Conectar
Childhood cancer survivors (CCSs) experience educational disruptions during and following treatment, yet robust, longitudinal evidence on educational performance remains limited. We will investigate differences in educational outcomes between CCSs and non-cancer peers during primary and secondary school. We will also explore how sociodemographic factors and age at diagnosis contribute to potential differences in General Certificate of Secondary Education (GCSE) examinations, a critical indicator of future academic and employment prospects.
We will use the Education and Child Health Insights from Linked Data (ECHILD) to capture linked health and education data for children born in National Health Service (NHS)-funded hospitals in England. We will generate birth cohorts spanning September 1997 to August 2015 (estimated sample size: ~10 million), formed of pupils expected to have undertaken national curriculum assessments between academic years 2004/2005 and 2021/2022 including Key Stage (KS) 1, 2 and 4, corresponding to ages 7, 11 and 16 respectively. Cancer diagnosis will be identified from inpatient hospital records, using International Classification of Diseases, 10th Revision codes (ICD-10). We will investigate differences between CCS and their non-cancer peers in terms of their sociodemographic characteristics and describe trends in educational performances at all KSs, recorded Special Educational Needs and Disabilities (SEND) and school absences. Differences in KS4 (GCSE) performances between CCS and non-cancer peers will be quantified, according to and accounting for geographic region, sex, deprivation, ethnicity and birth characteristics. To assess whether cancer diagnosis disrupts academic trajectories, we will restrict analysis to those with KS2 attainment data and investigate KS4 performance. We will finally explore the influence of age at diagnosis on educational performance at KS4.
Ethics approval was granted by NHS Health Research Authority Research Ethics Committee (20/EE/0180). Findings will be shared with academics, policymakers, children and families affected by childhood cancer, and published in journals. Code/metadata will be shared on ECHILD GitHub repository.
The aim of this integrative review is to critically appraise and synthesise empirical evidence on the clinical applications, outcomes, and implications of generative artificial intelligence in nursing practice.
Integrative review following Whittemore and Knafl's five-stage framework.
Systematic searches were performed for peer-reviewed articles and book chapters published between 1 January 2018 and 30 June 2025. Two reviewers independently screened titles/abstracts and full texts against predefined inclusion/exclusion criteria focused on generative artificial intelligence tools embedded in nursing clinical workflow (excluding nursing education-only applications). Data were extracted into a standardised matrix and appraised for quality using design-appropriate checklists. Guided by Whittemore and Knafl's integrative review framework, a constant comparative analysis was applied to derive the main themes and subthemes.
CINAHL, MEDLINE, and Embase.
Included literature was a representative mix of single-group quality improvement pilots, mixed-method usability and feasibility studies, randomised controlled trials, qualitative descriptive and phenomenological studies, as well as preliminary and proof-of-concept observational research. Four overarching themes emerged: (1) Workflow Integration and Efficiency, (2) AI-Augmented Clinical Reasoning, (3) Patient-Facing Communication and Education, and (4) Role Boundaries, Ethics and Trust.
Generative artificial intelligence holds promise for enhancing nursing efficiency, supporting clinical decision making, and extending patient communication. However, consistent human validation, ethical boundary setting, and more rigorous, longitudinal outcome and equity evaluations are essential before widespread clinical adoption.
Although generative artificial intelligence could reduce nurses' documentation workload and routine decision-making burden, these gains cannot be assumed. Safe and effective integration will require rigorous nurse training, robust governance, transparent labelling of AI-generated content, and ongoing evaluation of both clinical outcomes and equity impacts. Without these safeguards, generative artificial intelligence risks introducing new errors and undermining patient safety and trust.
PRISMA 2020.
To examine residential aged care staff's experience of death and grief, and their support needs.
A mixed-methods sequential explanatory design, using an online cross-sectional survey that included the Texas Revised Inventory of Grief and the Grief Support in Health Care Scale. Followed by semi-structured interviews with direct care workers and managers working in residential aged care homes were conducted.
