Pub Date : 2025-09-08DOI: 10.1016/j.ijnsa.2025.100417
Mathulada Chaimee , Jutharat Attawet , Yunjing Qiu , Thomas J Hugh , Pauline Murray-Parahi , Amanda Wilson
<div><h3>Background</h3><div>Delayed discharge is a global challenge that strains healthcare systems and affects patient outcomes. In gastrointestinal surgery patients, delays often result from a continuum, clinical complications prolong the acute stay and create additional care needs, such as rehabilitation and specialised homecare, which lead to further delays. However, existing literature provides limited insight into this patient group, as most studies generalise the issue. A focused integrative review is therefore needed to synthesise the causes, impacts, and strategies of delayed discharge and to inform more effective discharge planning.</div></div><div><h3>Objective</h3><div>This review aims to synthesise evidence related to delayed discharge in patients undergoing gastrointestinal surgery. Specifically, it seeks to: (1) identify multi-level contributing factors (patient, clinical, and healthcare system); (2) evaluate significant clinical and economic impacts on patients, family, healthcare staff and healthcare system; and (3) identify and describe effective interventions implemented to promote timely and safe discharge in this population.</div></div><div><h3>Method</h3><div>A literature search was conducted across CINAHL, Medline, Scopus, Cochrane, and PsycINFO databases for studies published from 2000 to January 2025. Keywords used included “delayed discharge,” “factors,” “impact,” “gastrointestinal surgery,” and “intervention.” Inclusion criteria focused on peer-reviewed studies involving adult gastrointestinal surgery patients in acute hospital settings. Two authors independently screened titles, abstracts, and full texts using the Joanna Briggs Institute SUMARI software. The methodological quality of studies was assessed using the Joanna Briggs Institute critical appraisal tools. Data extraction focused on study characteristics, factors, impacts, and interventions, followed by a deductive narrative analysis to identify patterns and relationships.</div></div><div><h3>Results</h3><div>Of the 572 articles identified, 20 met inclusion criteria: 17 cohort studies (12 retrospective, five prospective), one analytic cross-sectional study, and two clinical trials. The findings encompassed the length of stay and delayed discharge rate, contributing factors, impacts, and potential interventions. Delayed discharge stemmed from patient, surgical, and system-related factors, affecting patients and hospital efficiency. Targeted interventions, like nurse-led stoma education and streamlined discharge criteria, significantly reduced delays (<em>p</em> < 0.0001).</div></div><div><h3>Conclusion</h3><div>Delayed discharge in gastrointestinal surgery patients stems from a complex interplay of patient, surgical, and systemic factors, affecting both individual and healthcare system. Evidence supports nurse-led and multidisciplinary approaches in mitigating delays, improving outcomes and enhancing healthcare efficiency. Future research should employ qualit
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Pub Date : 2025-09-07DOI: 10.1016/j.ijnsa.2025.100418
Yu Chen , Ying Lin , Xinyue Dong , Yan Xue , Dong Wu
Background
Self-care is crucial for improving the quality of life of patients with chronic heart failure. Self-care behaviors change over time, and the trajectories differ among patients with varying characteristics. However, the trajectories of self-care behaviors in older adults with chronic heart failure have not been fully studied.
Objective
This study aimed to identify the trajectory patterns of self-care behaviors over 3 months after hospital discharge in Chinese older adults with chronic heart failure, as well as the factors influencing these patterns.
Methods
A prospective observational study was conducted from October 2022 to July 2023, involving 255 older adults with chronic heart failure recruited from a tertiary hospital in Shanghai, China. Demographic and clinical information, self-care behaviors, self-care confidence, illness perception, self-efficacy, social support, and heart failure knowledge were investigated using a validated questionnaire and electronic health records at baseline, 2 weeks, 4 weeks, 2 months, and 3 months post-discharge. Growth mixture modeling was used to identify the trajectory patterns of self-care behaviors. Logistic regression was used to determine the influencing factors of different trajectory patterns.
Results
The best-fit growth mixture modeling revealed a 2-class model for self-care maintenance: “sustained good” group and “poor-gradually improving” group; a 3-class model for symptom perception: “gradually decreasing”, “persistently poor”, and “poor-gradually improving” groups; and a 3-class model for self-care management: “poor-gradually improving”, “sustained good”, and “early boost then decline” groups. Self-care confidence, heart failure knowledge, economic level, and the source of medical expenses were determinants of the different trajectory patterns in self-care behaviors.
Conclusion
This study enhances the understanding of the diverse behavioral trajectory patterns exhibited by Chinese older adults with chronic heart failure, as well as the factors that influence these patterns. Tailored interventions that focus on the unique needs of diverse groups should be developed to sustain satisfactory self-care behaviors.
