International Journal of Nursing Studies最新文献

{"title":"Refining the program theory of the nurse-led Rapid Response Team in acute care hospitals: A realist evaluation","authors":"Gitte Bunkenborg ,&nbsp;Jesper Frederiksen ,&nbsp;Tina C.B. Hansen ,&nbsp;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}

{"title":"Palliative care needs of adults severely affected by sickle cell disease: A mixed-methods systematic review","authors":"Khulood Alyami ,&nbsp;Katherine Bristowe ,&nbsp;Elizabeth Dzeng ,&nbsp;Oladayo Afolabi ,&nbsp;Catherine J. Evans","doi":"10.1016/j.ijnurstu.2025.105278","DOIUrl":"10.1016/j.ijnurstu.2025.105278","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;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.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Objective&lt;/h3&gt;&lt;div&gt;To synthesise published primary evidence on the palliative care needs and experiences of adults severely affected by sickle cell disease.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Design&lt;/h3&gt;&lt;div&gt;Mixed method systematic narrative review.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;Four databases (Medline, PsycINFO, Embase and CINHAL) were searched from inception to April 2024. Eligibility criteria were adults aged ≥&lt;!--&gt; &lt;!--&gt;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.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;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.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;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}

{"title":"Nurses' role in deprescribing for older adults: A scoping review","authors":"Giorgia Barbuiani ,&nbsp;Stefano Terzoni ,&nbsp;Rosario Caruso ,&nbsp;Silvia Cilluffo ,&nbsp;Luca Pasina ,&nbsp;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}

{"title":"Effectiveness of interactive digital health services in non-communicable diseases: An umbrella review and evidence synthesis from 26 meta-analyses","authors":"Elina Laukka ,&nbsp;Miia Jansson ,&nbsp;Petra Suonnansalo ,&nbsp;Reetta Ojanperä ,&nbsp;Henna Härkönen ,&nbsp;Sanna Lakoma ,&nbsp;Paulus Torkki","doi":"10.1016/j.ijnurstu.2025.105277","DOIUrl":"10.1016/j.ijnurstu.2025.105277","url":null,"abstract":"<div><h3>Background</h3><div>New digital health services are continuously developed, implemented, tested, and refined to meet diverse health and system needs. With the rise in non-communicable diseases, these services are increasingly integrated into care processes. However, the effectiveness of digital health services varies across time and settings, highlighting the need to evaluate their effectiveness longitudinally and in specific settings.</div></div><div><h3>Objective</h3><div>To synthesize current evidence from meta-analyses on the effectiveness of digital health services in non-communicable diseases.</div></div><div><h3>Design</h3><div>Umbrella review.</div></div><div><h3>Data sources</h3><div>A search was conducted in Jun 2025 using Cochrane, Ovid Medline, Scopus, and Web of Science databases.</div></div><div><h3>Review methods</h3><div>We included only peer-reviewed meta-analyses that synthetized RCTs that compared digital health services with usual care on outcomes in non-communicable diseases. Screening, data extraction, and risk of bias assessment were carried out independently by two researchers. Additionally, the strength of evidence was assessed.</div></div><div><h3>Results</h3><div>This umbrella review analyses 26 meta-analyses to evaluate the effectiveness of digital health services in 12 non-communicable diseases. Most reviews indicate non-significant difference between digital health services and usual care in the clinical outcomes. Digital health services were associated with better clinical outcomes in type 2 diabetes, hypertension and heart failure. Digital health services were also associated with higher patient satisfaction. The heterogeneity of outcome measures limited possibilities in meta-analysis. Convincing evidence for improved outcomes was found in 3.75 %, highly suggestive evidence in 7.5 %, suggestive in 5.6 %, and weak evidence in 23.75 % of the reviews, respectively.</div></div><div><h3>Conclusions</h3><div>Digital health services are generally as effective as usual care in managing non-communicable diseases, while in specific patient groups they can yield improved clinical outcomes and, overall, higher patient satisfaction. This underscores the need for cost-effectiveness studies to identify services that deliver comparable outcomes at reduced costs. In addition, more high-quality research with standardized outcome measures is needed, as evidence on digital health services involving patient-professional interaction remains non-significant.</div></div>","PeriodicalId":50299,"journal":{"name":"International Journal of Nursing Studies","volume":"174 ","pages":"Article 105277"},"PeriodicalIF":7.1,"publicationDate":"2025-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145447443","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}

