Pub Date : 2025-12-13DOI: 10.1016/j.ijnurstu.2025.105318
Jiayi Wang , Yaming Dai , Hongyi Li , Xiaojiao Wang , Xinli Zhu , Hui Min , Chunyi Gu
<div><h3>Background</h3><div>Adverse perinatal outcomes remain a significant global health challenge, exacerbated by limited access to healthcare and the need for intensified surveillance in high-risk pregnancies. Traditional foetal monitoring methods have been complemented by emerging telemedicine solutions, which provide opportunities for continuous remote monitoring. However, the synthesis of evidence regarding their clinical effectiveness in high-risk populations remains insufficiently explored.</div></div><div><h3>Objective</h3><div>This systematic review aims to evaluate the effectiveness of remote foetal health monitoring in improving maternal-foetal outcomes among high-risk pregnancies.</div></div><div><h3>Methods</h3><div>We systematically searched Web of Science, Embase, PubMed, Scopus, CINAHL, Cochrane Library, the China Biomedical Literature Service System (Sino-Med), CNKI, Wanfang, and VIP Database from their inception until December 31, 2024. The search focused on randomised controlled trials comparing remote foetal health monitoring with routine prenatal care in high-risk pregnancies. The primary outcomes included maternal-foetal adverse outcomes and the detection rate of abnormal non-stress test. Two researchers independently conducted the study selection, data extraction, and risk-of-bias assessment using the Cochrane RoB 2 tool. Random-effects meta-analyses were performed using Review Manager version 5.4 and Stata version 18, with subgroup analyses based on predefined covariates, and the certainty of evidence was assessed using the GRADE framework.</div></div><div><h3>Results</h3><div>A total of seventeen randomised controlled trials (n = 2782 participants) were included in this analysis, with the majority (15 trials) were conducted in China. Compared to traditional prenatal care, remote foetal health monitoring among high-risk pregnancies significantly reduced the likelihood of neonatal asphyxia (RR = 0.25, 95 % CI 0.17–0.37, <em>p</em> < 0.001) and the incidence of meconium-stained amniotic fluid (RR = 0.45, 95 % CI 0.27–0.75, <em>p</em> = 0.002), and improved the non-stress test abnormality detection rate (RR = 1.95, 95 % CI 1.19–3.18, <em>p</em> = 0.008). No statistically significant effect was observed on caesarean section rates (RR = 0.88, 95 % CI 0.76–1.03, <em>p</em><span><math><mo>=</mo></math></span>0.110). The reduction in preterm birth (RR = 0.53, 95 % CI 0.36–0.76, <em>p</em> < 0.001) lost significance after adjusting for publication bias using the trim-and-fill method (RR = 0.85, 95 % CI 0.59–1.24, <em>p</em> = 0.401).</div></div><div><h3>Conclusions</h3><div>Remote foetal health monitoring effectively enhances foetal surveillance and reduces specific neonatal complications among high-risk pregnancies. However, the predominance of evidence from China may limit immediate generalisability to other settings. Future multinational studies are needed to confirm global applicability and assess cost-effectiveness.</d
不利的围产期结局仍然是一个重大的全球健康挑战，由于获得医疗保健的机会有限和需要加强对高危妊娠的监测而加剧。新兴的远程医疗解决方案补充了传统的胎儿监测方法，为持续远程监测提供了机会。然而，关于它们在高危人群中的临床有效性的综合证据仍然没有得到充分的探索。目的评价远程胎儿健康监测在高危妊娠中改善母婴结局的效果。方法系统检索Web of Science、Embase、PubMed、Scopus、CINAHL、Cochrane图书馆、中国生物医学文献服务系统（chinese - med）、中国知网（CNKI）、万方数据库、VIP数据库，检索时间为网站开通至2024年12月31日。研究重点是随机对照试验，比较远程胎儿健康监测与高危妊娠的常规产前护理。主要结局包括母胎不良结局和非应激试验异常检出率。两位研究者使用Cochrane RoB 2工具独立进行了研究选择、数据提取和偏倚风险评估。使用Review Manager版本5.4和Stata版本18进行随机效应荟萃分析，并基于预定义协变量进行亚组分析，并使用GRADE框架评估证据的确定性。结果共纳入17项随机对照试验（n = 2782名受试者），其中大部分（15项试验）在中国进行。与传统产前护理相比，高危妊娠远程胎生监护可显著降低新生儿窒息的发生几率（RR = 0.25, 95% CI 0.17-0.37, p < 0.001）和羊水粪染发生率（RR = 0.45, 95% CI 0.27-0.75, p = 0.002），提高非应激试验异常检出率（RR = 1.95, 95% CI 1.19-3.18, p = 0.008）。对剖宫产率无显著影响（RR = 0.88, 95% CI 0.76-1.03, p=0.110）。早产儿的减少（RR = 0.53, 95% CI 0.36-0.76, p < 0.001）在使用trim- fill方法调整发表偏倚后失去了显著性（RR = 0.85, 95% CI 0.59-1.24, p = 0.401）。结论远程胎儿健康监测可以有效地加强胎儿监护，减少高危妊娠的新生儿特异性并发症。然而，来自中国的证据的优势可能限制了对其他情况的直接推广。未来的多国研究需要确认全球适用性和评估成本效益。普洛斯彼罗CRD 42024606744，于2024年11月29日注册。
{"title":"Effectiveness of remote foetal health monitoring in improving maternal and foetal outcomes among high-risk pregnancies: A systematic review and meta-analysis","authors":"Jiayi Wang , Yaming Dai , Hongyi Li , Xiaojiao Wang , Xinli Zhu , Hui Min , Chunyi Gu","doi":"10.1016/j.ijnurstu.2025.105318","DOIUrl":"10.1016/j.ijnurstu.2025.105318","url":null,"abstract":"<div><h3>Background</h3><div>Adverse perinatal outcomes remain a significant global health challenge, exacerbated by limited access to healthcare and the need for intensified surveillance in high-risk pregnancies. Traditional foetal monitoring methods have been complemented by emerging telemedicine solutions, which provide opportunities for continuous remote monitoring. However, the synthesis of evidence regarding their clinical effectiveness in high-risk populations remains insufficiently explored.</div></div><div><h3>Objective</h3><div>This systematic review aims to evaluate the effectiveness of remote foetal health monitoring in improving maternal-foetal outcomes among high-risk pregnancies.</div></div><div><h3>Methods</h3><div>We systematically searched Web of Science, Embase, PubMed, Scopus, CINAHL, Cochrane Library, the China Biomedical Literature Service System (Sino-Med), CNKI, Wanfang, and VIP Database from their inception until December 31, 2024. The search focused on randomised controlled trials comparing remote foetal health monitoring with routine prenatal care in high-risk pregnancies. The primary outcomes included maternal-foetal adverse outcomes and the detection rate of abnormal non-stress test. Two researchers independently conducted the study selection, data extraction, and risk-of-bias assessment using the Cochrane RoB 2 tool. Random-effects meta-analyses were performed using Review Manager version 5.4 and Stata version 18, with subgroup analyses based on predefined covariates, and the certainty of evidence was assessed using the GRADE framework.</div></div><div><h3>Results</h3><div>A total of seventeen randomised controlled trials (n = 2782 participants) were included in this analysis, with the majority (15 trials) were conducted in China. Compared to traditional prenatal care, remote foetal health monitoring among high-risk pregnancies significantly reduced the likelihood of neonatal asphyxia (RR = 0.25, 95 % CI 0.17–0.37, <em>p</em> < 0.001) and the incidence of meconium-stained amniotic fluid (RR = 0.45, 95 % CI 0.27–0.75, <em>p</em> = 0.002), and improved the non-stress test abnormality detection rate (RR = 1.95, 95 % CI 1.19–3.18, <em>p</em> = 0.008). No statistically significant effect was observed on caesarean section rates (RR = 0.88, 95 % CI 0.76–1.03, <em>p</em><span><math><mo>=</mo></math></span>0.110). The reduction in preterm birth (RR = 0.53, 95 % CI 0.36–0.76, <em>p</em> < 0.001) lost significance after adjusting for publication bias using the trim-and-fill method (RR = 0.85, 95 % CI 0.59–1.24, <em>p</em> = 0.401).