{"title":"Trajectories and influencing factors of self-care behaviors in Chinese older adults with chronic heart failure: A prospective observational study","authors":"Yu Chen , Ying Lin , Xinyue Dong , Yan Xue , Dong Wu","doi":"10.1016/j.ijnsa.2025.100418","DOIUrl":"10.1016/j.ijnsa.2025.100418","url":null,"abstract":"<div><h3>Background</h3><div>Self-care is crucial for improving the quality of life of patients with chronic heart failure. Self-care behaviors change over time, and the trajectories differ among patients with varying characteristics. However, the trajectories of self-care behaviors in older adults with chronic heart failure have not been fully studied.</div></div><div><h3>Objective</h3><div>This study aimed to identify the trajectory patterns of self-care behaviors over 3 months after hospital discharge in Chinese older adults with chronic heart failure, as well as the factors influencing these patterns.</div></div><div><h3>Methods</h3><div>A prospective observational study was conducted from October 2022 to July 2023, involving 255 older adults with chronic heart failure recruited from a tertiary hospital in Shanghai, China. Demographic and clinical information, self-care behaviors, self-care confidence, illness perception, self-efficacy, social support, and heart failure knowledge were investigated using a validated questionnaire and electronic health records at baseline, 2 weeks, 4 weeks, 2 months, and 3 months post-discharge. Growth mixture modeling was used to identify the trajectory patterns of self-care behaviors. Logistic regression was used to determine the influencing factors of different trajectory patterns.</div></div><div><h3>Results</h3><div>The best-fit growth mixture modeling revealed a 2-class model for self-care maintenance: “sustained good” group and “poor-gradually improving” group; a 3-class model for symptom perception: “gradually decreasing”, “persistently poor”, and “poor-gradually improving” groups; and a 3-class model for self-care management: “poor-gradually improving”, “sustained good”, and “early boost then decline” groups. Self-care confidence, heart failure knowledge, economic level, and the source of medical expenses were determinants of the different trajectory patterns in self-care behaviors.</div></div><div><h3>Conclusion</h3><div>This study enhances the understanding of the diverse behavioral trajectory patterns exhibited by Chinese older adults with chronic heart failure, as well as the factors that influence these patterns. Tailored interventions that focus on the unique needs of diverse groups should be developed to sustain satisfactory self-care behaviors.</div></div>","PeriodicalId":34476,"journal":{"name":"International Journal of Nursing Studies Advances","volume":"9 ","pages":"Article 100418"},"PeriodicalIF":3.1,"publicationDate":"2025-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145104553","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.ijnsa.2025.100416
Linglong Liu , Xiaoping Fang , Xinbo Wang , Xiaoyan Wang , Yehua Xie , Yaoyao Cai , Lei Cui , Tianying Yao , Xiaoxuan Li , Qian Li , Mingxia Chen
Background
Family caregivers ('carers') bear the highest care burden during the postoperative survivorship period of pancreatic cancer, given its poor prognosis. Most carers report unmet needs when taking on caregiving responsibilities during this period. Thoroughly investigating carers' needs is essential for helping families address practical care challenges. However, this important topic remains underexplored.
Objective
To assess the need levels and identify need subgroups among carers of patients with pancreatic cancer 6 months after surgery and demographic predictors contributing to heterogeneity.
Design
Cross-sectional study.
Setting(s)
Participants were recruited from the pancreas centres of four tertiary A-level comprehensive hospitals in Jiangsu Province, China.
Participants
240 patients with pancreatic cancer and their carers ('dyads') participated in the survey.
Methods
Carers completed the Comprehensive Needs Assessment Tool in Cancer for Carers, the Activities of Daily Living Scale for patients, and the General Demographic Information Questionnaire for dyads. Latent profile analysis (LPA) was used to categorise carers' needs. Non-parametric and chi-square tests were used to examine differences in need scores and sociodemographic characteristics among subgroups. Multiple logistic regression (MLR) was used to analyse sociodemographic impacts.
Results
Six months post-surgery, the total carers' need score was 41.83 ± 22.65 points, indicating a moderate level, with the highest needs reported for healthcare personnel, information and knowledge, and facilities and services. The LPA results revealed that carers were divided into five distinct subgroups based on differing levels of need across the domains assessed by the Comprehensive Needs Assessment Tool in Cancer for Carers, with proportions of 8.8 %, 22.5 %, 8.3 %, 55 %, and 5.4 %. Subgroup membership was predicted by four factors: carers' sex (odds ratio [OR]: 11.08, 95 % confidence interval [CI]: 1.64, 74.99, p = 0.01), carers' education levels (OR: 3.92, 95 % CI: 1.04, 14.72, p = 0.04), patients' treatment after surgery (OR: 0.10, 95 % CI: 0.01, 0.84, p = 0.04) and activities of daily living levels (OR: 14.63, 95 % CI: 1.97, 108.77, p < 0.01).
Conclusions
We have highlighted the complex individualised needs of carers of patients with pancreatic cancer. Through LPA and MLR, we identified distinct need subgroups and their predictors. Healthcare professionals may be able to improve dyads’ health by tailoring support to each subgroup’s specific needs and issues.
Registration
Registration number: ChiCTR2400079415, registered 03/01/2024, first recruitment 04/02/2024.
背景：由于胰腺癌预后不良，在其术后生存期，家庭照顾者（“照顾者”）承担着最高的照顾负担。大多数护理人员报告说，在这一时期承担照顾责任时，需求未得到满足。彻底调查护理人员的需求对于帮助家庭应对实际护理挑战至关重要。然而，这一重要话题仍未得到充分探讨。目的评估胰腺癌患者术后6个月护理人员的需求水平，确定需求亚组，以及导致异质性的人口统计学预测因素。DesignCross-sectional研究。参与者从中国江苏省四所三级甲等综合医院的胰腺中心招募。参与者：240名胰腺癌患者及其护理人员（“二人组”）参与了这项调查。方法护理人员完成《癌症护理人员综合需求评估工具》、《患者日常生活活动量表》和《一般人口统计信息问卷》。使用潜在特征分析（LPA）对照顾者需求进行分类。采用非参数检验和卡方检验检验亚组间需求得分和社会人口学特征的差异。采用多元逻辑回归（MLR）分析社会人口统计学影响。结果术后6个月护理人员需求总分为41.83±22.65分，处于中等水平，其中护理人员需求、信息知识需求和设施服务需求最高。LPA结果显示，根据护理人员癌症综合需求评估工具评估的不同领域需求水平，护理人员被分为五个不同的亚组，比例分别为8.8%,22.5%,8.3%，55%和5.4%。亚组成员由四个因素预测：护理者性别（比值比[OR]: 11.08, 95%可信区间[CI]: 1.64, 74.99, p = 0.01），护理者教育水平（OR: 3.92, 95% CI: 1.04, 14.72, p = 0.04），患者术后治疗（OR: 0.10, 95% CI: 0.01, 0.84, p = 0.04）和日常生活活动水平（OR: 14.63, 95% CI: 1.97, 108.77, p < 0.01）。结论我们强调了胰腺癌患者护理人员复杂的个性化需求。通过LPA和MLR，我们确定了不同的需求亚群及其预测因子。医疗保健专业人员可以根据每个子群体的具体需求和问题定制支持，从而改善二人组的健康状况。报名编号：ChiCTR2400079415, 2024年3月1日报名，2024年2月4日首次招聘。
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Pub Date : 2025-08-29DOI: 10.1016/j.ijnsa.2025.100415
Leslie T. Zimpelman
Objective
Failure to rescue occurs when nurses fail to detect signals of clinically significant changes in the early stages of disease complication or patient deterioration. Pediatric patient deterioration detection poses a different challenge because pediatric patients physiologically respond differently from adults. Nursing students are especially challenged in detecting pediatric patient deterioration because adult illness is the primary focus of nursing education. The study aims to identify vital signs that nursing students categorize as signals of pediatric deterioration, determine influences on their response to signals, and how these influences affect their performance in signal detection trials.