Over 60% of participants experienced five or more resident deaths in the previous 12 months. Although, different levels of grief were experienced among different roles, the importance of open communication and opportunities for farewells after resident death was highlighted. Participants suggested support and education to normalise grief and promote self-care.
Recognising staff grief following the resident death is important. Providing support and education may help improve staff wellbeing and contribute to the delivery of high-quality care for both residents and their families.
Staff grief after a resident death needs to be recognised, and continuing education and support are required for their wellbeing.
The STROBE and SRQR checklists were applied.
No Patient or Public contribution.
by Stefan Saverimuttu, Kate McInnes, Kristin Warren, Lian Yeap, Stuart Hunter, Brett Gartrell, An Pas, James Chatterton, Bethany Jackson
The ability to efficiently derive insights from wildlife necropsy data is essential for advancing conservation and One Health objectives, yet close reading remains the mainstay of knowledge retrieval from ubiquitous free-text clinical data. This time-consuming process poses a barrier to the efficient utilisation of such valuable resources. This study evaluates part of a bespoke text-mining application, DEE (Describe, Explore, Examine), designed for extracting insights from free-text necropsy reports housed in Aotearoa New Zealand’s Wildbase Pathology Register. A pilot test involving nine veterinary professionals assessed DEE’s ability to quantify the occurrence of four clinicopathologic findings (external oiling, trauma, diphtheritic stomatitis, and starvation) across two species datasets by comparison to manual review. Performance metrics—recall, precision, and F1-score—were calculated and analysed alongside tester-driven misclassification patterns. Findings reveal that while DEE (and the principals underlying its function) offers time-efficient data retrieval, its performance is influenced by search term selection and the breadth of vocabulary which may describe a clinicopathologic finding. Those findings characterized by limited terminological variance, such as external oiling, yielded the highest performance scores and the most consistency across application testers. Mean F1-scores across all tested findings and application testers was 0.63–0.93. Results highlight the utility and limitations of term-based text-mining approaches and suggests that enhancements to automatically capture this terminological variance may be necessary for broader implementation. This pilot study highlights the potential of relatively simple, rule-based text-mining approaches to derive insights natural language wildlife data in the support of One Health goals.Artificial intelligence (AI)-based clinical decision support systems (CDSSs) are currently being developed to aid prescribing in primary care. There is a lack of research on how these systems will be perceived and used by healthcare professionals and subsequently on how to optimise the implementation process of AI-based CDSSs (AICDSSs).
To explore healthcare professionals’ perspectives on the use of an AICDSS for prescribing in co-existing multiple long-term conditions (MLTC), and the relevance to shared decision making (SDM).
Qualitative study using template analysis of semistructured interviews, based on a case vignette and a mock-up of an AICDSS.
Healthcare professionals prescribing for patients working in the English National Health Service (NHS) primary care in the West Midlands region.
A purposive sample of general practitioners/resident doctors (10), nurse prescribers (3) and prescribing pharmacists (2) working in the English NHS primary care.
The proposed tool generated interest among the participants. Findings included the perception of the tool as user friendly and as a valuable complement to existing clinical guidelines, particularly in a patient population with multiple long-term conditions and polypharmacy, where existing guidelines may be inadequate. Concerns were raised about integration into existing clinical documentation systems, medicolegal aspects, how to interpret findings that were inconsistent with clinical guidelines, and the impact on patient-prescriber relationships. Views differed on whether the tool would aid SDM.
AICDSSs such as the OPTIMAL tool hold potential for optimising pharmaceutical treatment in patients with MLTC. However, specific issues related to the tool need to be addressed and careful implementation into the existing clinical practice is necessary to realise the potential benefits.
To map the extent of the use of the term ‘planetary health’ in peer-reviewed nursing literature.
Scoping Review.
