搜索结果：Journal of research in nursing : JRN

The phenomenon of 'failing to fail' underperforming pre-registration nursing students in clinical placements is widely recognised. In the United Kingdom, updated Nursing and Midwifery Council guidelines aim to support registered nurses (RNs) in supervising and assessing students. The aim of the study is to explore RNs' experiences of the phenomenon of 'failing to fail' underperforming pre-registration nursing students in clinical placements. This research is a qualitative descriptive study. Semi-structured one-to-one online interviews with 14 RNs enrolled in postgraduate nursing courses at a university in the United Kingdom. Data were analysed using Elo and Kyngäs' content analysis framework. Four key categories were identified: (1) The Stigma of Failure - failure perceived as stigmatised; (2) Organisational Constraints and Time Pressures - limiting effective mentoring and assessment; (3) Emotional and Relational Barriers to Failing - including personal relationships, lack of confidence and fear of repercussions and (4) Enablers - including supportive workplace culture, collaboration with universities, training and clear guidance. Failing to fail is a complex issue influenced by cultural, organisational and individual factors. It has significant implications for patient safety, professional standards and the future nursing workforce. Addressing these challenges requires changes in mentorship practices and institutional support.

Conscientious objection in nursing care represents a critical ethical dilemma that undermines nurses' moral integrity and causes moral distress. The resulting internal conflict between professional responsibilities and personal values places a substantial emotional and ethical burden on nurses, potentially intensifying feelings of guilt and inadequacy and leading to conscience-related stress. This study aimed to develop and validate a scale for assessing conscientious objection in nursing care. Psychometric analyses were conducted with 165 nurses working in clinical and intensive care units of a university hospital in Türkiye. Exploratory factor analysis, reliability testing, and thematic analysis of open-ended questions using MAXQDA were performed. The final scale comprised 20 items across four factors: conscientious practice, conscientious stress, conscientious sensitivity, and conscientious perception - explaining 59.4% of the total variance. Cronbach's alpha coefficients ranged from 0.710 to 0.863 for subscales and 0.887 for the total scale. Thematic analysis also revealed three main themes regarding conscientious objection: refusal of situations that conflict with their value systems, conscientious conflict, and deviation from conscientious values. The Conscientious Objection in Nursing Care Scale' (COSINC) is a valid and reliable instrument for evaluating nurses' attitudes and tendencies towards conscientious objection. By contributing to the consideration of ethical decision-making processes in clinical practice, the scale can support the development of institutional policies and practices regarding conscience-based ethical issues.

Proper documentation of peripheral intravenous catheter assessment and care is essential for improving outcomes related to its use. However, adherence to peripheral intravenous catheter documentation remains low, despite nursing documentation being essential for continuity of care, timely identification of complications and safe clinical decision-making. To determine the impact of the I-DECIDED&#xae; tool on nursing staff documentation of peripheral intravenous catheter assessment in a paediatric inpatient unit and to assess its impact across different nursing roles. A quasi-experimental interrupted time series study. The sample included 810 peripheral intravenous catheters documentation observations (405 pre- and 405 post-intervention) performed by 27 nursing staff. Data were collected at six points: three pre- and three post-intervention. Data were analysed using the Generalised Estimating Equations model. After the use of the I-DECIDED&#xae; tool, compliance with peripheral intravenous catheter assessment documentation significantly improved in six of the eight evaluated items overall (p&#x2009;<&#x2009;0.05), with notable increases in device need, effective function and complications, all with p&#x2009;<&#x2009;0.001. Documentation reliability by nursing staff, assessed by comparing their records with researcher observations, improved significantly, from 42.9% to 75.4% (p&#x2009;<&#x2009;0.001). The I-DECIDED&#xae; tool increased both the compliance and reliability of nursing documentation related to peripheral intravenous catheter assessment. However, challenges remain regarding full adherence to all tool items, especially among nursing technicians/assistants.