</div></div><div><h3>Conclusions</h3><div>Remote foetal health monitoring effectively enhances foetal surveillance and reduces specific neonatal complications among high-risk pregnancies. However, the predominance of evidence from China may limit immediate generalisability to other settings. Future multinational studies are needed to confirm global applicability and assess cost-effectiveness.</d","PeriodicalId":50299,"journal":{"name":"International Journal of Nursing Studies","volume":"175 ","pages":"Article 105318"},"PeriodicalIF":7.1,"publicationDate":"2025-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145730738","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-12DOI: 10.1016/j.ijnurstu.2025.105316
Yusheng Xie , Zhaoqing Liu , Yue Ming , Qiansha Wang , Kehuan He , Pu Nie , Zhuping Wang , Rongrong Huang
<div><h3>Background</h3><div>Diabetic high-risk foot—the pre-ulcerative phase of diabetic foot disease—offers a critical window for prevention. Insufficient self-care and during this stage markedly increases ulcer risk, and once ulcers develop, treatment postponement precipitates infection, amputation, and death. Targeted education that enhances self-care and motivates prompt consultation is therefore essential, yet structured nurse-led healthcare-seeking programs specifically designed for diabetic high-risk foot remain scarce.</div></div><div><h3>Objective</h3><div>To develop and evaluate the effects of a nurse-led health education program on treatment-seeking delay intention, actual delay behaviour, foot care knowledge, foot care behaviour, and self-efficacy among patients with diabetic high-risk foot.</div></div><div><h3>Design</h3><div>Assessor-blind two-arm randomised controlled trial with a repeated-measures design.</div></div><div><h3>Setting</h3><div>Participants were recruited from inpatients in the endocrinology and metabolism department of a university-affiliated hospital in Guizhou province, China.</div></div><div><h3>Participants</h3><div>A total of 70 patients with diabetic high-risk foot.</div></div><div><h3>Methods</h3><div>Participants were randomised to an intervention group or a usual-care control group. The intervention group received a structured nurse-led program in addition to standard care, which comprised assessment, personalised risk and harm-perception education, foot-care behaviour guidance, delay-consequence alerts, and medical-care pathway planning, weekly classes and workshop sessions delivered during hospitalisation, with post-discharge support maintained through a WeChat-based platform. The control group received routine discharge education only. The data collection process spanned 12 months, with baseline (T<sub>0</sub>) collected pre-intervention, and follow-ups conducted at discharge (T<sub>1</sub>), 3 months (T<sub>2</sub>), 6 months (T<sub>3</sub>), and 12 months (T<sub>4</sub>). Outcomes included treatment delay intention, foot-care knowledge, behaviour, and self-efficacy; diabetic foot incidence and treatment timing were additionally recorded at T<sub>4</sub>. Data were analysed using generalised estimating equations to examine group, time, and interaction effects, with statistical significance set at p < 0.05.</div></div><div><h3>Results</h3><div>Compared with controls, intervention participants demonstrated statistically significant improvements in treatment delay intention, foot-care knowledge, behaviour, and self-efficacy (p < 0.05). No statistically significant between-group difference was observed in diabetic-foot incidence (p > 0.05); however, among incident cases, delayed treatment was statistically significantly less frequent in the intervention group (p < 0.05).</div></div><div><h3>Conclusions</h3><div>The program was effective for improving foot care knowledge, behaviour, and self-eff
{"title":"The effect of a nurse-led health education intervention on treatment delay in patients with diabetic high-risk foot: A randomised controlled trial","authors":"Yusheng Xie , Zhaoqing Liu , Yue Ming , Qiansha Wang , Kehuan He , Pu Nie , Zhuping Wang , Rongrong Huang","doi":"10.1016/j.ijnurstu.2025.105316","DOIUrl":"10.1016/j.ijnurstu.2025.105316","url":null,"abstract":"<div><h3>Background</h3><div>Diabetic high-risk foot—the pre-ulcerative phase of diabetic foot disease—offers a critical window for prevention. Insufficient self-care and during this stage markedly increases ulcer risk, and once ulcers develop, treatment postponement precipitates infection, amputation, and death. Targeted education that enhances self-care and motivates prompt consultation is therefore essential, yet structured nurse-led healthcare-seeking programs specifically designed for diabetic high-risk foot remain scarce.</div></div><div><h3>Objective</h3><div>To develop and evaluate the effects of a nurse-led health education program on treatment-seeking delay intention, actual delay behaviour, foot care knowledge, foot care behaviour, and self-efficacy among patients with diabetic high-risk foot.</div></div><div><h3>Design</h3><div>Assessor-blind two-arm randomised controlled trial with a repeated-measures design.</div></div><div><h3>Setting</h3><div>Participants were recruited from inpatients in the endocrinology and metabolism department of a university-affiliated hospital in Guizhou province, China.</div></div><div><h3>Participants</h3><div>A total of 70 patients with diabetic high-risk foot.</div></div><div><h3>Methods</h3><div>Participants were randomised to an intervention group or a usual-care control group. The intervention group received a structured nurse-led program in addition to standard care, which comprised assessment, personalised risk and harm-perception education, foot-care behaviour guidance, delay-consequence alerts, and medical-care pathway planning, weekly classes and workshop sessions delivered during hospitalisation, with post-discharge support maintained through a WeChat-based platform. The control group received routine discharge education only. The data collection process spanned 12 months, with baseline (T<sub>0</sub>) collected pre-intervention, and follow-ups conducted at discharge (T<sub>1</sub>), 3 months (T<sub>2</sub>), 6 months (T<sub>3</sub>), and 12 months (T<sub>4</sub>). Outcomes included treatment delay intention, foot-care knowledge, behaviour, and self-efficacy; diabetic foot incidence and treatment timing were additionally recorded at T<sub>4</sub>. Data were analysed using generalised estimating equations to examine group, time, and interaction effects, with statistical significance set at p < 0.05.