CINAHL, ProQuest Nursing & Allied Health Premium, MEDLINE, APA PsycINFO, ProQuest Dissertations & Theses and Web of Science were searched in January and February 2024 for English and French-language publications. A follow-up search was conducted on 10 June 2024 to determine if additional literature was published.
A scoping review was conducted using the Arksey and O'Malley methodology for scoping reviews. To be included the article had to explicitly use the term ‘planetary health’ and ‘nursing’ or ‘nurses’.
Sixty-eight articles met the criteria for the scoping review and were included in this review, with the majority published between 2017 and 2024. Predominant literature included discussion papers, commentaries and editorials. A lack of original research is apparent. Most of the publications were calls to action for nurses to advance planetary health in nursing education, practice, research and advocacy work.
Literature confirms that planetary health is a recent and an important topic in nursing, and nurses have a well-documented role to play in planetary health, given the numerous calls to action in nursing leadership, education, practice and research. There is a need to publish the essential work nurses are doing in planetary health in various nursing domains.
This scoping review revealed a clear and urgent call to action for nurses to address planetary health. Given this finding, nurses have a responsibility to advocate for a planetary health approach in the profession and take action to contribute to planetary health through education, research, practice and advocacy.
Not applicable, as no patients or public were involved.
by Jack Jefferson, Claire Reigate, Alessandra Giacomini, M. Jordana Rivero, Matthew Hitchings, Tamsyn Uren Webster, Konstans Wells
Livestock grazing in confined pastures often means grazing on a less diverse diet than under more natural conditions and increased exposure to gastrointestinal parasites prevailing in these pastures. However, how sward composition influences gut microbiome (GM) diversity and its relationship with parasite burden remains poorly understood. In this study, we analysed the faecal GM of weaned lambs grazing on two distinct sward types (perennial ryegrass and a mixed-species sward) over three consecutive months using 16S rRNA sequencing, in order to assess how microbial diversity and composition are related to environmental conditions and the gastrointestinal nematode (GIN) burden in naturally infected lambs. Sward type and sampling time explained some of the variation in GM alpha diversity and community composition (beta diversity), whereas individual lamb identity accounted for considerably more variation in microbial assemblages. Shifts in the relative abundance of bacterial genera such as Saccharofermentans, Anaerosporobacter, Butyrivibrio in relation to sward type and sampling time suggest mostly adaptive fluctuations in response to diet and pasture condition. Abundance shifts of Negativibacillus, and Candidatus Saccharimonas were also associated with GIN burden, which, in turn, was higher in lambs grazing on mixed swards compared to ryegrass. Our findings add to the growing understanding of how sheep microbiomes vary with pasture management and changes in parasite burden. We highlight that individual identity may shape gut microbiota, and that potential triadic interactions among gastrointestinal parasites, sward exposure, and the gut microbiome underscore the importance of considering host, parasite, and environmental factors collectively when evaluating microbiome dynamics in grazing livestock.by Jack Le Vance, Alexandra Emms, Victoria Hodgetts Morton, R. Katie Morris, Leo Gurney
High-risk pregnancies undergo regular antenatal monitoring, including cardiotocography (CTG) and ultrasound. Recently there has been an emergence of sophisticated remote telehealth interventions, potentially enabling care to be shifted into the home setting. Our aim was to evaluate the feasibility and acceptability of home CTG and home ultrasound monitoring for high-risk pregnancies. This was a single center study. Women aged ≥18 years, English speaking, singleton pregnancy, ≥ 32 weeks gestation and had at least one of four high-risk obstetric conditions were eligible. Participants were randomized to one of three groups: (1) home ultrasound; (2) home CTG; and (3) both, whilst continuing their routine antenatal care. The primary outcome was completion of 20 minutes of interpretable fetal heart recording and/or completion of an interpretable fetal ultrasound for each monitoring episode. Ultrasound interpretability was assessed for three validated criteria: fetal heartbeat, fetal movements and liquor volume assessment. Secondary outcomes included monitoring adherence, anxiety management, acceptability and safety. Fifteen participants, within three groups, completed 24 remote ultrasounds and 59 remote CTGs. Overall, the fetal heartbeat, movements and an assessment of the liquor volume were identified in 92%, 83% and 100% of all ultrasound scans respectively. 