Journal of Clinical Nursing最新文献

Aim: The aim of this study is to assess nurse practitioner students' perceptions and engagement with Isabel's artificial intelligence (AI) based differential diagnosis tool to support their decision-making skills during their theoretical and clinical placement training.

Design: This pilot study used a cross-sectional design.

Methods: Twenty-six nurse practitioner students provided feedback on their use of an AI differential diagnosis tool in both academic and clinical contexts. This survey used the Post-Study System Usability Questionnaire to assess the engagement levels and usability of the AI tool. Additional questions were included to evaluate the usage patterns, adequacy in training and confidence in diagnosis.

Results: There were mixed engagement levels: 44.4% (n = 8/18) used Isabel in two subjects-typically one or both clinical placement units-and 27.8% (n = 5/18) in one subject; students most often used the tool to confirm differential diagnoses. Usability was rated positively with the disease ranking, red flag diagnosis and link to national guideline features demonstrating the highest student usage. While most students found the tool beneficial to use during clinical placement and completing university assignments, some reported challenges due to insufficient training, impacting confidence in clinical application.

Conclusion: Isabel has potential as a valuable educational tool in Nurse Practitioner programs, but successful implementation depends on adequate training and support. The findings highlight the importance of comprehensive training and support to maximise AI tool utilisation, with direct implications for programme curricula, clinical education strategies and potential improvements in diagnostic reasoning skills for future nurse practitioners.

Implications for the profession and/or patient care: This study provides an example of integrating artificial intelligence (AI) guided clinical decision-making training in nurse practitioner (NP) education. The findings can be used by educational institutions to trial similar AI-integrated learning approaches, enhancing diagnostic competence and potentially improving patient care outcomes.

Reporting method: The Study adhered to the STROBE checklist for reporting.

Patient or public contribution: No patient or public contribution was made to this study.

Background: Psychological burden is a central aspect of living with chronic cardiovascular disorders and profoundly affects how individuals experience and cope with fear, dependency and loss of control. Understanding these experiences is essential for delivering high-quality, holistic and person-centred care.

Aim: This study explored the experiences of psychological burden among individuals living with chronic cardiovascular disorders in a low- and middle-income context.

Methods: We conducted a qualitative descriptive study. Nineteen individuals were purposively recruited using maximum variation sampling and interviewed using a semi-structured interview guide between May and September 2024. Data were analysed using reflexive thematic analysis software (MAXQDA).

Findings: The analysis of 19 interviews generated three overarching themes: (a) multifaceted disruption of life from acute onset to enduring dependency; (b) burden of existential fear and struggle for control; and (c) faith-based burden management: prayer, practice and spiritual resilience.

Conclusion: Individuals with chronic cardiovascular disorders experience a significant psychological burden, including sudden illness onset, dependency and existential fear, despite available treatment. Faith, family and community support serve as key sources of coping. The integration of psychological care, spiritual support and culturally sensitive interventions alongside biomedical management is essential for improving outcomes in low and middle-income countries.

Implications for patient care: Health care professionals should integrate psychological screening and counselling to address existential fears, social withdrawal and suppressed emotional expression among individuals with chronic cardiovascular disorders.

Patient or public contribution: Patients with chronic cardiovascular disorders informed the design of the interview guide, participated in interviews and helped validate the interpretation of findings, ensuring that the study reflected their lived experiences.

Reporting method: This study adhered to the Consolidated Criteria for Reporting Qualitative Studies (COREQ).

Aim: Nanocrystalline silver dressings are increasingly used as alternatives to silver sulfadiazine dressings in burn management, but comparative evidence remains inconclusive. This meta-analysis aimed to compare the efficacy and safety of nanocrystalline silver dressings versus silver sulfadiazine dressings in burn patients.

Design: Systematic review and meta-analysis following PRISMA guidelines. The review was registered with PROSPERO (CRD420251060978).

Data sources: PubMed, Embase, Cochrane Library and Web of Science were searched from inception through April 2025.

Methods: Randomized controlled trials comparing nanocrystalline silver dressings with silver sulfadiazine dressings in burn patients were included. Primary outcomes were wound healing time and adverse events. Secondary outcomes included complete re-epithelialization rates and dressing change frequency. Risk of bias was assessed using the Cochrane risk of bias tool. Evidence certainty was evaluated using the Grading of Recommendations, Assessment, Development and Evaluations framework. Meta-analysis was performed using Review Manager 5.4.

Results: Eight randomized controlled trials (724 patients) were included. Nanocrystalline silver dressings significantly reduced wound healing time (mean difference [MD] = -3.29 days, 95% confidence interval [CI]: -3.82 to -2.76; p < 0.00001; I² = 0%) and dressing change frequency (MD = -8.76, 95% CI: -12.68 to -4.85; p < 0.00001; I² = 94%). No significant differences were found in re-epithelialization rates (odds ratio = 1.08, p = 0.80) or adverse events (risk difference = -0.00, p = 0.99). Evidence certainty was low to very low across all outcomes.