Methods
To assess and understand nursing students’ pediatric deterioration detection performance, an explanatory sequential mixed-method design was conducted with second-semester senior baccalaureate nursing students. Students participated in signal detection trials, and then a subset was interviewed about their performance and thought processing. The quantitative data were analyzed for descriptive statistics, mean rate, sensitivity, and response bias. The qualitative data were analyzed with thematic analysis. The quantitative and qualitative results were compared to examine how performance and influences on response are related.
Results
Participants (n=21) had a low sensitivity d’ = 1.19 (SD 0.85) to signals of pediatric deterioration and an increased tendency c = -0.03 (SD 0.66) to misclassify non-critical stimuli as indicators of deterioration. Respiratory rate changes were the most accurately identified among all signal types. Vital sign type did not significantly affect detection. Four major themes were identified as factors influencing student responses in the trials. Differences in detection performance corresponded with differences in influencing factors.
Conclusion
Students demonstrated low sensitivity in detecting early signs of patient deterioration. These findings highlight the need to enhance student knowledge and preparedness to detect signals of pediatric deterioration early and reduce failure to rescue. This study demonstrates the innovative use of signal detection to assess nursing students’ ability to recognize patient deterioration cues. By quantifying the sensitivity index and response bias, educators can identify knowledge gaps and tailor remediation to individual needs. Signal detection testing provides a unique framework to evaluate decision-making under uncertainty, advancing nursing education to better prepare students for clinical practice.
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Pub Date : 2025-08-27DOI: 10.1016/j.ijnsa.2025.100413
Daria Schneider-Matyka , Kamila Rachubińska , Anna Maria Cybulska , Mariusz Panczyk , Przemysław Ustianowski , Ireneusz Walaszek , Dorota Ćwiek , Elżbieta Grochans , Małgorzata Szkup
Background
: Nursing care rationing is a global issue, but its intensity may vary across countries depending on available resources and healthcare system characteristics.
Objective
: This study aimed to examine factors associated with the severity of nursing care rationing among Polish nurses.
Design
: Cross-sectional observational study.
Setting(s)
: Two university clinical hospitals in Szczecin, Poland.
Participants
The study involved 411 nurses working in 40 wards and clinics across both institutions.
Methods
: A self-designed questionnaire was used to collect socio-demographic and work-related information, alongside standardized instruments: the Emotional Intelligence Questionnaire (INTE), the Perceived Stress Scale (PSS-10), and the Perceived Implicit Rationing of Nursing Care (PIRNCA). Descriptive statistics and both univariate and multivariate linear regression analyses were performed.
Results
: The severity of nursing care rationing was significantly associated with stress level (B = 0.039, p < 0.001) and emotional intelligence (B = –0.006, p = 0.002). Nurses with secondary education and those working under civil law contracts reported significantly higher levels of care rationing. Additionally, care rationing was more prevalent among hospital nurses compared to those in other settings.
Conclusions
: Low levels of emotional intelligence among Polish nurses coexist with high levels of stress and increased nursing care rationing. These findings indicate that emotional intelligence may serve as a protective factor that reduces the negative impact of stress on care provision.
Trial Registration
: Not applicable.
