Nurse staffing in psychiatric inpatient care is difficult to plan because reliable measures of patient demand are lacking. Existing indicators are not well established across diverse patient groups. The Health of the Nation Outcome Scales (HoNOS), routinely collected in Switzerland, may provide a pragmatic proxy for patient acuity to inform staffing decisions. We conducted a multicentre cross-sectional study (MatchRN Psychiatry) in adult, nonforensic psychiatric inpatient units in Switzerland, linking 2022 routine patient data with 2023/2024 unit-manager reports of typical structural staffing configurations. Patient mental health status and symptom severity were measured using the HoNOS. Associations between nurse staffing hours, HoNOS scores and unit characteristics were analysed using lasso-selected linear mixed-effects models. Model estimates were used to describe how RN staffing varied with patient acuity, and model-predicted staffing was compared with reported staffing to characterise between-unit variation. Data from 107 psychiatric inpatient units in 13 hospitals (25,294 patient cases) showed wide variation in unit structures and patient mental health status but relatively little variation in staffing patterns. The median number of beds was 21, and the typical early shift included 2 registered nurses. Regression analyses indicated that higher HoNOS total scores and several single items were significantly associated with increased RN staffing, with the total score showing the strongest effect. A 20% increase in the HoNOS total score corresponded to 48.5 additional registered nurse hours per week or 1.3 full-time equivalents per year. Comparing predicted with reported staffing, smaller units tended to fall below and larger units above their predicted levels. Routinely collected clinical data, particularly HoNOS scores, were linked to nurse staffing in psychiatric inpatient care. Patient acuity and unit size were both associated with staffing, indicating that routine data can provide a pragmatic basis for more transparent and sustainable workforce planning.
While efforts to enhance employment outcomes for individuals with intellectual and developmental disabilities (IDD) have increased, research has primarily focused on job attainment rather than long-term employment sustainability (e.g., 12 months or more). Few studies have explored whether staff using evidence-based employment models (e.g., Project SEARCH) express an interest in virtual reality support tools to enhance employment sustainability. This study sought to examine whether Project SEARCH staff expressed interest in using virtual reality as a potential method to support employment sustainability for transition-age youth with IDD. Project SEARCH staff (N = 234) completed a brief descriptive survey about their experiences with students with IDD and the role that practicing workplace conversations via virtual reality has in their students' ability to sustain employment. The majority of Project SEARCH staff report that over 75% of the youth they served were able to obtain employment with low rates of job loss. Additionally, 91.9% of Project SEARCH staff perceived virtual reality as a helpful means to support workplace conversations among transition-age students with IDD. Project SEARCH staff expressed an interest in virtual reality tools to help students practice workplace conversations. Future efforts should consider technologies that incorporate soft skills in the workplace to enhance employment sustainability.
Intensive care bed block has been a persistent problem worldwide. Current Australian evidence is mostly from single or small-scale multisite studies, and there is a lack of evidence on a bigger scale. To explore multidisciplinary ICU staff's perspectives on the facilitators and barriers to timely ICU patient discharge in Australia. A national cross-sectional online survey was distributed via professional organisations to ICU staff across Australia. The survey comprised 45 quantitative and eight qualitative items informed by systematic reviews and studies at end of the sentence. A total of 114 ICU staff completed the survey. Three-quarters (n = 77, 75%) reported the discharge process as 'extremely' or 'somewhat difficult', with the majority (n = 91, 80%) reporting ward bed unavailability as the primary cause of discharge delay. Respondents expressed that emergency departments and operating theatres were prioritised over ICUs during hospital bed allocation. Ward bed allocation was mostly communicated verbally (n = 44, 39%) or by phone (n = 71, 62%), with only 39% (n = 44) using digital methods. Facilitators included post-ICU ward follow-up assessment and management, ICU discharge liaison nurse coordination of patient transfer and assessment of ward staffing, skill-mix and bed readiness. Additional factors included early identification of dischargeable patients, the use of guidelines, and adherence to policies and checklists. Barriers included lack of ward-level clinical support, incompatibility of documentation platforms, staff shortages and discharge task inefficiencies. Few respondents reported existing strategies to address discharge delays in their hospitals. Respondents highlighted the need for improved digital systems, permanent discharge liaison or co-ordination roles, and post-ICU clinical support services with dedicated funding and appropriate or 24/7 coverage to support timely ICU discharge. Findings highlight the need for organisational-level and workflow-focused strategies to reduce ICU exit block to support timely and safe patient discharge across Australian ICUs.
