases. In the first phase, using the Delphi method, opinions from 10 experts were synthesized to establish core health indicators for older adults with dementia. In the second phase, with a descriptive research approach, an integrated health assessment toolkit was developed, evaluated by 10 daycare case managers for feasibility, and then pilot tested with 50 older adults with dementia across three daycare centers.

Results

The core health indicators for older adults with dementia covered 18 indicators in five domains: (1) cognitive and behavioral impairment, (2) sensory and perceptual impairment, (3) disease and dysfunction, (4) functional fitness deterioration, and (5) social isolation. After two rounds of assessments, experts rated the criteria's importance and clarity at 0.94 and 0.89 on the scale-level content validity index/universal agreement (S-CVI/UA), respectively. In the second phase, the integrated health assessment toolkit was developed, which integrated five observational assessment scales and six physical function measures. The average applicability scores ranged from 7.80 to 9.90 out of 10. In the pilot test, the assessment process proceeded smoothly without any adverse events. However, 10 participants did not comply with wearing the actigraphy device.

Linking Action to Evidence

The core health indicators and the corresponding health assessment toolkit are feasible to assess the health of older adults with dementia that could provide valuable insights and guide future interventions to enhance their well-being.

☐ ☆ ✇ Journal of Nursing Scholarship

Nursing Care in Hospital Settings for Victims of Mental Disorders: Systematic Review With Meta‐Aggregation

ABSTRACT

Introduction

Approximately 25% of the Brazilian population suffers from mental disorders, a prevalence exacerbated by systemic and cultural factors such as socioeconomic inequalities, underfunded mental health services, regional disparities, and persistent stigma. These conditions significantly impact hospital care. Nurses, due to their direct contact with these patients, face challenges ranging from managing physical conditions to handling verbal aggression and psychiatric crises. This study aimed to assess the scientific evidence regarding nursing care for hospitalized patients with psychiatric disorders.

Methods

A systematic review with a mixed-methods approach was conducted, registered in PROSPERO (#CRD42022359288) and guided by PRISMA standards. Databases, such as MEDLINE, LILACS, PubMed, Web of Science, Scopus, and BDEnf, were searched using keywords like “Mental disorder,” “Psychiatric health,” “Nursing care,” and “Hospital.” Methodological quality was assessed using JBI and SQUIRE tools. The integration of quantitative and qualitative components occurred through meta-aggregation of qualitative data and frequency-based coding of quantitative themes, allowing thematic convergence across study designs.

Results

Six studies were included. Meta-aggregation revealed frequent terms, such as “Nurse,” “Emergency,” “Screening,” “Patient,” and “Care.” Similarity analysis linked “Nurse” with “perception” and “experience” and “Emergency” with “Screening” and “Mental health,” highlighting the importance of experience and training. Five categories emerged: (1) professional experience (19.05%, showing skill gaps despite experience); (2) caring process (19.05%, stressing efficient screening); (3) barriers and challenges (19.05%, revealing difficulty with comorbidities); (4) training process (19.05%, identifying training deficiencies); and (5) therapeutic interventions (23.81%, discussing restraint use). These percentages refer to the proportional frequency of themes identified across the total number of studies analyzed. For thematic classification, only statistically significant chi-square values (p < 0.05) were considered in the grouping of content.

Conclusion

Nursing care for psychiatric patients in hospitals faces challenges like insufficient training and difficulty managing psychiatric comorbidities. Recommendations include incorporating structured mental health content into nursing curricula and hospital-based continuing education programs. These strategies may guide future healthcare policies in Brazil by improving patient safety, reducing hospital readmissions, and promoting more humane, evidence-based therapeutic interventions.

Clinical Relevance

The findings emphasize the urgent need for targeted education and training to improve nursing care for psychiatric patients in hospital settings.

