Nursing Open最新文献

Aim: This study aimed to investigate associations between the nurse practice environment and nurse-sensitive patient outcomes in Hong Kong.

Design: This was a 4-wave repeated cross-sectional study.

Methods: The sample comprised 71 adult general medical, surgical and orthopaedic wards recruited from four public hospitals. Data on nurses' practice environment and nurse-sensitive patient outcomes were collected quarterly from each hospital over a one-year period from January 2016 to December 2018. The number of participating nurses per survey wave ranged from 604 to 865. Measures comprised the Practice Environment Scale of the Nursing Work Index and four nurse-sensitive patient outcomes identified from the National Quality Forum-endorsed nursing-sensitive care measure set. The associations between each outcome and the practice environment were examined using multiple regression analysis.

Results: Nurse practice environments were rated favourably. The 'Nursing foundations for quality of care' subscale received the highest score (59.6) while the 'Staffing and resource adequacy' subscale received the lowest score (36.7). Though no significant associations were found between the overall practice environment and nurse-sensitive patient outcomes, the subscale of 'Staffing and resource adequacy' was significantly associated with the incidence of inpatient falls and catheter-associated urinary tract infections.

Conclusions: Our findings suggest that staffing is a core nurse workplace concern which impacts the outcomes of inpatient falls and catheter-associated urinary tract infections. However, the overall nurse practice environment was not significantly associated with any patient outcomes, and further studies are needed to corroborate these results. Additional mediating factors such as nurse resilience, which may potentially affect patient outcomes, should also be explored.

No patient or public contribution: Patients or the general public were not involved in the design, analysis, or interpretation of the data in this study.

Aims: To explore the perceptions and experiences of parents raising children with special educational needs, focusing on the impact of the COVID-19 pandemic and its aftermath.

Design: A descriptive qualitative approach was conducted using a photovoice design.

Methods: Individual interviews were conducted with 17 parents of children with special educational needs. These parents were asked to take photos that reflected their caring experiences of their children, especially during the COVID-19 pandemic, and to add captions to each photo. Data were analysed using an inductive thematic analysis.

Results: The analysis revealed four themes: flashbacks of COVID-19 memories, impacts that last beyond the pandemic, lessons learnt, and services needed. Our findings suggested that the experience of life under lockdown during the pandemic has created lasting memories for parents. It has had positive and negative impacts on family relationships and children's learning, extending beyond the pandemic's immediate effects. Despite their numerous challenges, parents expressed gratitude for discovering their own solutions, recognising the importance of quality time spent with their children, and acknowledging the growth experienced by both their children and themselves. However, they also emphasised the crucial need for comprehensive and continuous psychological support and services to be provided to them.

Conclusions: This study sheds light on the unique caregiving experiences of parents raising children with special educational needs, particularly during the challenging times of the COVID-19 pandemic and its aftermath. It revealed both positive and negative aspects of their experiences, offering a new perspective on their caregiving journeys and highlighting their ongoing needs.

Implications for the profession and/or patient care: It suggests the need to consider the well-being and needs of parents who engage in complex caregiving-children interactions at home.

Impacts: Insights gained from this study serve as a foundation for community service planning and developing supportive interventions that recognise the unique needs of parents of children with special care needs, ultimately improving the overall quality of life for parents and their children.

Reporting method: The study followed the Consolidated Criteria for Reporting Qualitative Research guideline.

Patient or public contribution: No patient or public contribution.

Aim: This study aimed to investigate the information needs for artificial intelligence chatbot-based interventions on prenatal care among pregnant women of advanced maternal age.

Design: This study employed a qualitative research method using thematic analysis.

Methods: Participants were pregnant women of advanced maternal age aged 35 and older who attended childbirth classes or used midwifery services in three cities. Participants were recruited through purposive sampling from September 23, 2023, to February 24, 2024, until saturation was reached. Semi-structured interviews were conducted with a total of 13 participants. The analysis was conducted in accordance with Braun and Clarke's six phases of thematic analysis: familiarisation with the data, generating initial codes, searching for themes, reviewing themes, defining and naming themes, and producing the report.