Voice is essential in university teaching, yet evidence integrating self-reported vocal fatigue with health, lifestyle, sociodemographic, and professional indicators in lecturers remains limited. This study analyzed the associations between two symptom-related dimensions of vocal fatigue, vocal tiredness and physical vocal discomfort, and multidimensional health, lifestyle, sociodemographic, and occupational indicators in university teaching staff. A cross-sectional online survey was conducted among teaching staff from the Spanish Network of Health-Promoting Universities. The final sample included 1560 lecturers from 13 Spanish universities, 49.9% men, mean age 47.39 years, SD 11.29. Self-reported vocal fatigue, health-related quality of life, burnout, emotional symptomatology, physical activity, sedentary time, sleep quality, and professional characteristics were assessed. Vocal Fatigue Index-defined vocal tiredness was identified in 7.1% of participants, and physical vocal discomfort in 12.8%. Women reported higher scores in both dimensions, and sex remained independently associated with both outcomes in adjusted models. Lecturers with vocal tiredness or physical vocal discomfort showed lower health-related quality of life and higher anxiety, depression, stress, emotional exhaustion, depersonalization, and sleep problems. Hierarchical regression models identified lower physical well-being, higher anxiety, and greater emotional exhaustion as the main factors associated with both outcomes. Physical activity, sedentary time, teaching modality, and number of students taught were not clearly associated with vocal fatigue symptoms. Self-reported vocal fatigue symptoms were present in a meaningful minority of university lecturers and were associated with poorer perceived well-being, greater psychological distress, and higher emotional exhaustion, supporting the inclusion of vocal health in university occupational health strategies.
Chronic psychological stress and poor cardiometabolic health are major public health concerns that can accelerate cellular ageing, yet their combined impact on shorter telomere length (TL) - a biomarker of cellular ageing - remains poorly understood in occupational settings. This study examined their associations and potential interactions among university staff in Australia. TL was measured from blood leukocytes. Cardiometabolic indicators included adiposity, blood pressure (BP), lipid profile, fasting plasma glucose (FPG), insulin resistance, C-reactive protein, and cortisol. Psychological stress, burnout, well-being, and health-related quality of life (HRQoL) were assessed using validated questionnaires, and wearable devices captured sleep and nocturnal autonomic nervous system activity. Correlation, multiple linear regression, and moderator analyses were used to analyse the data. Among 126 participants [65% female, mean age 48.84 (± 9.43) years], the average TL was 7.06 ± 1.00 kilobase. While visceral fat, systolic BP, and FPG were associated with TL, these associations were attenuated in age-adjusted models. Psychological variables were not directly associate with the TL; however, burnout (B = -0.26 [95% CI: -0.51, -0.01], p = .042), sleep-related impairment (B = -0.02 [95% CI: -0.04, 0.0004], p = .046), and HRQoL-mental component (B = 0.02 [95% CI: 0.001, 0.04], p = .034) significantly moderated the association between FPG and TL. Age was the primary correlate of TL. Burnout, sleep-related impairment, and mental quality of life may moderate the association between FPG and TL. These exploratory findings suggest that addressing both psychological and cardiometabolic health may support TL in working adults. ACTRN12625000134426.
Large language model (LLM) chat tools have the potential to transform healthcare workflows by improving efficiency and reducing administrative burdens. While prior research has predominantly focused on clinicians, non-clinician healthcare staff constitute the majority of the workforce, and their real-world chat tool use remains uncharacterized. This retrospective, cross-sectional study analyzed de-identified chat logs from a secure, HIPAA-compliant LLM chat tool deployed at an academic medical center over an 11-month period. Among 30,503 chat threads analyzed, 98% originated from non-clinician users across 239 roles. Usage was dominated by administrative tasks including email and document writing (53.9%), text manipulation (9.1%), and brainstorming (6.7%). A notable proportion of interactions included off-label queries unrelated to work or organizational goals, including 5.9% involving clinical decision-making. These findings highlight the need for targeted training, tailored governance policies, and refined evaluation frameworks to optimize appropriate LLM use while mitigating risks in healthcare settings.