79% of all scans had all three criteria unanimously assessed. Three-quarters of all CTGs contained at least 20 minutes of continuous interpretable computerized fetal heartrate recording. Neither ethnicity, parity, BMI nor fetal presentation were significant factors for achievement of the primary outcome for both devices. There was non-significant reduction in anxiety scores before and after device usage (p = 0.19). Participants’ monitoring adherence and acceptability ratings were high in all groups. No adverse maternal-fetal outcomes relating to device usage occurred. Home ultrasound and cardiotocography are potentially feasible and acceptable to high-risk pregnant women. Larger studies are required to refine how best to implement such devices into clinical practice. ClinicalTrials ID: NCT06366711.Retinal neurodegeneration has recently been shown to occur in tandem with neurodegenerative disease. In the expectation that disease-modifying treatments for Alzheimer’s disease (AD) and Parkinson’s disease (PD) will soon become available, it will be important to have clinically useful biomarkers for neurodegenerative disease subtyping to guide early diagnosis, inform on prognosis and stratify subgroups for treatment. Understanding differences in detectable retina changes in individuals with different neurodegenerative disease subtypes is therefore fundamental. The emerging field of oculomics posits that systemic and neurodegenerative disease can be characterised using detectable ocular biomarkers within retinal diagnostics. The aim of this review is to compare the performance of common retinal imaging modalities in neurodegenerative disease detection and subtyping.
This protocol has been reported in accordance with the PRISMA-P (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols) guidelines. A comprehensive literature search will be conducted in PubMed, Web of Science and Scopus. Eligible studies will have reported using retinal diagnostic tools defined as optical coherence tomography (OCT), OCT angiography (OCTA), colour fundus photography (CFP) and electroretinography (ERG) in individuals with neurodegenerative diseases, including AD, PD, dementia with Lewy bodies, frontotemporal dementia, vascular dementia and mild cognitive impairment. There will be no time restrictions placed in these searches. Studies not written in English, not peer-reviewed and grey literature will be excluded. Screening for eligible studies and data extraction will be conducted by two independent reviewers, using predefined inclusion criteria. Any disagreements between the reviewers will be settled by discussion, and if required, third senior reviewer arbitration. The systematic review primary outcome is the performance of retinal diagnostics, namely OCT, OCTA, CFP and ERG in the detection and subtyping of aforementioned neurodegenerative diseases. The secondary outcome is to evaluate the association between changes in retinal diagnostic features (eg, retinal layer thicknesses) and neurodegenerative disease subtypes. The quality of the included studies will be assessed using the GRADE (Grading of Recommendations Assessment, Development and Evaluations) tool. A narrative synthesis approach will be used to analyse the results, with meta-analysis performed if there is sufficient data.
Ethical approval for this manuscript is not required, as this is a protocol for a systematic review and therefore no data are to be collected. Findings for this systematic review will be disseminated as a peer-reviewed publication and presentations at national and international symposiums including International Lewy Body Dementia Conference, International Congress of Parkinson’s Disease and Movement Disorders, The Association for Research in Vision and Ophthalmology.
CRD42023434024.
To report organisational factors known to positively contribute to nurses' well-being in the workplace.
Integrative literature review.
Peer-reviewed journal articles using various methodological approaches, and theoretical works, published in English with a focus on organisational factors and nurses' well-being were included. Papers reporting on other healthcare professional groups and/or nursing students were excluded. Data were synthesised into an integrative review, with findings organised theoretically, according to the PERMA model (Positive emotions, Engagement, Relationships, Meaning, Accomplishment), otherwise known as The Well-being Model.
