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Urinary tract infection is the most diagnosed infection in older people. It accounts for more than 50% of antibiotic prescriptions in care homes and is a frequent reason for care home residents being hospitalised. This realist review developed and refined programme theories for preventing and recognising urinary tract infection, exploring what works, for whom and in what circumstances. The review used realist synthesis to explore existing literature on the detection and prevention of urinary tract infection, complemented by stakeholder consultation. It applies to the UK context, although other healthcare systems may identify synergies in our findings. Bibliographic databases searched included MEDLINE, CINAHL, EMBASE, Cochrane Library, Web of Science Core Collection (including the Social Sciences Citation Index), Sociological Abstracts, Bibliomap and National Institute for Health and Care Research Journals Library. Title and abstract screening were undertaken by two researchers independently of each other. Selection and assessment were based on relevance and rigour and cross-checked by a second researcher. Data extracted from the included studies were explored for explanations about how the interventions were considered to work (or not). Evidence tables were constructed to enable identification of patterns across studies that offered insight about the features of successful interventions. Programme theories were constructed through a four-stage process involving scoping workshops, examination of relevant extant theory, analysis and synthesis of primary research, teacher-learner interviews and a cross-system stakeholder event. A process of abductive and retroductive reasoning was used to construct context-mechanism-outcome configurations to inform programme theory. The scoping review and stakeholder engagement identified three theory areas that address the prevention and recognition of urinary tract infection and show what is needed to implement best practice. Nine context-mechanism-outcome configurations provided an explanation of how interventions to prevent and recognise urinary tract infection might work in care homes. These were (1) recognition of urinary tract infection is informed by skills in clinical reasoning, (2) decision-support tools enable a whole care team approach to communication, (3) active monitoring is recognised as a legitimate care routine, (4) hydration is recognised as a care priority for all residents, (5) systems are in place to drive action that helps residents to drink more, (6) good infection prevention practice is applied to indwelling urinary catheters, (7) proactive strategies are in place to prevent recurrent urinary tract infection, (8) care home leadership and culture fosters safe fundamental care and (9) developing knowledgeable care teams. We adapted our approach and work to online interactions with stakeholders and as a research team because of COVID-19. This also had an impact on bringing stakeholders together at a face-to-face event at the end of the project. Studies focusing on the prevention of urinary tract infection in care home settings were predominantly from the USA and Europe where the regulatory and funding systems for the long-term care of the elderly have some differences, particularly in the USA where national reporting plays a significant role in driving improvements in care. Care home staff have a vital role in the prevention and recognition of urinary tract infection, which can be enabled through integration and prioritisation within the systems and routines of care homes and delivery of person-centred care. Promoting fundamental care as a means of facilitating a holistic approach to prevention and recognition of urinary tract infection helps staff to recognise how they can contribute to antimicrobial stewardship and recognition of sepsis. Challenging assumptions made by staff about the presentation of urinary tract infection is complex and requires education that facilitates 'unlearning' and questioning of low-value practices. Programmes to prevent urinary tract infection need to be co-designed and supported through active and visible leadership by care home managers with support from specialist practitioners. We will focus on co-designing tools that facilitate implementation of our findings to ensure they fit with the care home context and address some of the challenges faced by care home leaders. This will underpin action at care home and system levels. Further research is needed to better understand the perspectives of residents and family carers, the effectiveness of non-pharmacological, pharmacological and specialist practitioner interventions and non-traditional approaches to training and educating the workforce in care home settings. This study is registered as PROSPERO CRD42020201782. This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: NIHR130396) and is published in full in Health Technology Assessment; Vol. 28, No. 68. See the NIHR Funding and Awards website for further award information. This study was about how interventions to prevent and recognise urinary tract infections might work in care homes to reduce urinary tract infection in older people. We used an approach called realist synthesis. This aims to understand everything that influences how care is delivered to find out what works in particular situations and settings. We did this by talking to care home staff, residents, family carers and other experts about how to reduce urinary tract infection in older people living in care homes. We combined their experiences and ideas with the evidence from the research literature. From this, we developed three areas of focus: care approaches to support accurate recognition of urinary