</div></div><div><h3>Results</h3><div>Compared with controls, intervention participants demonstrated statistically significant improvements in treatment delay intention, foot-care knowledge, behaviour, and self-efficacy (p < 0.05). No statistically significant between-group difference was observed in diabetic-foot incidence (p > 0.05); however, among incident cases, delayed treatment was statistically significantly less frequent in the intervention group (p < 0.05).</div></div><div><h3>Conclusions</h3><div>The program was effective for improving foot care knowledge, behaviour, and self-eff","PeriodicalId":50299,"journal":{"name":"International Journal of Nursing Studies","volume":"175 ","pages":"Article 105316"},"PeriodicalIF":7.1,"publicationDate":"2025-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145730742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-11DOI: 10.1016/j.ijnurstu.2025.105309
An Vanthienen , Niels Martin , Benoît Depaire
Purpose
The process mining research domain uses process execution data to gain insights into work processes and has been applied in a wide variety of domains, including healthcare. The extensive use of electronic health record systems has made the data they capture a common input for process mining, yet data quality issues persist. While these issues are recognized in literature, empirical work examining the (mis)match between nursing interventions and their electronic health record registrations remains scarce. This study addresses this gap through an observational study.
Methods
A cross-sectional observational study was carried out between February 23 and April 10, 2024, covering 119.75 h of observation in the urology and neurology wards of a Belgian hospital. Data were collected on both nursing interventions and their electronic health record registrations.
Results
The analysis revealed several mismatches between electronic health record registrations and actual nursing work: (i) 20.34 % of all observed intervention types were never recorded in the EHR, (ii) only 23.32 % of registered interventions were recorded without a time gap between execution and registration, and (iii) there is not always a one-to-one relationship between interventions and registrations.
Conclusion
This study underscores the importance of thorough data quality assessment when using routinely collected data for research or analysis. Beyond assessing the data itself, it highlights the need to understand real-world work processes and how data is recorded in supporting systems. Such insights enable the anticipation and potentially the mitigation of data quality issues prior to their actual use. These efforts are essential to determine how accurately the available data reflects real-world practices and thereby how trustworthy any conclusions based on this data can be.
{"title":"Investigating the (mis)match between electronic health records and actual nursing work: An observational study","authors":"An Vanthienen , Niels Martin , Benoît Depaire","doi":"10.1016/j.ijnurstu.2025.105309","DOIUrl":"10.1016/j.ijnurstu.2025.105309","url":null,"abstract":"<div><h3>Purpose</h3><div>The process mining research domain uses process execution data to gain insights into work processes and has been applied in a wide variety of domains, including healthcare. The extensive use of electronic health record systems has made the data they capture a common input for process mining, yet data quality issues persist. While these issues are recognized in literature, empirical work examining the (mis)match between nursing interventions and their electronic health record registrations remains scarce. This study addresses this gap through an observational study.</div></div><div><h3>Methods</h3><div>A cross-sectional observational study was carried out between February 23 and April 10, 2024, covering 119.75 h of observation in the urology and neurology wards of a Belgian hospital. Data were collected on both nursing interventions and their electronic health record registrations.</div></div><div><h3>Results</h3><div>The analysis revealed several mismatches between electronic health record registrations and actual nursing work: (i) 20.34 % of all observed intervention types were never recorded in the EHR, (ii) only 23.32 % of registered interventions were recorded without a time gap between execution and registration, and (iii) there is not always a one-to-one relationship between interventions and registrations.</div></div><div><h3>Conclusion</h3><div>This study underscores the importance of thorough data quality assessment when using routinely collected data for research or analysis. Beyond assessing the data itself, it highlights the need to understand real-world work processes and how data is recorded in supporting systems. Such insights enable the anticipation and potentially the mitigation of data quality issues prior to their actual use. These efforts are essential to determine how accurately the available data reflects real-world practices and thereby how trustworthy any conclusions based on this data can be.</div></div>","PeriodicalId":50299,"journal":{"name":"International Journal of Nursing Studies","volume":"175 ","pages":"Article 105309"},"PeriodicalIF":7.1,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145730743","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-10DOI: 10.1016/j.ijnurstu.2025.105313
Po-Jen Kung , Ching-Min Chen , Esther Ching-Lan Lin , Bih-Ching Shu , YiQian Tew , Jingyi He , Ching-Ju Fang , Nancy R. Reynolds , Katherine A. Ornstein
Background
Mandatory vaccination policies have sparked global ethical debates, particularly in the context of COVID-19. Among healthcare workers, nurses—the largest segment of the frontline workforce—face distinct tensions between professional responsibilities and personal autonomy. Yet, the ethical challenges these policies pose from nurses' perspectives remain insufficiently examined.
Aim
This review examines the ethical challenges of mandatory vaccination from nurses' perspectives, informs ethical policymaking, and provides insights to navigate similar future scenarios.