Relevant papers published between May 2020 and April 2025 were identified using CINAHL and PsycINFO electronic databases. Search date, April 24, 2025.
The review included 18 articles, mostly from Europe and the United States, examining workplace factors that contribute to the health and well-being of nurses. Mapping findings to the PERMA domains showed that organisational support and individual strategies together foster flourishing among nurses.
This review highlights both individual factors (such as self-care, strength use and adaptive coping) and organisational structures (including supportive environments, professional development and recognition) that are essential for nurses' well-being and flourishing. However, effective interventions require systemic change, with leadership and education playing key roles in supporting nurses to flourish in the workplace.
This review addressed the need to go beyond deficit models of nurses' well-being to pinpoint specific organisational factors that can help nurses to flourish. Prioritising nurse well-being is vital for high-quality, safe and sustainable healthcare systems. Investing in environments where nurses can flourish benefits both individuals and the broader healthcare system.
This integrative review was reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
This study did not include patient or public involvement in its design, conduct or reporting.
by Karyn Fu, Dylan B. Jackson, Alexander Testa
BackgroundAdverse childhood experiences (ACEs) have been linked to negative health outcomes and behaviors in adulthood. Despite widespread research on ACEs, their relationship with COVID-19 vaccination uptake, particularly heterogeneity across demographic groups, remains underexplored. This study examined the association between ACEs and COVID-19 vaccination status, with a focus on how this relationship varies by sex and urban-rural residence.
MethodsData were obtained from the 2022 Behavioral Risk Factor Surveillance System (BRFSS), including respondents who participated in the ACEs and COVID-19 vaccination optional state modules (N = 12,085 adults). COVID-19 vaccination status (yes/no) served as the dependent variable, while ACEs were categorized into four levels: 0, 1, 2–3, and 4 + ACEs. Multivariable logistic regression analyses, stratified by sex and urban-rural residence, were conducted to assess the association between ACEs and vaccination status.
ResultsAmong the sample, 76.2% reported receiving at least one dose of the COVID-19 vaccine. Multivariable analysis revealed no statistically significant association between ACEs and vaccination status for the full sample. Stratified analyses indicated that male respondents living in rural counties with 4 + ACEs had significantly lower odds of vaccination (adjusted odds ratio [aOR] = 0.57, 95% CI = 0.34–0.96). No significant associations were observed for other demographic groups (e.g., females in urban or rural areas; males in urban areas).
ConclusionsThe findings suggest that males in rural areas with high ACE exposure may be vulnerable to low COVID-19 vaccination uptake. Targeted trauma-informed public health interventions warrant consideration to address vaccination uptake among this population.
by Jackline Estomihi Mayende Kiwelu, Patrick Ngulube
BackgroundPostharvest losses caused by poor drying and storage practices lead to maize waste, reduced food availability, unsafe food due to aflatoxin contamination, and income loss for farmers. This exacerbates food insecurity and threatens the livelihoods of rural communities. Leveraging digital solutions to provide quality maize postharvest handling information is critical to mitigating these challenges.
ObjectiveThis study examined maize postharvest handling extension information services provided by rural agricultural extension officers in selected districts of Uganda, focusing on how evidence-based practices supported by information sources, expert knowledge, and ICT infrastructure ensure the quality and relevance of the information delivered.
MethodsA convergent parallel mixed-methods design was employed. Data were collected from 312 rural smallholder maize farmers, 22 extension officers, and four information officers. Qualitative data were analyzed thematically using ATLAS.ti version 24, quantitative data were analyzed in SPSS version 29 to generate descriptive statistics and conduct Pearson’s chi-square tests.