{"title":"Associations between healthcare workers' substance use and quality of care: Findings from a one-year Swedish follow-up study","authors":"Josefina Peláez Zuberbuhler ,&nbsp;Amr Aroub ,&nbsp;Emelie Thern ,&nbsp;Siw Tone Innstrand ,&nbsp;Bodil J. Landstad ,&nbsp;Malin Sjöström ,&nbsp;Emma Brulin","doi":"10.1016/j.ijnurstu.2025.105276","DOIUrl":"10.1016/j.ijnurstu.2025.105276","url":null,"abstract":"<div><h3>Background</h3><div>Problem drinking and illicit drug use among healthcare workers (i.e., physicians and nurses) may impair their attention and cognitive functioning, thereby increasing the risk of medical errors and diminishing the quality of patient care.</div></div><div><h3>Objective</h3><div>To investigate the association between healthcare workers' problem drinking and illicit drug use with subsequent self-rated quality of care provided.</div></div><div><h3>Design</h3><div>A two-wave longitudinal observational study.</div></div><div><h3>Methods</h3><div>Panel data were drawn from the Longitudinal Occupational Health Survey in Healthcare Sweden (LOHHCS), collected in 2022 (baseline) and 2023 (follow-up), encompassing a sample of 3280 healthcare workers. Questionnaires included problem drinking, illicit drug use (cannabis and stimulants), and self-rated quality of care they provide to patients. Logistic regression models analysed relationships between the study variables.</div></div><div><h3>Results</h3><div>At baseline, the prevalence of problem drinking was 3.8 %, and illicit drug use was 1.3 %. Both problem drinking (OR = 1.93, 95 % CI = 1.28–3.02) and illicit drug use (OR = 2.07, 95 % CI = 1.00–4.29) were significantly associated with lower self-rated quality of care provided at follow-up, after adjustment for confounding variables.</div></div><div><h3>Conclusions</h3><div>This novel longitudinal study shows that healthcare workers reporting substance use at baseline were about twice as likely to report providing poor quality of care one year later. These findings are of clinical relevance and highlight the need for targeted preventive measures and interventions to safeguard the health and well-being of healthcare workers while maintaining quality standards in patient care.</div></div>","PeriodicalId":50299,"journal":{"name":"International Journal of Nursing Studies","volume":"174 ","pages":"Article 105276"},"PeriodicalIF":7.1,"publicationDate":"2025-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145427377","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}

