Journal of Clinical Nursing最新文献

Aim: To develop a person-centred nurse-led model of care framework to empower people post hip fracture.

Design: Modified e-Delphi study.

Methods: A Modified e-Delphi study seeking expert opinion from people with the lived experience of hip fracture and clinicians was implemented. Content experts consisted of 17 nursing and medical clinicians and four people with the experience of hip fracture.

Results: Study found > 70% consensus on all 20 statements rating the importance and feasibility of care components in the Modified e-Delphi survey. Themes developed from content analysis of expert free text responses comprised: Relationships support person-centred care; Value of a Specialist Hip Fracture Nurse; Prioritising is key to positive outcomes. PREPARE-Empowering People Post Hip Fracture: A Conceptual Framework for a nurse-led model of care was developed from study findings, highlighting key principles: person-centred care; evidence-informed practice; Health Empowerment; organisational governance; follow-up and evaluation, constituting this framework.

Conclusion: This study presents PREPARE-Empowering People Post Hip Fracture: A Conceptual Framework for a nurse-led model of care. PREPARE presents a structured approach to empowering people post hip fracture, outlining the aim and context in which the model of care is intended. It highlights an integrated, shared, coordinated approach to the care of people post hip fracture. Shared care empowers people and their support person to effectively manage their recovery journey and safely remain supported in the community.

Implications for practice: PREPARE outlines a structured framework to support nurse leaders in implementing nurse-led models of care for people post hip fracture. There is an opportunity to empower nurse leaders and patients to support the recovery journey through education encompassing this person-centred holistic framework.

Impact: To our knowledge this is the first study to develop a conceptual framework for a nurse-led model of care to empower people post hip fracture. This model highlights opportunities for an integrated shared, coordinated approach to the care of people post hip fracture. PREPARE-Empowering People Post Hip Fracture: A Conceptual Framework for a nurse-led model of care, offers a structured approach for localised health service development of person-centred nurse-led empowerment models of care.

Reporting method: DELPHISTAR-Delphi studies in social and health sciences-Recommendations for an interdisciplinary standardised reporting.

Patient or public contribution: The experiences of people post-hip fracture, and clinicians were elicited to inform the PREPARE Conceptual Framework.

Aim(s): To develop theories about how Nursing Associate (NA) roles are implemented and working within NHS practice: What works, for whom, in what contexts and how?

Methods: Rapid realist synthesis of: (1) empirical and grey literature; (2) realist interviews with stakeholders. Sources were analysed using a realist approach that explored the data for novel or causal insights to generate initial programme theories.

Results: Empirical and grey sources (n = 15) and transcripts from stakeholder interviews (n = 11) were synthesised which identified three theory areas relating to NA implementation: (1) Scope of NA role: Communication and expectations; (2) Variations to the NA model of working; and (3) Career progression: Entry point, stepping stone and career in itself.

Conclusion: The NA holds the potential to improve nursing workforce stability by encouraging locally based, non-registered healthcare staff to transition to an NA. However, the lack of collective understanding of the NA scope of practice can cause staff friction. It is unknown whether this friction will reduce over time or if staff divisions will lead to further deterioration of the workforce.

Implications for the profession and/or patient care: Ongoing clear communication regarding NA scope of practice needs to be provided to aid understanding of their supplementary role and its potential contribution to nursing teams.

Impact: This work represents a first step to support both researchers and nursing workforce leaders in furthering knowledge of the impact of integrating NAs in diverse healthcare contexts and to unearth the mechanisms underpinning the success or failure of this new role.

Reporting method: Realist and meta-narrative evidence syntheses: Evolving standards.

Community inclusion and engagement (cie): Planning of the research design and interpretation of the results was completed with nurse clinicians with experience in the NA role.

This paper responds to the recently published article on nurses' turnover intentions and their lived experiences of disempowerment, moral distress and organisational neglect. While the study illuminates important workplace realities, it overlooks the perspectives of nurses who have left not only their institutions but also their countries of origin. From the vantage point of Filipino nurses in the diaspora, the decision to migrate mirrors the dynamic, cumulative processes described in the article. Migration is seldom the result of one critical incident; rather, it arises from entrenched systemic issues-understaffing, lack of respect and persistent undervaluing of nursing contributions-that transcend borders. Diaspora nurses bring with them narratives of resilience, yet their departure reflects health system fragility in their home countries and exposes new challenges in host nations. This commentary highlights the urgent need for global cooperation, stronger leadership and policy innovations that recognise migration as part of the retention equation, not apart from it.

Aim: To examine the characteristics of the health care needs corresponding to the medical care process and HR-QOL of women with cancer.

Design: A descriptive design was adopted.

Methods: The study's participants were 122 women with cancer who completed a survey before and 6 months after treatment initiation. A principal component analysis (PCA) was conducted on a set of 12 health care satisfaction scores at each point. Correlations were examined between the resulting components and HR-QOL indicators, including subjective well-being, symptoms, symptom-related interference, anxiety and depression.

