Global crises, such as pandemics and armed conflicts, highlight the need for resilient healthcare systems. Nurse middle managers play a critical meso-level role in bridging frontline staff and senior leadership, yet their crisis experiences remain underexplored.
Aims
(1) To identify coping strategies used by nurse middle managers and their impact on bedside nurses' resilience during crises; (2) to explore how prior crises, such as COVID-19, shaped their approaches, and (3) to examine contextual factors influencing their ability to anticipate, cope, and adapt.
Methods
A descriptive qualitative design was employed, involving semi-structured interviews with 17 nurse middle managers from diverse healthcare sectors. Data were analyzed using Duchek's Organizational Resilience Model, focusing on anticipation, coping, and adaptation.
Results
Nurse middle managers play a crucial role in organizational resilience by acting as intermediaries between frontline staff and senior leadership. Their prior experiences with crises, such as COVID-19, strengthened their ability to manage uncertainty, problem-solve, and support their teams. Key resilience-enhancing strategies included fostering team cohesion, adapting workflows in real time, and advocating for staff well-being. However, systemic challenges, such as resource shortages and gaps in structured emergency preparedness, hindered their effectiveness.
Conclusions
This study underscores the pivotal role of nurse middle managers in fostering organizational resilience during healthcare crises. Their leadership, adaptability, and capacity to support teams through uncertainty were instrumental in maintaining care continuity. However, systemic challenges—including limited preparedness frameworks, ethical ambiguities, and resource constraints—hindered their effectiveness. These findings highlight the urgent need for structured crisis leadership training, investment in mental health support, and inclusive preparedness planning. Strengthening these areas can enhance organizational readiness, reduce burnout, and reinforce the resilience of both the workforce and the healthcare system at large.
{"title":"Navigating crisis: A qualitative study of nurse middle managers' role in building resilience during times of crisis","authors":"Nadya Golfenshtein , Anat Drach-Zahavy , Daniel Sperling , Tatiana Talya Fleishman , Miriam Hirschfeld , Nurith Wagner , Einav Srulovici","doi":"10.1016/j.ijnurstu.2025.105289","DOIUrl":"10.1016/j.ijnurstu.2025.105289","url":null,"abstract":"<div><h3>Background</h3><div>Global crises, such as pandemics and armed conflicts, highlight the need for resilient healthcare systems. Nurse middle managers play a critical meso-level role in bridging frontline staff and senior leadership, yet their crisis experiences remain underexplored.</div></div><div><h3>Aims</h3><div>(1) To identify coping strategies used by nurse middle managers and their impact on bedside nurses' resilience during crises; (2) to explore how prior crises, such as COVID-19, shaped their approaches, and (3) to examine contextual factors influencing their ability to anticipate, cope, and adapt.</div></div><div><h3>Methods</h3><div>A descriptive qualitative design was employed, involving semi-structured interviews with 17 nurse middle managers from diverse healthcare sectors. Data were analyzed using Duchek's Organizational Resilience Model, focusing on anticipation, coping, and adaptation.</div></div><div><h3>Results</h3><div>Nurse middle managers play a crucial role in organizational resilience by acting as intermediaries between frontline staff and senior leadership. Their prior experiences with crises, such as COVID-19, strengthened their ability to manage uncertainty, problem-solve, and support their teams. Key resilience-enhancing strategies included fostering team cohesion, adapting workflows in real time, and advocating for staff well-being. However, systemic challenges, such as resource shortages and gaps in structured emergency preparedness, hindered their effectiveness.</div></div><div><h3>Conclusions</h3><div>This study underscores the pivotal role of nurse middle managers in fostering organizational resilience during healthcare crises. Their leadership, adaptability, and capacity to support teams through uncertainty were instrumental in maintaining care continuity. However, systemic challenges—including limited preparedness frameworks, ethical ambiguities, and resource constraints—hindered their effectiveness. These findings highlight the urgent need for structured crisis leadership training, investment in mental health support, and inclusive preparedness planning. Strengthening these areas can enhance organizational readiness, reduce burnout, and reinforce the resilience of both the workforce and the healthcare system at large.</div></div>","PeriodicalId":50299,"journal":{"name":"International Journal of Nursing Studies","volume":"174 ","pages":"Article 105289"},"PeriodicalIF":7.1,"publicationDate":"2025-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145553313","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 : 2025-11-14DOI: 10.1016/j.ijnurstu.2025.105286
Elsie Mari , Jennie King , Yun-Hee Jeon , Sarah Yeun-Sim Jeong
Background
Older people residing in aged care homes often have complex health needs that can lead to hospitalisations, some of which are potentially avoidable. To address this, nurse-led or nurse-involved interventions have been implemented to reduce unnecessary hospital presentations.
Objective
To review and synthesise evidence on the impact of nurse-led or nurse-involved hospital avoidance outreach interventions on health service use for aged care home residents.
Design
A mixed-methods systematic review guided by the Joanna Briggs Institute framework.
Data sources
Databases searched included Ovid Medline, Scopus, and the Cumulative Index of Nursing and Allied Health Literature (CINAHL).
Methods
An initial search was conducted in October 2022 to identify peer-reviewed studies published in English between January 2011 to October 2022, with an update in August 2025. Titles, abstracts, and full text selections were screened by two or more independent reviewers and assessed for methodological quality. A convergent segregated approach was used for data synthesis and integration.
Findings
Twenty-four studies met the inclusion criteria: 16 quantitative, seven qualitative and one mixed-method study. The majority were conducted in Australia (n = 21), with others in Finland, Denmark and France. Nurse-led or nurse-involved hospital avoidance interventions were associated with reductions in emergency department presentations, re-presentations and hospital admissions via the emergency department. Four studies reported cost savings, although findings were heterogeneous. Health professionals reported positive experiences, but the perspectives of aged care home residents and their families were underrepresented. Key enablers of intervention success included staff support, leadership, rapid response outreach interventions, technological infrastructure, and outreach team expertise. Operational barriers include inconsistent guidelines and policies, limited service hours, and challenges with technology implementation.