FindingsAgriculture extension officers applied digital evidence-based information practices to improve maize postharvest handling advisory services. The study reported that the most frequently used practices were asking (identifying farmers’ information needs), acquiring (gathering relevant information), appraising (evaluating information quality), and applying (guiding farmers’ decisions). Aggregation (organizing information for accessibility) and assessment (evaluating the effectiveness of applied information) were less practiced. The study suggests a significant relationship between evidence application and maize postharvest handling practices (p = 0.002). No significant relationship between asking farmers’ information needs and maize postharvest handling practices (p = 0.887). The study identified inadequate updated sources of information, insufficient skills in evidence-based practices, and information communication technologies.
ConclusionThis study suggests that decision-makers update the evidence source and develop continuous professional development (CPD) training programs for rural agricultural extension officers to equip them with knowledge and skills in maize postharvest handling, evidence-based information practices, and new developments in ICTs.
Transitions of care (TOC) between hospital, ambulatory and home settings for high-risk adults with chronic diseases are complex, costly and often result in poor health outcomes. Suboptimal care transitions lead to medication errors, non-adherence, decreased self-management skills and inadequate follow-up, all of which contribute to readmissions or emergency department visits. The Transitional Care Model aims to address these challenges through patient-centred, in-home interventions. We propose to implement and evaluate TELE-TOC: Telehealth Education Leveraging Electronic Transitions Of Care for Chronic Obstructive Pulmonary Disease (COPD) patients. This study will evaluate the added value of a virtual, pharmacy-based intervention integrated into an existing COPD TOC program within a single healthcare system.
Informed by the Proctor Framework implementation, service and health outcome domains, we will conduct a randomised controlled trial comparing the addition of at-home pharmacy team-based virtual visits to the standard of care (ie, our existing COPD TOC programme). Adult patients hospitalised for a COPD exacerbation will be randomised to receive the standard COPD TOC programme alone or the standard programme plus TELE-TOC virtual at-home pharmacy visits. We will use a pragmatic type II hybrid effectiveness-implementation trial. The primary effectiveness outcome is inhaler technique at 30 days postdischarge, and the primary implementation outcome is the proportion of patients receiving the intervention. Intention-to-treat analysis will be applied to all outcomes with ² and logistic regression models adjusting for demographic factors. Treatment effects through 30 days will be assessed with generalised estimating equations and generalised linear mixed models.
This study, the waiver of consent and the opt-out flyer were approved by the University of Chicago Institutional Review Board (23–0934). Dissemination of the findings is planned for up to 4 years of completion of the study to local, regional and national conferences and peer-reviewed journals.
To explore clinical nurses’ process of coping during COVID-19 and develop a grounded theory that can be used by leaders to support clinical nurses during a disaster.
The COVID-19 pandemic has provoked widespread disruption to clinical nurses’ work. It is important to understand clinical nurses’ processes of coping during disasters to support the nursing workforce during events such as global pandemics.
We employed the Corbin and Strauss variant of grounded theory methodology, informed by symbolic interactionism, and applied the EQUATOR guidelines for qualitative research publication (COREQ).
Data collection entailed semi-structured interviews with experienced clinical nurses (n =20) across diverse settings. We analysed data by identifying key points in the nurses’ coping processes inductively building concepts around these points.
The predictor of nurses’ outcomes in this grounded theory was their confidence in their ability to cope during the pandemic. When nurses lacked confidence, they experienced working in the context of acute COVID—a state of chaos and anxiety, with negative consequences for nurses. However, when nurses were confident in their abilities to cope with the pandemic, they experienced working in the context of chronic COVID, a calmer state of acceptance. There were many workplace factors that influenced nurses’ confidence, including adequacy of personal protective equipment, clear information and guidance, supportive leadership, teamwork and adequate staffing.
Understanding clinical nurses’ experience of coping during COVID-19 is essential to maintain the nursing workforce during similar disasters.
Nurse leaders can target areas that support nurses’ confidence, such as adequate PPE and staffing. In turn, increased confidence enables clinical nurses to cope during disasters such as a global pandemic.
To examine what was known about disaster preparedness in residential care and to consider this in the light of the current COVID-19 pandemic.