Design
A mixed-methods systematic review guided by the Joanna Briggs Institute methodology.
Data sources
Final searches of five databases—Embase, MEDLINE, CINAHL, Web of Science, and Scopus—were conducted in September 2025. Additional records were identified through citation tracking and supplementary searches.
Methods
Empirical studies published from 2019 onward were screened for relevance and assessed for methodological quality using standardized critical appraisal tools. Studies were included if they examined nurses' experiences, attitudes, or ethical perspectives regarding mandatory vaccination. A narrative synthesis approach was applied to integrate qualitative, quantitative, and mixed-methods findings.
Results
Twenty-eight studies were included (19 quantitative, 5 qualitative, and 4 mixed methods). Four themes emerged: (1) Walking a Tightrope—Between Vaccine Safety and Effectiveness; (2) Silent Burden—Navigating Stigma in the Shadows; (3) Navigating the Fine Line—Balancing Rights and Public Health in Times of Crisis; and (4) Strengthening Leadership and Communication.
Conclusions
While mandatory vaccination policies may serve public health goals, they can also generate ethical distress, undermine trust, and increase stigmatization among nurses who remain unvaccinated. Future policies should move beyond enforcement toward fostering ethical alignment through education, open dialog, and respectful engagement.
强制性疫苗接种政策引发了全球伦理辩论，特别是在2019冠状病毒病背景下。在医疗工作者中，护士——一线劳动力中最大的一部分——面临着职业责任和个人自主权之间明显的紧张关系。然而，从护士的角度来看，这些政策所带来的伦理挑战仍然没有得到充分的审查。目的：本综述从护士的角度审视了强制性疫苗接种的伦理挑战，为伦理政策制定提供信息，并为应对类似的未来情景提供见解。设计一个由乔安娜布里格斯研究所方法论指导的混合方法系统评价。数据来源对embase、MEDLINE、CINAHL、Web of Science和scopus这五个数据库的最终检索于2025年9月进行。通过引文跟踪和补充检索确定了其他记录。方法筛选2019年以后发表的实证研究的相关性，并使用标准化的关键评估工具评估方法质量。如果研究调查了护士关于强制性疫苗接种的经历、态度或伦理观点，则纳入研究。采用叙事综合方法整合定性、定量和混合方法的研究结果。结果共纳入研究28项，其中定量方法19项，定性方法5项，混合方法4项。出现了四个主题：(1)在疫苗安全性和有效性之间走钢丝；(2)无声的负担——在阴影中导航耻辱；(3)把握好危机时期权利与公共健康的平衡；(4)加强领导和沟通。虽然强制性疫苗接种政策可能服务于公共卫生目标，但它们也可能产生道德困境，破坏信任，并增加未接种疫苗的护士的污名化。未来的政策应超越强制执行，通过教育、公开对话和相互尊重的参与来促进道德一致性。普洛斯彼罗注册号：CRD42024551112，于2024年6月3日注册。
{"title":"Ethical challenges around mandatory vaccination among nurses: A systematic review of qualitative and quantitative evidence","authors":"Po-Jen Kung , Ching-Min Chen , Esther Ching-Lan Lin , Bih-Ching Shu , YiQian Tew , Jingyi He , Ching-Ju Fang , Nancy R. Reynolds , Katherine A. Ornstein","doi":"10.1016/j.ijnurstu.2025.105313","DOIUrl":"10.1016/j.ijnurstu.2025.105313","url":null,"abstract":"<div><h3>Background</h3><div>Mandatory vaccination policies have sparked global ethical debates, particularly in the context of COVID-19. Among healthcare workers, nurses—the largest segment of the frontline workforce—face distinct tensions between professional responsibilities and personal autonomy. Yet, the ethical challenges these policies pose from nurses' perspectives remain insufficiently examined.</div></div><div><h3>Aim</h3><div>This review examines the ethical challenges of mandatory vaccination from nurses' perspectives, informs ethical policymaking, and provides insights to navigate similar future scenarios.</div></div><div><h3>Design</h3><div>A mixed-methods systematic review guided by the Joanna Briggs Institute methodology.</div></div><div><h3>Data sources</h3><div>Final searches of five databases—Embase, MEDLINE, CINAHL, Web of Science, and Scopus—were conducted in September 2025. Additional records were identified through citation tracking and supplementary searches.</div></div><div><h3>Methods</h3><div>Empirical studies published from 2019 onward were screened for relevance and assessed for methodological quality using standardized critical appraisal tools. Studies were included if they examined nurses' experiences, attitudes, or ethical perspectives regarding mandatory vaccination. A narrative synthesis approach was applied to integrate qualitative, quantitative, and mixed-methods findings.</div></div><div><h3>Results</h3><div>Twenty-eight studies were included (19 quantitative, 5 qualitative, and 4 mixed methods). Four themes emerged: (1) Walking a Tightrope—Between Vaccine Safety and Effectiveness; (2) Silent Burden—Navigating Stigma in the Shadows; (3) Navigating the Fine Line—Balancing Rights and Public Health in Times of Crisis; and (4) Strengthening Leadership and Communication.</div></div><div><h3>Conclusions</h3><div>While mandatory vaccination policies may serve public health goals, they can also generate ethical distress, undermine trust, and increase stigmatization among nurses who remain unvaccinated. Future policies should move beyond enforcement toward fostering ethical alignment through education, open dialog, and respectful engagement.</div></div><div><h3>Registration</h3><div>PROSPERO registration number: CRD42024551112, registered 03/06/2024.</div></div>","PeriodicalId":50299,"journal":{"name":"International Journal of Nursing Studies","volume":"175 ","pages":"Article 105313"},"PeriodicalIF":7.1,"publicationDate":"2025-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145730744","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-09DOI: 10.1016/j.ijnurstu.2025.105314
Longhui Xu , Xiao Cong , Cuiping Xu
Background
High attrition among newly graduated nurses is a persistent global problem. Conventional research attributes this to “transition shock,” often framing newly graduated nurses as passive subjects requiring remediation through individual-focused training. This perspective overlooks a critical reality: professional socialization occurs not through formal programs, but through daily interactions with senior colleagues who wield power via knowledge, experience, and evaluative authority.
Objective
Drawing on Goffman's dramaturgical theory, this study explores how newly graduated nurses use impression management to navigate asymmetrical power relations with senior colleagues and ultimately shape their professional role transition.