Conclusion
This review highlights growing evidence base supporting nurse-led and nurse-involved outreach interventions to avoid hospitalisation for unwell aged care home residents. The enablers and barriers identified in this systematic review offer valuable insights for clinicians and researchers planning or refining hospital avoidance initiatives.
Registration
The protocol for this systematic review was registered at the PROSPERO register on 31 December 2022 [CRD42022385659].
{"title":"Nurse-involved hospital avoidance outreach interventions for aged care home residents: A mixed-method systematic review","authors":"Elsie Mari , Jennie King , Yun-Hee Jeon , Sarah Yeun-Sim Jeong","doi":"10.1016/j.ijnurstu.2025.105286","DOIUrl":"10.1016/j.ijnurstu.2025.105286","url":null,"abstract":"<div><h3>Background</h3><div>Older people residing in aged care homes often have complex health needs that can lead to hospitalisations, some of which are potentially avoidable. To address this, nurse-led or nurse-involved interventions have been implemented to reduce unnecessary hospital presentations.</div></div><div><h3>Objective</h3><div>To review and synthesise evidence on the impact of nurse-led or nurse-involved hospital avoidance outreach interventions on health service use for aged care home residents.</div></div><div><h3>Design</h3><div>A mixed-methods systematic review guided by the Joanna Briggs Institute framework.</div></div><div><h3>Data sources</h3><div>Databases searched included Ovid Medline, Scopus, and the Cumulative Index of Nursing and Allied Health Literature (CINAHL).</div></div><div><h3>Methods</h3><div>An initial search was conducted in October 2022 to identify peer-reviewed studies published in English between January 2011 to October 2022, with an update in August 2025. Titles, abstracts, and full text selections were screened by two or more independent reviewers and assessed for methodological quality. A convergent segregated approach was used for data synthesis and integration.</div></div><div><h3>Findings</h3><div>Twenty-four studies met the inclusion criteria: 16 quantitative, seven qualitative and one mixed-method study. The majority were conducted in Australia (n = 21), with others in Finland, Denmark and France. Nurse-led or nurse-involved hospital avoidance interventions were associated with reductions in emergency department presentations, re-presentations and hospital admissions via the emergency department. Four studies reported cost savings, although findings were heterogeneous. Health professionals reported positive experiences, but the perspectives of aged care home residents and their families were underrepresented. Key enablers of intervention success included staff support, leadership, rapid response outreach interventions, technological infrastructure, and outreach team expertise. Operational barriers include inconsistent guidelines and policies, limited service hours, and challenges with technology implementation.</div></div><div><h3>Conclusion</h3><div>This review highlights growing evidence base supporting nurse-led and nurse-involved outreach interventions to avoid hospitalisation for unwell aged care home residents. The enablers and barriers identified in this systematic review offer valuable insights for clinicians and researchers planning or refining hospital avoidance initiatives.</div></div><div><h3>Registration</h3><div>The protocol for this systematic review was registered at the PROSPERO register on 31 December 2022 [CRD42022385659].</div></div>","PeriodicalId":50299,"journal":{"name":"International Journal of Nursing Studies","volume":"174 ","pages":"Article 105286"},"PeriodicalIF":7.1,"publicationDate":"2025-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145535850","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 : 2025-11-14DOI: 10.1016/j.ijnurstu.2025.105285
Xin Wang , Yan-Hong Zhang , Jing-wen Ju , Zhao-Hong Chen , Ming-Wen Tang
Background
Non-suicidal self-injury is highly prevalent among adolescents with mood disorders. It not only severely jeopardizes their physical and mental health but also imposes a substantial burden on families. Nurses working in psychiatric settings frequently report challenges in providing care to these young people, often experiencing negative emotional impacts and occupational burnout. The personal experiences of non-suicidal self-injury, and how they intersect with the broader socio-cultural context to influence behavior in this population, are not well understood, thereby hindering the development of effective nursing interventions.
Objective
This study applied the Benefits and Barriers Model to elucidate the dynamic interplay of motivations, barriers, and contextual factors underlying non-suicidal self-injury among Chinese adolescents with mood disorders, with a specific focus on its cultural relevance.
Methods
An exploratory qualitative design was adopted. Eighteen adolescents with mood disorders and experience of non-suicidal self-injury were recruited from a tertiary psychiatric hospital in mainland China. Semi-structured interviews were conducted between January 2024 and January 2025. Data were analyzed using reflexive thematic analysis.
Results
Three core dimensions of perceived benefits were identified: release of negative emotions, pleasurable experience following stress reduction, and escape from interpersonal and communication difficulties. Three primary categories of barriers emerged: internal psychological resources, external emotional support, and awareness of social norms. Key contextual factors that intersect with these benefits and barriers were identified as emotional state, the quality of parent–child relationships, social adaptation strategies, and involvement in online communities. Distinctive socio-cultural contexts were also observed, including a highly competitive academic environment, shifting parent–child dynamics and relational insecurities, and cultural traditions prioritizing introspection and emotional restraint.
Conclusions
This study examined non-suicidal self-injury among adolescents with mood disorders through a benefits–barriers framework, characterizing it as a dynamic adaptation shaped by the interplay of perceived benefits, barriers, and contextual factors. The findings highlight the need for culturally responsive, systemic nursing interventions that foster emotional regulation, interpersonal trust, and environmental support across individual, familial, and societal levels. This holistic approach, grounded in the participants' lived experiences, provides a critical foundation for mitigating self-injury risk in this population.