Variations of electronic Holistic Needs Assessments (eHNAs) are well-established in cancer care worldwide, traditionally delivered by nurses. Although nursing teams are ideally placed to provide eHNAs, organisational dynamics and culture can affect their value to patients. This paper focuses on understanding healthcare professionals' perceptions of eHNAs in breast cancer care, including barriers and enablers to implementation. Qualitative case studies were undertaken in two healthcare organisations in England, involving 24 healthcare professionals. Data collected included semi-structured interviews, observations, and documentary analysis of care plans. Data were analysed using principles of Framework Analysis. Two main categories affected implementation of eHNAs: Leadership and Motivations (sub-categories: First Impressions, Prioritising Targets, Infrastructure and Accountability) and Service-Level Integration and Culture (sub-categories: Developing Processes, Resistance to Change and Business-as-usual). Findings highlighted challenges in adopting eHNAs and a lack of infrastructure to facilitate implementation. Methods of integrating eHNAs should focus on effective service integration, staff engagement and resource allocation. If eHNAs are implemented without resource and infrastructure, or misalignment to the service, this may negatively impact nursing team dynamics or the assessments' value to patients. Processes to successfully embed this may require more creative methods that provide a greater prioritisation of eHNAs as an essential part of nursing care.

Given the significant impact of sleep quality on patient outcomes, integrating evidence-based sleep promotion into routine care practices is essential. This study aims to explore sleep nursing champions' (SNCs) experiences of an evidence-based sleep-promoting project in the context of inpatient hospital care. An explorative qualitative descriptive design with an abductive approach, using the Capability, Opportunity and Motivation - Behaviour (COM-B) model as a theoretical framework, was applied. Data were collected through five semi-structured individual interviews and analysed inductively using a reflexive thematic analysis. Five themes were theoretically interconnected with the determinants of the COM-B model. The findings describe barriers and facilitators in the implementation of evidence-based sleep promotion in hospital care. Motivational and hindering factors included the empowering role of the SNC, organisational structures, time and the interprofessional team, all of which influenced changes to current practice. Establishing SNCs requires organisational, practical, social and cultural adaptations. When these conditions are met, SNCs can contribute to person-centred, conducive sleep-promoting environments. The results contribute to nursing practice by advancing theoretical understanding of contextual factors shaping sleep-promoting care and by informing future development of evidence-based strategies for improving patients' sleep in hospital settings.

The digital transformation of nursing education requires understanding how technology reshapes reflective practice. Technology-mediated reflective practice (TMRP) tools are widely adopted, but their pedagogical applications and links to learning outcomes remain inadequately mapped. The aim of this review is to systematically map TMRP tools in nursing education and analyse their reported connections to foundational learning outcomes. A scoping review guided by JBI methodology and PRISMA-ScR was undertaken. Data sources included: MEDLINE, CINAHL, Scopus, ERIC, PsycINFO and Web of Science (2000-2025). Two reviewers independently screened and extracted data using descriptive statistics and thematic analysis. Sixty-eight studies identified seven TMRP tool categories: e-portfolios, blogs, video debriefing, VR, AR, mobile apps, and AI tools. Implemented across clinical, simulation, and classroom settings, tools were linked to cognitive (critical thinking), affective (professional identity), behavioural (communication), and metacognitive (self-awareness) outcomes. Benefits included accessibility and structured guidance; challenges involved equity, privacy, and educator readiness. Policy-related themes were identified, including the need for infrastructure investment, educator training, and ethical guidelines to support equitable and secure TMRP implementation. TMRP tools support nursing education outcomes, but evidence of long-term clinical impact is limited. Pedagogical intentionality is essential to ensure technology deepens rather than merely digitises reflection.