tract infection care approaches to prevent urinary tract infection/catheter-associated urinary tract infection making best practice happen. Our research shows that care staff are best placed to recognise subtle changes in a resident’s behaviour or well-being which might indicate an infection. There are several things care staff can do to proactively help residents from developing a urinary tract infection such as prioritising residents’ hydration needs and addressing poor fluid intake. Putting in place infection prevention measures such as caring for, or where possible, removing a urinary catheter can also help. Actively monitoring residents to determine reasons for changes in behaviour can increase the focus on preventative activities and help avoid inappropriate treatment. The detection and prevention of urinary tract infection in older people could be improved in several ways, including: education tailored to the roles and work of care home staff leaders of care homes providing a culture of safety and improvement where urinary tract infection is recognised as something preventable rather than unavoidable having a safe and supportive environment where staff are confident to communicate their concerns all care team members, residents and their families and other professionals linked with the home having a common language and shared goals in the recognition, prevention and diagnosis of urinary tract infection. The COVID-19 pandemic required us to adapt our approach and work mainly online both in our interactions with stakeholders and as a research team. While this provided opportunities to extend our reach to a wider group of stakeholders, it also limited some of our engagement work.
Background: Nursing theory plays an integral part of the nursing discipline. The use of nursing theory provides value and confidence to nurses in practice within the discipline. The American Association of Colleges of Nursing recognizes the importance of nursing theory by noting in their new Essentials that theory must be integrated into curricula at entry and advanced levels in nursing education. However, the use and value of nursing theory in nursing administration practice are unclear. The American Organization of Nursing Leadership Core Competencies do not explicitly mention nursing theory use in nursing administration practice. Therefore, this discussion article seeks to identify the status of nursing theory use in nursing administration practice. Design: A discussion paper format is used. Literature Review: Sixteen articles published from 1986 to 2025 were retrieved from searches using CINAHL, Embase, PubMed, Scopus, and ScienceDirect and were sorted and analyzed using thematic networks to identify global themes reflecting the use of nursing theory in nursing administration practice. Implications for Nursing: There is a weak history of nursing theory use in nursing administration practice. Nursing administrators must develop business acumen and leadership skills to help guide their decision-making in health care while also incorporating theory use and development, including economic and leadership theories outside of nursing, anchored by nursing theory. Conclusion: Six global themes reflecting the use of nursing theory in nursing administration practice emerged: (a) undervaluing of nursing theory, (b) the case of borrowed theory, (c) theory imbalances of business acumen and nursing leadership, (d) importance of the practice environment, (e) intentionality of theory-integrated practice, and (f) underdevelopment of nursing theory-guided practice.
Background and Purpose: Chronic renal failure is a common public health problem worldwide, and hemodialysis has become the standard treatment. During this long and exhausting process, it is extremely important that individuals undergoing hemodialysis receive effective and high-quality nursing care so that accurate prognoses can be made and complications prevented. This study aimed to determine the effect of comfort theory-based nursing care on intolerance to uncertainty and comfort levels in hemodialysis patients. Methods: The sample of this randomized controlled study consisted of individuals receiving hemodialysis at a private dialysis center. The sample comprised a total of 60 patients, 30 in the experimental group and 30 in the control group. Patients in the experimental group received training during an 8-week dialysis period using nursing care interventions based on Katharine Kolcaba's comfort theory for health care needs. The training content covered holistic nursing care and consisted of physical, psychospiritual, sociocultural, and environmental dimensions in order to reduce uncertainty and increase comfort levels in the individuals receiving dialysis. This care was based on Kolcaba's comfort theory. A Personal Information Form including the individuals' descriptive, disease, and treatment characteristics, the Intolerance of Uncertainty Scale (IUS), and the General Comfort Questionnaire (GCQ) were used for data collection. Independent two-sample comparisons were performed using the χ² test for qualitative variables and the t test for quantitative variables. Results: In the comparison of the groups, there were significant results for the total GCQ and its subdimensions except for the relief subdimension (p < 0.05). The scores for the total IUS and its subdimensions were significant (p < 0.01). Implications for Practice: It was determined that comfort theory-based nursing care interventions were effective in reducing the level of intolerance of uncertainty and increasing the comfort level. It is recommended that comfort theory-based nursing care guidelines should be used to reduce the sense of uncertainty and increase the comfort levels of individuals receiving hemodialysis.