Conclusions: Nanocrystalline silver dressings may offer advantages over silver sulfadiazine dressings in reducing wound healing time and dressing change frequency in burn patients, but the overall certainty of evidence is low to very low. Future well-powered, multicenter trials with standardized outcomes and extended follow-up are needed.

Relevance to clinical practice: These findings support the consideration of nanocrystalline silver dressings for burn wound management, particularly for reducing wound healing time and nursing workload associated with dressing changes. However, dressing selection should be guided by burn depth, infection risk, patient-specific factors, and resource availability.

Reporting method: We have adhered to relevant EQUATOR guidelines, particularly the PRISMA checklist.

Patient or public contribution: No patient or public contribution.

Systematic review registration: PROSPERO CRD420251060978.

Background: Chronic diseases are a major global health burden, contributing to morbidity, mortality and healthcare costs. Self-care is essential for effective disease management, with health literacy (HL) and digital health literacy (eHL) playing a role in enabling individuals to engage in health-promoting behaviours. However, the relationship between HL and self-care remains inconclusive, necessitating further investigation to clarify its impact.

Objective: To synthesise evidence on the association between HL and self-care in chronic diseases and identify mediating and moderating factors influencing this relationship.

Information sources: A systematic search was conducted across PubMed, CINAHL, PsycINFO, Embase, Web of Science and Cochrane CENTRAL, supplemented by manual reference checks and author correspondence.

Methods: This systematic review and meta-analysis followed PRISMA guidelines, including observational studies and RCTs assessing HL and self-care. Meta-analyses were performed using Fisher's Z transformation. Risk of bias was assessed using ROBINS-E and certainty of evidence was evaluated through GRADE.

Results: A total of 138 studies were included, with 52 meta-analysed. Higher HL was associated with improved self-care behaviours, including medication adherence, disease monitoring and lifestyle modifications across chronic diseases, including type 2 diabetes, heart failure, hypertension, chronic kidney disease, asthma, coronary artery disease, arthritis and COPD. Psychological (self-efficacy, empowerment), cognitive (disease knowledge, decision-making) and social (healthcare communication, social support) factors mediated this relationship, while distress and depression moderated it. Meta-analysis revealed a moderate positive association between HL and self-care (r = 0.29, 95% CI: 0.26-0.31, p < 0.001). Subgroup analyses showed consistent positive effects across conditions. No significant publication bias was detected (Egger's test, p = 0.294). Risk of bias was high in 62 studies, while certainty of evidence ranged from very low to moderate.

Conclusions: HL positively influences self-care in chronic diseases, with its impact shaped by multiple mediators and moderators. Future interventions should integrate tailored education, digital tools and mental health support to enhance HL effectiveness.

Registration: PROSPERO (CRD42024488061, registered 20.01.2024).

Aim: To explore how nurse practitioners and physicians providing primary care for LGBTQ+ people experience and make sense of their practice.

Design: Qualitative study using Interpretative Phenomenological Analysis.

Methods: In-depth, semi-structured interviews were conducted with 12 clinicians (four nurse practitioners, eight physicians) working in LGBTQ+-focused primary care across diverse U.S. regions. Interviews were online, audio-recorded via Zoom, and lasted 50-90 min. Reflexive notes were maintained. Analysis followed Smith and Nizza's six-stage Interpretive Phenomenological Analysis (IPA) process from close reading to experiential statements, clustering to personal experiential themes, development of group experiential themes, and synthesis, supported by memoing and peer debriefing.

Results: Four Group Experiential Themes: (1) Belonging, Affirmation, and the Power of LGBTQ+-Centred Spaces: clinicians practised as their full selves and modelled culturally safe care; (2) Personal Pain as Professional Purpose: personal histories of marginalisation informed a reparative ethic that fostered empathy, trust, and safety; (3) Expanding the Boundaries of Health Work: care routinely extended beyond clinic walls to advocacy, harm reduction, administrative support, and navigation of social determinants amid political precarity; (4) Resistance Within Broken Systems: persistent, invisible labour was required to navigate heteronormative and cisnormative infrastructures.

Conclusion: LGBTQ+-focused primary care operates as clinical practice and social justice work. Clinicians translate lived experience into reparative, relational care while constantly negotiating systemic constraints and policy volatility.

Implications for the profession and/or patient care: Embed LGBTQ+-affirming competencies and reflexivity in education; redesign digital/administrative systems for affirmed names/pronouns and streamlined access; resource and protect services and staff wellbeing in hostile policy climates.

Impact: Problem: Persistent inequities and under-recognised experiential labour in LGBTQ+ primary care.

Main findings: Belonging and affirmation; reparative ethic; expanded health work; daily systemic workarounds. Impact Audience: Nurses, physicians, educators, leaders, and policymakers. Reporting Method: COREQ.

Patient or public contribution: No Patient or Public Contribution.