Artificial intelligence (AI) is rapidly reshaping health profession education through tools such as virtual simulation, adaptive learning platforms, intelligent tutoring systems and ChatGPT-assisted learning. However, its effectiveness compared with traditional teaching methods remains unclear. To evaluate whether AI-based and technology-enhanced educational tools improve learning outcomes among healthcare professionals and students compared with traditional teaching approaches. This systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and registered in PROSPERO CRD420251233817. Six databases were searched, with key terms relating to healthcare staff, AI and education. Papers published in English language were sought from 2015 to 2025. Nine studies met all the inclusion requirements and were incorporated into the final synthesis. Risk of bias was assessed using Cochrane Risk of Bias tool for RCT's (RoB-2). Level of evidence is assigned to studies based on the research design, quality of the study and applicability to patient care. The review noted virtual simulation, AI-supported problem-based learning and AI-generated personalised feedback were particularly beneficial. Findings related to critical thinking, clinical decision-making and skill performance and learner satisfaction were mixed, with several studies reporting comparable rather than superior outcomes in comparison to traditional instructional methods. Evidence on time efficiency was limited but generally suggested that certain AI tools may streamline learning and reduce faculty workload compared to lectures or low-fidelity simulation. AI-based educational tools provide meaningful benefits, especially for diagnostic accuracy and sustained knowledge and skill retention, but do not consistently outperform traditional methods across all educational outcomes. AI-based educational tools are beneficial to the lecturers as it enhances teaching efficiency, improves assessment quality, provides real-time learning analytics and saves time in administrative tasks.

This study aimed to develop and implement a community health nursing clinical placement focused on a health promotion project for nursing students in Korea. This quantitative descriptive study developed and implemented a community health nursing clinical placement curriculum based on a health promotion project. In this study, Jalinus et al's seven steps for project-based learning were applied: formulation of expected learning outcomes through community health promotion projects, understanding the concept of teaching materials, skill training, designing the community health promotion project theme, developing the community health promotion project proposal, executing the community health promotion project, and presenting the community health promotion project outcomes. Nursing students demonstrated positive satisfaction scores with the clinical placement. The community health nursing clinical placement focused on a health promotion project demonstrated a high level of student satisfaction. The nursing students actively engaged in the clinical placement and expressed strong satisfaction with the acquisition of new knowledge and the development of competencies to assess community health issues. Locally co-designed clinical placements that reflect regional characteristics may contribute to improved student satisfaction, and there is a need to include student participation in the future design of learner-driven, problem-solving-oriented curriculum.

The menopause transition is a complex biopsychosocial life-course event that often coincides with significant role changes, including caregiving responsibilities, evolving family dynamics and sustained workplace participation. Many women describe menopause as disruptive, isolating and threatening to identity, with implications for well-being, work performance and professional engagement. This paper argues for the integration of reflection into nursing practice, including education, clinical encounters and workplace well-being initiatives, to better support women in healthcare who are approaching or experiencing the menopause transition. Peer-reviewed and key grey literature examining menopause-related workplace impacts, healthcare gaps and service provision were reviewed. Established reflective practice models were synthesised and adapted, informed by the authors' body of work on menopause and the nursing workforce. An integrated menopause-specific reflective framework, the MIRROR Cycle, was developed. The framework outlines practical reflective strategies including journaling, reflective supervision, Schwartz rounds, structured debriefing, narrative work, mindfulness and appraisal checklists. Socio-cultural and systemic barriers including stigma, silence, fear, limited training, fragmented services and organisational ageism and sexism were identified as factors compounding menopausal distress. Embedding the MIRROR Cycle across education, clinical care and workplace policy may enhance coping, identity integration and organisational responsiveness, supporting inclusive and menopause-informed nursing practice.

A wealth of literature reports nursing preceptors' and novice or licensed nurses' experiences of preceptorship programmes. However, there is a paucity of nursing literature examining the association between clinical learning confidence and competence among nursing preceptors. To investigate the association between clinical learning confidence and competence among nursing preceptors. A cross-sectional, correlational design was used. Nursing preceptors (n&#x2009;=&#x2009;208) were consecutively recruited between April and June 2025 and completed two self-report scales. Descriptive and inferential statistics were used for data analysis. Participants had moderately high clinical teaching confidence and high clinical teaching competence. The clinical teaching competence was significantly different across age. Overall clinical teaching confidence and various teaching competence dimensions were statistically associated. The strongest predictor of teaching competence was the teaching confidence dimension of relating theory and practice. Preceptors' age was associated with clinical learning competency. Preceptors' clinical teaching confidence was directly correlated with teaching competence. Nursing preceptorship programmes must be cognisant to the inextricable link between clinical teaching competence and confidence and create programmes to cultivate their development.