Background and Purpose: Compassion is a well-known nursing principle with a rich literature on concept development and clarification. Despite being central to care and at risk of being compromised due to increasingly challenging working conditions, compassion continues to be described as a predominantly individual attribute, with the responsibility to demonstrate compassion (and address lack of compassion) placed squarely on the shoulders of individual nurses. There is scant literature holding health care institutions accountable for implementing policies and practices that demonstrate, support, and sustain compassion. Acknowledging the encouraging recent literature on the potential for compassionate leadership, we look to other models based on compassion as embedded in practices and communities to better examine how it can shape nursing work environments. Methods: This paper examines the Compassionate Communities movement, first developed at the intersection of public health and palliative care. We trace its development, highlight ongoing methodological and conceptual tensions, and showcase its applicability as a conceptual framework for research and policy in health care beyond the palliative care context, specifically in nursing. Results: Literature on Compassionate Communities aligns with the priorities and concerns of nursing care, policy, and research. It also has the potential to transform health care institutions, creating compassionate spaces for patients, families, and nurses themselves. Implications for Practice: Proposed definitions and principles for using Compassionate Communities as a conceptual framework are offered; considerations on how health care organizations can become more compassionate, using reflections from our program of research examining nurses' psychological safety.
Background and Purpose: Influenced by information technology development and the COVID-19 pandemic, nursing education is changing significantly, prompting nursing educators to track international trends. This study aimed to explore the research status and hotspots of nursing education in the past 5 years, providing insights for researchers. Methods: Articles published between 2020 and 2024 in five nursing education journals were analyzed with CiteSpace version 6.4.R1 for countries/regions, institutions, authors, and keywords. Results: A total of 4,362 articles were analyzed. The United States led in article numbers. Cooperation between authors and institutions was limited. Research hotspots included cultivating nursing students' core professional competencies, innovating teaching methods and approaches, and enhancing professional identity. Implications for Practice: This study systematically analyzes nursing education literature across multiple dimensions. It reveals the regional disparities, thereby prompting researchers to focus on the innovation and development of nursing education practices under different cultural backgrounds. The limitations in international scholarly networks highlight the imperative to establish robust global partnerships to foster knowledge exchange and interdisciplinary collaboration. By mapping and discussing keyword clusters, it vividly demonstrates the research hotspots in nursing education for educators and provides practical and actionable insights.
Background and Purpose: Social determinants of health (SDOH) significantly affect health care outcomes on an individual, community, national, and global level. Clinicians must fully appreciate their impact and need standardized information defining the concept and its application in health care settings. Clarification is necessary to integrate the concept of SDOH into health care workplace mission statements, continuing education, formal academic institutions, and government guidelines. No formal concept analysis of SDOH exists using a standard nursing theory framework, despite growing awareness of the concept and the critical need for clinicians to apply it to theory-guided practice. This article provides the first formal nursing theory concept analysis using Walker and Avant's methodology. Methods: A literature review was conducted using the CINAHL Ultimate, PubMed Central, and Web of Science databases for peer-reviewed academic journal articles from the last 5 years. Walker and Avant's concept analysis method was applied. The concept of SDOH was explored along with antecedents, consequences, defining attributes, and limitations. Implications for practice and relevance to nursing were presented, and a case example was provided. No Institutional Review Board review was required. Results: A concept analysis was conducted using Walker and Avant's (2019) eight-step method. The concept analysis established the following defining attributes of SDOH: (a) neighborhood and physical environment, (b) economic stability, (c) education access and quality, (d) community, safety, and social context, (e) health care access and quality, and (f) planetary conditions. Implications for Practice: A clearly defined concept of SDOH allows for the standardization of educational materials, the creation of risk assessment screening tools, and integration into theory-guided practice and government practice guidelines. Recognizing SDOH can reduce clinician burnout and depersonalization in the presence of repeated poor outcomes, increase empathy for patients facing external obstacles, and foster humanizing health care interactions. Health care interventions can be better tailored to patient needs, improving evidence-based practice. Increasing policymakers' and clinicians' awareness of SDOH will decrease health care inequalities, promote social justice, and strengthen praxis, applying emancipatory knowledge into practice.