{"title":"Why do adolescents hurt themselves? A qualitative study","authors":"Xin Wang , Yan-Hong Zhang , Jing-wen Ju , Zhao-Hong Chen , Ming-Wen Tang","doi":"10.1016/j.ijnurstu.2025.105285","DOIUrl":"10.1016/j.ijnurstu.2025.105285","url":null,"abstract":"<div><h3>Background</h3><div>Non-suicidal self-injury is highly prevalent among adolescents with mood disorders. It not only severely jeopardizes their physical and mental health but also imposes a substantial burden on families. Nurses working in psychiatric settings frequently report challenges in providing care to these young people, often experiencing negative emotional impacts and occupational burnout. The personal experiences of non-suicidal self-injury, and how they intersect with the broader socio-cultural context to influence behavior in this population, are not well understood, thereby hindering the development of effective nursing interventions.</div></div><div><h3>Objective</h3><div>This study applied the Benefits and Barriers Model to elucidate the dynamic interplay of motivations, barriers, and contextual factors underlying non-suicidal self-injury among Chinese adolescents with mood disorders, with a specific focus on its cultural relevance.</div></div><div><h3>Methods</h3><div>An exploratory qualitative design was adopted. Eighteen adolescents with mood disorders and experience of non-suicidal self-injury were recruited from a tertiary psychiatric hospital in mainland China. Semi-structured interviews were conducted between January 2024 and January 2025. Data were analyzed using reflexive thematic analysis.</div></div><div><h3>Results</h3><div>Three core dimensions of perceived benefits were identified: release of negative emotions, pleasurable experience following stress reduction, and escape from interpersonal and communication difficulties. Three primary categories of barriers emerged: internal psychological resources, external emotional support, and awareness of social norms. Key contextual factors that intersect with these benefits and barriers were identified as emotional state, the quality of parent–child relationships, social adaptation strategies, and involvement in online communities. Distinctive socio-cultural contexts were also observed, including a highly competitive academic environment, shifting parent–child dynamics and relational insecurities, and cultural traditions prioritizing introspection and emotional restraint.</div></div><div><h3>Conclusions</h3><div>This study examined non-suicidal self-injury among adolescents with mood disorders through a benefits–barriers framework, characterizing it as a dynamic adaptation shaped by the interplay of perceived benefits, barriers, and contextual factors. The findings highlight the need for culturally responsive, systemic nursing interventions that foster emotional regulation, interpersonal trust, and environmental support across individual, familial, and societal levels. This holistic approach, grounded in the participants' lived experiences, provides a critical foundation for mitigating self-injury risk in this population.</div></div>","PeriodicalId":50299,"journal":{"name":"International Journal of Nursing Studies","volume":"174 ","pages":"Article 105285"},"PeriodicalIF":7.1,"publicationDate":"2025-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145535851","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 : 2025-11-12DOI: 10.1016/j.ijnurstu.2025.105282
Stephanie Fox , Chiara Dall'Ora , Mark Young
Background
Occupational fatigue among healthcare professionals is a complex, multifaceted issue associated with increased likelihood of medical error, compromised patient safety and negative impacts on staff mental and physical health. While safety-critical sectors such as aviation and rail have implemented formal systems to manage fatigue-related risks, it remains unclear whether similarly structured approaches exist or operate effectively within healthcare.
Objective
This scoping literature review aimed to examine the current state of knowledge regarding fatigue risk management strategies and countermeasures in healthcare and explore the barriers and facilitators to their implementation. This review sought to highlight gaps and provide insights into advancing fatigue risk management practices within the healthcare context.
Methods
A systematic literature search to June 2025 was conducted across Medline, CINAHL Ultimate, and Scopus databases. Search terms were developed based on key concepts related to healthcare professions and fatigue risk management. Studies were included if they examined fatigue risk management strategies, countermeasures or organisational perceptions of fatigue in healthcare.
Results
Thirty-two studies met the inclusion criteria, including quantitative (n = 18), qualitative (n = 9), and mixed-methods (n = 5) designs. Findings were grouped into conceptual categories based on the study focus and/or intervention type. The majority of studies (n = 18) evaluated isolated interventions including informal/individual fatigue management strategies, napping, use of biomathematical models to predict fatigue risk, fatigue education, and the impact of scheduling practices. Only two studies reported on comprehensive, multi-component programmes. Nine studies explored staff perceptions and attitudes towards fatigue-related strategies, and three examined broader organisational understanding or design principles related to fatigue management. Key barriers to implementation included normalised cultural attitudes towards fatigue, limited managerial support, and inadequate infrastructure. Facilitators included improved staffing levels, better workload distribution, supportive leadership, and the development of non-punitive safety cultures that encouraged fatigue reporting.