Design
A descriptive qualitative study was conducted using one-on-one, semi-structured interviews with newly graduated nurses.
Methods
We employed purposive sampling to recruit newly graduated nurses from two tertiary hospitals in Shandong Province, China, between April and July 2025, analyzing the qualitative data using deductive content analysis.
Results
From our analysis of interviews with 21 newly graduated nurses, four themes emerged: (1) Performing as knowledge seekers: Scripting the frontstage quest for competence; (2) Performing as social intruders: Gaining access to the backstage “team”; (3) Performing as emotional laborers: Managing audience perceptions and reactions; and (4) The enduring impact of performance: The internalization of roles.
Conclusion
While impression management serves as a critical professional survival strategy for newly graduated nurses, it is a performance enacted at the steep price of burnout and self-alienation. This defensive posture risks becoming an internalized, intergenerationally transmitted harmful culture where today's survivors become tomorrow's gatekeepers, perpetuating a vicious cycle of workforce attrition and cultural toxicity. Breaking this cycle requires interventions that move beyond the individual. Organizations must foster psychologically safe environments with a zero-tolerance policy for incivility. Nursing education must make the hidden curriculum of workplace survival explicit, thereby empowering the next generation of nurses.
{"title":"Interaction strategies of newly graduated nurses with senior colleagues under asymmetrical power relations: A qualitative study","authors":"Longhui Xu , Xiao Cong , Cuiping Xu","doi":"10.1016/j.ijnurstu.2025.105314","DOIUrl":"10.1016/j.ijnurstu.2025.105314","url":null,"abstract":"<div><h3>Background</h3><div>High attrition among newly graduated nurses is a persistent global problem. Conventional research attributes this to “transition shock,” often framing newly graduated nurses as passive subjects requiring remediation through individual-focused training. This perspective overlooks a critical reality: professional socialization occurs not through formal programs, but through daily interactions with senior colleagues who wield power via knowledge, experience, and evaluative authority.</div></div><div><h3>Objective</h3><div>Drawing on Goffman's dramaturgical theory, this study explores how newly graduated nurses use impression management to navigate asymmetrical power relations with senior colleagues and ultimately shape their professional role transition.</div></div><div><h3>Design</h3><div>A descriptive qualitative study was conducted using one-on-one, semi-structured interviews with newly graduated nurses.</div></div><div><h3>Methods</h3><div>We employed purposive sampling to recruit newly graduated nurses from two tertiary hospitals in Shandong Province, China, between April and July 2025, analyzing the qualitative data using deductive content analysis.</div></div><div><h3>Results</h3><div>From our analysis of interviews with 21 newly graduated nurses, four themes emerged: (1) Performing as knowledge seekers: Scripting the frontstage quest for competence; (2) Performing as social intruders: Gaining access to the backstage “team”; (3) Performing as emotional laborers: Managing audience perceptions and reactions; and (4) The enduring impact of performance: The internalization of roles.</div></div><div><h3>Conclusion</h3><div>While impression management serves as a critical professional survival strategy for newly graduated nurses, it is a performance enacted at the steep price of burnout and self-alienation. This defensive posture risks becoming an internalized, intergenerationally transmitted harmful culture where today's survivors become tomorrow's gatekeepers, perpetuating a vicious cycle of workforce attrition and cultural toxicity. Breaking this cycle requires interventions that move beyond the individual. Organizations must foster psychologically safe environments with a zero-tolerance policy for incivility. Nursing education must make the hidden curriculum of workplace survival explicit, thereby empowering the next generation of nurses.</div></div>","PeriodicalId":50299,"journal":{"name":"International Journal of Nursing Studies","volume":"175 ","pages":"Article 105314"},"PeriodicalIF":7.1,"publicationDate":"2025-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145732196","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-09DOI: 10.1016/j.ijnurstu.2025.105315
Brigid M. Gillespie , Georgia Tobiano , Josephine Lovegrove , R.D. Udeshika Priyadarshani Sugathapala , Lukman Thalib , Rhea Liang , Rachel Walker , Annette Erickson , Joan Carlini , Stanley Thong , Keith Addy , Melinda Spencer , Wendy Chaboyer
<div><h3>Background</h3><div>Enhanced Recovery After Surgery programs have been implemented across surgical specialties; however, their effectiveness in reducing surgical site infection and 30-day hospital readmission remains unclear.</div></div><div><h3>Objective</h3><div>To determine the effect of Enhanced Recovery After Surgery programs on the clinical outcomes of surgical site infection and readmission and identify items of and implementation strategies for such programs.</div></div><div><h3>Design</h3><div>An umbrella review of published systematic reviews.</div></div><div><h3>Methods</h3><div>Systematic searches of MEDLINE, Embase, CINAHL, Cochrane Library, and Scopus databases were conducted in January 2025. Systematic reviews of randomised controlled trials and non-randomised studies of interventions comparing Enhanced Recovery After Surgery programs with standard care in adults after major open or laparoscopic gastrointestinal surgery, focusing on surgical site infection and 30-day hospital readmission, were included. Review quality and certainty of evidence were assessed using A MeaSurement Tool to Assess systematic Reviews (AMSTAR 2) and GRADE (Grading of Recommendations Assessment, Development and Evaluation) tools.</div></div><div><h3>Results</h3><div>49 reviews were included in the analysis. Meta-analysis of 42 unique primary randomised controlled trials with 5112 patients suggests a significant association between Enhanced Recovery After Surgery programs use and surgical site infection reduction (estimated odds ratio 0.70, 95 % confidence interval 0.59–0.82, p < 0.001, I<sup>2</sup> = 0 %). Meta-analysis of 53 primary randomised controlled trials with 7360 patients suggests no significant relationship between Enhanced Recovery After Surgery programs and hospital readmission (estimated odds ratio 1.025, 95 % confidence interval 0.85–1.23, p = 0.792, I<sup>2</sup> = 0 %). Summary estimates for surgical site infection were similar across non-randomised studies of interventions. GRADE assessments suggest ‘very low’ certainty across outcomes. Enhanced Recovery After Surgery programs included 5 to 28 components; implementation strategies were not described.</div></div><div><h3>Discussion</h3><div>Results suggest an association between Enhanced Recovery After Surgery programs and reductions in surgical site infection, and no relationship between hospital readmissions. However, the body of evidence is weak and inconclusive. These results also indicate heterogeneity in compliance with Enhanced Recovery After Surgery, reflecting the complexity in standardising this surgical care pathway.</div></div><div><h3>Conclusions</h3><div>Well-controlled primary research is warranted to understand the impact of Enhanced Recovery After Surgery programs.</div></div><div><h3>Registration</h3><div>PROSPERO registration number: CRD42024503357.</div></div><div><h3>Social media abstract</h3><div>Enhanced Recovery After Surgery programs may significantly re
