Journal of Clinical Nursing最新文献

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.

Aims: To determine the clinical characteristics and identify not only the Korean Triage and Acuity Scale levels of older patients with pneumonia in the emergency department but also the factors associated with their survival.

Design: This study employed a retrospective observational design.

Methods: This study was conducted at the emergency department of a university hospital in Seoul, South Korea. It utilised medical data from January 1 to December 31, 2023. The study sample comprised 327 patients aged 65 years or older who received a pneumonia diagnosis (International Classification of Diseases: J10-J18). Binary logistic regression analysis was performed to identify independent factors associated with their survival.

Results: Survival was significantly associated with and influenced by sex (specifically, male sex), initial Korean Triage and Acuity Scale level, oxygen supplementation in the emergency department, consciousness level (specifically, painful response), body temperature (> 37.5°C) and a diagnosis of solid or hematologic malignancies.

Conclusions: The findings highlight the need for improved triage protocols, emphasising consciousness level, body temperature and malignancies. Incorporating geriatric-specific age thresholds and oncologic status into Korean Triage and Acuity Scale classifications may enhance risk stratification, timely intervention and resource allocation in emergency department settings.

Implications for the profession and/or patient care: This study provides insight into triage accuracy for older pneumonia patients, emphasising early recognition of high-risk individuals and strengthening nursing assessment protocols. Improved Korean Triage and Acuity Scale classifications can optimise resource allocation and emergency care strategies, ultimately reducing mortality rates.

Impact: The study provides actionable insights for emergency nurses, triage clinicians and policymakers. The findings support the refinement of KTAS protocols to enhance risk stratification and guide resource allocation for older pneumonia patients, ultimately aiming to reduce mortality rates.

Reporting method: Adhered to STROBE guidelines for observational studies.

Patient or public contributions: Although patients did not directly participate, the findings advocate for patient-centred triage improvements, enhancing early identification of high-risk older patients with pneumonia.

Aim: This study aims to synthesise evidence on users' experiences of telephone cancer information and support services (CISS) to identify important service features and inform service development.

Design: A qualitative evidence synthesis.

Methods and data sources: OVID MEDLINE, EMBASE, CINAHL, PsycINFO and SocINDEX databases were searched for peer-reviewed qualitative literature fitting the inclusion criteria from database inception to 30 March 2023. The included articles were double-screened, and quality appraised using the CASP checklist. GRADE-CERQual was used as a tool to assess the confidence of review findings. Content synthesis combined the qualitative data with the Loiselle cancer experience measurement framework guiding analysis. This paper is reported as per the equator network recommended SRQR checklist.

Results: Of the 607 articles screened, seven studies were included. Four main themes and 14 sub-themes about CISS aspects were identified: psychological well-being (managing emotions/coping, hope/reassurance, supporting close others and a reluctance to call the CISS); knowledge is power (information seeking, the burden of knowledge and empowerment); truth and clarity (adjunct support, credible source and improved understanding and confidence); and service adequacy (operators' ability to connect with users, convenience, service provision and awareness, and the cancer journey).

Conclusion: Findings suggest people with cancer and their carers accessing a CISS value emotional support combined with trusted information, topic expertise and a connection with the service operator. future service provision should address the lack of awareness regarding the range of services and the convenience extended operating hours may offer.

Implications for patient care: The results add to our understanding of CISS service provision. However, knowledge gaps remain regarding preferences among service features and the hierarchy of CISS characteristics to be prioritised to enhance services.

Impact: Focused CISS awareness campaigns will inform communities and healthcare professionals of the available resources to improve the lives of those affected by cancer. Ongoing service review will enable resources to be tailored to callers' needs, potentially easing the burden on existing services that are overwhelmed and under-resourced.

Patient or public contribution: This qualitative evidence synthesis did not directly involve patient or public contribution to the manuscript.

Trial registration: Systematic Review Registration Number (PROSPERO): CRD42023413897.

Aim: To explore the existential lived experiences of emerging adult siblings of children with complex care needs.

Design: A qualitative phenomenological design.

Methods: In-depth conversational interviews were conducted between February and June 2022 with nine emerging adult siblings (aged 16-27), who grew up with a brother or sister with complex care needs. Data were analysed using van Manen's phenomenology of practice approach.

Results: Five core themes were identified: Loss of a familiar world: the profound changes and disruptions in siblings' lives. The sibling bond: endured and enduring love. Embracing the load: balancing responsibilities. Being behind the scenes: a lonely childhood. Jigsaw falling into place: siblings finding clarity and forging their own paths.

Conclusion: Early experiences of growing up with a sibling who has complex care needs, may resurface or shift in meaning, impacting long-term existential well-being, particularly when siblings feel overlooked by families, educators, and healthcare professionals. These silenced experiences often persist into emerging adulthood, shaping emotional health, relationships, and life choices.

Impact: The underrecognized existential needs of these siblings call for intentional, person-centred care. Our research advocates early, targeted interventions, emphasizing the pivotal role of nurses. A lifeworld-led phenomenological approach equips nurses to more effectively attend to the unmet needs of siblings within family care settings.