Endometriosis is a chronic condition where patients face challenging care journeys. There is minimal literature regarding perspectives of nurses on their approach to caring for endometriosis patients. This paper assesses Aotearoa New Zealand nurses' awareness and understanding of New Zealand guidelines, perceptions of endometriosis care, perspectives of their role in this care and interest in endometriosis-specialist nursing roles. Two hundred and ninety-two nurses completed an online, anonymous, exploratory, descriptive survey about their knowledge, view of the importance of endometriosis nursing roles and personal interest in becoming an endometriosis-specialist nurse. 16.1% of nurses perceived they knew enough about endometriosis for their routine practice. The majority (72.9%) of nurses surveyed indicated they were personally interested in becoming an endometriosis-specialist nurse, with some willing to dedicate several years to becoming qualified for this role. The results of this study indicate both a self-perceived lack of knowledge amongst nurses regarding endometriosis as a topic, as well as a desire for readily available education and upskilling regarding nursing for patients with the condition. The authors hypothesise that investment into having endometriosis-specialist nurses may alleviate some of the pressure from the primary and secondary health system care of endometriosis patients.

The clinical research nurse (CRN) plays a key role in conducting and managing clinical trials, ensuring patient safety, and aiding the advancement of care. However, a dearth of research has explored their role, responsibilities, motivations, and career aspirations of research nurses. To explore the motivations, experiences, and aspirations of CRNs. A qualitative descriptive design, employing semi-structured online interviews were conducted with CRNs (n&#x2009;=&#x2009;23), recruited via social media, between February and March 2023. Data were analysed using thematic analysis with inductive coding. COREQ reporting guidelines were used. Three themes were identified related to the CRN's role and aspirations: misconceptions and misunderstandings of the CRN role, role of the CRN and motivations, and professional identity and values. The role of the CRN is believed to be misunderstood within and across professionals' groupings. This was attributed to a lack of standardisation regarding job titles, scope of practice, professional identity, and career progression resulting in the role being undervalued. Recognising the unique identity and practice of CRNs is necessary to reduce misconceptions and build this career pathway for others.

The mediating role of mindfulness among lesbian, gay, bisexual, transgender and queer (LGBTQ) university students from lower-middle-income countries like the Philippines remains unreported. To examine the mediating role of mindfulness in the associations of depression, anxiety, stress and mental well-being among LGBTQ university students. This cross-sectional correlational study included 223 LGBTQ university students from three higher education institutions. Data were collected from February to April 2025 using three self-report scales and analysed through structural equation modelling. Depression (&#x3b2;D&#x2009;=&#x2009;-0.19, p&#x2009;=&#x2009;0.036), anxiety (&#x3b2;D&#x2009;=&#x2009;-0.23, p&#x2009;=&#x2009;0.035), and stress (&#x3b2;D&#x2009;=&#x2009;-0.25, p&#x2009;=&#x2009;0.003) negatively associated with mindfulness. Depression (&#x3b2;D&#x2009;=&#x2009;-0.21, p&#x2009;=&#x2009;0.008) and stress (&#x3b2;D&#x2009;=&#x2009;-0.32, p&#x2009;=&#x2009;0.001) negatively associated mental well-being. Mindfulness was directly associated with mental well-being (&#x3b2;D&#x2009;=&#x2009;0.36, p&#x2009;=&#x2009;0.001). Mindfulness mediated the associations between depression (&#x3b2;I&#x2009;=&#x2009;-0.07, p&#x2009;=&#x2009;0.050), anxiety (&#x3b2;I&#x2009;=&#x2009;-0.08, p&#x2009;=&#x2009;0.049), stress (&#x3b2;I&#x2009;=&#x2009;-0.11, p&#x2009;=&#x2009;0.006) and mental well-being. Depression, anxiety and stress accounted for 49.61% of the variance in mindfulness and 53.88% of the variance in mental well-being. Mindfulness mediated the associations between depression, anxiety, stress and mental well-being, such that higher levels of depression, anxiety and stress were indirectly associated with poorer mental well-being through lower mindfulness. These findings suggest relational pathways relevant to nursing assessment and mental health promotion, while remaining correlational.