{"title":"Effect of Enhanced Recovery After Surgery programs on surgical site infection and 30-day readmission in patients undergoing gastro-intestinal procedures: An umbrella review","authors":"Brigid M. Gillespie , Georgia Tobiano , Josephine Lovegrove , R.D. Udeshika Priyadarshani Sugathapala , Lukman Thalib , Rhea Liang , Rachel Walker , Annette Erickson , Joan Carlini , Stanley Thong , Keith Addy , Melinda Spencer , Wendy Chaboyer","doi":"10.1016/j.ijnurstu.2025.105315","DOIUrl":"10.1016/j.ijnurstu.2025.105315","url":null,"abstract":"<div><h3>Background</h3><div>Enhanced Recovery After Surgery programs have been implemented across surgical specialties; however, their effectiveness in reducing surgical site infection and 30-day hospital readmission remains unclear.</div></div><div><h3>Objective</h3><div>To determine the effect of Enhanced Recovery After Surgery programs on the clinical outcomes of surgical site infection and readmission and identify items of and implementation strategies for such programs.</div></div><div><h3>Design</h3><div>An umbrella review of published systematic reviews.</div></div><div><h3>Methods</h3><div>Systematic searches of MEDLINE, Embase, CINAHL, Cochrane Library, and Scopus databases were conducted in January 2025. Systematic reviews of randomised controlled trials and non-randomised studies of interventions comparing Enhanced Recovery After Surgery programs with standard care in adults after major open or laparoscopic gastrointestinal surgery, focusing on surgical site infection and 30-day hospital readmission, were included. Review quality and certainty of evidence were assessed using A MeaSurement Tool to Assess systematic Reviews (AMSTAR 2) and GRADE (Grading of Recommendations Assessment, Development and Evaluation) tools.</div></div><div><h3>Results</h3><div>49 reviews were included in the analysis. Meta-analysis of 42 unique primary randomised controlled trials with 5112 patients suggests a significant association between Enhanced Recovery After Surgery programs use and surgical site infection reduction (estimated odds ratio 0.70, 95 % confidence interval 0.59–0.82, p < 0.001, I<sup>2</sup> = 0 %). Meta-analysis of 53 primary randomised controlled trials with 7360 patients suggests no significant relationship between Enhanced Recovery After Surgery programs and hospital readmission (estimated odds ratio 1.025, 95 % confidence interval 0.85–1.23, p = 0.792, I<sup>2</sup> = 0 %). Summary estimates for surgical site infection were similar across non-randomised studies of interventions. GRADE assessments suggest ‘very low’ certainty across outcomes. Enhanced Recovery After Surgery programs included 5 to 28 components; implementation strategies were not described.</div></div><div><h3>Discussion</h3><div>Results suggest an association between Enhanced Recovery After Surgery programs and reductions in surgical site infection, and no relationship between hospital readmissions. However, the body of evidence is weak and inconclusive. These results also indicate heterogeneity in compliance with Enhanced Recovery After Surgery, reflecting the complexity in standardising this surgical care pathway.</div></div><div><h3>Conclusions</h3><div>Well-controlled primary research is warranted to understand the impact of Enhanced Recovery After Surgery programs.</div></div><div><h3>Registration</h3><div>PROSPERO registration number: CRD42024503357.</div></div><div><h3>Social media abstract</h3><div>Enhanced Recovery After Surgery programs may significantly re","PeriodicalId":50299,"journal":{"name":"International Journal of Nursing Studies","volume":"175 ","pages":"Article 105315"},"PeriodicalIF":7.1,"publicationDate":"2025-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145732195","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-04DOI: 10.1016/j.ijnurstu.2025.105312
Peter Griffiths
{"title":"A new chapter for the International Journal of Nursing Studies","authors":"Peter Griffiths","doi":"10.1016/j.ijnurstu.2025.105312","DOIUrl":"10.1016/j.ijnurstu.2025.105312","url":null,"abstract":"","PeriodicalId":50299,"journal":{"name":"International Journal of Nursing Studies","volume":"174 ","pages":"Article 105312"},"PeriodicalIF":7.1,"publicationDate":"2025-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145689333","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-02DOI: 10.1016/j.ijnurstu.2025.105310
Hongxiu Chen , Yilin Wang , Xuan Huang , Lihui Pu , Shuai Zhang , Qingqing Li , Xiaoxia Zhang , Yong Li , Guan Wang , Xiuying Hu
<div><h3>Background</h3><div>The Khorana score is a guideline-recommended tool for identifying cancer patients at high risk of venous thromboembolism (VTE), while recent evidence indicates that it fails to distinguish low- and high-risk patients accurately. Increasingly, modified Khorana scores are being proposed to improve VTE risk prediction, yet their predictive performance remains uncertain.</div></div><div><h3>Objectives</h3><div>This study aimed to systematically evaluate and compare the predictive performance of the modified Khorana scores with the original Khorana score, thereby assisting clinicians in selecting the most appropriate tool for clinical practice.</div></div><div><h3>Design</h3><div>Systematic review and network meta-analysis.</div></div><div><h3>Methods</h3><div>Eight databases were last searched on February 1, 2025, to identify studies that developed or validated the modified Khorana scores. The Prediction Model Risk of Bias Assessment Tool was used to evaluate the risk of bias and applicability concerns of the included studies. Both pairwise and Bayesian network meta-analysis were employed using random effects model to synthesize available data on predictive performances and thoroughly compare the modified and original Khorana scores.