Results: Most participants reported high health care satisfaction in both phases. PCA indicated the presence of 3 distinct domains: satisfaction with health care, health care management and supportive care. In both phases, these domains accounted for about 60% of the variance, while the remaining 40% was unexplained. Only satisfaction with health care was correlated with HR-QOL at both phases, with particularly strong associations observed for subjective well-being and depression at 6 months. Before treatment initiation, the item of 'nursing care and practice' received the highest average score, but demonstrated a negative loading on the component of 'satisfaction with health care management'. The component of 'satisfaction with supportive care needs' was retained at both phases.

Conclusion: Health care plays a pivotal role in maintaining patients' quality of life, while supportive care and the integration of nursing practice within health care management remain essential.

Implications for patient care: High satisfaction scores do not necessarily mean that all health care needs are met. Addressing unmet needs from the perspective of HR-QOL and ensuring continuous supportive care throughout the treatment process is imperative.

Patient contribution: Data provided by women with cancer was used.

Aim: This study aimed to explore and describe the experiences and perceptions of mothers of children with leukaemia regarding the transition of care from hospital to home.

Design: A qualitative content analysis with a conventional approach was employed, and this report follows the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist.

Methods: Thirteen mothers of children with leukaemia were recruited using purposive sampling from two Iranian paediatric hospitals. Data were collected through in-depth, semi-structured interviews conducted between 2023 and 2024 and analysed using conventional qualitative content analysis.

Results: Drowning in the Vortex of Fear and Doubt emerged as the central theme, encapsulating the shared experiences of mothers of children with leukaemia. This overarching theme comprised five categories: (1) Fear of Unpredictable and Life-Threatening Complications, (2) Paradoxical Concerns About Discharge, (3) Doubts and Hopelessness About Treatment Effectiveness, (4) Stress Regarding the Child's Future Life Trajectory and (5) Sense of Helplessness in Alleviating the Child's Suffering.

Conclusion: The findings underscore the need to provide comprehensive supportive services for parents of children with leukaemia. Policymakers and healthcare teams should prioritise initiatives that enhance parental awareness, deliver psychosocial support and empower families to navigate the arduous path of care and treatment with greater trust and confidence.

Implications for the profession and patient care: Ensuring the well-being and comfort of both the child with cancer and the parents throughout the treatment process is essential for improving care outcomes.

Reporting method: The study is reported according to the COREQ.

Public contribution: Mothers of children with leukaemia participated as interviewees and contributed to ensuring the rigour of the study through data validation.

Aim(s): To explore the caregiving experiences and support needs of fathers of children with medical complexity in Canada.

Design: A qualitative study guided by interpretive description methodology and informed by a Gender-Based Analysis Plus (GBA+) lens.

Methods: Data were collected through 60-min semi-structured interviews with seven fathers of children with medical complexity and analyzed using thematic analysis. The study followed the COREQ guidelines and checklist.

Results: Thematic analysis identified fathers' key roles as financial providers, hands-on caregivers, and as playing a key role in supporting their partners emotionally with the challenges of caregiving. Fathers prioritised the need for peer support, flexible workplace policies and improved access to mental health services.

Conclusion: The findings indicate that there is a critical need for more inclusive and flexible support systems and workplace policies that acknowledge and accommodate the important caregiving roles of fathers of children with medical complexity.

Relevance to clinical practice: The implications for healthcare professionals include actively involving fathers in care planning and providing targeted support services that recognise their roles to enhance child and family outcomes.

Patient or public contribution: We worked closely with our community advisory team, comprised of a physician, social worker and community organisation leader, who contributed to the study design, supported participant recruitment, and assisted in disseminating the findings back to the community, helping to ensure the research was grounded in and responsive to the needs of families of children with medical complexity.

Aims: With little known about the impact of acculturation on cardiovascular disease (CVD) self-care among immigrants, this study examined acculturation among Chinese immigrants and investigated its association with CVD self-care behaviours in this population.

Methods: A cross-sectional study was conducted, employing multiple acculturation indices and the Self-Care of Coronary Heart Disease Inventory to collect data from Chinese immigrants with CVD via Chinese Community Centres, social media and cardiac clinics. Descriptive statistics and multiple linear regression analyses were employed. The study adhered to the STROBE guidelines.

Results: Altogether 260 participants were recruited; 47.7% were female; the mean age was 71.8 years, the mean age at migration was 55.1 years and their mean duration of residence in Australia was 16.7 years; 41.2% could not speak English. Participants reported low acculturation levels via the Suinn Lew Asian Self-Identity Acculturation scale (mean score 1.8), but perceived high self-efficacy in coping with acculturation stressors relating to their health management (mean score 33.6). Their attitudes scored as slight agreement with Traditional Chinese Medicine (TCM) beliefs (mean score 3.4). Proxy acculturation measures revealed lower levels of acculturation associated with better CVD self-care behaviours. Higher perceived self-efficacy in coping with acculturation stress was linked with better CVD self-care maintenance and monitoring and better self-care management was observed among participants holding a stronger belief in TCM.

Conclusion: The acculturation of Chinese Australian immigrants contributed to the explanation of the variance in their CVD self-care behaviours.

Implication: Comprehensive assessment of acculturation in patients with culturally and linguistically diverse backgrounds can help nurses identify those likely to demonstrate poor CVD self-care behaviours, and culturally specific, individually tailored interventions may support improved self-care.

Patient or public contribution: Patients were involved as participants in this study for data collection.