Social media abstract
: Rationing nursing care, in addition to the characteristics of the working environment, depends on the buffering role of emotional intelligence and the severity of stress experienced by nurses. #RationungNursingCare#QualityOfCare
背景：护理配给是一个全球性问题，但根据可用资源和卫生保健系统的特点，其强度可能因国家而异。目的：本研究旨在探讨波兰护士护理配给严重程度的相关因素。设计：横断面观察性研究。地点：波兰什切青的两所大学临床医院。参与者这项研究涉及两家机构40个病房和诊所的411名护士。方法：采用自行设计的问卷收集社会人口统计学和工作相关信息，并采用标准化工具：情绪智力问卷（INTE）、感知压力量表（PSS-10）和感知隐性护理定量（PIRNCA）。描述性统计和单变量和多变量线性回归分析。结果：护理配给程度与压力水平（B = 0.039, p < 0.001）和情绪智力（B = -0.006, p = 0.002）显著相关。受过中等教育的护士和根据民法合同工作的护士报告说，护理配给水平明显较高。此外，与其他环境中的护士相比，医院护士的护理配给制更为普遍。结论：波兰护士的低情商与高压力和护理配给增加并存。这些发现表明，情绪智力可以作为一种保护因素，减少压力对护理提供的负面影响。试验注册：不适用。摘要：配给护理，除了工作环境的特点外，还取决于情绪智力的缓冲作用和护士所经历的压力的严重程度。# RationungNursingCare # QualityOfCare
{"title":"Factors associated with nursing care rationing in Poland: A cross-sectional observational study","authors":"Daria Schneider-Matyka , Kamila Rachubińska , Anna Maria Cybulska , Mariusz Panczyk , Przemysław Ustianowski , Ireneusz Walaszek , Dorota Ćwiek , Elżbieta Grochans , Małgorzata Szkup","doi":"10.1016/j.ijnsa.2025.100413","DOIUrl":"10.1016/j.ijnsa.2025.100413","url":null,"abstract":"<div><h3>Background</h3><div><strong>:</strong> Nursing care rationing is a global issue, but its intensity may vary across countries depending on available resources and healthcare system characteristics.</div></div><div><h3>Objective</h3><div><strong>:</strong> This study aimed to examine factors associated with the severity of nursing care rationing among Polish nurses.</div></div><div><h3>Design</h3><div><strong>:</strong> Cross-sectional observational study.</div></div><div><h3>Setting(s)</h3><div><strong>:</strong> Two university clinical hospitals in Szczecin, Poland.</div></div><div><h3>Participants</h3><div>The study involved 411 nurses working in 40 wards and clinics across both institutions.</div></div><div><h3>Methods</h3><div><strong>:</strong> A self-designed questionnaire was used to collect socio-demographic and work-related information, alongside standardized instruments: the Emotional Intelligence Questionnaire (INTE), the Perceived Stress Scale (PSS-10), and the Perceived Implicit Rationing of Nursing Care (PIRNCA). Descriptive statistics and both univariate and multivariate linear regression analyses were performed.</div></div><div><h3>Results</h3><div><strong>:</strong> The severity of nursing care rationing was significantly associated with stress level (B = 0.039, p < 0.001) and emotional intelligence (B = –0.006, p = 0.002). Nurses with secondary education and those working under civil law contracts reported significantly higher levels of care rationing. Additionally, care rationing was more prevalent among hospital nurses compared to those in other settings.</div></div><div><h3>Conclusions</h3><div><strong>:</strong> Low levels of emotional intelligence among Polish nurses coexist with high levels of stress and increased nursing care rationing. These findings indicate that emotional intelligence may serve as a protective factor that reduces the negative impact of stress on care provision.</div></div><div><h3>Trial Registration</h3><div><strong>:</strong> Not applicable.</div></div><div><h3>Social media abstract</h3><div><strong>:</strong> Rationing nursing care, in addition to the characteristics of the working environment, depends on the buffering role of emotional intelligence and the severity of stress experienced by nurses. #RationungNursingCare#QualityOfCare</div></div>","PeriodicalId":34476,"journal":{"name":"International Journal of Nursing Studies Advances","volume":"9 ","pages":"Article 100413"},"PeriodicalIF":3.1,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145007600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nurses form the largest professional group in the United Kingdom (UK) healthcare system, yet they remain significantly underrepresented in research and academic leadership. While the medical profession has benefited from well-defined academic pathways, structured support for nurses in research remains inconsistent, limiting their influence in shaping evidence-based care and healthcare innovation.
Aim
This narrative Review explores the current landscape of nursing representation and progression in research and academic leadership in the UK. It identifies enabling factors, systemic and cultural barriers, and the implications for workforce development and policy.
Methods
A systematic narrative Review was conducted using literature published between 2006 and April 2025, sourced from PubMed, Scopus, and the Cochrane Library. Eighteen eligible studies focusing on clinical academic roles for nurses were included. Data extraction and synthesis followed narrative methods, and study quality was appraised using the GRADE framework and ROBINS-I risk of bias tool.
Results
Included studies highlighted a range of initiatives, particularly the HEE/NIHR Integrated Clinical Academic (ICA) Programme, that have supported early clinical academic development and contributed to strengthening professional identity. However, progression to senior research leadership remains constrained by multiple structural and organisational barriers. These include poor visibility of nursing leadership, lack of integrated career frameworks, limited access to research mentors, insufficient protected time for academic activity, and poor alignment between NHS and academic institutions. Cultural expectations, undervaluing of nursing research, and gendered norms around leadership roles further hinder advancement. Key enablers included early exposure to research, access to structured development schemes, inclusive institutional culture, and visible role models. While the overall quality of evidence ranged from low to moderate, the ROBINS-I assessment identified frequent concerns around study design and reporting clarity. Equity issues affecting nurses from global majority backgrounds were underexplored and represent an important area for future research.
Conclusion
Advancing nursing leadership in research requires a nationally coordinated, long-term strategy with sustained investment, equitable access to career development, and cultural transformation. Mentorship, funding, structural support, and inclusive leadership are essential to enabling nurses to fully contribute to healthcare research and innovation. Addressing underrepresentation and inequality is critical for a diverse and sustainable clinical academic workforce.
Registration
Not registered, as this is a systematic narrative Review.