</div></div><div><h3>Results</h3><div>Twenty-eight studies were included, identifying 12 modified versions of the Khorana score. Among these, PROTECHT, CONKO, ONKOTEV, and Vienna CATS were the most extensively validated, with pooled C-indices of 0.59 (95 % confidence interval [CI] 0.56, 0.62), 0.57 (95 % CI 0.54, 0.60), 0.70 (95 % CI 0.56, 0.81), and 0.63 (95 % CI 0.13, 0.95), respectively. In pairwise meta-analysis, no modified Khorana scores were significantly superior to the original Khorana score, while leave-one-out sensitivity analyses showed significantly better performance for CONKO (mean difference [MD] = 0.02, 95 % CI 0.00, 0.04) compared with the original Khorana score. Bayesian network meta-analysis demonstrated that none of the comparisons (PROTECHT, CONKO, ONKOTEV, Vienna CATS, and the original Khorana score) was significantly different (<em>P</em> > 0.05). Calibration performance was rarely reported across the modified scores. The majority of included studies (96.4 %) were identified to have a high risk of bias.</div></div><div><h3>Conclusion</h3><div>Many modified Khorana scores have been developed and validated in different settings and cancer populations. Modified Khorana scores showed limited discriminative ability and were not superior to the original Khorana score. Given the pervasive high risk of bias of included studies and the poor pooled discriminative ability of the modified Khorana scores, the Khorana score and its modifications did not currently meet clinically desirable standards of evidence quality and predictive accuracy. Further large-scale, high-quality validation studies are warranted to validate them comprehensively.</div></div><div><h3>Registration</h3><d
Khorana评分是一种指南推荐的工具，用于识别静脉血栓栓塞（VTE）高风险的癌症患者，但最近的证据表明，它不能准确区分低风险和高风险患者。越来越多的人提出修改Khorana评分来改善静脉血栓栓塞风险预测，但其预测性能仍不确定。目的本研究旨在系统评估和比较修改后的Khorana评分与原始Khorana评分的预测性能，从而帮助临床医生选择最合适的工具进行临床实践。设计系统回顾和网络荟萃分析。方法最后一次检索seight数据库是在2025年2月1日，以确定开发或验证修改后的Khorana评分的研究。使用预测模型偏倚风险评估工具评估纳入研究的偏倚风险和适用性问题。采用随机效应模型，采用两两元分析和贝叶斯网络元分析，综合现有的预测性能数据，并对修改后的Khorana评分与原始评分进行全面比较。结果纳入了28项研究，确定了12个修改版本的霍拉纳评分。其中，PROTECHT、CONKO、ONKOTEV和Vienna CATS得到了最广泛的验证，其合并c指数分别为0.59（95%可信区间[CI] 0.56, 0.62）、0.57 （95% CI 0.54, 0.60）、0.70 （95% CI 0.56, 0.81）和0.63 （95% CI 0.13, 0.95）。在两两荟萃分析中，没有修改后的Khorana评分明显优于原始Khorana评分，而留一敏感性分析显示CONKO的表现明显优于原始Khorana评分（平均差异[MD] = 0.02, 95% CI 0.00, 0.04）。贝叶斯网络meta分析显示，PROTECHT、CONKO、ONKOTEV、Vienna CATS和原始Khorana评分的比较均无显著差异（P > 0.05）。在修改后的分数中很少报告校准性能。大多数纳入的研究（96.4%）被确定为具有高偏倚风险。结论许多改进的Khorana评分在不同的环境和癌症人群中得到了开发和验证。修改后的霍拉纳评分显示出有限的区分能力，并不优于原始霍拉纳评分。考虑到纳入的研究普遍存在高偏倚风险，以及修改后的Khorana评分的综合判别能力较差，Khorana评分及其修改目前未达到临床所需的证据质量和预测准确性标准。需要进一步大规模、高质量的验证研究来全面验证它们。本研究的方案已在PROSPERO注册（注册号：CRD42024601258）。
{"title":"Comparison of modified Khorana scores for prediction of venous thromboembolism in cancer patients: A systematic review and network meta-analysis","authors":"Hongxiu Chen , Yilin Wang , Xuan Huang , Lihui Pu , Shuai Zhang , Qingqing Li , Xiaoxia Zhang , Yong Li , Guan Wang , Xiuying Hu","doi":"10.1016/j.ijnurstu.2025.105310","DOIUrl":"10.1016/j.ijnurstu.2025.105310","url":null,"abstract":"<div><h3>Background</h3><div>The Khorana score is a guideline-recommended tool for identifying cancer patients at high risk of venous thromboembolism (VTE), while recent evidence indicates that it fails to distinguish low- and high-risk patients accurately. Increasingly, modified Khorana scores are being proposed to improve VTE risk prediction, yet their predictive performance remains uncertain.</div></div><div><h3>Objectives</h3><div>This study aimed to systematically evaluate and compare the predictive performance of the modified Khorana scores with the original Khorana score, thereby assisting clinicians in selecting the most appropriate tool for clinical practice.</div></div><div><h3>Design</h3><div>Systematic review and network meta-analysis.</div></div><div><h3>Methods</h3><div>Eight databases were last searched on February 1, 2025, to identify studies that developed or validated the modified Khorana scores. The Prediction Model Risk of Bias Assessment Tool was used to evaluate the risk of bias and applicability concerns of the included studies. Both pairwise and Bayesian network meta-analysis were employed using random effects model to synthesize available data on predictive performances and thoroughly compare the modified and original Khorana scores.</div></div><div><h3>Results</h3><div>Twenty-eight studies were included, identifying 12 modified versions of the Khorana score. Among these, PROTECHT, CONKO, ONKOTEV, and Vienna CATS were the most extensively validated, with pooled C-indices of 0.59 (95 % confidence interval [CI] 0.56, 0.62), 0.57 (95 % CI 0.54, 0.60), 0.70 (95 % CI 0.56, 0.81), and 0.63 (95 % CI 0.13, 0.95), respectively. In pairwise meta-analysis, no modified Khorana scores were significantly superior to the original Khorana score, while leave-one-out sensitivity analyses showed significantly better performance for CONKO (mean difference [MD] = 0.02, 95 % CI 0.00, 0.04) compared with the original Khorana score. Bayesian network meta-analysis demonstrated that none of the comparisons (PROTECHT, CONKO, ONKOTEV, Vienna CATS, and the original Khorana score) was significantly different (<em>P</em> > 0.05). Calibration performance was rarely reported across the modified scores. The majority of included studies (96.4 %) were identified to have a high risk of bias.</div></div><div><h3>Conclusion</h3><div>Many modified Khorana scores have been developed and validated in different settings and cancer populations. Modified Khorana scores showed limited discriminative ability and were not superior to the original Khorana score. Given the pervasive high risk of bias of included studies and the poor pooled discriminative ability of the modified Khorana scores, the Khorana score and its modifications did not currently meet clinically desirable standards of evidence quality and predictive accuracy. Further large-scale, high-quality validation studies are warranted to validate them comprehensively.</div></div><div><h3>Registration</h3><d","PeriodicalId":50299,"journal":{"name":"International Journal of Nursing Studies","volume":"175 ","pages":"Article 105310"},"PeriodicalIF":7.1,"publicationDate":"2025-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145657182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-02DOI: 10.1016/j.ijnurstu.2025.105311
Hugh P. McKenna , David R. Thompson
{"title":"Achieving research impact: the advice we would give to our younger selves","authors":"Hugh P. McKenna , David R. Thompson","doi":"10.1016/j.ijnurstu.2025.105311","DOIUrl":"10.1016/j.ijnurstu.2025.105311","url":null,"abstract":"","PeriodicalId":50299,"journal":{"name":"International Journal of Nursing Studies","volume":"175 ","pages":"Article 105311"},"PeriodicalIF":7.1,"publicationDate":"2025-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145657177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.ijnurstu.2025.105306
