Nursing Open最新文献

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: 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.

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: To provide a comprehensive understanding of how nurse managers' leadership styles affect staff engagement and to identify key themes that influence engagement from both statistical and experiential perspectives within a multicultural healthcare context.

Design: Explanatory sequential mixed-methods design, with integration occurring across the design, methods and reporting stages using the Pillar Integration Process.

Methods: The study was conducted in four public hospitals in western Saudi Arabia. Quantitative data were collected from 278 registered nurses using the validated Multifactor Leadership Questionnaire (MLQ-5X) and Utrecht Work Engagement Scale (UWES-9). Thirteen nurses participated in follow-up semi-structured interviews. The study adhered to the Good Reporting of a Mixed Methods Study (GRAMMS) guidelines.

Results: Four integrated themes emerged: relational leadership, recognition and reward, impact of neglectful leadership and cultural competence in leadership. Saudi and non-Saudi nurses perceived leadership differently, influenced by cultural norms.

Patient or public contribution: No patient or public contribution.

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.

Aim: To conduct an in-depth concept analysis of exnovation, exploring its significance, conceptual mechanisms and impacts in administration, business and healthcare, particularly emphasising its relevance to nursing.

Background: Exnovation is applicable in diverse fields, including information technology, manufacturing, business, education and cultural contexts; however, its utilisation in nursing and healthcare is limited and not widely adopted.

Data sources: The literature for this concept analysis was retrieved from two databases, PubMed and Scopus. A systematic search approach was employed across studies from business, administration and health care, specifically without restriction based on the year of publication.

Review methods: The article utilised Walker and Avant's 8-step approach to concept analysis, which entailed identifying the applications of the concept in various settings, its fundamental conceptual characteristics and developing model, borderline, related and contradictory instances. Additionally, the antecedents, consequences and empirical references of exnovation in nursing were established.

Results: The analysis revealed both onomasiological approaches to elucidate the evolution of innovation terminology and a semasiological approach to explain the concept across various contexts. Moreover, it identified antecedents to innovation in nursing, such as technological advancements and the adoption of evidence-based practices (EBPs), while also delineating consequences primarily focused on enhancing quality patient care and job satisfaction.

Conclusion: As exnovation emerges as a novel concept in nursing and medical practice, further research is warranted to tackle the recognised limitations and formulate practical guidelines for effectively integrating exnovation within nursing and healthcare settings.

Aim: To identify and map the breadth of available evidence on nurses' perspectives of the facilitators and barriers to relatives' involvement in the care continuum of patients with acquired brain injury or malignant brain tumour.

Background: The involvement of relatives in care and treatment may have a significant positive impact on the quality of care and treatment, leading to higher satisfaction with hospitalisation for patients, relatives and healthcare professionals. Nurses play an important role in nurturing a trusting and facilitating relatives' involvement. However, involving relatives seems complex and multifaceted, with many possible facilitators and barriers to consider.

Design: This scoping review was conducted in accordance with the Joanna Briggs Institute's methodology for scoping reviews and a published a priori protocol.

Data sources: A comprehensive literature search was conducted in MEDLINE (PubMed), CINAHL (EBSCO) and Embase (OVID). Reference lists of included studies, Google Scholar and Web of Science were also searched. Literature published in the English, German or Scandinavian languages since 2010 was included.

Results: The search identified 4330 studies, of which 18 were included. No studies including involvement of relatives to patients with Malignant Brain Tumour was found. Nurses' perspectives of the facilitators and barriers to relatives' involvement of patients with acquired brain injury indicates that several facilitators and barriers contribute to or hinder relatives' involvement. The facilitators for involvement were mostly related to nursing tasks within the healthcare system, acknowledging relatives in their own rights, building a trusting relationship and using communication as a tool. Contrary, barriers were organisational factors, when the patient was seen as a primary focus of care, and informational challenges.

Conclusions: The results illustrate the complex nature of involvement from the perspective of nurses. The results indicate a paradox because several of the identified aspects are not mutually exclusive but rather represent aspects of involvement that range along a continuum.

Implication for the profession: Nurses' involvement of relatives in the care continuum is important, however evidence suggests that the relationships between relatives and nurses need to be strengthened to individualise the level of involvement. We suggest that the organisational and contextual factors that shape relative involvement need to be studied further.

Report method: PRISMA-ScR.

Patient or public contribution: No Patient or Public Contribution. However, the review findings were shared and discussed with a panel of nurses from the neurosurgical speciality who validated and nuanced the findings into a Danish context.

Background: The United States (US) declared drug overdose a public health emergency in 2017. Despite this, two million people reported having an opioid use disorder (OUD) in 2018. However, following the beginning of COVID-19 there was a 53% increase in overdose deaths, with American Indian/Alaska Native (AI/AN) individuals experiencing the highest rates of all racial groups. In response to the COVID-19 pandemic and OUD treatment access challenges, OUD treatment policies were changed to improving access to care.

Purpose: This review examines how the state- and federal-level policies impacted access to medications for opioid use disorder (MOUD) during the COVID-19 pandemic. Due to the devastating impact of overdose and COVID-19 on AI/AN communities, as a secondary aim, we examined the inclusion of these populations in the samples of the included studies.

Methods: We completed a narrative review using a data-based convergent synthesis design.

Results: Forty-four studies met the inclusion criteria. Most of the studies were quantitative descriptive studies (n = 25). Only two studies offer AI/AN as a category for ethnicity and both had less that 4% of the sample that identified as an AI/AN individual.

Conclusion and implications: Telehealth OUD treatment increased initiation and retention for patients taking buprenorphine. No increase in overdose rates was associated with allowing for additional take-home doses of methadone. However, access to treatment, even telehealth, remains difficult for individuals due to a lack of OUD treatment providers and access to the internet. More needs to be done to address the opioid overdose crisis, especially among AI/AN communities. Research focused on cultural strategies to address this health disparity is desperately needed. We included nursing implications in response to this health disparity among AI/AN individuals.

Aim: To explore the lived experiences of Thai participants of public mass shooting during the COVID-19 pandemic.

Design: A phenomenographic research approach was used.

Methods: Fifteen participants were recruited using purposive and snowball sampling. Data were collected through dialogical interviews and analysed using thematic analysis within a Heideggerian interpretive framework. The study adhered to the Consolidated Criteria for Reporting Qualitative Research (COREQ).

Results: Through a hermeneutic lens, five interpretive themes were identified: dwelling in the shadow of threat, bearing witness to collective rupture, embodied echoes of trauma, grounding the self through everyday rituals and yearning for attuned care. These themes illuminate survivors' meaning-making amid dual crises and reflect the complex interplay of somatic, psychological and social adaptation.

Conclusion: The narratives of survivors underscore the urgent need for trauma-informed, relationally grounded nursing care in the aftermath of mass shooting incidents. The five emergent themes-ranging from embodied fear to the yearning for attuned care-highlight the complex interplay of psychological, social and existential dimensions of trauma. These findings emphasise the importance of holistic, context-sensitive interventions that not only validate survivors' emotional experiences but also foster adaptive coping and social reintegration. By recognising the embodied nature of fear and addressing survivors' multifaceted needs, healthcare professionals can play a pivotal role in facilitating recovery and promoting long-term well-being.

Patient or public contribution: Fifteen individuals with firsthand experience of mass shootings during the COVID-19 pandemic contributed personal narratives that informed the study's thematic analysis and nursing implications.