Conclusions
Despite growing awareness of the risks associated with occupational fatigue, healthcare systems continue to rely on fragmented, informal, and largely individual approaches to fatigue management. In contrast to other high-risk industries, healthcare has yet to embed fatigue management within formal safety governance structures. Advancing practice in this area requires a shift towards system-level thinking that is supported by organisational leadership, effective fatigue monitoring, and workforce education. Additionally, this shift al
{"title":"Fatigue risk management in healthcare: A scoping literature review","authors":"Stephanie Fox , Chiara Dall'Ora , Mark Young","doi":"10.1016/j.ijnurstu.2025.105282","DOIUrl":"10.1016/j.ijnurstu.2025.105282","url":null,"abstract":"<div><h3>Background</h3><div>Occupational fatigue among healthcare professionals is a complex, multifaceted issue associated with increased likelihood of medical error, compromised patient safety and negative impacts on staff mental and physical health. While safety-critical sectors such as aviation and rail have implemented formal systems to manage fatigue-related risks, it remains unclear whether similarly structured approaches exist or operate effectively within healthcare.</div></div><div><h3>Objective</h3><div>This scoping literature review aimed to examine the current state of knowledge regarding fatigue risk management strategies and countermeasures in healthcare and explore the barriers and facilitators to their implementation. This review sought to highlight gaps and provide insights into advancing fatigue risk management practices within the healthcare context.</div></div><div><h3>Methods</h3><div>A systematic literature search to June 2025 was conducted across Medline, CINAHL Ultimate, and Scopus databases. Search terms were developed based on key concepts related to healthcare professions and fatigue risk management. Studies were included if they examined fatigue risk management strategies, countermeasures or organisational perceptions of fatigue in healthcare.</div></div><div><h3>Results</h3><div>Thirty-two studies met the inclusion criteria, including quantitative (n = 18), qualitative (n = 9), and mixed-methods (n = 5) designs. Findings were grouped into conceptual categories based on the study focus and/or intervention type. The majority of studies (n = 18) evaluated isolated interventions including informal/individual fatigue management strategies, napping, use of biomathematical models to predict fatigue risk, fatigue education, and the impact of scheduling practices. Only two studies reported on comprehensive, multi-component programmes. Nine studies explored staff perceptions and attitudes towards fatigue-related strategies, and three examined broader organisational understanding or design principles related to fatigue management. Key barriers to implementation included normalised cultural attitudes towards fatigue, limited managerial support, and inadequate infrastructure. Facilitators included improved staffing levels, better workload distribution, supportive leadership, and the development of non-punitive safety cultures that encouraged fatigue reporting.</div></div><div><h3>Conclusions</h3><div>Despite growing awareness of the risks associated with occupational fatigue, healthcare systems continue to rely on fragmented, informal, and largely individual approaches to fatigue management. In contrast to other high-risk industries, healthcare has yet to embed fatigue management within formal safety governance structures. Advancing practice in this area requires a shift towards system-level thinking that is supported by organisational leadership, effective fatigue monitoring, and workforce education. Additionally, this shift al","PeriodicalId":50299,"journal":{"name":"International Journal of Nursing Studies","volume":"174 ","pages":"Article 105282"},"PeriodicalIF":7.1,"publicationDate":"2025-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145525043","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 : 2025-11-11DOI: 10.1016/j.ijnurstu.2025.105281
Jonathan Bayuo , Arkers Kwan Ching Wong , Frances Kam Yuet Wong , Eric Ampomah Adinkrah
<div><h3>Background</h3><div>Paediatric burn injuries pose a critical global health challenge, affecting millions of children annually. Beyond the immediate physical harm, burns disrupt developmental trajectories, leaving enduring psychological, physical, and relational impacts as children transition into adulthood. While advancements in acute care have improved survival rates, understanding the dyadic recovery process between parent and children remains underexplored. The prolonged and complex nature of post-burn recovery necessitates sustained caregiver support, emphasising the need to examine how parent–child dyads experience and collectively navigate this journey.</div></div><div><h3>Objective</h3><div>To generate a theory explaining how parent–child dyads experience and navigate through the post-burn recovery process.</div></div><div><h3>Design</h3><div>Constructivist grounded theory.</div></div><div><h3>Participants</h3><div>Paediatric burn survivors with a discharge status of up to 1 month or more and their informal caregivers who were present throughout the period of hospitalisation.</div></div><div><h3>Methods</h3><div>Initial purposive and subsequent theoretical sampling approaches were employed. Data were collected through face-to-face dyadic interviews at mutually agreed time and locations, supplemented by field notes. Concurrent data analysis utilised constant comparative approach to iteratively refine emerging codes and categories. To ensure congruence with the dyadic interviewing approach, the constant comparative approach employed did not only focus on uncovering categories, but also the content (emerging narratives) and interaction (how parents and children communicated noting areas of convergence and divergence in their narratives).</div></div><div><h3>Results</h3><div>Twenty-three (23) parent–child dyads participated in the study. The children and parents (19 mothers and 4 fathers) are aged 10–16 years and 33–49 years respectively. The core category, <em>Coming to Terms</em>, conceptualises the dyadic recovery journey from injury occurrence to acceptance and adaptation. Three interrelated categories characterised this process: (1) <em>Being with Each Other in a Trauma Bubble</em> (mutual emotional entrapment in acute distress), (2) <em>Living with the Scars</em> (physical and psychological marks shaping identity), and (3) <em>Navigating the Recovery Maze</em> (collaborative adaptation to post-burn realities). The <em>Theory of Coming to Terms</em> underscores post-burn recovery as an emotionally fraught negotiation marked by asymmetrical burdens for dyads, requiring reconciliation with lasting physical, psychological, and relational consequences. Although most aspects of the recovery journey showed commonalities across dyads, a notable divergence emerged in attitudes toward scars: while parents and older children tended to conceal these marks, younger children often chose to display them openly.</div></div><div><h3>Conclusion</
