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The study aims to understand the changing context of RACFs and the role of RACF managers in preparing to confront the COVID-19 pandemic and to provide insights into how the use of visual telehealth consultation might be incorporated to assist with managing whatever might arise.
An interpretive descriptive study design was employed, and data were collected using semi-structured interviews conducted via telephone or videoconference. Purposive recruitment targeted clinical managers responsible for the COVID-19 response in RACFs.
RACF clinical managers were invited to discuss their responses to COVID-19 including the management of RACF and staff. Semi-structured interviews explored the COVID-19-related challenges, the response to these challenges and how telehealth might assist in overcoming some of these challenges. This study followed Thorne's (2008) three-stage process of interpretive description. The COREQ checklist was used in preparing this manuscript.
Two main themes were identified. The first theme ‘keeping people safe’ was comprised of three subthemes; fear and uncertainty, managing the risks and retaining and recruiting staff. The second theme was ‘keeping people connected’, had two subthemes; being disconnected and isolated and embracing technology.
Findings from this study provide valuable insight into understanding the context and the challenges for RACFs and the staff as they attempt to keep residents safe and connected with healthcare providers and the outside world.
Understanding the experiences of RACF managers in preparing to respond to the pandemic will better inform practice development in aged care in particular the use of telehealth and safe practices during COVID-19. Increased awareness of the challenges faced by RACFs during a pandemic provides policymakers with valuable insights for future planning of pandemic responses.
To investigate clinicians' perspectives on the transition from hospital to home and identify gaps in care for older adults living with frailty during the transfer of care.
Qualitative reflexive thematic analysis of focus groups
Focus groups were conducted with clinicians using purposive sampling. Participants were eligible if they had provided or overseen the clinical care of a patient transferring from hospital to home. Verbatim transcripts were analysed, and themes were identified using NVivo through the development of codes and exploration of core commonalities.
A total of 28 clinicians participated in five focus groups. Participants included nurses (n = 14), allied health (n = 8), medical officers (n = 2), managers and hospital executives (n = 4). Themes were categorised into four domains: (1) system fragmentation and finite resources challenge healthcare navigation for everyone; (2) the interplay of cultural and societal considerations in the context of ageing; (3) fragile cycle of care for older patients who frequent hospitalisation; and (4) effective communication and expertise being critical for quality care.
Despite decades of research, the transition from hospital to home for older adults living with frailty remains a persistent challenge. This study identified significant and continued unmet needs in navigating a complex health system, underscoring the evidence-practice gap in transitional care services. Results have informed the development and implementation of a feasibility study (TRANSFER-II), currently underway, that tests the feasibility of a nurse-coordinated model of transitional care support for older adults.
Transfers from hospital to home, frequent readmissions and transitions in care are common for older adults living with frailty. Understanding the enablers and barriers in transitional care for this vulnerable population can enhance the quality of care, improve communication and inform the development of more effective transitional care models. The findings underline the critical role nurses play in addressing systemic gaps and improving continuity of care for older adults across diverse health systems.
Transitional care is complex, and older populations are more at risk of returning to hospital. Findings highlight the significant unmet needs in navigating a complex health system and revealed the fragile cycle of care for older adults who frequent hospital. Reiterating the importance of effective communication and clinical expertise in delivering safe patient-centred nursing care.
This qualitative study was reported in accordance with the consolidated criteria for reporting qualitative research (COREQ) checklist.
Patients and carers contributed to the design of this qualitative study through consultation with a consumer advisory group, where potential transitional care interventions were discussed. These discussions highlighted a need to further explore transitional care unmet needs, informing the development of this focus group study.
Effective postoperative pain management is a critical component of surgical care, directly influencing patient recovery, satisfaction and long-term outcomes. Despite recent advances in pain management, postoperative pain remains poorly managed worldwide, suggesting that postoperative pain outcomes are influenced by factors beyond the inherent efficacy of available treatments. This scoping review aims to map the factors influencing postoperative pain management and recommendations that support optimal, evidence-based pain management after surgery.
A mixed methods scoping review will be conducted in accordance with the Joanna Briggs Institute manual for evidence synthesis and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping review guidelines. PubMed (MEDLINE), Cumulative Index to Nursing & Allied Health Literature and PsycINFO will be searched for the relevant literature from the journals’ inception to September 2025. Two reviewers will independently conduct the screening of titles and abstracts, full-text articles and data extraction. Data will be mapped onto the Theoretical Domains Framework and Capability, Opportunity, Motivation—Behavior model. Where additional data requires coding, thematic analysis will be conducted using NVivo data management software.
The scoping review will analyse publicly available data. Therefore, ethical approval is not required. The findings will serve as a foundation for engaging relevant stakeholders in discussions aimed at implementing systemic changes to support healthcare providers in enhancing postoperative pain management. The results will be disseminated through a peer-reviewed journal publication, local fora and conference presentations to ensure broad visibility and impact.