The operating department is a complex, collaborative environment where nurse anaesthetists ensure patient well-being while supporting students' learning. Effective supervision requires combining clinical expertise with educational skills, adapted to students' needs. To explore nurse anaesthetists' experiences of supervising nurse anaesthesia students through the concepts of strategy, skill and shared values within the person-centred curriculum framework. A qualitative interview study was conducted with 16 nurse anaesthetists using a deductive approach and qualitative content analysis as described by Graneheim and Lundman. Three categories were identified in line with the theoretical framework: strategy promotes learning where supervisors encouraged practical experience, students' initiative and the creation of a safe learning environment; skill facilitates learning involving the development of students' knowledge of person-centred care in anaesthesia, individualised supervision, mutual feedback as well as growth in the supervisory role; and shared values contribute to learning highlighting the development of communication skills, humanistic values and the ability to handle conflict constructively. This study provides new insights into the importance of person-centred values in nursing supervision as they support both professional and personal growth for supervisors and students, suggesting the inclusion of these values in supervision policies.

Mixed methodology continues to grow as a rigorous and respected research design. However, the value of qualitatively driven mixed methods research within nursing is underrepresented. Qualitatively driven mixed methods, where qualitative data dominate meaning-making, have the potential to capture critical experiential elements pertinent to nursing research while supporting empirical rigour. This methodology paper argues for the importance of qualitatively driven mixed methods approaches within nursing research to enable greater understanding of complex phenomenon. Through discussion and case example the role of qualitatively driven mixed methods, including within a sequential explanatory design, are presented. Nurses and midwives are well placed to design and conduct health research, and this paper provides methodological guidance and advances epistemological understanding of qualitatively driven mixed methods within research to improve staff and patient outcomes. For health and social care policy, these methods provide rich contextual data that can inform policy development and evidence-based practice. This methodological discussion piece highlights how qualitatively driven mixed methods enable greater understanding of complex phenomenon and experiential insights.

The aim of this study is to explore the experiences of student learning disability nurses and student midwives in supporting mothers with an intellectual disability. The Ockenden Report (2022), an independent review into maternity care in the United Kingdom, highlighted workforce challenges and inequalities in maternity services. The report specifically highlighted the need for mothers with intellectual disabilities to have individualised care and support. Public Health England (2021) suggested that continuity of supporting staff is beneficial to mothers with intellectual disabilities. Additionally, specific support is needed for mothers with a learning disability. This case study adopted a qualitative approach by interviewing current student learning disability nurses and student midwives through purposive and convenience sampling. Data were gathered by conducting semi-structured interviews. Data was analysed thematically through Braun and Clarke's (2021) six step process. There were three overarching themes identified from the analysed data: Knowledge and Skills; Curriculum, and Exposure and Support when caring for mothers with an intellectual disability. The findings prompt inter-professional working in maternity services, which in turn can facilitate better outcomes for mothers with an intellectual disability. It may also facilitate the development of materials to raise awareness, reduce stigma, and clarify misconceptions related to supporting mothers with an intellectual disability.