{"title":"The influence of workplace experience and professional education on enhancing empathy among doctors, nurses and healthcare students: A comparative cross-sectional study","authors":"Honghong Cai ,&nbsp;Qing Wu ,&nbsp;Pei Wang","doi":"10.1016/j.ijnurstu.2025.105275","DOIUrl":"10.1016/j.ijnurstu.2025.105275","url":null,"abstract":"<div><h3>Background</h3><div>Empathy is crucial for effective clinical practice, and patient care. Despite its importance, the comparative studies and effectiveness analyses focusing on empathy-training strategies within both medical education and clinical practice are limited, particularly in China. The objective of this study is to compare empathy levels across doctors, nurses, medical students, and nursing students in China, exploring how workplace settings, professional roles, and training stages influence empathy development, to inform targeted empathy education strategies.</div></div><div><h3>Methods</h3><div>A cross-sectional survey was conducted using the Chinese Version of the Jefferson Scale of Healthcare Professional Empathy (C-JSHPE). Participants included doctors, nurses, medical students and nursing students from primary, secondary, and tertiary hospitals, as well as medical schools located in eastern (economically developed), central (moderately developed), and western (less developed) regions of China.</div></div><div><h3>Results</h3><div>Qualified professionals (licensed nurses and doctors) exhibited significantly higher empathy scores than healthcare students (doctors vs medical students t = 12.959, p &lt; 0.001; nurses vs nursing students t = 7.135, p &lt; 0.001). Nurses exhibited significantly higher empathy than doctors (t = 4.081, p &lt; 0.001), and nursing students likewise exhibited markedly greater empathy than their medical student counterparts (t = 5.221, p &lt; 0.001). Significant differences in empathy scores were observed between nursing students who participated in internships and those who did not (t = 2.548, p &lt; 0.05). In contrast, no such differences emerged among medical students (t = −<!--> <!-->0.228, p &gt; 0.05). Both doctors and nurses with more clinical experience demonstrated higher empathy scores (F physician = 10.696, p &lt; 0.001; F nurse = 30.029, p &lt; 0.001). In contrast, those working in tertiary hospitals reported reduced empathy (F physician = 94.018, p &lt; 0.001; F nurse = 486.586, p &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>This study underscored the importance of both developing and retaining empathy in qualified professionals and healthcare students, and highlighted the significant role of clinical work environments and stages of professional development in shaping empathic capacity. The findings suggested that empathy was not static, but evolved in response to the demands, pressures, and relational dynamics of different clinical roles. Simulation-based education and other experiential learning approaches represent promising avenues for fostering empathy, particularly when integrated longitudinally throughout training and aligned with authentic clinical contexts. Embedding these strategies into the continuum of medical education may be key to sustaining empathy as a core professional competence in complex healthcare systems.</div></div>","PeriodicalId":50299,"journal":{"name":"International Journal of Nursing Studies","volume":"173 ","pages":"Article 105275"},"PeriodicalIF":7.1,"publicationDate":"2025-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145397132","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}

{"title":"The prevalence and risk factors of shift work disorder among nurses: A systematic review and meta-analysis","authors":"Xiaoyan Zhao ,&nbsp;Li Zhang ,&nbsp;Xinyue Zhang ,&nbsp;Jing Guo ,&nbsp;Ruijia Guan ,&nbsp;Yuanjuan Cheng ,&nbsp;Yong Jia","doi":"10.1016/j.ijnurstu.2025.105273","DOIUrl":"10.1016/j.ijnurstu.2025.105273","url":null,"abstract":"<div><h3>Background</h3><div>Shift work disorder is common among nurses, marked by circadian rhythm disruption, excessive sleepiness, and cognitive impairment. It increases the risk of cardiovascular and metabolic diseases and contributes to clinical errors from fatigue, endangering patient safety. Its prevalence is notably higher in nurses than in other shift-working populations.</div></div><div><h3>Objectives</h3><div>This systematic review and meta-analysis aimed to determine the prevalence of and risk factors for shift work disorder among nurses. The ultimate aim was to provide evidence-based guidance for optimizing scheduling system and developing health intervention strategies.</div></div><div><h3>Methods</h3><div>Nine databases were comprehensively searched up to February 20, 2025, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A random-effects model was used for the meta-analysis, which was performed using Stata software. The quality of the studies was evaluated using the Joanna Briggs Institute (JBI) tool, and heterogeneity was assessed using the I² test. Publication bias was examined using funnel plots and the Egger test.</div></div><div><h3>Results</h3><div>A total of 24 observational studies involving 15,479 nurses were included for analysis. The pooled prevalence of shift work disorder among nurses was 45.5 % (95 % CI: 39.2–51.8 %). Subgroup analysis revealed that Africa (51.0 %) and Asia (46.5 %) had the highest prevalence rates, with a 61.7 % prevalence among nurses working in a “three-shift” model. Risk factors for shift work disorder included high stress (OR = 1.019, 95 % CI: 1.003–1.036), the number of night shifts in the past year (OR = 1.010, 95 % CI: 1.010–1.020), increasing age (OR = 1.025, 95 % CI: 1.002–1.047), the number of quick shifts (OR = 2.593, 95 % CI: 1.979–3.397), anxiety (OR = 1.073, 95 % CI: 1.039–1.108), depression (OR = 1.178, 95 % CI. 1.135–1.223) and fatigue (OR = 1.145, 95 % CI: 1.096–1.197). Heterogeneity analysis of the assessment tools revealed that scales and questionnaires (54.2 %) yielded higher prevalence rates than did the International Classification of Sleep Disorders −<!--> <!-->3 (40.2 %) and International Classification of Sleep Disorders −<!--> <!-->2 (32.9 %) criteria.</div></div><div><h3>Conclusions</h3><div>The prevalence of shift work disorder in the nurse population is high although there is substantial heterogeneity across studies. The risk of shift work disorder should be reduced by decreasing the frequency of rapid shifts and night shifts, optimizing scheduling stability, enhancing mental health support, and using standardized assessment tools. The findings provide key evidence for healthcare organizations to develop evidence-based intervention strategies.</div></div><div><h3>Registration</h3><div>This review was registered with PROSPERO (CRD 42023494210).</div></div>","PeriodicalId":50299,"journal":{"name":"International Journal of Nursing Studies","volume":"174 ","pages":"Article 105273"},"PeriodicalIF":7.1,"publicationDate":"2025-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145397131","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}