Limited evidence exists regarding the effectiveness of learning approaches in supporting interprofessional wound care education transnationally. The aim of this pilot study was to explore the feasibility and preliminary impact of an international, online interprofessional masterclass in supporting baccalaureate health students' learning about wound care. Data were collected using multiple methods including quantitative survey, qualitative focus groups, and interviews with baccalaureate nursing, pharmacy, dietetics, podiatry and paramedicine students from two universities based in Australia and Northern Ireland. A retrospective pre-test design was used. A survey retrospectively assessed students' self-reported confidence and understanding before and after the masterclass, while qualitative methods explored students' experiences of interprofessional learning and wound care. Self-reported improvements in students' understanding of wound assessment and management, as well as heightened awareness of interprofessional contributions to patient care indicated the potential value of this interprofessional and international collaboration in supporting wound care education. Qualitative analysis identified four themes: recognising a wound is a person's wound; comparing international healthcare practices; fostering learner engagement; interprofessional recognition, acknowledgment, and understanding of each profession's roles, contributions and expertise. This pilot study has highlighted key issues to be addressed in future research examining the impact of a collaborative online international initiative on baccalaureate students' interprofessional learning about wound care.
While digital technologies can increase the availability and access to evidence-based interventions, little is known about how users engage with them and the mechanisms associated with effective outcomes. Process evaluations are an important component in understanding the aforementioned factors. The ‘SPARX-UK’ study is a randomised controlled pilot and feasibility trial evaluating personalised human-supported (from an ‘eCoach’) vs a self-directed computerised cognitive behavioural therapy intervention (cCBT), called SPARX (Smart, Positive, Active, Realistic, X-factor thoughts), aimed at adolescents with mild to moderate depression. We are comparing supported vs self-directed delivery of SPARX to establish which format should be used in a proposed definitive trial of SPARX. The control is a waitlist group. We will conduct a process evaluation alongside the trial to determine how the intervention is implemented and provide context for interpreting the feasibility trial outcomes. We will also look at the acceptability of SPARX and how users engage with the intervention. This protocol paper describes the rationale, aims and methodology of the SPARX-UK trial process evaluation.
The process evaluation will use a mixed-methods design following the UK Medical Research Council’s 2015 guidelines, comprising quantitative and qualitative data collection. This will include analysing data usage of participants in the intervention arms; purposively sampled, semi-structured interviews of adolescents, parents/guardians, eCoaches and clinicians/practitioners from the SPARX-UK trial; and analysis of qualitative comments from a survey from those who dropped out early from the trial. Quantitative data will be analysed descriptively. We will use thematic analysis in a framework approach to analyse qualitative data. Quantitative and qualitative data will be mixed and integrated to provide an understanding of how the intervention was implemented and how adolescents interacted with the intervention. This process evaluation will explore the experiences of adolescent participants, parents/guardians, eCoaches and clinicians/practitioners in relation to a complex digital intervention.
Ethical approval was granted by the National Health Service (NHS) Health Research Authority South West - Cornwall & Plymouth Research Ethics Committee (Ethics Ref: 22/SW/0149).
Contextualising how the intervention was implemented, and the variations in uptake and engagement, will help us to understand the trial findings in greater depth. The findings from this process evaluation will also inform the decision about whether and how to proceed with a full randomised controlled trial, as well as the development of more effective interventions which can be personalised more precisely via varying levels of human support. We plan to publish the findings of the process evaluation and the wider project in peer-reviewed journals, as well as disseminate via academic conferences.
ISRCTN: ISRCTN15124804. Registered on 16 January 2023,
To determine the effects of nurse-coordinated interventions in improving readmissions, cumulative hospital stay, mortality, functional ability and quality of life for frail older adults discharged from hospital.
Systematic review with meta-analysis.
A systematic search using key search terms of ‘frailty’, ‘geriatric’, ‘hospital’ and ‘nurse’. Covidence was used to screen individual studies. Studies were included that addressed frail older adults, incorporated a significant nursing role in the intervention and were implemented during hospital admission with a focus on transition from hospital to home.
This review searched MEDLINE (Ovid), CINAHL (EBSCO), PubMed (EBSCO), Scopus, Embase (Ovid) and Cochrane library for studies published between 2000 and September 2023.
Of 7945 abstracts screened, a total 16 randomised controlled trials were identified. The 16 randomised controlled trials had a total of 8795 participants, included in analysis. Due to the heterogeneity of the outcome measures used meta-analysis could only be completed on readmission (n = 13) and mortality (n = 9). All other remaining outcome measures were reported through narrative synthesis. A total of 59 different outcome measure assessments and tools were used between studies. Meta-analysis found statistically significant intervention effect at 1-month readmission only. No other statistically significant effects were found on any other time point or outcome.
Nurse-coordinated interventions have a significant effect on 1-month readmissions for frail older adults discharged from hospital. The positive effect of interventions on other health outcomes within studies were mixed and indistinct, this is attributed to the large heterogeneity between studies and outcome measures.
This review should inform policy around transitional care recommendations at local, national and international levels. Nurses, who constitute half of the global health workforce, are ideally situated to provide transitional care interventions. Nurse-coordinated models of care, which identify patient needs and facilitate the continuation of care into the community improve patient outcomes.
Review findings will be useful for key stakeholders, clinicians and researchers to learn more about the essential elements of nurse-coordinated transitional care interventions that are best targeted to meet the needs of frail older adults.
When frail older adults experience transitions in care, for example discharging from hospital to home, there is an increased risk of adverse events, such as institutionalisation, hospitalisation, disability and death. Nurse-coordinated transitional care models have shown to be a potential solution to support adults with specific chronic diseases, but there is more to be known about the effectiveness of interventions in frail older adults. This review demonstrated the positive impact of nurse-coordinated interventions in improving readmissions for up to 1 month post-discharge, helping to inform future transitional care interventions to better support the needs of frail older adults.
This systematic review was reported in accordance with the Referred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
No Patient or Public Contribution.
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