Nursing Open最新文献

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.

Objective: To examine the psychosocial impact and parental stress associated with severe neurological disorders and intellectual disabilities in children, with a particular focus on the relationships between parental response styles and family stress and impact.

Design: A descriptive, cross-sectional, prospective study was conducted.

Methods: The study included parents of children with neurological disorders and intellectual disabilities. Participants completed the Family Management Style Framework, Parenting Stress Index, and Parental Response Style Questionnaire. In addition, clinical characteristics related to psychological or psychiatric problems and conduct disorders were collected via parent-reported questionnaire items and analysed as categorical variables.

Results: One hundred parents participated in the survey, with data from 100 children analysed. Discomfort and Stress showed positive and significant relationships with all the factors of the Parental Response Style Questionnaire, except for Overprotection, while the Family Management Style Framework subscales did so with the Apathy/dysphoria. The presence and clinical complexity of psychological or psychiatric problems and conduct disorders were significantly associated with higher levels of parental stress and family impact.

Conclusions: Families of children with intellectual disabilities face substantial challenges that affect family functioning and daily activities. The presence and clinical complexity of psychological or psychiatric problems and conduct disorders emerged as key clinical characteristics associated with increased parental stress and family impact. Given the cross-sectional design of the study, these findings should be interpreted as associative, and no causal, directional, or temporal inferences can be drawn.

Impact: Parents provided critical insights into the challenges of caring for children with severe neurological disorders and intellectual disabilities, contributing to a better understanding of family dynamics and stress-related factors. Identifying relevant clinical characteristics may help nurses and other health professionals tailor family-centred interventions.

Reporting method: This paper is reported according to the STROBE Statement.

Patient or public contribution: Parents of children with severe neurological disorders and intellectual disabilities were the subjects of data collection for this study and participated in the survey after providing voluntary consent to participate.

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.

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.

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.

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: 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.

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.