{"title":"Challenges to nursing leadership in research and academia in the UK: A systematic narrative review","authors":"Arun Vamadevan , Vijesh Vijayan , KasiReddy Jayasudha , Styja Varghese , Oghale Eboh , Ajeesh Karthikeyan , Christine Cole , Lauren Walker","doi":"10.1016/j.ijnsa.2025.100411","DOIUrl":"10.1016/j.ijnsa.2025.100411","url":null,"abstract":"<div><h3>Background</h3><div>Nurses form the largest professional group in the United Kingdom (UK) healthcare system, yet they remain significantly underrepresented in research and academic leadership. While the medical profession has benefited from well-defined academic pathways, structured support for nurses in research remains inconsistent, limiting their influence in shaping evidence-based care and healthcare innovation.</div></div><div><h3>Aim</h3><div>This narrative Review explores the current landscape of nursing representation and progression in research and academic leadership in the UK. It identifies enabling factors, systemic and cultural barriers, and the implications for workforce development and policy.</div></div><div><h3>Methods</h3><div>A systematic narrative Review was conducted using literature published between 2006 and April 2025, sourced from PubMed, Scopus, and the Cochrane Library. Eighteen eligible studies focusing on clinical academic roles for nurses were included. Data extraction and synthesis followed narrative methods, and study quality was appraised using the GRADE framework and ROBINS-I risk of bias tool.</div></div><div><h3>Results</h3><div>Included studies highlighted a range of initiatives, particularly the HEE/NIHR Integrated Clinical Academic (ICA) Programme, that have supported early clinical academic development and contributed to strengthening professional identity. However, progression to senior research leadership remains constrained by multiple structural and organisational barriers. These include poor visibility of nursing leadership, lack of integrated career frameworks, limited access to research mentors, insufficient protected time for academic activity, and poor alignment between NHS and academic institutions. Cultural expectations, undervaluing of nursing research, and gendered norms around leadership roles further hinder advancement. Key enablers included early exposure to research, access to structured development schemes, inclusive institutional culture, and visible role models. While the overall quality of evidence ranged from low to moderate, the ROBINS-I assessment identified frequent concerns around study design and reporting clarity. Equity issues affecting nurses from global majority backgrounds were underexplored and represent an important area for future research.</div></div><div><h3>Conclusion</h3><div>Advancing nursing leadership in research requires a nationally coordinated, long-term strategy with sustained investment, equitable access to career development, and cultural transformation. Mentorship, funding, structural support, and inclusive leadership are essential to enabling nurses to fully contribute to healthcare research and innovation. Addressing underrepresentation and inequality is critical for a diverse and sustainable clinical academic workforce.</div></div><div><h3>Registration</h3><div>Not registered, as this is a systematic narrative Review.</div></div>","PeriodicalId":34476,"journal":{"name":"International Journal of Nursing Studies Advances","volume":"9 ","pages":"Article 100411"},"PeriodicalIF":3.1,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145007602","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<div><h3>Background</h3><div>Up to half of hospital inpatients are malnourished, a condition that prolongs recovery, increases complications and raises healthcare costs. Although evidence-based nutritional care can mitigate these effects, its routine implementation remains inconsistent.</div></div><div><h3>Objective</h3><div>To synthesise and evaluate current evidence on the implementation and the clinical effectiveness of strategies designed to promote evidence-based nutritional care practices within healthcare settings.</div></div><div><h3>Methods</h3><div>A mixed-methods systematic review followed the Joanna Briggs Institute guidelines. Fifteen databases were searched for studies published between January 2015 and January 2025 that evaluated implementation strategies targeting evidence-based nutrition care for any patient or healthcare professional group. Two reviewers independently screened records extracted data and applied the Mixed-Methods Appraisal Tool. Because study designs, contexts and outcome metrics varied, findings were integrated narratively using the Consolidated Framework for Implementation Research, the Expert Recommendations for Implementing Change taxonomy and the Implementation Outcomes Framework.</div></div><div><h3>Results</h3><div>Twenty-nine primary studies involving 1624 healthcare professionals and 13,523 patients were included. All interventions were multifaceted and tailored to the context. The most frequent components were staff education (97 %), audit with feedback (93 %), stakeholder engagement structures (62 %), and adaptations to electronic or physical workflows (28 %). Principal barriers experienced by healthcare professionals comprised scarce resources, fragmented communication, inadequate infrastructure, and knowledge deficits; key facilitators were visible leadership, standardised communication tools, iterative planning, and a strong evidence base. Fidelity of intervention delivery by healthcare professionals was consistently high (median ≥ 80 %); acceptability exceeded 70 % in all studies that assessed it, and feasibility was rated favourably. Where measured, penetration and sustainability were moderate but positive. Service outcomes improved across settings, including earlier initiation of nutrition therapy, greater dietary adequacy, and fewer treatment interruptions or nutrition-related complications. Patient-level benefits comprised reduced weight loss, improved nutritional status, better health-related quality of life, and higher satisfaction.</div></div><div><h3>Conclusion</h3><div>Context-sensitive, multifaceted implementation strategies, particularly those coupling education, audit-feedback, leadership engagement, and system redesign, can improve the uptake and impact of evidence-based nutritional care. Future studies should employ standardised frameworks, extended follow-up, and rigorous evaluation designs to assess sustainability and inform large-scale implementation.</div></div><div><h3>PROSPERO r
