Journal of Clinical Nursing最新文献

Background: Ample evidence has shown the benefit of high-fidelity simulation (HFS) in promoting learning in pre-licensure nursing students, but the evidence for practising registered nurses has not been synthesised.

Objective: To evaluate the effects of HFS training on learning outcomes and satisfaction in practising registered nurses.

Methods: In this systematic review and meta-analysis, we searched PubMed, CINAHL, ERIC, Cochrane Library, Web of Science and China National Knowledge Infrastructure (CNKI) for studies published in English or Chinese from database inception to 31 May 2023 (updated on 20 April 2025). All randomised controlled trials (RCT) or quasi-experiments that compared HFS training with traditional methods (e.g., lecture) for practising registered nurses and reported learning outcomes and satisfaction were included. Risk of bias was assessed by the Cochrane risk-of-bias tool for randomised trials (RoB 2) and non-randomised trials (ROBINS-I). Inverse-variance random-effect models were used to calculate standardised mean differences (SMDs) with 95% confidence interval (CI). We followed the PRISMA 2020 guideline.

Results: Of 1404 records, eight eligible studies (five RCTs and three quasi-experiments) involving 275 practising nurses were identified. Two RCTs had high risk of bias, while others showed some concerns or moderate risk of bias. Meta-analyses showed that HFS could promote knowledge acquisition (SMD = 0.65, 95% CI, [0.35, 0.95], p < 0.01, I² = 0%), professional skills (SMD = 0.72, 95% CI, [0.41, 1.04], p < 0.01, I² = 0%) and learning satisfaction (SMD = 1.24, 95% CI, [0.35, 2.13], p < 0.01; I² = 67%), compared with traditional methods. The pooled effect on self-confidence was marginally insignificant (SMD = 0.59, 95% CI, [-0.04, 1.22], p = 0.07; I² = 67%).

Conclusion: Compared with traditional training methods, HFS is effective in promoting knowledge acquisition, professional skills and learning satisfaction and may enhance self-confidence among practising nurses. To strengthen the evidence base, more rigorous RCTs with larger sample sizes, adequate reporting of HFS design, and standardised outcome measures are warranted.

Protocol registration: PROSPERO (CRD42022358717). No Patient or Public Contribution.

Aim: To explore community dwelling adults' lived experiences of participating in death café in Singapore.

Design: A descriptive phenomenological study with Photovoice.

Methods: A purposive sample of community dwelling adults who participated in a community-based death café was recruited for this study. Data was collected through online individual semi-structured interviews. The Colaizzi's six-step descriptive phenomenological analysis was conducted for data analysis.

Results: Twenty community dwelling adults who participated in a death café were recruited. Participants' experiences of the death café were expounded in four themes: appeals of attending death cafés, enabling features of death café, engaging in die-logues, and perceived impacts of death café on everyday lives. The participants were attracted to death cafés for various reasons including curiosity and grief. A comfortable environment, accompanied by open dialogues and refreshments, was credited as enablers for death conversations. Through these 'die-logues', the participants had a deeper understanding of death and began engaging in advance planning.

Conclusions: Death cafés provide a supportive environment for individuals to engage in death-related conversations that may not easily occur in daily life. By engaging in conversations about mortality within death cafés, participants are encouraged to take proactive steps towards advance planning.

Implications for the profession and/or patient care: Findings from this study can guide the development of community-based interventions by highlighting the essential components required for a death café tailored to the Asian context.

Impact: This study describes the community dwelling adults' lived experiences of participating in a death café. The findings from this study underscore the role of informal conversations about death as a tool to promote population health based palliative care initiatives such as overcoming death taboos and stimulating advance care planning among community dwelling adults.

Reporting method: The Consolidated Criteria for Reporting Qualitative Studies was used.

Patient and public contribution: Community-dwelling adults participated in the interviews.

Aim/design: This retrospective cohort study evaluated the relationship between patient falls, Morse Fall Scale (MFS) items, patient demographics, length of stay and hospital site.

Methods: Data were acquired from 72 hospitals in a health system. Logistic regression models were conducted including MFS items, demographics, length of stay, and interaction terms. The final mixed effects logistic regression model included significant patient-level covariates as fixed effects and hospital site as a random effect.

Results: 6531 of 978,920 total admissions included a patient fall. Four MFS items (fall history, secondary diagnosis, gait weak/impaired, mental status-overestimates/forgets limitations) and three demographic items (male gender, increased age, longer length of stay) were associated with increased likelihood of falling. Two MFS items (ambulatory aids, intravenous therapy/lock) and Hispanic ethnicity were associated with decreased risk of falling. An interaction effect was present between male gender and mental status. Males who overestimate/forget limitations had 3.16 times higher odds of falling than females oriented to their own ability. The proportion of variance in falls between hospitals was 0.23 and the median odds ratio (MOR) 1.57.