{"title":"A framework and practical approach to identify and address ethical issues arising in interventional health systems research","authors":"Edna Mutua ,&nbsp;Dorothy Oluoch ,&nbsp;Sebastian Fuller ,&nbsp;Gloria Ngaiza ,&nbsp;Nancy Odinga ,&nbsp;Caroline Waithira ,&nbsp;Vincent Kagonya ,&nbsp;Onesmus Onyango ,&nbsp;Naima Nasir ,&nbsp;Gulraj Grewal ,&nbsp;Abdulazeez Imam ,&nbsp;Asma Rababeh ,&nbsp;Michuki Maina ,&nbsp;Kenneth Karumba ,&nbsp;Maureen Kelley ,&nbsp;Mike English ,&nbsp;Sassy Molyneux","doi":"10.1016/j.ijnurstu.2025.105263","DOIUrl":"10.1016/j.ijnurstu.2025.105263","url":null,"abstract":"<div><h3>Background</h3><div>Embedded, interventional health systems research is increasingly promoted to better understand and strengthen the performance of health systems. However, for these forms of research, boundaries between clinical care, quality improvement, and public health can be blurred, and ethical implications and frameworks to draw upon are unclear. While there is evolving ethical guidance, few health systems studies have documented ethical dilemmas experienced post ethics approval, and the value of support processes introduced to manage arising dilemmas. In this discussion paper, we share our approach to handling the ethical dilemmas that arose while conducting embedded interventional health systems research in public-sector newborn units in Kenya.</div></div><div><h3>Methods</h3><div>Building on our past research, and literature on debriefs, reflective learning, ethics reflection groups and moral case deliberations, we evolved an approach to holding regular structured ethics debriefs to discuss and agree upon how to handle ethical issues experienced during ‘fieldwork’. The research team maintained a ‘living log’ of all discussions, detailing all emerging ethical issues and any agreed actions. To prepare this paper, we conducted a thematic analysis of the living log and associated meeting minutes/recordings, and held a series of wider team meetings to reflect upon our learning.</div></div><div><h3>Findings and discussion</h3><div>Numerous dilemmas were shared by research staff in our debrief fora. We grouped ethical issues encountered into 1) ‘bystander’ issues (defined here as background issues impacting health system functioning, facility staff, patients or families that were not caused or exacerbated by our research activities), 2) issues for those groups that were ‘research imposed’ and 3) issues related to the ‘comfort and well-being of research team members’. Most dilemmas raised related to feeling like bystanders in highly constrained health systems, complicated by our positionalities as ‘outsiders-within’, whereby as health researchers spending time in facilities we were neither fully ‘outsiders’ nor ‘insiders’ to the health system. There was constant moral labour involved in considering our responsibilities for action, which ranged from immediate action from a safety perspective, through rethinking how the research was conducted, to various forms of engagement and feedback across a web of stakeholders.</div></div><div><h3>Conclusion</h3><div>The approach we developed offers a framework to assist research team members with the significant ethical dilemmas and challenges that arise over the course of conducting studies. We suggest activities to support working prospectively through emerging ethical dilemmas in future studies.</div></div>","PeriodicalId":50299,"journal":{"name":"International Journal of Nursing Studies","volume":"174 ","pages":"Article 105263"},"PeriodicalIF":7.1,"publicationDate":"2025-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145382812","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}