Reporting method: The research followed the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist.

Patient and public contribution: Emerging adult siblings with lived experience of growing up alongside a brother or sister with complex care needs contributed important insights into the interpretation of findings, ensuring relevance to clinical nursing.

Background: Stroke nurses must perform dysphagia screening on all suspected stroke patients, adhering to best practice guidelines. While comprehensive training is essential for safe and competent screening, the variability in dysphagia screening tools leads to significant differences in education.

Aim: This scoping review aims to collate and report what education is provided to stroke nurses on the use of dysphagia screening tools.

Design: A scoping review guided by the PRISMA-ScR checklist.

Methods: A systematic review of three electronic databases identified 318 peer-reviewed studies. After screening and eligibility assessment in COVIDENCE, 10 studies were included. Data from these studies was analysed using Arksey and O'Malley's thematic framework.

Data sources: MEDLINE, CINHAL, Scopus.

Results: Ten studies were included in this review which yielded the following major themes: (1) comprehensive and structured training; (2) diversity of training methods; (3) ongoing education and competency assessment; and (4) standardised protocols and tools.

Conclusion: Offering comprehensive training programs to stroke nurses on dysphagia screening tools is associated with more timely interventions and improved outcomes; however inconsistent approaches to training make it difficult to benchmark outcomes of the education provided. Future research should explore stroke nurses' experiences with current training to guide future training program development.

Relevance to clinical practice: This review highlights the importance of training stroke nurses to use dysphagia screening tools to improve patient outcomes.

Patient or public contribution: No patient or public contribution.

Aim(s): To explore how neonatal nurse leaders sustain human-centred care while implementing digital technologies in neonatal intensive care units (NICUs).

Design: Qualitative descriptive multi-site study across four NICUs in the Eastern Region of Saudi Arabia (November 2024-May 2025), reported in accordance with COREQ.

Methods: Purposive maximum-variation sampling recruited 24 neonatal nurse leaders across leadership levels, hospital types and digital maturity stages. Semi-structured interviews were conducted in Arabic or English, transcribed, translated as needed and thematically analysed in NVivo 14 using a hybrid inductive-deductive approach. Directed content analysis of key organisational documents enabled triangulation. Trustworthiness was supported through member checking, peer debriefing, audit trail, external review and double coding of a subset of transcripts.

Results: Four interrelated strategies were identified: (1) embedding a values-based human-centred vision; (2) selecting and customising digital tools to strengthen, not replace, nurse-family connection; (3) redesigning workflows (e.g., device-free openings, protected presence time, family-inclusive portals) to preserve presence and partnership; and (4) fostering team capability and psychological safety for digital-human integration.

Conclusion: Human-centred care in digital NICUs is intentionally led and structurally engineered. The study offers a practice-ready framework that translates values into reproducible routines within complex sociotechnical systems.

Implications for the profession and/or patient care: The framework supports nurse leaders in aligning digital transformation with family-centred care, protecting nurse-family presence, and enhancing safety, trust and partnership for high-risk neonates.

Impact: Addresses risks of relational erosion in digital and AI-enabled NICUs and provides transferable nurse-led strategies to sustain ethical, family-centred practice.

Reporting method: COREQ-compliant qualitative study.

Patient or public contribution: No Patient or Public Contribution.

Background: Advance Care Planning (ACP) has the potential to enhance end-of-life care and improve the allocation of healthcare resources for patients with cancer. However, its successful implementation requires considerable effort to overcome challenges and deliver health benefits. Healthcare providers and patients are key players in ACP, and their perceptions of the process must be understood to address implementation challenges effectively.

Aims and objectives: To identify barriers and facilitators to ACP implementation in Chinese oncology settings, providing a foundation for culturally appropriate healthcare strategies.

Methods: A qualitative study guided by the Consolidated Framework for Implementation Research (CFIR). Semi-structured interviews (n = 30) were conducted between April and August 2022 to synthesise the perspectives of nurses, physicians, patients with cancer and their families who had participated in ACP. Data were analysed using a directed qualitative content analysis approach, and reporting followed the SRQR guidelines.

Results: Twenty implementation determinants were identified across four CFIR domains, including 13 barriers and 7 facilitators. Key barriers included limited adaptability of ACP to local cultural and family norms, high complexity of ACP processes, insufficient knowledge and skills among clinicians, unclear team responsibilities, low organisational readiness, limited resources and poor public awareness. Facilitators included strong team culture, clinician motivation, supportive leadership and alignment with national policies. Two determinants showed mixed influences: the relative advantage of ACP compared to existing practices, and the extent of collaboration with external organisations.

Conclusions: Our study highlights the challenges of implementing ACP in China, as well as the unique and specific barriers to implementation. These findings contribute to a deeper understanding of context-specific determinants and offer actionable insights to inform the development of culturally tailored ACP implementation strategies in resource-limited healthcare settings.

Relevance to clinical practice: To inform the development of implementation strategies to promote ACP in healthcare systems dominated by traditional medicine.