☐ ☆ ✇ Journal of Clinical Nursing

Patient Reported Experiences of Receiving Person‐Centred, Nurse‐Led Follow‐Up After Revascularisation for Intermittent Claudication: Secondary Analysis of a Randomised Controlled Trial

ABSTRACT

Aim

To evaluate the quality of care from the patients' perspective after receiving either person-centred, nurse-led follow-up or standard care after surgical treatment of intermittent claudication.

Design

Secondary analysis of a randomised controlled trial.

Methods

Patients at two centres for vascular surgery in Stockholm, Sweden were randomised to either a person-centred, nurse-led follow-up programme (intervention group) or a standard follow-up programme with surgeons. During their visits at 4 to 8 weeks and 1 year after surgery, they received the questionnaire Quality from patients' perspective with 28 items. The patients responded to each item from two aspects: (1) how they perceived the quality of received care and (2) subjective importance (how important the care was for them).

Results

A total of 104 of 138 patients at 4–8 weeks and 159 of 193 patients at 1 year after surgery completed the questionnaire. At 4–8 weeks, the intervention group scored significantly higher perceived quality of care regarding five items: receiving useful information about “How I should take care of myself” and “Which nurse were responsible for my care”, “Nurses were respectful towards me”, “Nurses showed commitment/cared about me” and “Easy to get in contact with the clinic through telephone”. At 1 year, the intervention group scored higher regarding two items: “Which nurses were responsible for my care” and “Next of kin treated well”.

Conclusion

Person-centred, nurse-led follow-up as implemented in this study has been shown to lead to a higher perception of quality of care regarding information about self-care, the experience of being respected, and knowing the care provider responsible for their care. Thus, it could contribute towards improved patient satisfaction without compromising the perception of quality of care regarding other factors such as receiving the best medical care or timeliness.

Implications for the Profession and/or Patient Care

This study addresses how patients with intermittent claudication, who underwent revascularisation, perceive a follow-up care that is person-centred and nurse-led compared to standard care delivered by surgeons. The results indicate that patients find the person-centred and nurse-led follow-up programme satisfactory, with equal or higher quality of care and that follow-up can be delivered by nurses with retained patient safety. Thus, vascular units may consider transitioning follow-up care from surgeons to nurses while maintaining positive patient's perception of quality of care, patient satisfaction and safety.

Reporting Method

Reporting of the work was made using the Consolidated Standards of Reporting Trials (CONSORT) statement.

Patient or Public Contribution

No patient or public contribution.

Trial Registration

Study Details | Person-centred Follow-up and Health Promotion Programme After Revascularization for Intermittent Claudication | ClinicalTrials.gov: NCT03283358

☐ ☆ ✇ Worldviews on Evidence-Based Nursing

Online and In‐Person Mindfulness‐Based Stress Reduction (MBSR) Improves Stress Resilience in Nursing Education

Por: Rebecca A. Schwartz‐Mette · Maile Sapp · Kelley Strout — Mayo 12th 2025 at 05:34

ABSTRACT

Background

Evidence-based interventions (EBI) can reduce nursing burnout and improve retention and healthcare quality. Nursing school is an ideal time to implement EBI to mitigate burnout and increase resilience in pre-professional populations.

Aim

The current study tested whether Mindfulness-Based Stress Reduction (MBSR) significantly improved stress, burnout, and wellness in a university-based nursing school.

Methods

Using a non-randomized clinical trial design, multilevel modeling for repeated measures tested intervention effects over time in MBSR participants (n = 73) and matched controls (n = 73), as well as potential moderation of intervention effects by modality (online vs. in-person MBSR) and subpopulation (students vs. faculty/staff).

Results

MBSR effectively reduced perceived stress, exhaustion, and total burnout and increased positive affect and frequency of using two key mindfulness skills: observing and nonreactivity. No significant effects of the intervention were observed for disengagement from work, satisfaction with life, negative affect, or the mindfulness skills of describing, acting with awareness, and nonjudgment. Effects were similar across modality and subpopulation.