{"title":"“Coming to terms” - the post-burn recovery journey of parent–child dyads: A constructivist grounded theory","authors":"Jonathan Bayuo , Arkers Kwan Ching Wong , Frances Kam Yuet Wong , Eric Ampomah Adinkrah","doi":"10.1016/j.ijnurstu.2025.105281","DOIUrl":"10.1016/j.ijnurstu.2025.105281","url":null,"abstract":"<div><h3>Background</h3><div>Paediatric burn injuries pose a critical global health challenge, affecting millions of children annually. Beyond the immediate physical harm, burns disrupt developmental trajectories, leaving enduring psychological, physical, and relational impacts as children transition into adulthood. While advancements in acute care have improved survival rates, understanding the dyadic recovery process between parent and children remains underexplored. The prolonged and complex nature of post-burn recovery necessitates sustained caregiver support, emphasising the need to examine how parent–child dyads experience and collectively navigate this journey.</div></div><div><h3>Objective</h3><div>To generate a theory explaining how parent–child dyads experience and navigate through the post-burn recovery process.</div></div><div><h3>Design</h3><div>Constructivist grounded theory.</div></div><div><h3>Participants</h3><div>Paediatric burn survivors with a discharge status of up to 1 month or more and their informal caregivers who were present throughout the period of hospitalisation.</div></div><div><h3>Methods</h3><div>Initial purposive and subsequent theoretical sampling approaches were employed. Data were collected through face-to-face dyadic interviews at mutually agreed time and locations, supplemented by field notes. Concurrent data analysis utilised constant comparative approach to iteratively refine emerging codes and categories. To ensure congruence with the dyadic interviewing approach, the constant comparative approach employed did not only focus on uncovering categories, but also the content (emerging narratives) and interaction (how parents and children communicated noting areas of convergence and divergence in their narratives).</div></div><div><h3>Results</h3><div>Twenty-three (23) parent–child dyads participated in the study. The children and parents (19 mothers and 4 fathers) are aged 10–16 years and 33–49 years respectively. The core category, <em>Coming to Terms</em>, conceptualises the dyadic recovery journey from injury occurrence to acceptance and adaptation. Three interrelated categories characterised this process: (1) <em>Being with Each Other in a Trauma Bubble</em> (mutual emotional entrapment in acute distress), (2) <em>Living with the Scars</em> (physical and psychological marks shaping identity), and (3) <em>Navigating the Recovery Maze</em> (collaborative adaptation to post-burn realities). The <em>Theory of Coming to Terms</em> underscores post-burn recovery as an emotionally fraught negotiation marked by asymmetrical burdens for dyads, requiring reconciliation with lasting physical, psychological, and relational consequences. Although most aspects of the recovery journey showed commonalities across dyads, a notable divergence emerged in attitudes toward scars: while parents and older children tended to conceal these marks, younger children often chose to display them openly.</div></div><div><h3>Conclusion</","PeriodicalId":50299,"journal":{"name":"International Journal of Nursing Studies","volume":"174 ","pages":"Article 105281"},"PeriodicalIF":7.1,"publicationDate":"2025-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145492223","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 : 2025-11-11DOI: 10.1016/j.ijnurstu.2025.105283
Ian Norman
{"title":"An era of transformation: Reflecting on two decades at the International Journal of Nursing Studies","authors":"Ian Norman","doi":"10.1016/j.ijnurstu.2025.105283","DOIUrl":"10.1016/j.ijnurstu.2025.105283","url":null,"abstract":"","PeriodicalId":50299,"journal":{"name":"International Journal of Nursing Studies","volume":"173 ","pages":"Article 105283"},"PeriodicalIF":7.1,"publicationDate":"2025-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145498787","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 : 2025-11-07DOI: 10.1016/j.ijnurstu.2025.105279
Xiang Qiu , Jiagui Liang , Lan Luo , Xinyu Huang , Guanjie Yi , Chen Xiong , Ni Gong
Background
Social participation significantly promotes health in older adults with chronic multimorbidity. However, their needs and characteristics of social participation demonstrate substantial heterogeneity due to multidimensional influences. Current standardized community service models inadequately address this population's diverse needs. User personas, as a group classification model derived from integrating the characteristics of target populations along specific dimensions, can provide a basis for addressing the current challenge in which standardized community services fail to meet the diverse needs of this population.
Objective
To characterize the social participation behaviors of older adults with multimorbidity, construct representative user personas, and establish foundations for personalized community interventions.
Methods
From November 2024 to May 2025, we conducted semi-structured interviews with 32 multimorbid older adults through purposive sampling at two community health centers in Guangzhou, Guangdong Province, China. Interview data were analyzed using content analysis to identify persona label dimensions. Based on these dimensions, user personas were constructed with manual extraction and clustering of individual characteristics. The personas were visualized through a combination of word clouds and tables.
Results
Six key dimensions profiling social participation emerged: daily activities, physical health, psychological state, interpersonal relationships, participation in organized activities, and community environment concerns. Based on these dimensions, five distinct user personas were identified: the care-dependent withdrawers, the family-depleting strugglers, the functionally-compensated stabilizers, the self-pleasure enjoyers and the value-creation builders.
Conclusion
Multidimensional factors, including physical, psychological, familial and environmental, shape heterogeneous social participation patterns among multimorbid older adults. Future policies and interventions should be differentiated based on persona characteristics, integrating medical, psychological and environmental support to enhance the social participation level and quality of life of older adults with chronic multimorbidity.