Autonomous nurse practitioners (NPs) are an effective and useful member of the healthcare team, particularly when given a less restrictive scope of practice at the state level. In Ohio - a midwestern state in the United States - NPs treating worker's compensation (WC) patients are limited in treating the injured worker because of the bureaucratic paperwork WC requires of its providers. Collaboration was initiated with an organisation in Ohio seeking to improve the profession of Advanced Practice Nursing through legislative change. Project and objectives were discussed, as well as a collaboration to get the legislation changed in Ohio regarding the NP Medco-14 form practice issue. This Needs Analysis quantitative study was completed by conducting chart reviews of WC patients assessed by the NP evaluating any disparities between work restrictions recommended by the NP versus the physician. The proposed work restriction instructions given by the NP were reviewed, and the review included only initial injury evaluation patients. The charts were randomly selected from the past schedules of two occupational NPs in rural Ohio. The charts selected at random were based on meeting the study inclusion criteria (first visit patient or new injury patient) in a chosen 3-month block time frame: January-March. Of the 70 random charts reviewed, 100% had no discrepancies between the NP work recommendations and that of the physician. Allowing NPs to sign Medco-14 forms - also known as a return-to-work authorisation form or signed work excuse explaining limited work duties due to injury - will increase patient access to care, which in turn results in better patient outcomes. This study can be used as the foundational needs analysis to propose a legislative change in Ohio to allow NPs to independently sign the Medco-14 for Ohio WC patients. The collaborating organisation is currently drafting a legislative change proposal to modify the current Ohio NP Medco-14 restriction.

Shared governance enhances nurses' participation in decision-making and professional autonomy. The Index of Professional Nursing Governance (IPNG) is a validated tool for measuring such perceptions, but no German version previously existed. This study aimed to translate, culturally adapt, and evaluate the psychometric properties of the German version of the IPNG. A two-phase study was conducted. Phase 1 included forward-backward translation and cognitive debriefing interviews with 10 clinical nurses. In Phase 2, a cross-sectional online survey was administered to 1090 registered nurses at a Swiss university hospital. Structural validity was assessed using confirmatory factor analysis (CFA), and internal consistency was evaluated with Cronbach's alpha. Known-groups validity was tested based on demographic and organisational variables. CFA supported the original six-factor structure with good fit indices (comparative fit index&#x2009;=&#x2009;0.97, Tucker-Lewis index&#x2009;=&#x2009;0.97). The root mean square error of approximation (0.09) and the standardised root mean square residual (0.09) exceeded the threshold but remained within the acceptable range for multifactorial models. Most items had factor loadings above 0.70. Internal consistency was strong (&#x3b1;&#x2009;>&#x2009;0.80). Known-groups validity showed significant differences by age and commitment. The German IPNG is a valid and reliable instrument for assessing shared governance.

Pictorial instruments can facilitate the assessment of anxiety levels in children and support nurses in selecting appropriate interventions. This study aimed to analyse the validity and reliability of the Children's Anxiety Questionnaire Brazilian version (CAQ-BR) in children and adolescents with cancer who are undergoing chemotherapy in a Brazilian context. A multicentre psychometric evaluation of the CAQ-BR was conducted in three hospitals in S&#xe3;o Paulo, Brazil, between 2020 and 2022. We included children aged 4-12&#x2009;years, who completed the CAQ-BR based on four facial expressions - Happy/Content, Calm/Relaxed, Tense/Nervous, and Worried/Afraid - and evaluated the emotions of fictional characters. The Visual Analog Scale (VAS) was used for comparison. Data were analysed using classical test theory, including Cronbach's alpha for internal consistency, item discrimination indices, and Fleiss Kappa for agreement analysis. The study included 48 children aged 4-12&#x2009;years (average age&#x2009;=&#x2009;8.2&#x2009;&#xb1;&#x2009;0.70), 69% of whom were male. The CAQ-BR discrimination indices for the items 'Happy/Content', 'Calm/Relaxed', 'Tense/Nervous', and 'Worried/Afraid' were 0.917, 0.833, 0.667 and 0.667, respectively. For the characters, the discrimination indices were 0.583, 0.750, 0.833 and 0.750, respectively. A significant age-related difference was observed for the item 'Tense/Nervous', with younger children reporting lower anxiety compared to older ones (p&#x2009;=&#x2009;0.003). Low internal consistency (&#x3b1;&#x2009;=&#x2009;0.51-0.53) is attributable to the low number of items. The CAQ-BR provides preliminary evidence of validity, though reliability was not fully supported. The tool is useful in paediatric nursing as a quick, pictorial, method to assess children's anxiety and enhance communication, but further research is needed for its application in younger children.