Linking Evidence to Action

MBSR increases stress resilience and can be delivered effectively online and in person. Moreover, MBSR appears equally impactful for nursing students and faculty/staff. Implications for integrating EBI into schools of nursing to improve well-being are discussed.

☐ ☆ ✇ Worldviews on Evidence-Based Nursing

An Evidence‐Based Safe Sleep Program Is Associated With Less Infant Sleep‐Related Deaths

ABSTRACT

Background

Sudden unexpected infant death (SUID) is a leading cause of infant mortality in the United States. Hospitals have implemented infant safe sleep programs with varying measures and degrees of success, but few have demonstrated improvements in hospital-based and home safe sleep practices with nurse subject matter experts (SMEs) and community SUID prevention campaigns.

Aims

This project evaluated the impact of a state-wide, evidence-based infant safe sleep program for birthing hospitals using nurse SMEs and a community awareness campaign on nurse knowledge, safe sleep environments, and trends in infant sleep-related deaths.

Methods

Between 2016 and 2021, a pre- and post-test quality improvement intervention-based design was used to enroll hospitals and train and embed SMEs to educate peers, conduct practice surveillance and audits, and address practice deviations. A website housed comprehensive resources, and a large-scale community-based social and print media campaign on safe sleep practices occurred. Nurse and practice data from 12 hospitals that fully implemented the program were compared pre- and post-implementation. State-wide survey data for key safe sleep indicators reported by parents were compared from our 12 birthing hospitals to other facilities.

Results

Of trained nurses (N = 902), 83.4% reported making substantial or exceptional progress in being proactive in surveillance of safe sleep environments. Pre- and post-implementation environmental audits showed a significantly higher proportion of infants in safe sleep positions post-implementation (94.3%) than pre-implementation (89.6%) (p = 0.001). Statewide survey data from birth parents discharged from our program hospitals significantly outperformed those discharged from other state facilities. Multi-media campaigns resulted in over 1.4 million impressions on our website. Sleep-related deaths for infants born at four program hospitals dropped 16.1% from 31 in 2018 to 26 in 2021.

Linking Evidence to Action

A safe sleep program improved hospital-based nurses' knowledge and practice and birth parent's knowledge and behaviors, and it was associated with a decrease in infant sleep-related deaths.

☐ ☆ ✇ Journal of Clinical Nursing

Segregation and Recycling in the Operating Room. An Intervention to Accelerate the Decarbonisation Process in the Health Sector

ABSTRACT

Aim

To evaluate the impact of a multilevel intervention in a surgical department on the segregation of non-hazardous healthcare waste (plastic and paper) during the perioperative period as well as its effect on the carbon footprint of the healthcare organisation.

Methods

A prospective before–after interventional study without a control group was carried out in the operating room of the Universitary Hospital Mútua Terrassa in Catalonia (Spain). A multilevel programme to improve the segregation process during the surgical interventions was implemented in several phases from May 2023 to December 2024. Data collection was conducted in each phase of the study through questionnaires addressed to the professionals along with calculations of the carbon footprint and the volume of waste segregation. The study is framed within the socio-ecological model and employs a collaborative design. The study population included all professionals working in the operating room (n = 320).

Results

A multidisciplinary team was formed with consideration for all stakeholders. The project phases were implemented consecutively. A total of 141 professionals (44.4%) completed the baseline questionnaire. As a result of the project's development, the carbon footprint has been reduced to 79.1 kg CO2 eq/week, representing an 85% reduction in emissions.

Conclusion

The implementation of the recycling project has led to significant reductions in the amount of waste generated and it has been positively evaluated by the professionals.

The benefits of fostering a behavioural change among the professionals, coupled with the implementation of a well-designed segregation and recycling system, lead to significant benefits for the institution in carbon footprint.

Implications for the Profession and/or Patient Care

Nurses can lead this type of project with a clear impact on both the institution and the environment.