{"title":"Using implementation science to promote evidence-based nutritional care in healthcare settings: A mixed-methods systematic review","authors":"Jerome Molle , Joris Agnel , Sebastien Colson , Audrey Chays-Amania","doi":"10.1016/j.ijnsa.2025.100414","DOIUrl":"10.1016/j.ijnsa.2025.100414","url":null,"abstract":"<div><h3>Background</h3><div>Up to half of hospital inpatients are malnourished, a condition that prolongs recovery, increases complications and raises healthcare costs. Although evidence-based nutritional care can mitigate these effects, its routine implementation remains inconsistent.</div></div><div><h3>Objective</h3><div>To synthesise and evaluate current evidence on the implementation and the clinical effectiveness of strategies designed to promote evidence-based nutritional care practices within healthcare settings.</div></div><div><h3>Methods</h3><div>A mixed-methods systematic review followed the Joanna Briggs Institute guidelines. Fifteen databases were searched for studies published between January 2015 and January 2025 that evaluated implementation strategies targeting evidence-based nutrition care for any patient or healthcare professional group. Two reviewers independently screened records extracted data and applied the Mixed-Methods Appraisal Tool. Because study designs, contexts and outcome metrics varied, findings were integrated narratively using the Consolidated Framework for Implementation Research, the Expert Recommendations for Implementing Change taxonomy and the Implementation Outcomes Framework.</div></div><div><h3>Results</h3><div>Twenty-nine primary studies involving 1624 healthcare professionals and 13,523 patients were included. All interventions were multifaceted and tailored to the context. The most frequent components were staff education (97 %), audit with feedback (93 %), stakeholder engagement structures (62 %), and adaptations to electronic or physical workflows (28 %). Principal barriers experienced by healthcare professionals comprised scarce resources, fragmented communication, inadequate infrastructure, and knowledge deficits; key facilitators were visible leadership, standardised communication tools, iterative planning, and a strong evidence base. Fidelity of intervention delivery by healthcare professionals was consistently high (median ≥ 80 %); acceptability exceeded 70 % in all studies that assessed it, and feasibility was rated favourably. Where measured, penetration and sustainability were moderate but positive. Service outcomes improved across settings, including earlier initiation of nutrition therapy, greater dietary adequacy, and fewer treatment interruptions or nutrition-related complications. Patient-level benefits comprised reduced weight loss, improved nutritional status, better health-related quality of life, and higher satisfaction.</div></div><div><h3>Conclusion</h3><div>Context-sensitive, multifaceted implementation strategies, particularly those coupling education, audit-feedback, leadership engagement, and system redesign, can improve the uptake and impact of evidence-based nutritional care. Future studies should employ standardised frameworks, extended follow-up, and rigorous evaluation designs to assess sustainability and inform large-scale implementation.</div></div><div><h3>PROSPERO r","PeriodicalId":34476,"journal":{"name":"International Journal of Nursing Studies Advances","volume":"9 ","pages":"Article 100414"},"PeriodicalIF":3.1,"publicationDate":"2025-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145157595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-22DOI: 10.1016/j.ijnsa.2025.100412
Anu Soikkeli-Jalonen , Suvi Vierelä , Antti Kaipia , Eeva Harju , Elina Haavisto
Aim
To describe the psychometric properties and content of the instruments used for assessing penile cancer patients’ quality of life
Design
A systematic review
Method
A systematic literature search was conducted in October 2024 across four electronic databases: PubMed, CINAHL, PsycINFO, and the Cochrane Library. The systematic approach was adhered to when conducting the review, and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed to ensure explicit reporting. The search across the four databases generated 135 articles, out of which 16 were included in the review.
Results
Eight instruments assessing the quality of life (QoL) among penile cancer patients were identified: four generic, two cancer-specific, and two penile cancer-specific. The content of these instruments fell into three main categories: physical functioning, psychosocial resilience, and overall life functions. However, none of the instruments covered all these aspects comprehensively. Additionally, no instrument was reported to be thoroughly valid or reliable.
Conclusions
A psychometrically tested and validated QoL instrument that covers all aspects of penile cancer patients' well-being was not found. There is a need for holistic instruments tailored to evaluate and improve the QoL for these patients. Such instruments would enable the identification and comparison of individual care needs and factors influencing their QoL.
{"title":"Psychometric properties and content of instruments for assessing penile cancer patients’ quality of life: A systematic review","authors":"Anu Soikkeli-Jalonen , Suvi Vierelä , Antti Kaipia , Eeva Harju , Elina Haavisto","doi":"10.1016/j.ijnsa.2025.100412","DOIUrl":"10.1016/j.ijnsa.2025.100412","url":null,"abstract":"<div><h3>Aim</h3><div>To describe the psychometric properties and content of the instruments used for assessing penile cancer patients’ quality of life</div></div><div><h3>Design</h3><div>A systematic review</div></div><div><h3>Method</h3><div>A systematic literature search was conducted in October 2024 across four electronic databases: PubMed, CINAHL, PsycINFO, and the Cochrane Library. The systematic approach was adhered to when conducting the review, and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed to ensure explicit reporting. The search across the four databases generated 135 articles, out of which 16 were included in the review.</div></div><div><h3>Results</h3><div>Eight instruments assessing the quality of life (QoL) among penile cancer patients were identified: four generic, two cancer-specific, and two penile cancer-specific. The content of these instruments fell into three main categories: physical functioning, psychosocial resilience, and overall life functions. However, none of the instruments covered all these aspects comprehensively. Additionally, no instrument was reported to be thoroughly valid or reliable.</div></div><div><h3>Conclusions</h3><div>A psychometrically tested and validated QoL instrument that covers all aspects of penile cancer patients' well-being was not found. There is a need for holistic instruments tailored to evaluate and improve the QoL for these patients. Such instruments would enable the identification and comparison of individual care needs and factors influencing their QoL.</div></div>","PeriodicalId":34476,"journal":{"name":"International Journal of Nursing Studies Advances","volume":"9 ","pages":"Article 100412"},"PeriodicalIF":3.1,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145007601","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-19DOI: 10.1016/j.ijnsa.2025.100388
Kei Matoba, So Yayama, Taiki Teshima, Akiko Miki
Background
Research has identified evidence of coercion and abuse in psychiatric hospitals. The psychiatric care system in Japan is characterized by a custodial approach and long-term inpatient care, potentially increasing the risk of abuse. However, few studies have examined the occurrence and dynamics of abuse in psychiatric institutions, and there is a major research gap regarding the roles of hospital culture and management in contributing to inpatient abuse.
Objective
To investigate the experiences of psychiatric nursing managers of the factors contributing to inpatient abuse in psychiatric hospitals.
Design
A multisite, phenomenological, qualitative, and descriptive study.
Settings
Four hospitals in Japan that were either psychiatric hospitals or general hospitals dominated by psychiatric wards.