Results: Four central themes were identified that described prenatal care information needs for AI chatbots, as follows: (1) Information needs for an AI chatbot supporting advanced maternal age pregnancy; (2) childcare; (3) postpartum recovery; and (4) breastfeeding promotion.

Conclusion: These findings highlight the importance of developing an accessible, interactive, and empathetic AI chatbot-based prenatal care application that can provide reliable information and support to improve maternal and fetal health among women of advanced maternal age.

Implications for the profession and/or patient care: The themes identified in this study offer concrete guidance for developing an AI chatbot that delivers relevant support for postpartum recovery, breastfeeding, newborn emergencies, and child health management among pregnant women of advanced maternal age.

Reporting method: The study follows the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines.

Patient or public contribution: No patient or public contribution.

Aims: This study aims to investigate the barriers encountered by specialised nurses working in nurse-led clinics at a tertiary hospital and to identify strategies for enhancing service delivery and operational management.

Design: A descriptive qualitative study, conducted in accordance with the Consolidated Criteria for Reporting Qualitative Research (COREQ).

Methods: Purposeful sampling was employed to select 20 specialty nurses providing outpatient care at nurse-led clinics in a tertiary hospital in Fujian Province, China. Semistructured in-depth interviews were conducted, and data were analysed using conventional content analysis.

Results: The strategies and barriers identified in nurse-led clinics can be categorised into four main themes: (1) Challenges and Difficulties in Work, (2) Resource Support and Optimisation, (3) Advantages of Specialty Integration, and (4) Innovations and Development.

Conclusions: The development of nurse-led clinics requires risk protection and robust support, underscoring the importance of managerial attention and collaboration among healthcare professionals. Additionally, enriching professional content and implementing innovative service models are essential for the long-term advancement of specialty nursing outpatient practice.

Aim: To explore pre-registration male nursing students' choice of nursing as a career, gender role of a nurse misconceptions and clinical learning experience to inform regional career advice, recruitment, support and shaping the image of a nurse.

Design: An exploratory convergent parallel mixed-method study.

Methods: Selected data of pre-registration male nursing students studying in a regional nursing programme was taken from a larger national convergent parallel mixed-method study (n = 1410) involving 16 Australian universities and the Australian College of Nursing. Students were surveyed July-September 2021 using an online survey tool; a 17-item self-report Gender, Attitude and Misconception (GEMINI) scale and a 19-item clinical learning experience (CLEI-19) scale. Qualitative data consisted of responses to three statements.

Results: Pre-registration male nursing students (n = 42). Nursing was a first career choice for most males n = 35 (83.3%). The leading education pathway to nursing was higher school certificate n = 12 (28.6%) and diploma n = 11 (26.2%). Gender misconceptions were higher in Australia-born males compared to males born overseas. Males with previous health-related work experience reported a more positive clinical experience and sense of belonging. Qualitative statements did not evoke responses from all male participants. Themes revealed most males are aware of the professional qualities of a nurse and are treated equally during their clinical experience. The view for many males born in Australia is that male discrimination still exists.

Conclusion: Gender misconceptions of the role of a nurse exist for Australian born males and may reflect the local region cultures' views ingrained from historical epistemes. Males' participation rates in nursing will remain low unless misconceptions of the gender role of the nurse are addressed through a broader societal raised awareness that nursing is a valid career choice for men.

Implications for the profession and/or patient care: Monitoring pre-registration male nursing students' nursing gender role misconception is a needed indicator to assist in measuring and evaluating the effectiveness of career advice, recruitment strategies and support for males within nursing programmes, and shaping the contemporary image of a nurse.

Impact statement: Australia is experiencing a nursing shortage. Addressing the cultures' misconceptions of the role of the nurse will increase male participation rates and assist in growing the nursing workforce.

Reporting method: Adhered to relevant EQUATOR guidelines and followed STROBE guidelines.