Impact

Reduction of the carbon footprint in the operating room increased satisfaction among professionals for contributing to environmental improvement.

Reporting Method

The reporting of intervention evaluation studies using nonrandomized designs: the TREND statement Des Jarlais et al. (2004) was used to evaluate the quality of the study.

Patient or Public Contribution

N/A. Only professionals are involved in this study.

☐ ☆ ✇ Journal of Clinical Nursing

The Central Role of Learning in Preventing Foot Complications in Persons With Diabetes: A Scoping Review

Por: Kristofer Björk · Susanne Andersson · Ulla Hellstrand Tang · Henrik Eriksson — Febrero 26th 2025 at 06:19

ABSTRACT

Background

Despite a variety of literature reviews, there is limited understanding of the learning strategies healthcare professionals use to help patients adopt and maintain effective foot care practices.

Aim

To explore learning processes and educational strategies for persons with diabetes focusing on foot care and examine how different learning processes influence these strategies.

Method

The scoping review followed the methodological framework established by Arksey and O'Malley and refined by Levac et al. Additionally, the PRISMA-ScR checklist was followed. A literature search was conducted in the PubMed, CINAHL, MEDLINE and Academic Search Premier databases, using specific search terms related to diabetic foot care and learning strategies. The selection process involved screening 906 articles based on inclusion criteria such as relevance to diabetic foot care, learning processes, and educational strategies, and excluded studies that were not written in English. The data were charted and quantitative and qualitative data were synthesised and thematically analysed to identify key learning strategies.

Results

The analysis identified two main themes: learning insights for comprehensive understanding and self-efficacy, and increased practical knowledge leads to improved footcare. Subthemes included integrative and reflective learning, motivational and collaborative learning, task-oriented and procedural learning, and feedback and reinforcement-based learning.

Conclusion

Effective diabetic foot care education should be multifaceted, incorporating deep learning, practical skills, and motivational elements. Early learning plays a central role in this process. Tailoring educational interventions to personal learning styles and providing continuous support can significantly improve patients' foot care outcomes. A framework for understanding the progressive stages of patient learning and self-management is presented as a starting point. Future research should focus on developing and evaluating educational models that address diverse learning needs, ultimately contributing to better management and prevention of diabetic foot complications.

☐ ☆ ✇ Journal of Advanced Nursing

Reasons for (Not) Seeking Care for Fatigue and Care Needs Among Patients With Inflammatory Bowel Disease: A Qualitative Interview Study

Por: Quirine M. Bredero · Milou M. Ter Avest · Gerard Dijkstra · Joke Fleer · Maya J. Schroevers — Febrero 25th 2025 at 11:39

ABSTRACT

Aims

To explore reasons why patients with inflammatory bowel disease (IBD) do (not) engage in fatigue-related care and their care needs.

Design

A qualitative interview study, using a phenomenological methodological approach.

Methods

We included 16 fatigued patients with IBD in remission. Data were collected between December 2021 and March 2022, using semi-structured interviews. Template analysis was performed.

Results

We identified six themes regarding reasons why (not) to seek care for fatigue: (1) Cognitions about fatigue and coping with fatigue, (2) perceptions of fatigue-related care and previous care experiences, (3) perceived knowledge and behaviour of healthcare professionals, (4) physical and emotional well-being, (5) social relationships and support, and (6) practical factors. Regarding their care needs, patients reported a need for a holistic and person-centred care approach, with healthcare professionals actively addressing fatigue and offering care. They suggested a range of options for what care to offer, including eliminating physical causes of fatigue, discussing medication options, providing information on fatigue management, lifestyle support, psychological support, peer support and practical support.

Conclusion

Both patient- and healthcare-related factors play a role in why IBD patients do (not) seek fatigue-related care. Our findings emphasise the importance of active screening and discussion of fatigue, using a holistic and person-centred approach to treat fatigue.