Participants
Eighteen nurse managers (including directors of nursing, deputy directors of nursing, and head nurses) working in psychiatric hospitals or in general hospitals dominated by psychiatric wards.
Methods
From May 2023 to July 2023, individual semi-structured interviews were conducted with each participant to obtain data on factors contributing to abuse in psychiatric hospitals. Reflexive thematic analysis was used to analyze the data. The data were coded, and the codes organized into themes and subthemes.
Results
Six themes and 23 subthemes were extracted that described participants’ perspectives on systemic, personal, and environmental contributors to inpatient abuse. The themes were ‘Structural challenges embedded in psychiatric care systems’ (e.g., finances, staffing, working conditions); ‘Organizational cultures lacking self-correction’ (e.g., the insularity of psychiatric hospitals, use of outdated nursing practices); ‘Dysfunctional team dynamics that undermine professional competence’ (e.g., suppression of nurses’ opinions and autonomy); ‘Asymmetries in patient–nurse relationships’ (e.g., power imbalances); ‘Illness factors that complicate the detection of abuse’ (e.g., interpretation of abuse as symptoms); and ‘The fragility of psychiatric nurses’ professional identity’ (e.g., lack of skills, experience, confidence, and fulfillment).
Conclusions
The results show that nurse managers play a key role in identifying institutional, personal, and relationship-based factors that contribute to inpatient abuse in psychiatric wards. The findings indicate a need for more policies to support patient-centered care and develop the role of nurse managers to create safer psychiatric wards.
Study registration
Not registered.
Tweetable abstract
nurse managers’ perspectives on contributors to inpatient abuse in psychiatric hospitals
{"title":"Nursing managers’ perspectives on factors contributing to abuse in psychiatric hospitals: A reflective thematic analysis","authors":"Kei Matoba, So Yayama, Taiki Teshima, Akiko Miki","doi":"10.1016/j.ijnsa.2025.100388","DOIUrl":"10.1016/j.ijnsa.2025.100388","url":null,"abstract":"<div><h3>Background</h3><div>Research has identified evidence of coercion and abuse in psychiatric hospitals. The psychiatric care system in Japan is characterized by a custodial approach and long-term inpatient care, potentially increasing the risk of abuse. However, few studies have examined the occurrence and dynamics of abuse in psychiatric institutions, and there is a major research gap regarding the roles of hospital culture and management in contributing to inpatient abuse.</div></div><div><h3>Objective</h3><div>To investigate the experiences of psychiatric nursing managers of the factors contributing to inpatient abuse in psychiatric hospitals.</div></div><div><h3>Design</h3><div>A multisite, phenomenological, qualitative, and descriptive study.</div></div><div><h3>Settings</h3><div>Four hospitals in Japan that were either psychiatric hospitals or general hospitals dominated by psychiatric wards.</div></div><div><h3>Participants</h3><div>Eighteen nurse managers (including directors of nursing, deputy directors of nursing, and head nurses) working in psychiatric hospitals or in general hospitals dominated by psychiatric wards.</div></div><div><h3>Methods</h3><div>From May 2023 to July 2023, individual semi-structured interviews were conducted with each participant to obtain data on factors contributing to abuse in psychiatric hospitals. Reflexive thematic analysis was used to analyze the data. The data were coded, and the codes organized into themes and subthemes.</div></div><div><h3>Results</h3><div>Six themes and 23 subthemes were extracted that described participants’ perspectives on systemic, personal, and environmental contributors to inpatient abuse. The themes were ‘Structural challenges embedded in psychiatric care systems’ (e.g., finances, staffing, working conditions); ‘Organizational cultures lacking self-correction’ (e.g., the insularity of psychiatric hospitals, use of outdated nursing practices); ‘Dysfunctional team dynamics that undermine professional competence’ (e.g., suppression of nurses’ opinions and autonomy); ‘Asymmetries in patient–nurse relationships’ (e.g., power imbalances); ‘Illness factors that complicate the detection of abuse’ (e.g., interpretation of abuse as symptoms); and ‘The fragility of psychiatric nurses’ professional identity’ (e.g., lack of skills, experience, confidence, and fulfillment).</div></div><div><h3>Conclusions</h3><div>The results show that nurse managers play a key role in identifying institutional, personal, and relationship-based factors that contribute to inpatient abuse in psychiatric wards. The findings indicate a need for more policies to support patient-centered care and develop the role of nurse managers to create safer psychiatric wards.</div></div><div><h3>Study registration</h3><div>Not registered.</div></div><div><h3>Tweetable abstract</h3><div>nurse managers’ perspectives on contributors to inpatient abuse in psychiatric hospitals</div></div>","PeriodicalId":34476,"journal":{"name":"International Journal of Nursing Studies Advances","volume":"9 ","pages":"Article 100388"},"PeriodicalIF":3.1,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145007603","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pressure injuries in pediatric patients are associated with increased morbidity, mortality, and prolonged hospital stays, making the identification of effective risk assessment tools critical in clinical practice. Accurate risk assessment is essential in clinical practice. Although several assessment tools exist, their applicability and effectiveness vary across pediatric populations.
Objective
To identify and evaluate tools designed to assess the risk of pressure injuries in children, focusing on their characteristics, validation populations, reliability, and applicability across different clinical contexts.
Design
A systematic review was conducted.
Methods
This systematic review (PROSPERO: CRD42024527687) was conducted in accordance with the Cochrane Handbook. Comprehensive searches were performed in five databases—PubMed, Google Scholar, CINAHL, Web of Science, and Embase—for studies published between January 2010 and March 2024. Eligible studies included those describing the development, use, or validation of pressure injury risk assessment tools in children. Two independent reviewers conducted the selection and appraisal process. Methodological quality was assessed using the QUADAS-2 and QAREL checklists, with general reference to COSMIN guidelines.