Conclusion: This study uniquely assessed fall risk at the level of the patient and hospital, using data from nearly 1 million admissions at 72 hospitals. Controlling for patient characteristics, results demonstrate variability in fall risk among hospitals. Research informing hospital differences as well as gender and racial/ethnic differences in falls is needed to identify appropriate interventions.

Implications for patient care: As hospitals increasingly adopt risk-directed fall prevention, assessment tools should be re-evaluated for clinical utility and corresponding prevention practices. The MFS may be enhanced by removing intravenous lock as a risk and screening for additional risks such as medications and medical equipment. Quality improvement efforts must also consider the hospital's environment and processes that may further contribute to fall risk.

Reporting method: Authors adhered to STROBE guidelines for reporting.

Patient contribution: No Patient or Public Contribution.

Aims: To assess the prevalence of malnutrition risk, especially of undernutrition, among patients admitted to the Internal Medicine and Orthopaedics wards at Michele and Pietro Ferrero Hospital, Italy, using the Nutritional Risk Screening 2002 (NRS-2002) tool, administered by trained nursing staff, and to evaluate the adherence to related care interventions.

Design: Cross-sectional study.

Methods: We included 248 adult patients, screened by trained nurses for nutritional risk within 48 h of admission using the NRS-2002 tool, which takes into account patients' Body Mass Index, recent weight loss, reduced dietary intake, and disease severity. Information on nursing interventions was also collected.

Results: We identified 36 subjects at risk of malnutrition with NRS ≥ 3. Prevalence was higher in Internal Medicine, reflecting differences in patient characteristics and clinical complexity. Patients at risk were older, had longer hospital stays, and higher risks of falls and pressure sores. Nursing interventions such as proper meal selection, administration of hypercaloric-hyperproteic supplements, and completion of food diary were implemented in most cases, although adherence was not complete. Post-training questionnaire showed that, overall, nurses integrated nutritional screening into practice, but areas for improvement were identified.

Conclusion: Results confirmed the high prevalence of malnutrition risk in hospitalised patients, especially in Internal Medicine. Proper training and empowerment can enable nurses to effectively identify and manage patients at intermediate risk of malnutrition.

Implications for the profession and/or patient care: Nurses can play key roles in hospital nutritional care by facilitating early identification and appropriate management of patients at malnutrition risk.

Impact: Malnutrition is very common among inpatients. Trained and empowered nurses can perform nutritional screening at admission to identify and early manage patients at risk, thereby helping to prevent increased morbidity, mortality and healthcare costs.

Reporting method: STROBE guidelines.

Patient or public contribution: None.

Aim: To describe the lived decision-making experiences of parents during the first 6 months after their children's new cancer diagnoses.

Design: Descriptive phenomenological study.

Methods: This study was conducted from 2022 to 2023 at an academic teaching hospital in Taiwan. Parents of children newly diagnosed with cancer within the previous 6 months were recruited using purposive sampling. Data were collected via in-depth interviews with 18 participants and subsequently analysed using the Giorgi method.

Results: Three major themes emerged: (1) making decisions without choices, with the subthemes of parallel universes and realities and overwhelming information and unanswered questions; (2) deferring decisions to expert judgements, with the subthemes of trust in professionals, working together, and seeing the future; and (c) balancing quality of life and survival, with the subthemes of confronting and suffering, mental preparation and worry, and being a strong supporter and carrying burdens. Hope for their children's survival sustained parents, empowering them to become steadfast sources of strength and support. Through hope, they transitioned from feeling helpless to actively advocating and assuming the primary caregiver role.

Conclusions: After deciding to proceed with their children's cancer treatment, hope for survival becomes the strongest factor motivating parents to navigate, explore, and move forward in an environment filled with uncertainty. Psychological preparation and understanding ease parental anxiety.

Implications for the profession and/or patient care: The development of clear, structured care plans is recommended to help parents feel supported and transition early from novices to confident guides.

Impact: The findings of this study highlight the shift in parents' roles following children's cancer diagnoses from facing unavoidable decision-making to actively striving to balance children's quality of life with treatment outcomes. They provide guidance for the support of parents' engagement with decision-making plans in clinical practice.

Reporting method: Standards for Reporting Qualitative Research.

Patient or public contribution: None.