Patient or public contribution: No Patient or Public Contribution.

Background: Clinical practice competency is crucial for midwifery and nursing students, as it directly impacts the quality of patient care and health outcomes.

Aim/objective: This systematic review and meta-analysis aims to evaluate the level of clinical practice competency among midwifery and nursing students in Ethiopia and identify associated factors influencing their competency.

Design: A comprehensive literature search was conducted across multiple databases, including MEDLINE, Scopus, Web of Science, Cochrane Library, Hinari and Google Scholar.

Methods: Studies were included if they examined clinical practice competency among midwifery and nursing students in Ethiopia and were published before 10 August 2025. Two independent reviewers conducted study selection, data extraction and quality assessment, with discrepancies resolved by a third reviewer. Meta-analysis was performed using random-effects models, and heterogeneity was assessed using I² statistics.

Results: The review included nine studies with a total of 2706 participants. The pooled proportion of clinical practice competency among midwifery and nursing students was 39.02% (95% CI: 29.95%-48.09%), showing substantial heterogeneity (I² = 96.14%). Factors significantly associated with competency included conducive clinical settings (AOR = 2.92), positive attitudes and confidence (AOR = 2.70), instructor support (AOR = 2.97), clinical preceptor support (AOR = 4.44) and encouragement from clinical staff (AOR = 3.95).

Conclusions: The review revealed a low clinical practice competency rate of 39.02%, indicating a critical need for improved training. Factors positively impacting competency highlight the importance of supportive environments and targeted interventions to enhance clinical skills among nursing and midwifery students.

Limitations: The most significant limitation of this systematic review is the high degree of heterogeneity among the included studies, as reflected by an I² value of 96.14%.

Trial registration: PROSPERO: CRD420251111145.

Aim: To investigate the specific risk factors associated with the development of hospital-acquired pressure injuries in critically ill patients.

Design: A retrospective case-control study.

Methods: Using evidence-based and Delphi methods, 36 potential risk factors for HAPI in critically ill patients were identified. Data were collected from non-COVID patients admitted to the ICU of Huzhou from January 2019 to December 2021. Univariate and multivariate analyses were used to identify significant risk factors.

Results: A total of 197 patients were included, with 53 (26.9%) developing HAPI. Univariate analysis indicated significant differences across 25 variables, including patient-specific factors, tissue tolerance and correlation scores. Multivariate analysis identified co-morbidities (OR = 3.16), a MEWS score ≥ 5 (OR = 5.83), use of sedative drugs (OR = 2.28), low Braden nutritional score (OR = 4.05), skin oedema (OR = 4.60) and faecal incontinence (OR = 13.17) as independent risk factors for HAPI in critically ill patients.

No patient or public contribution: To mitigate HAPI risks, nursing staff should prioritise monitoring high-risk patients, perform comprehensive risk assessments and implement timely, targeted interventions to enhance patient care and reduce adverse events.

Trial registration: ClinicalTrials.gov ID: NCT05564975.

Background: Post-discharge care continuity represents a modifiable factor influencing outcomes in myocardial infarction survivors, yet its multidimensional relationship with treatment adherence and psychological morbidity remains underexplored.

Methods: This retrospective cohort study analysed 452 adults with first-time acute myocardial infarction discharged between 2019 to 2024 from Beijing Tongren Hospital. Care continuity was quantified via a validated 10-point score (0-10) assessing follow-up frequency (0-4 points), content coverage (0-3 points), and multidisciplinary coordination (0-3 points). Participants were stratified into low (≤ 3 points, n = 231), moderate (4-6 points, n = 157), and high continuity (≥ 7 points, n = 64) groups. Primary outcomes were 6-month treatment adherence (composite of medication possession ratio ≥ 80% for ≥ 2 core medications and ≥ 75% scheduled visit completion) and anxiety/depression symptoms (PHQ-9 ≥ 10, GAD-7 ≥ 8, or clinical diagnosis). Multivariable logistic regression adjusted for sociodemographic, clinical, and psychological confounders.