Implications

This study contributes to the understanding of IBD patients' facilitators and barriers for seeking care for fatigue and their care needs. Moreover, results can inform nurses and physicians about ways to optimise the offer and uptake of fatigue-related care, and the development of interventions that fit patients' needs. Results also provide implications for the treatment of fatigue in other chronic (inflammatory) conditions.

Impact

The current results can inform nurses and physicians about ways to optimise the offer and uptake of fatigue-related care, and the development of interventions that fit the needs of patients with IBD. An increase in the uptake of effective and acceptable interventions can improve patients' health and well-being.

Reporting Method

Findings were reported following the consolidated criteria for reporting qualitative research (COREQ).

Patient or Public Contribution

No patients, service users or members of the public were involved in this study. The study focused on patients' experiences with fatigue-related care and their needs.

☐ ☆ ✇ Journal of Clinical Nursing

Meeting Parents' Health Literacy Needs—Designing and Feasibility Testing of a Three‐Step Intervention in the Childhood Epilepsy Context

Por: Merete K. Tschamper · Astrid K. Wahl · Rita Jakobsen · Marie H. Larsen — Enero 28th 2025 at 09:05

ABSTRACT

Aims

(1) To codesign a health literacy intervention within a specialist healthcare setting to help the parents of children with epilepsy access, comprehend, use and communicate information and (2) to assess the intervention's feasibility by exploring stakeholders' perspectives on its usefulness, ease of use of trial methods and contextual factors impacting its execution.

Design

A codesign participatory approach followed by a feasibility approach inspired by the OPtimising HEalth LIteracy and Access to Health Services (Ophelia) process for health literacy intervention development.

Methods

(1) The codesign approach included workshops with (a) multidisciplinary personnel (n = 9) and (b) parents (n = 12), along with (c) an interview with one regional epilepsy specialist nurse (n = 1). The participants discussed parents' health literacy needs on the basis of vignettes and brainstormed service improvements. A three-step intervention was subsequently designed. (2) The intervention's feasibility was assessed via interviews with six parents (n = 6), a focus group interview with study nurses, a short doctors survey and a log of time spent testing the intervention.

Results

(1) The parents of first-time admitted children to a specialist epilepsy hospital were targeted for the intervention. Nurse–parent consultations were central to the intervention, activating parents in codeveloping and executing a tailored education plan. (2) Feasibility: parents (n = 6) experienced consultations and education plans that were beneficial for enhancing their self-efficacy in managing the child's condition. The study nurses (n = 3) acknowledged positive outcomes in streamlining patient education but felt that their training on the intervention methods was insufficient. Both parents and nurses identified limited personnel resources as a significant barrier to executing the intervention.

Conclusion

The codesigned intervention engaged nurses and parents in HL development despite system barriers. The parents experience enhanced self-efficacy in managing their child's condition. However, needs refinements and further feasibility tests are needed before future implementation.

Reporting Method

The Consort Statement 2010 extension for reporting non-randomised pilot and feasibility studies was used to ensure the methodological quality of the study. A Consort Statement 2010 checklist is provided as an additional file.

Patient or Public Contribution

The collaboration of parents within the target group, the providers involved and the project's steering committee was crucial in codesigning and evaluating this three-step intervention. Parents and multidisciplinary providers actively contributed through workshops, interviews and in discussion meetings. The study nurses testing the intervention played a key role in defining the documentation process for the codeveloped education plan.

Implications for Professional Care

This three-step health literacy intervention can positively impact parents' self-efficacy in managing their child's condition. Enhancing nurses' communication skills is essential for improving parents' health literacy, making it crucial to allocate resources for such training. The intervention content and strategies to meet parents' health literacy needs require refinement, with more provider involvement to better adapt it to the context. Future studies should focus on further feasibility testing by considering a more flexible time frame.

Trial Registration

Open Science Framework: https://osf.io/fg9c7/

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