Background: Cardioprotective medications have been shown to be effective in reducing morbidity and mortality in patients with a history of myocardial infarction; however, the adherence rate is lower than expected. An adherence-based intervention was designed. Purpose: The purpose of the study is to describe the theory of "Action and Coping Plans for Medication Adherence Intervention (ADHERE)," a nursing intervention to promote adherence to cardioprotective medications. Methods: Theoretical and empirical approaches were combined with the clinical and research experience of a committee of experts to carry out the following stages: (a) in-depth understanding of the problem under study, (b) defining the objectives and identifying the theoretical framework of the intervention, and (c) operationalization of the intervention and identification of immediate, intermediate, and final outcomes. Results: The application of the stages resulted in the generation of the theory underpinning the ADHERE nursing intervention, which aims to promote adherence to cardioprotective medications in patients with a history of myocardial infarction and should be implemented by a nurse in a primary health care unit. The content of ADHERE is delivered through action and coping plans, developed by patients with the support of the nurse, verbally and in writing, in a meeting lasting 30 minutes and a reinforcement at a 30-day interval. Implications for Practice: The description of the theory of this intervention provides detailed information to researchers and health professionals about how the intervention contributes to changing behavior related to medication adherence and in what context; the theory can enhance the fidelity of its implementation in clinical practice.
Background: Real-time or clinical debriefing is considered an effective tool for promoting perinatal team dynamics, communication, patient safety, and perinatal outcomes. Several studies have investigated the outcomes of clinical debriefing in the obstetric (OB) setting. Purpose: We reviewed nursing debriefing practices after OB emergencies to examine the gap between principles and actual practices. This review focused on two key areas: (a) the effectiveness of OB debriefing in terms of communication, teamwork, and perinatal outcomes; and (b) the examination of current practices related to the standardization of debriefing. Study Design and Methods: This is a focused review of peer-reviewed research studies, posters, presentations, and abstracts. Following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews checklist, MEDLINE, Scopus, and Cumulative Index to Nursing and Allied Health Literature databases were searched using the search terms "obstetric emergencies," "real-time debriefing," "debriefing," and "perinatal emergencies." The initial yield was 307 records. Results: This review identified three key themes in the literature on real-time debriefing: the tools and requirements for effective debriefing; the impact on safety culture, communication, and team dynamics; and observations of distress and emotional healing. Conclusion and Clinical Implications: Standardizing best practices for debriefing after OB emergencies is essential. Developing a standardized tool or form is necessary to enable OB nurses to lead debriefing efforts confidently and competently after emergencies. Educating and empowering nurses to lead debriefing sessions following critical OB events can enhance teamwork, improve patient safety, and increase team members' satisfaction. Consistent use of debriefings is one way to promote desired professional behaviors while improving safety culture. A standardized debriefing tool for OB emergencies is crucial for quality improvement.
Background and Purpose: A good understanding of nursing organizational well-being can allow nurse managers to monitor their work context, guide clinical practice, and improve care quality. Theoretical studies of nursing organizational well-being are limited, and this article proposes a situation-specific theory. Methods: The article's content explains the development of this situational theory of nursing organizational well-being following the integrative approach by Im and Meleis by checking assumptions for theorization, initiating theorization through multiple sources, reasoning through critical analyses, documenting theorization, and reporting and sharing theorization. Results: Eight theoretical propositions are conceptualized, emphasizing the interconnectedness of various professionals and work context factors with nursing organizational well-being and related outcomes. Nursing demands and nursing resources have been identified in this situational theory as crucial in determining nursing organizational well-being. Implications for Practice: This article discusses the implications of developing knowledge on nursing organizational well-being. Using this situational theory, researchers can understand the variables determining nursing organizational well-being, and the theory can guide their research study. Health care managers can also use this situational theory to evaluate the nursing work environment and the variables influencing it, subsequently improving outcomes for nurses, organizations, and patients.