{"title":"Erratum to “Priorities for ‘out-of-hours’ home-based palliative care for professionals, patients, and family caregivers: A qualitative interview study” [Int. J. Nurs. Stud. 171 (2025) 105193]","authors":"Joanna Goodrich ,&nbsp;Alice M. Firth ,&nbsp;Inez Gaczkowska ,&nbsp;Richard Harding ,&nbsp;Fliss E.M. Murtagh ,&nbsp;Catherine J. Evans","doi":"10.1016/j.ijnurstu.2025.105254","DOIUrl":"10.1016/j.ijnurstu.2025.105254","url":null,"abstract":"","PeriodicalId":50299,"journal":{"name":"International Journal of Nursing Studies","volume":"173 ","pages":"Article 105254"},"PeriodicalIF":7.1,"publicationDate":"2025-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145370635","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}

{"title":"Assistive technology products for toilet-use and continence containment problems in the home setting: A mapping review","authors":"Marjolein Woodhouse ,&nbsp;Miriam Avery ,&nbsp;Lois Woods ,&nbsp;David Alexander Scott ,&nbsp;Mandy Fader ,&nbsp;Margaret Macaulay ,&nbsp;Karen Ashton ,&nbsp;Catherine Murphy","doi":"10.1016/j.ijnurstu.2025.105264","DOIUrl":"10.1016/j.ijnurstu.2025.105264","url":null,"abstract":"<div><h3>Purpose</h3><div>This study aimed to identify common toilet-use and continence containment problems among community-dwelling adults, explore the range of assistive products available for these issues, and map the products identified to the problems they address.</div></div><div><h3>Design</h3><div>A mapping review methodology was employed, modified to include grey literature, to identify the full range of toilet-use and continence containment assistive products that are designed for use in the home setting.</div></div><div><h3>Methods</h3><div>An initial inventory of toilet-use and continence containment problems was derived from toilet-use task sequence analysis and commonly occurring containment challenges. This was supplemented by scoping searches of grey literature and refined with feedback from partner representatives. Assistive products were identified through structured online searches and review of seminal texts. A nurse researcher with community health experience then mapped the categories of assistive products to the identified problems.</div></div><div><h3>Results</h3><div>Thirty-three toilet-use and containment problems were identified, stratified into 295 subproblems based on end-user characteristics, including physical and cognitive function, and urinary or faecal voiding needs. The search revealed 163 categories of assistive products and mapping these to the subproblems resulted in more than 1500 product-to-problem links. No suitable assistive product options were identified for six sub-problems.</div></div><div><h3>Conclusion</h3><div>Given the diversity of toilet-use and containment challenges faced by community-dwelling individuals and the array of available assistive products, this novel study highlights the complexity of matching products to individual needs. These findings emphasise the need for better resources to support individuals, caregivers and healthcare professionals in optimising decision-making on and selection of toilet-use and continence containment products.</div></div>","PeriodicalId":50299,"journal":{"name":"International Journal of Nursing Studies","volume":"173 ","pages":"Article 105264"},"PeriodicalIF":7.1,"publicationDate":"2025-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145382814","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}