{"title":"Patterns of social participation among older adults with chronic multimorbidity in the community: A qualitative study","authors":"Xiang Qiu , Jiagui Liang , Lan Luo , Xinyu Huang , Guanjie Yi , Chen Xiong , Ni Gong","doi":"10.1016/j.ijnurstu.2025.105279","DOIUrl":"10.1016/j.ijnurstu.2025.105279","url":null,"abstract":"<div><h3>Background</h3><div>Social participation significantly promotes health in older adults with chronic multimorbidity. However, their needs and characteristics of social participation demonstrate substantial heterogeneity due to multidimensional influences. Current standardized community service models inadequately address this population's diverse needs. User personas, as a group classification model derived from integrating the characteristics of target populations along specific dimensions, can provide a basis for addressing the current challenge in which standardized community services fail to meet the diverse needs of this population.</div></div><div><h3>Objective</h3><div>To characterize the social participation behaviors of older adults with multimorbidity, construct representative user personas, and establish foundations for personalized community interventions.</div></div><div><h3>Methods</h3><div>From November 2024 to May 2025, we conducted semi-structured interviews with 32 multimorbid older adults through purposive sampling at two community health centers in Guangzhou, Guangdong Province, China. Interview data were analyzed using content analysis to identify persona label dimensions. Based on these dimensions, user personas were constructed with manual extraction and clustering of individual characteristics. The personas were visualized through a combination of word clouds and tables.</div></div><div><h3>Results</h3><div>Six key dimensions profiling social participation emerged: daily activities, physical health, psychological state, interpersonal relationships, participation in organized activities, and community environment concerns. Based on these dimensions, five distinct user personas were identified: the care-dependent withdrawers, the family-depleting strugglers, the functionally-compensated stabilizers, the self-pleasure enjoyers and the value-creation builders.</div></div><div><h3>Conclusion</h3><div>Multidimensional factors, including physical, psychological, familial and environmental, shape heterogeneous social participation patterns among multimorbid older adults. Future policies and interventions should be differentiated based on persona characteristics, integrating medical, psychological and environmental support to enhance the social participation level and quality of life of older adults with chronic multimorbidity.</div></div>","PeriodicalId":50299,"journal":{"name":"International Journal of Nursing Studies","volume":"174 ","pages":"Article 105279"},"PeriodicalIF":7.1,"publicationDate":"2025-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145461346","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}
Caring for unstable patients in a general ward is a challenging task for nurses and impacts patients' safety. To assist nurses in detecting and managing patient deterioration, the nurse-led Rapid Response Team has been implemented worldwide for over 25 years with divergent results regarding reduced patient mortality, cardiac arrest rates, and admissions for intensive care. To develop new initiatives targeting well-documented challenges embedded in using the nurse-led Rapid Response Team, research-based knowledge from a broader perspective on the Rapid Response Team is crucial. This study evaluated how and for whom the nurse-led Rapid Response Team works.
Objective
To test initial and alternative program theories of the nurse-led Rapid Response Team in acute care hospitals and further refine the program theories of this complex health care intervention.
Design
A realist evaluation.
Methods
A four-stage cycle process was applied, involving a synthesis of literature of the Rapid Response Team published between 2014-24, and empirical data from six qualitative studies, serving as analytical tools. To explore multiple stakeholders' perceptions of the Rapid Response Team a variety of data-collection methods including participant observations, focus group interviews, and individual interviews were used in the qualitative studies. Intensive care and general ward nurses, physicians in clinical and coordinating roles, and multiple hospital managers across various levels at three acute care hospital in three Danish regions were involved in the six qualitative studies.
Findings
The fourth stage of the realist evaluation resulted in a refined program theory stating, “If Rapid Response Team-nurses use their intensive care skills and competences and collaborate amiably, creating a respectful and calm atmosphere whilst also capturing the needs of both nurses and patients, then the role as a Rapid Response Team-nurse is fulfilled and responsibility between the involved parties is shared. General ward nurses will then choose to call the team for assistance and Rapid Response Team-nurses will choose to engage in future Rapid Response Team calls, which will subsequently lead to clinical actions being taken, patients being helped, and general ward nurses feeling secure whilst also learning new skills”.
Conclusion
The nurse-led Rapid Response Team is perceived to work for patients, general ward nurses, Rapid Response Team-nurses, and the organization, due to Rapid Response Team-nurses' skills, the respect between nurses, and the essential collaboration inherent in intra-professional nursing teamwork across nursing positions and working areas. The primary responsibility for this collaboration lies with the individual Rapid Response Team-nurse and the Rapid Response Team-coordinator.
{"title":"Refining the program theory of the nurse-led Rapid Response Team in acute care hospitals: A realist evaluation","authors":"Gitte Bunkenborg , Jesper Frederiksen , Tina C.B. Hansen , Tracey Bucknall","doi":"10.1016/j.ijnurstu.2025.105280","DOIUrl":"10.1016/j.ijnurstu.2025.105280","url":null,"abstract":"<div><h3>Background</h3><div>Caring for unstable patients in a general ward is a challenging task for nurses and impacts patients' safety. To assist nurses in detecting and managing patient deterioration, the nurse-led Rapid Response Team has been implemented worldwide for over 25 years with divergent results regarding reduced patient mortality, cardiac arrest rates, and admissions for intensive care. To develop new initiatives targeting well-documented challenges embedded in using the nurse-led Rapid Response Team, research-based knowledge from a broader perspective on the Rapid Response Team is crucial. This study evaluated how and for whom the nurse-led Rapid Response Team works.</div></div><div><h3>Objective</h3><div>To test initial and alternative program theories of the nurse-led Rapid Response Team in acute care hospitals and further refine the program theories of this complex health care intervention.</div></div><div><h3>Design</h3><div>A realist evaluation.</div></div><div><h3>Methods</h3><div>A four-stage cycle process was applied, involving a synthesis of literature of the Rapid Response Team published between 2014-24, and empirical data from six qualitative studies, serving as analytical tools. To explore multiple stakeholders' perceptions of the Rapid Response Team a variety of data-collection methods including participant observations, focus group interviews, and individual interviews were used in the qualitative studies. Intensive care and general ward nurses, physicians in clinical and coordinating roles, and multiple hospital managers across various levels at three acute care hospital in three Danish regions were involved in the six qualitative studies.