Results
Of 964 records screened, 28 studies met the inclusion criteria, encompassing research from 15 countries, with Brazil being the most represented. Studies focused on pediatric and neonatal intensive care units, general wards, and surgical units. Ten different risk assessment tools were identified, including the Braden Q, Braden QD, and Glamorgan scales. The Braden QD scale—an adaptation of the Braden Q including medical device-related risk—was the most frequently evaluated. Other tools, such as the Pediatric Pressure Ulcer Prediction and Evaluation Tool and the Braden Q+P, were specifically developed or adapted for pediatric and neonatal use.
Conclusions
All identified tools demonstrated acceptable validity and inter-rater reliability. However, no single tool proved universally applicable across all pediatric contexts. The Braden QD, Braden Q, and Glamorgan scales emerged as the most comprehensive, particularly in intensive care settings, aligning with National and European Pressure Ulcer Advisory Panel recommendations. Further research is warranted to enhance tool accuracy and contextual adaptability across pediatric care environments.
Guidelines
PRISMA.
背景：儿科患者的压力性损伤与发病率、死亡率增加和住院时间延长有关，因此确定有效的风险评估工具在临床实践中至关重要。准确的风险评估在临床实践中至关重要。虽然存在几种评估工具，但它们的适用性和有效性在儿科人群中有所不同。目的确定和评估用于评估儿童压力损伤风险的工具，重点关注其特征、验证人群、可靠性和在不同临床背景下的适用性。进行了DesignA系统评价。方法本系统评价（PROSPERO: CRD42024527687）按照Cochrane手册进行。在pubmed、b谷歌Scholar、CINAHL、Web of Science和embase这五个数据库中进行了全面的检索，检索了2010年1月至2024年3月间发表的研究。符合条件的研究包括描述儿童压力损伤风险评估工具的开发、使用或验证的研究。两名独立评审员进行了选择和评估过程。使用QUADAS-2和QAREL检查清单评估方法学质量，并一般参考COSMIN指南。结果在筛选的964项记录中，28项研究符合纳入标准，包括来自15个国家的研究，其中巴西最具代表性。研究集中在儿科和新生儿重症监护病房、普通病房和外科病房。确定了10种不同的风险评估工具，包括Braden Q、Braden QD和Glamorgan量表。布雷登QD量表是对布雷登Q量表的改编，包括医疗器械相关的风险，是最常被评估的。其他工具，如儿童压疮预测和评估工具和布雷登Q+P，是专门为儿童和新生儿使用开发或调整的。结论所有鉴定的工具均具有可接受的效度和量表间信度。然而，没有一种工具被证明普遍适用于所有儿科情况。Braden QD、Braden Q和Glamorgan量表是最全面的，特别是在重症监护环境中，与国家和欧洲压疮咨询小组的建议一致。需要进一步的研究来提高工具在儿科护理环境中的准确性和上下文适应性。
{"title":"Assessment tools for the risk of pressure injury in children: A systematic review","authors":"Faustine Dessi , Julien Valeille , Pascale Beloni , Jean Toniolo","doi":"10.1016/j.ijnsa.2025.100410","DOIUrl":"10.1016/j.ijnsa.2025.100410","url":null,"abstract":"<div><h3>Background</h3><div>Pressure injuries in pediatric patients are associated with increased morbidity, mortality, and prolonged hospital stays, making the identification of effective risk assessment tools critical in clinical practice. Accurate risk assessment is essential in clinical practice. Although several assessment tools exist, their applicability and effectiveness vary across pediatric populations.</div></div><div><h3>Objective</h3><div>To identify and evaluate tools designed to assess the risk of pressure injuries in children, focusing on their characteristics, validation populations, reliability, and applicability across different clinical contexts.</div></div><div><h3>Design</h3><div>A systematic review was conducted.</div></div><div><h3>Methods</h3><div>This systematic review (PROSPERO: CRD42024527687) was conducted in accordance with the Cochrane Handbook. Comprehensive searches were performed in five databases—PubMed, Google Scholar, CINAHL, Web of Science, and Embase—for studies published between January 2010 and March 2024. Eligible studies included those describing the development, use, or validation of pressure injury risk assessment tools in children. Two independent reviewers conducted the selection and appraisal process. Methodological quality was assessed using the QUADAS-2 and QAREL checklists, with general reference to COSMIN guidelines.</div></div><div><h3>Results</h3><div>Of 964 records screened, 28 studies met the inclusion criteria, encompassing research from 15 countries, with Brazil being the most represented. Studies focused on pediatric and neonatal intensive care units, general wards, and surgical units. Ten different risk assessment tools were identified, including the Braden Q, Braden QD, and Glamorgan scales. The Braden QD scale—an adaptation of the Braden Q including medical device-related risk—was the most frequently evaluated. Other tools, such as the Pediatric Pressure Ulcer Prediction and Evaluation Tool and the Braden Q+P, were specifically developed or adapted for pediatric and neonatal use.</div></div><div><h3>Conclusions</h3><div>All identified tools demonstrated acceptable validity and inter-rater reliability. However, no single tool proved universally applicable across all pediatric contexts. The Braden QD, Braden Q, and Glamorgan scales emerged as the most comprehensive, particularly in intensive care settings, aligning with National and European Pressure Ulcer Advisory Panel recommendations. Further research is warranted to enhance tool accuracy and contextual adaptability across pediatric care environments.</div></div><div><h3>Guidelines</h3><div>PRISMA.</div></div>","PeriodicalId":34476,"journal":{"name":"International Journal of Nursing Studies Advances","volume":"9 ","pages":"Article 100410"},"PeriodicalIF":3.1,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144879586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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