Care homes provide long-term care to vulnerable, frail older people, as well as to young people with profound disabilities. The COVID-19 pandemic has shown that the residential care sector has been seriously affected in many parts of the world and has exposed major flaws and vulnerabilities in infection control and other processes that have resulted in considerable loss of life of residents of these facilities.
Discursive paper informed by a systematic literature. Review was carried out in line with PRISMA reporting guidelines. The review protocol was registered with PROSPERO on 2020 [CRD42020211847].
The review identified six papers meeting inclusion criteria across care residential facilities in different countries. Several prevention and mitigation strategies were identified to manage and reduce the spread and severity of viral respiratory infection pandemics. These strategies include isolation, restriction of movement, personal protective and hygienic measures, health education and information sharing, monitoring and coordination, and screening and treatment. Preparedness strategies identified were contingency planning such as reporting/communication, leadership, human resource, insurance, occupational health and resource availability. The prevention/mitigation and preparedness strategies helped to achieve decline in disease severity, reduced prevalence, reduced spread of the disease, improved readiness criteria, resource usefulness and increased intervention acceptability. This paper presents a conceptual framework exploring the interconnectedness of preparedness and prevention/ mitigation strategies and associated outcomes. We discuss areas of concern in the context of workforce employment patterns in the sector. Concerns related to the unintended consequences of strategies placed on aged care facilities, which may worsen mental health outcomes for residents, are discussed.
Persons in residential care settings are at greater risk of infection during a pandemic, and therefore, strict measures to protect their safety are warranted. However, they are also a group who already experience social isolation and so any measures involving restrictions to visiting and social interaction, particularly over the longer term, must be accompanied by strategies to mitigate potential loneliness and mental health sequelae arising from long-term pandemic restrictions.
Though there was evidence of activity in preparedness for disasters within the residential care sector, various contextual factors affecting the sector were clearly not adequately considered or addressed in pre-pandemic disaster planning, particularly in the areas of staff movements between care homes and the length of time that social isolation and restriction measures would need to be in place. Future pandemic planning should consider the nature of the workforce model in the care home sector, and factor in strategies to better support the mobile and highly casualised workforce.
To highlight the need for the development of effective and realistic workforce strategies for critical care nurses, in both a steady state and pandemic.
In acute care settings, there is an inverse relationship between nurse staffing and iatrogenesis, including mortality. Despite this, there remains a lack of consensus on how to determine safe staffing levels. Intensive care units (ICU) provide highly specialised complex healthcare treatments. In developed countries, mortality rates in the ICU setting are high and significantly varied after adjustment for diagnosis. The variability has been attributed to systems, patient and provider issues including the workload of critical care nurses.
Discursive paper.
Nursing workforce is the single most influential mediating variable on ICU patient outcomes. Numerous systematic reviews have been undertaken in an effort to quantify the effect of critical care nurses on mortality and morbidity, invariably leading to the conclusion that the association is similar to that reported in acute care studies. This is a consequence of methodological limitations, inconsistent operational definitions and variability in endpoint measures. We evaluated the impact inadequate measurement has had on capturing relevant critical care data, and we argue for the need to develop effective and realistic ICU workforce measures.
COVID-19 has placed an unprecedented demand on providing health care in the ICU. Mortality associated with ICU admission has been startling during the pandemic. While ICU systems have largely remained static, the context in which care is provided is profoundly dynamic and the role and impact of the critical care nurse needs to be measured accordingly. Often, nurses are passive recipients of unplanned and under-resourced changes to workload, and this has been brought into stark visibility with the current COVID-19 situation. Unless critical care nurses are engaged in systems management, achieving consistently optimal ICU patient outcomes will remain elusive.
Objective measures commonly fail to capture the complexity of the critical care nurses’ role despite evidence to indicate that as workload increases so does risk of patient mortality, job stress and attrition. Critical care nurses must lead system change to develop and evaluate valid and reliable workforce measures.
FreshRSS 