</div></div><div><h3>Findings</h3><div>The fourth stage of the realist evaluation resulted in a refined program theory stating, “If Rapid Response Team-nurses use their intensive care skills and competences and collaborate amiably, creating a respectful and calm atmosphere whilst also capturing the needs of both nurses and patients, then the role as a Rapid Response Team-nurse is fulfilled and responsibility between the involved parties is shared. General ward nurses will then choose to call the team for assistance and Rapid Response Team-nurses will choose to engage in future Rapid Response Team calls, which will subsequently lead to clinical actions being taken, patients being helped, and general ward nurses feeling secure whilst also learning new skills”.</div></div><div><h3>Conclusion</h3><div>The nurse-led Rapid Response Team is perceived to work for patients, general ward nurses, Rapid Response Team-nurses, and the organization, due to Rapid Response Team-nurses' skills, the respect between nurses, and the essential collaboration inherent in intra-professional nursing teamwork across nursing positions and working areas. The primary responsibility for this collaboration lies with the individual Rapid Response Team-nurse and the Rapid Response Team-coordinator.</div></div>","PeriodicalId":50299,"journal":{"name":"International Journal of Nursing Studies","volume":"174 ","pages":"Article 105280"},"PeriodicalIF":7.1,"publicationDate":"2025-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145461348","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 : 2025-11-05DOI: 10.1016/j.ijnurstu.2025.105278
Khulood Alyami , Katherine Bristowe , Elizabeth Dzeng , Oladayo Afolabi , Catherine J. Evans
<div><h3>Background</h3><div>Sickle cell disease is one of the most common inherited monogenetic blood disorders. People living with sickle cell disease experience both acute pain and long-lasting complications, leading to co-morbidities which impact their quality of life. Palliative care is both under-reported and under-utilised for people living with sickle cell disease despite the profound impacts of this illness across their lives.</div></div><div><h3>Objective</h3><div>To synthesise published primary evidence on the palliative care needs and experiences of adults severely affected by sickle cell disease.</div></div><div><h3>Design</h3><div>Mixed method systematic narrative review.</div></div><div><h3>Methods</h3><div>Four databases (Medline, PsycINFO, Embase and CINHAL) were searched from inception to April 2024. Eligibility criteria were adults aged ≥<!--> <!-->18 years with severe sickle cell disease defined in the disease severity classification system as Class II (moderate severity) and Class III (most severe). Data from qualitative and quantitative studies were analysed using data-based convergent synthesis. A best-fit framework synthesis approach was used with the World Health Organization definition of palliative care as the a priori framework. Results were mapped to Bronfenbrenner Ecological Model to pursue interaction between needs across different environmental systems.</div></div><div><h3>Results</h3><div>23 studies met eligibility (12 qualitative and 11 quantitative studies). Needs were evident across the five domains of palliative care, and an additional domain titled experiences of using healthcare services: i) Physical needs included distressing symptoms focusing mainly on pain (n = 22 studies). Pain manifested as both acute and chronic and impacted all aspects of a person's life; ii) Psychological needs encompassed depression, suicidal ideation, coping and stigma related to the disease itself and need for opioids for pain management; iii) Social needs included the impact on social life, functioning, personal relationships, employment and education; iv) Spirituality was described in terms of its use when living with a complex chronic condition; v) Family caregiver needs and the support provided included the family feeling unable to support the person at times, and vi) Experiencing access to healthcare services which included lack of trust in healthcare providers.</div></div><div><h3>Conclusions</h3><div>Synthesised palliative care needs for people severely affected by sickle cell disease are interlinked and impact one another. This is influenced by the unpredictability of the disease itself and its chronic complications such as living with and managing chronic wounds. Stigma associated with the disease impacted the person in multiple ways, notably delaying seeking medical treatment, discrimination in the workplace and social isolation. Sickle cell disease is a multifaceted complex condition. Management requires a dynamic holis
{"title":"Palliative care needs of adults severely affected by sickle cell disease: A mixed-methods systematic review","authors":"Khulood Alyami , Katherine Bristowe , Elizabeth Dzeng , Oladayo Afolabi , Catherine J. Evans","doi":"10.1016/j.ijnurstu.2025.105278","DOIUrl":"10.1016/j.ijnurstu.2025.105278","url":null,"abstract":"<div><h3>Background</h3><div>Sickle cell disease is one of the most common inherited monogenetic blood disorders. People living with sickle cell disease experience both acute pain and long-lasting complications, leading to co-morbidities which impact their quality of life. Palliative care is both under-reported and under-utilised for people living with sickle cell disease despite the profound impacts of this illness across their lives.</div></div><div><h3>Objective</h3><div>To synthesise published primary evidence on the palliative care needs and experiences of adults severely affected by sickle cell disease.</div></div><div><h3>Design</h3><div>Mixed method systematic narrative review.</div></div><div><h3>Methods</h3><div>Four databases (Medline, PsycINFO, Embase and CINHAL) were searched from inception to April 2024. Eligibility criteria were adults aged ≥<!--> <!-->18 years with severe sickle cell disease defined in the disease severity classification system as Class II (moderate severity) and Class III (most severe). Data from qualitative and quantitative studies were analysed using data-based convergent synthesis. A best-fit framework synthesis approach was used with the World Health Organization definition of palliative care as the a priori framework. Results were mapped to Bronfenbrenner Ecological Model to pursue interaction between needs across different environmental systems.</div></div><div><h3>Results</h3><div>23 studies met eligibility (12 qualitative and 11 quantitative studies). Needs were evident across the five domains of palliative care, and an additional domain titled experiences of using healthcare services: i) Physical needs included distressing symptoms focusing mainly on pain (n = 22 studies). Pain manifested as both acute and chronic and impacted all aspects of a person's life; ii) Psychological needs encompassed depression, suicidal ideation, coping and stigma related to the disease itself and need for opioids for pain management; iii) Social needs included the impact on social life, functioning, personal relationships, employment and education; iv) Spirituality was described in terms of its use when living with a complex chronic condition; v) Family caregiver needs and the support provided included the family feeling unable to support the person at times, and vi) Experiencing access to healthcare services which included lack of trust in healthcare providers.</div></div><div><h3>Conclusions</h3><div>Synthesised palliative care needs for people severely affected by sickle cell disease are interlinked and impact one another. This is influenced by the unpredictability of the disease itself and its chronic complications such as living with and managing chronic wounds. Stigma associated with the disease impacted the person in multiple ways, notably delaying seeking medical treatment, discrimination in the workplace and social isolation. Sickle cell disease is a multifaceted complex condition. Management requires a dynamic holis","PeriodicalId":50299,"journal":{"name":"International Journal of Nursing Studies","volume":"174 ","pages":"Article 105278"},"PeriodicalIF":7.1,"publicationDate":"2025-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145447444","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}
To map the evidence on nurses' roles and contributions in deprescribing within the multidisciplinary team across all clinical settings.