Physical exercise has emerged as a promising non-pharmacological approach for improving cognitive and physical function in older adults with mild cognitive impairment (MCI). However, most existing interventions in nursing homes lack a strong theoretical foundation, standardized delivery, and evidence-based practice. This study aims to develop and evaluate a multicomponent exercise program grounded in the Health Action Process Approach-Theory of Planned Behavior theory (HAPA-TPB) to improve adherence and cognitive outcomes in older adults with MCI living in nursing homes. This is a randomized, single-blind, parallel-group controlled trial conducted in nursing homes in Huzhou, China. A total of 156 older adults with MCI were randomly assigned to either a 12-week, group-based multicomponent exercise intervention or a control group receiving usual care. The intervention, theoretically grounded in an integrated HAPA-TPB framework, integrates aerobic, resistance, and mind-body training with structured behavioral change strategies designed to enhance motivation, adherence, and sustained engagement, including peer interaction. The primary outcome is cognitive function assessed by the Montreal Cognitive Assessment-Basic (MoCA-B). Secondary outcomes include physical performance, sleep quality, intrinsic capacity, frailty, social support, and intervention feasibility. A total of 1351 participants completed preliminary eligibility screening, of whom 156 were eligible and randomized (78 per group). The mean (SD) age was 69.19 years (SD = 8.97), and 69.23% of participants were female. Baseline characteristics were comparable across groups in terms of demographic, socioeconomic, and health status indicators. Baseline cognitive function, assessed using the MoCA-B, showed no significant between-group difference (intervention: mean = 17.29, SD = 2.32; control: mean = 16.74, SD = 2.19; F = 2.320, p = 0.130), indicating comparability prior to the intervention. This MIND-STEP study will provide high-quality evidence on the effectiveness and implementation of a theory-based, multicomponent exercise intervention for older adults with MCI in nursing homes. Findings will inform future intervention design and policy development to promote cognitive and functional health in institutionalized older populations. Chinese Clinical Trial Registry ChiCTR2400088301. Registered on 15 August 2024.
Background: Understanding and promoting healthy eating behaviors in young children is essential for their immediate and long-term health outcomes. However, these behaviors are influenced by an intricate network of factors that extend beyond individual choices, posing challenges for health practitioners seeking effective interventions. Purpose: This article aims to explore how the Social Ecological Model (SEM) can serve as a framework for understanding the multilevel determinants of young children's eating behaviors, and the seminal role that nursing plays in this dynamic. Discussion: The SEM encompasses five levels of influence: individual, interpersonal, community, organizational, and policy. At the individual level, factors include the child's biological predispositions and nutritional knowledge. The interpersonal level highlights the role of parents and caregivers in modeling and shaping dietary habits. Community influences focus on access to nutritious foods and social norms, while the organizational level emphasizes the importance of schools and health care settings in reinforcing healthy eating. The policy level addresses government regulations and public health initiatives that shape the food environment. Together, these interconnected layers provide a comprehensive understanding of the factors impacting children's eating behaviors. Implications for Nursing: By applying the SEM, nursing professionals can develop multilayered, culturally sensitive interventions that address these determinants, advocating for policies and practices that support healthy eating habits and promote holistic well-being in children.