Laura J. McGowan , Beth Nichol , Maisie McKenzie , Angel Chater , Ivo Vlaev , Aikaterini Grimani
<div><h3>Background</h3><div>The World Health Organization estimates a shortage of 4.5 million nurses by 2030. In England, traditional nursing degrees cost ∼£9535/year, while apprenticeships are salaried, but take longer and currently have fewer places available. To better inform policy and workforce planning, it is crucial to understand the factors influencing entry into nursing. This study aims to explore factors influencing decision-making processes of prospective nurses, with particular focus on pathway preferences.</div></div><div><h3>Methods</h3><div>Qualitative semi-structured interviews (N = 40) were conducted online with 10 prospective nursing students, 10 current nursing students, 10 recently graduated nursing students, and 10 training providers. Participants were identified through policy partners, educational institutions, and snowball sampling methods. Thematic analysis was conducted, structured using the Framework approach.</div></div><div><h3>Findings</h3><div>Six themes were generated: 1) The role of professionalisation, identity, and stigma in shaping educational decision-making; 2) Balancing life, learning, and livelihood in the context of consumerist attitudes to higher education; 3) Preference for practical learning and embedded experience; 4) Career aspirations and progression opportunities; 5) Support systems and student experience; 6) Course delivery challenges. Stigmatised perceptions of educational pathways, with apprenticeships typically perceived as less prestigious than traditional degrees, appeared to contribute to a vocational-versus-academic divide, and differential delivery approaches (concurrent-versus-sequential delivery of practical and theoretical learning) also appeared to influence choices. Negative media portrayals of nursing post-COVID reportedly discouraged recruitment. Financial stability and family commitments were considered key factors in educational choices, with the financial structure of apprenticeships perceived as preferable for mature students with children. Apprenticeships were considered to have more robust support systems, facilitating positive educational experiences and mitigating academic confidence issues, with peer support and camaraderie highly valued across both routes. However, some younger students questioned their readiness to enter the workforce and reported their desire for a more traditional university experience. Providers reported apprenticeship delivery as more costly to educational institutions due to additional regulations and administrative load, and many noted a dichotomy in learning types between pathways, meaning integration of teaching across pathways would need careful consideration.</div></div><div><h3>Conclusions</h3><div>Addressing the shortages in applications to nursing courses in England requires a multifaceted approach. This may include national awareness campaigns to improve perceptions of nursing careers, enhanced financial support for degree students, and regu
{"title":"Pathways to nursing: A qualitative exploration of the education and training decision-making of nursing students","authors":"Laura J. McGowan , Beth Nichol , Maisie McKenzie , Angel Chater , Ivo Vlaev , Aikaterini Grimani","doi":"10.1016/j.ijnurstu.2025.105306","DOIUrl":"10.1016/j.ijnurstu.2025.105306","url":null,"abstract":"<div><h3>Background</h3><div>The World Health Organization estimates a shortage of 4.5 million nurses by 2030. In England, traditional nursing degrees cost ∼£9535/year, while apprenticeships are salaried, but take longer and currently have fewer places available. To better inform policy and workforce planning, it is crucial to understand the factors influencing entry into nursing. This study aims to explore factors influencing decision-making processes of prospective nurses, with particular focus on pathway preferences.</div></div><div><h3>Methods</h3><div>Qualitative semi-structured interviews (N = 40) were conducted online with 10 prospective nursing students, 10 current nursing students, 10 recently graduated nursing students, and 10 training providers. Participants were identified through policy partners, educational institutions, and snowball sampling methods. Thematic analysis was conducted, structured using the Framework approach.</div></div><div><h3>Findings</h3><div>Six themes were generated: 1) The role of professionalisation, identity, and stigma in shaping educational decision-making; 2) Balancing life, learning, and livelihood in the context of consumerist attitudes to higher education; 3) Preference for practical learning and embedded experience; 4) Career aspirations and progression opportunities; 5) Support systems and student experience; 6) Course delivery challenges. Stigmatised perceptions of educational pathways, with apprenticeships typically perceived as less prestigious than traditional degrees, appeared to contribute to a vocational-versus-academic divide, and differential delivery approaches (concurrent-versus-sequential delivery of practical and theoretical learning) also appeared to influence choices. Negative media portrayals of nursing post-COVID reportedly discouraged recruitment. Financial stability and family commitments were considered key factors in educational choices, with the financial structure of apprenticeships perceived as preferable for mature students with children. Apprenticeships were considered to have more robust support systems, facilitating positive educational experiences and mitigating academic confidence issues, with peer support and camaraderie highly valued across both routes. However, some younger students questioned their readiness to enter the workforce and reported their desire for a more traditional university experience. Providers reported apprenticeship delivery as more costly to educational institutions due to additional regulations and administrative load, and many noted a dichotomy in learning types between pathways, meaning integration of teaching across pathways would need careful consideration.</div></div><div><h3>Conclusions</h3><div>Addressing the shortages in applications to nursing courses in England requires a multifaceted approach. This may include national awareness campaigns to improve perceptions of nursing careers, enhanced financial support for degree students, and regu","PeriodicalId":50299,"journal":{"name":"International Journal of Nursing Studies","volume":"174 ","pages":"Article 105306"},"PeriodicalIF":7.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145651075","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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