Methods
This scoping review was conducted using Arksey and O'Malley's framework and the Joanna Briggs Institute (JBI) methodology, and reported by the PRISMA-ScR 2020 checklist. A systematic search was conducted across CINAHL, Embase, MEDLINE (Ovid), Web of Science, Scopus and Google Scholar, with no time restrictions. Studies in English and Italian were included if they explored the role of nurses in deprescribing in older adults (≥ 65 years) across hospital, home, or community settings. A wide range of study designs was considered, including empirical studies, reviews, and gray literature.
Results
28 studies were included in the review. Nurses played key roles in deprescribing through medication review, adherence assessment, detection of adverse drug effects or drug–drug interactions, patient education, and monitoring. Nurse-led interventions, conducted independently or in collaboration with the multidisciplinary team, were effective in reducing potentially inappropriate medications and improving adherence as primary outcomes. Key facilitators of nurses' views on deprescribing included strong interdisciplinary collaboration, training, and use of decision-support tools. Limited resources, a lack of trust in medication counseling, fragmented care, and patient-related difficulties were the main obstacles.
Conclusions
The changing and crucial role that nurses play in the deprescribing process is highlighted in this scoping review. The medication safety of older adults necessitates empowering nurses through organizational frameworks, technology support, and training. There is a clear need for stronger, high-quality evidence, including randomized controlled trials and rigorously designed implementation studies, to assess outcomes and guide the integration of nurse-led deprescribing interventions into everyday clinical practice.
Registration
Protocol registered on the Open Science Framework (doi:10.17605/OSF.IO/C49BU).
目的在所有临床环境中，绘制护士在多学科团队中描述处方的角色和贡献的证据。方法采用Arksey和O'Malley的框架和乔安娜布里格斯研究所（JBI）的方法进行范围审查，并通过PRISMA-ScR 2020检查表进行报告。系统检索了CINAHL、Embase、MEDLINE （Ovid）、Web of Science、Scopus和谷歌Scholar，没有时间限制。在医院、家庭或社区环境中，如果研究护士在老年人（≥65岁）开处方中的作用，则纳入英语和意大利语研究。我们考虑了广泛的研究设计，包括实证研究、综述和灰色文献。结果共纳入28项研究。护士通过药物审查、依从性评估、发现药物不良反应或药物相互作用、患者教育和监测，在开处方方面发挥了关键作用。护士主导的干预，独立进行或与多学科团队合作，在减少潜在的不适当药物和提高依从性作为主要结果方面是有效的。护士对处方的看法的主要促进因素包括强有力的跨学科合作、培训和决策支持工具的使用。资源有限、对药物咨询缺乏信任、支离破碎的护理和患者相关的困难是主要障碍。结论本综述强调了护士在处方过程中所起的重要作用。老年人的用药安全需要通过组织框架、技术支持和培训来授权护士。显然需要更有力、高质量的证据，包括随机对照试验和严格设计的实施研究，以评估结果，并指导将护士主导的处方化干预措施纳入日常临床实践。RegistrationProtocol注册在开放科学框架上（doi:10.17605/OSF.IO/C49BU）。
{"title":"Nurses' role in deprescribing for older adults: A scoping review","authors":"Giorgia Barbuiani , Stefano Terzoni , Rosario Caruso , Silvia Cilluffo , Luca Pasina , Maura Lusignani","doi":"10.1016/j.ijnurstu.2025.105274","DOIUrl":"10.1016/j.ijnurstu.2025.105274","url":null,"abstract":"<div><h3>Purpose</h3><div>To map the evidence on nurses' roles and contributions in deprescribing within the multidisciplinary team across all clinical settings.</div></div><div><h3>Methods</h3><div>This scoping review was conducted using Arksey and O'Malley's framework and the Joanna Briggs Institute (JBI) methodology, and reported by the PRISMA-ScR 2020 checklist. A systematic search was conducted across CINAHL, Embase, MEDLINE (Ovid), Web of Science, Scopus and Google Scholar, with no time restrictions. Studies in English and Italian were included if they explored the role of nurses in deprescribing in older adults (≥<!--> <!-->65 years) across hospital, home, or community settings. A wide range of study designs was considered, including empirical studies, reviews, and gray literature.</div></div><div><h3>Results</h3><div>28 studies were included in the review. Nurses played key roles in deprescribing through medication review, adherence assessment, detection of adverse drug effects or drug–drug interactions, patient education, and monitoring. Nurse-led interventions, conducted independently or in collaboration with the multidisciplinary team, were effective in reducing potentially inappropriate medications and improving adherence as primary outcomes. Key facilitators of nurses' views on deprescribing included strong interdisciplinary collaboration, training, and use of decision-support tools. Limited resources, a lack of trust in medication counseling, fragmented care, and patient-related difficulties were the main obstacles.</div></div><div><h3>Conclusions</h3><div>The changing and crucial role that nurses play in the deprescribing process is highlighted in this scoping review. The medication safety of older adults necessitates empowering nurses through organizational frameworks, technology support, and training. There is a clear need for stronger, high-quality evidence, including randomized controlled trials and rigorously designed implementation studies, to assess outcomes and guide the integration of nurse-led deprescribing interventions into everyday clinical practice.</div></div><div><h3>Registration</h3><div>Protocol registered on the Open Science Framework (<span><span>doi:10.17605/OSF.IO/C49BU</span><svg><path></path></svg></span>).</div></div>","PeriodicalId":50299,"journal":{"name":"International Journal of Nursing Studies","volume":"174 ","pages":"Article 105274"},"PeriodicalIF":7.1,"publicationDate":"2025-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145447445","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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