Background and Purpose: Evaluating self-efficacy for symptom management and self-care is crucial for ensuring follow-up care after cardiac surgery. As there is not yet a validated measurement tool for this evaluation, the aim of this study was to develop the Self-Efficacy Scale for Symptom Management and Self-Care (SESMSC: Cardiac Surgery) in patients with cardiac surgery and to examine its psychometric properties. Methods: The Symptom Management Theory and Bandura's Self-Efficacy Theory were used as the theoretical background for scale development. A multiphase design was utilized. The initial development phase consisted of item generation and expert panel review. The second phase comprised a three-step validation process: (a) face and content validity analysis, (b) exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) for construct validity, and (c) Cronbach's α, test-retest, and item-total correlation analysis to assess internal consistency reliability. The sample (n = 401) was randomly divided into two subsamples for EFA and CFA (EFA group: n = 201; CFA group: n = 200). Results: EFA suggested a 20-item, two-factor structure with factor loadings of .342-0.782. The two subscales of the scale were labeled symptom management self-efficacy and self-efficacy for self-care activities. Goodness-of-fit indices indicated a good model fit. Cronbach's α, test-retest, and item-total correlation results demonstrated acceptable internal consistency reliability. Implications for Practice: The SESMSC: Cardiac Surgery may be a useful tool to evaluate self-efficacy for symptom management and self-care after cardiac surgery. Further evaluation in independent samples is needed to investigate its psychometric properties and usefulness in clinical practice.
Underrepresentation of care home residents in research has resulted in a poorer evidence base for health care in care homes. Fewer opportunities to take part in research, as well as assumptions made by others about their interest or wishes, creates challenges for residents' inclusion in research. Early discussions about research preferences and wishes may be beneficial. This qualitative study aimed to explore stakeholders' views about how care home residents can be supported to communicate their wishes about research participation. Semi-structured interviews were conducted with 25 stakeholders: care home residents (n = 5), relatives (n = 5), care home staff (n = 5), other health and social care professionals who work with care homes (n = 6), and care home researchers (n = 4). Interviews were conducted virtually or face-to-face and data were analysed using thematic analysis. Views about resident research participation, the barriers and facilitators to their inclusion, and the role of advance research planning were iteratively organized into three themes: (i) We're of no value to research; (ii) Research is difficult; and (iii) Advance research planning: good in theory, challenging in practice. Subthemes were also identified, and findings were discussed with a Patient and Public Involvement group for additional reflections. Stakeholders identified a number of barriers to including care home residents in research, including knowing their preferences about research. The development of interventions to facilitate communication that can be adapted to individuals' requirements are needed to support discussions and decision-making with care home residents about wishes and preferences for future research participation.
In England, most long-term care for older people with complex health care needs is provided by private care homes. They rely on primary care to provide medical care and access to specialist health care services. This study explored the working relationships between care homes and primary care in one region in England to inform a theory of change for achieving improved relationships. We carried out a multi-method qualitative study using appreciative inquiry. We thematically analysed data from 33 survey responses, 15 interviews, and eight workshops with care home and primary care staff, family carers, and other community specialists to populate the theory of change. A patient and public involvement representative supported data collection, analysis, and write-up. Study participants described activities that encouraged role understanding, communication, and learning together benefitting staff, relationships, and quality of services. The lessons and experiences from the COVID-19 pandemic had shaped participants' understanding of what is required to sustain cross-sector collaboration. Key inputs included time, staff, and funding to facilitate learning how to work together effectively, as well as the capacity to adapt to diverse care settings and address the complex, individual needs of care home residents. Participants noted the few opportunities they had to share their learning and discuss best practice. The theory of change identified different dimensions of good practice, providing insight into areas for action to inform service design and practice. Ongoing organisational changes should consider what is already working well and build on these achievements to enable positive care home and primary care working relationships and so foster high quality care and equitable access to services.