Results: High continuity care demonstrated significantly increased treatment adherence versus low continuity (adjusted odds ratio [aOR] = 2.50, 95% confidence interval [CI]: 1.82-3.42) and reduced anxiety/depression symptoms (aOR = 0.48, 95% CI: 0.30-0.77). Each 1-point continuity increase improved adherence by 22% (aOR = 1.22, 95% CI: 1.15-1.30) and decreased psychological risk by 13% (aOR = 0.87, 95% CI: 0.82-0.93). Absolute adherence difference between high and low continuity groups was 35.1% (number needed to treat = 3). Cardiovascular events decreased progressively across continuity levels (low: 22.1%, moderate: 12.7%, high: 7.8%; p = 0.003), with high continuity independently reducing event risk by 58% (aOR = 0.42, 95% CI: 0.24-0.73). Urban residence and higher left ventricular ejection fraction predicted better continuity access.

Conclusion: Quantified care continuity exhibits a dose-dependent association with superior medication adherence, psychological wellbeing, and reduced cardiovascular risk in myocardial infarction survivors. Optimising continuity represents a high-yield strategy for secondary prevention.

Aim: Spiritual care is vital to patient-centred care, yet gaps persist in nursing and midwifery education. This study presents the self-assessed spiritual care competencies of Slovenian nursing and midwifery students.

Design: A cross-sectional design was used.

Methods: A non-experimental, cross-sectional design was applied to a purposive sample of 319 undergraduate and graduate nursing and midwifery students. Data were collected based on the Spiritual Care Competency Self-Assessment Tool.

Results: The results showed that 51.7% (n = 165) of students demonstrated a moderate level of spiritual care competence, 40.4% (n = 129) achieved a good level and only 5.3% (n = 17) attained a high level. Nursing students scored significantly higher than midwifery students (p < 0.05), particularly in intrapersonal and interpersonal spirituality. Female students reported higher competence in spiritual care planning and interpersonal spirituality compared with males (p < 0.05). No significant differences were found regarding study format, year of study, or religious affiliation.

Conclusions: The findings highlight the need for targeted educational interventions to improve spiritual care training, ensuring all healthcare students develop the necessary competencies to provide holistic, patient-centred care.

Patient or public contribution: Nursing and midwifery students participated in this study.

Background: In clinical environments, nursing students encounter a variety of stressors, which can significantly impact their well-being, learning outcomes and the quality of care they provide to patients.

Aims: To develop and validate the Nursing Students' Clinical Practice Stress Scale (NSCPSS) to measure clinical practice stressors in nursing students in Sri Lanka.

Design: An exploratory sequential mixed methods design.

Methods: The study was conducted in two phases. The NSCPSS items were developed in the qualitative phase based on data gathered through focus group interviews and a literature review. The quantitative phase focused on the psychometric evaluation of the scale, assessing its face, content, construct, convergent, discriminant validity and reliability using data from 183 nursing undergraduate students.

Results: Four factors were extracted from 30 items through exploratory factor analysis: (1) lack of knowledge, skills and experience, (2) lack of academic communication and support systems, (3) challenges in managing academic and clinical demands and (4) challenges in the clinical learning environment. These four factors collectively explained 57.0% of the total variance. The confirmatory factor analysis demonstrated the acceptable goodness-of-fit indices. All factors showed reliability, with internal consistency and composite reliability indices > 0.6.

Conclusion: The NSCPSS is a valid and reliable instrument to measure the clinical stressors experienced by undergraduate nursing students.

Implications for practice: The development and validation of the NSCPSS is a key step toward identifying stressors that undergraduate nursing students experience during clinical practice. It contributes to enhancing effective learning during clinical practice and students' well-being and develops a resilient future nursing workforce capable of delivering high-quality patient care.

Reporting method: Good Reporting of a Mixed Methods Study (GRAMMS) checklist.

Patient or public contribution: No patient or public contribution.