Patient participation is key in person-centred care, emphasizing individual choices in treatment. Oral health, integral to overall well-being, is sometimes a neglected part of health. This intervention introduces a novel approach to strengthen person-centred care in homecare settings, employing collaborative, interprofessional teamwork and shared documentation across care organizations. This protocol outlines the design of a cluster-randomized controlled trial (RCT) in Sweden, comparing traditional oral assessments with an interorganizational, team-based oral health care planning model facilitated by a shared digital platform for documentation. The overall aim is to evaluate a person-centred interprofessional and interorganizational model for oral health care planning supported by a digital platform to enable healthy ageing. The intervention, co-designed with older adults, academic institutions, healthcare providers in public dental care, and municipal organizations, will undergo ethical approval. The RCT will randomize older adults, dental hygienists (DHs) and nursing assistants (NAs) into two groups. The intervention group will attend a two-day workshop on a person-centred, three-step team-based model, while the control group will continue using standard procedures. Thereafter, the three-step collaborative model will be compared to standard procedures. Primary outcomes will be measured using the Revised Oral Assessment Guide (ROAG) and the General Oral Health Assessment Index (GOHAI). Secondary outcomes include health economic evaluations, participation rates and quality of care assessments. Qualitative studies from theoretical perspectives of change and learning based on interviews with key stakeholders will be conducted in both the test and control groups. Taking a co-produced approach where theory and practice shape the research iteratively, a person-centred health care planning model supported by a shared digital platform for home settings is evaluated. Anticipated outcomes include improved oral assessments and a deeper understanding of effective person-centred care practices. The co-produced approach of the intervention is also expected to further develop knowledge regarding co-production within domains of healthy ageing from an oral health perspective. As such, the intervention shapes and fosters co-produced person-centred care and healthy ageing. ClinicalTrials.gov NCT06310798. Registered on 13 March 2024.
Aim: To report an analysis of the concept of moral distress among nurses caring for undocumented immigrants (UIs). Design: Concept analysis is the study design. Data Sources: Data sources included nursing and health care databases searched from 2015 to 2025. Eight articles were identified that addressed moral distress in the context of nursing care for UIs. Review Methods: Walker and Avant's method was used to identify definitions, antecedents, consequences, and empirical referents of the concept. Model, related, and contrary cases were developed to illustrate conceptual boundaries. Results: Defining attributes of moral distress among nurses caring for UIs included moral awareness, perceived or actual constraints, emotional and psychological distress, conflict between professional role and structural injustice or advocacy, and capability for reflection and growth. Antecedents were awareness of an ethical obligation or right action and encounters with UIs facing policy, institutional, or legal barriers. Consequences encompassed emotional and psychological effects such as guilt, frustration, sadness, burnout, and job dissatisfaction or turnover, moral residue, compromised patient care, and questioning of professional identity and values. Empirical referents included the Moral Distress Scale-Revised and the Moral Distress Thermometer. Conclusion: Moral distress is a pervasive and underexamined phenomenon for nurses who care for UIs. The analysis demonstrates that systemic constraints and ethical conflicts contribute to significant personal and professional consequences for nurses, ultimately threatening both workforce sustainability and delivery of equitable care. Conceptual clarity and empirical tools adapted for this context are needed to inform effective interventions.
Background: Integrating evidence into nursing practice remains challenging due to gaps in nurses' research experience, knowledge, and skills. Purpose: To address these challenges, an Evidence Resource Nurse (ERN) program was developed using implementation science frameworks to enhance nurses' research literacy and skills and foster a culture of inquiry. Methods: Baseline data identified deficiencies in nurses' knowledge and confidence in utilizing research to inform practice. The ERN program was designed using the Consolidated Framework for Implementation Research and the Capability, Opportunity, Motivation, and Behavior model. The 4-hour core course is supplemented by quarterly seminars and self-paced activities in collaboration with governance councils, policy owners, and quality improvement coaches. This approach ensures that participants acquire both theoretical knowledge and practical experience in applying evidence in clinical settings. Results: The program has engaged over 100 nurses since its launch, with the latest evaluations showing improvements in participants' knowledge and skills. The program's integration into nursing professional development specialists' onboarding demonstrates institutional commitment to facilitating evidence-informed practice. Future evaluations will assess the programs' influence on nurses' initiation of evidence-informed practice changes at the unit and institutional level. Implications for Practice: The ERN program offers a model for bridging the gap between research and practice and demonstrates the use of implementation science methods to create targeted programs designed for specific populations and settings. Data-driven approaches better address nurses' professional development needs and enhance educational offerings.
Background and Purpose: The body has undergone significant aesthetic transformations throughout the centuries. A normalization has gradually taken place in contemporary Western society regarding the criteria attributed to a healthy and attractive body. The image of a thin body is omnipresent in how we conceptualize aesthetic norms in Western societies. This dominance of bodily beauty, this idealization of thinness, generates and reinforces a "cult of the body" that is already prevalent in our current societies. Methods: We believe our understanding of the "cult of the body" could be enlightened by the writings of Michel Foucault and Nikolas Rose. Results: The forthcoming article will initially delve into how immanent power operates within normative disciplinary practices, technologies of the self, and neoliberal practices. It will then seek to comprehend the extent and influence of the normative regime on the social construction of societal ideals of beauty and thinness to which adolescents in contemporary societies may be exposed. Implications for Practice: Foucault's and Rose's works allow us to expose power relations and interrogate the patient's body as constructed through technical and medical discourse. Their work allows for questioning, reevaluation, and deconstruction of certain paradigms in mental health nursing and raises awareness of not unquestionably accepting a single psychiatric and mental health nursing epistemology. Finally, they provide important insights for nursing practice, especially when it comes to comprehending how societal standards around beauty and health influence the behaviors and body image of adolescents.
Background and Purpose: Health care systems are characterized by significant unpredictability. For inpatient nurses, unpredictability is a work stressor that creates mismatches between work demands and available resources. Although unpredictability is recognized as a facet of nursing work, it has lacked formal conceptual analysis. This article examines and clarifies the concept of unpredictability within nursing work. Methods: Rodgers' evolutionary approach was used to identify the concept's defining attributes and contextual features, including its antecedents, consequences, surrogate terms, related concepts, and references. Inductive thematic analysis was used to analyze a total of 69 articles, identified through a systematic search of literature in CINAHL, Academic Source Complete, and MEDLINE databases. Articles that described unpredictability in the work, work processes, and/or work environment of inpatient nurses were included. Results: Unpredictability in nursing work arises from individual heterogeneity, uncertain diseases, dependence on shared resources, and system complexity. Nurses experience unpredictability in their patients' acuity and care needs, personal safety, resource sufficiency, team dynamics, and workflow. Consequences of unpredictability include process inefficiencies, harm to nurse well-being, and negative impacts on patient care. This concept has demonstrated rising interest from multiple academic disciplines across the world. Implications for Practice: Concept analyses provide new insight into poorly defined phenomena within nursing practice. This article offers practicing nurses clarity into their own work, including the currently recognized causes, attributes, and consequences of unpredictability. Practicing nurses should advocate for policies and institutional strategies to address the drivers of unpredictability and better support nursing work.
Background and Purpose: Supported Conversation for Adults with Aphasia (SCA™ ), an evidence-based framework to improve communicative access, is a unique concept to nursing with theoretical and technical components. Effective communication is essential in all patient interactions, and SCA™ could aid health care professionals in meeting the needs of people with aphasia. Methods: A principle-based concept analysis was conducted using a systematic and conceptually driven literature search. A review of literature from 1998 to 2024 contained in CINAHL, PubMed, and PsycINFO databases was performed on the concept of SCA™ The concept was explored for (a) definitional clarity (epistemological principle), (b) relevance to nursing (pragmatic principle), (c) consistency in meaning (linguistic principle), and (d) differentiation from related concepts (logical principle). Results: The final dataset consisted of 49 articles. Findings revealed that (a) SCA™ is composed of theoretical and technical components used to acknowledge and reveal the competence of a person with aphasia, but there is a vague use and a lack of definitional clarity; (b) the philosophical framework and techniques outlined by the concept are relevant and useful for nursing; (c) there is variability in the use, nomenclature, and conceptualization of SCA™; and (d) the concept is poorly differentiated from other similar concepts. Implications for Practice: Nurses working with people diagnosed with aphasia and other communication disorders should consider SCA™ and its application in nursing practice. Findings from this concept analysis stress the importance of an interdisciplinary approach to future SCA™ studies, as nursing can lend its distinct viewpoint to integrate SCA™ techniques into practice.