Temporary employment is widely used in eldercare to address staffing shortages, but heavy reliance on temporary workers may compromise continuity of care, staff workload, and quality of care. Managers are key to how staffing is organised and handled in daily practice. This study examined how managers at different organisational levels perceived the opportunities and challenges of temporary employment in municipal eldercare. This qualitative study was based on semi-structured interviews with 16 managers across four organisational levels in Swedish municipal eldercare, including residential care homes, home care services, and higher-level management. The interview guide focused on managers' experiences of temporary employment, staffing practices, care continuity, work environment, and perceived effects on care quality. Data were analysed using qualitative content analysis. Three themes were identified. Balancing staffing on a tightrope describes managers' struggle to ensure continuity in a system that relies on short-term solutions and often prioritising shift coverage over competence. Leading with tied hands captures managers' limited control over recruitment and workforce planning, which reinforced reliance on temporary employment. From rigidity to flexibility highlights managers' suggestions for improving staffing stability. Managers across levels identified similar challenges, but their priorities differed. First-line managers focused on daily staffing, staff well-being, and quality of care, while higher-level managers emphasised long-term planning. Temporary workers helped cover staffing gaps, but also increased permanent employees' workloads and complicated workforce planning. Managers expressed frustration with centralised staffing decisions that prioritised immediate coverage over long-term stability. Temporary workers were often treated as interchangeable rather than integrated team members, reflecting systemic problems in staffing practices. Temporary workers are essential for keeping eldercare services running, but over-reliance on temporary employment may reinforce reactive staffing practices, increase pressure on permanent staff, and weaken continuity. Managers suggested better onboarding, greater local hiring control, and dedicated staffing pools. Addressing these issues requires both immediate measures to integrate temporary workers into regular teams and longer-term changes in workforce planning, staffing levels, and local managerial influence.
Adolescents with haematological malignancies face significant emotional and relational challenges, often accompanied by difficulties in communicating their needs within the healthcare context. To address these issues, a narrative-based psycho-educational intervention based on the creation and prescription of Ironic Medications was developed. These fictional remedies were designed to express emotions, experiences and needs in a playful yet meaningful way while exploring differences in how adolescents and healthcare staff perceive communication and relational needs. The intervention unfolded in two phases: (1) weekly group sessions in which adolescents explored irony and storytelling while developing Ironic Medications addressing relational and communicative needs; and (2) a presentation of the medications to hospital staff followed by a metacognitive exercise exploring alignment in perceived needs. Quantitative surveys assessed the perceived usefulness of the medications and differences between adolescents' and healthcare professionals' perspectives. Adolescents rated Ironic Medications as equally valuable for relational and communication needs, whereas staff mainly recognised their intragroup function, overlooking their intergroup communicative potential. Misalignments emerged at multiple levels: staff's self-prescriptions and predictions of adolescents' choices did not align with adolescents' actual prescriptions, with greater discrepancies among physicians than nurses. Adolescents prioritised normality (Normalvit) and relational support (Conversan), while staff emphasised confidence-building (Xpecta) and temporal relief (Temporil). Nurses showed greater alignment with adolescents but reported lower comfort in receiving Ironic Medications. The intervention revealed perspective-taking gaps between adolescents and staff. Ironic Medications fostered self-reflection, empathy and relational skills, suggesting a promising narrative-based tool to support patient-provider communication in adolescent oncology care.
Persistent medicine shortages across the Asia-Pacific region suggest variability in hospital inventory management capacity. Despite available guidelines, variations exist across hospitals in adopting recommended inventory management practices. Thus, this study aimed to identify existing inventory management methods, evaluate related challenges, and highlight recommendations for improvement. Searches were performed to identify relevant sources from 39 countries on CINAHL, Cochrane, Embase, PubMed, Scopus, Business Source Complete, and Emerald Insight. Non-indexed literature was retrieved through Google Scholar and general Google searches. Backward and forward citation searching was conducted. Data were extracted based on an initial framework comprising three components: planning and procurement, storage and stock management, and staff management. The framework was later expanded through inductive coding to include 12 subcomponents. Findings were narratively synthesised to describe inventory management methods and their impact on medicine supply. Methodological quality of the included empirical publications was assessed using the Mixed Methods Appraisal Tool (MMAT). Seventy-two publications from 20 countries were included. Practices varied between hospitals even within the same country. Hospitals shared common inventory management challenges that weakened medicine supply systems. A conceptual framework was developed to outline three key themes: systemic constraints, infrastructural limitations, and staff skill gaps. Overcoming systemic constraints requires streamlining expenditure and enhancing central distribution systems. Implementing multi-supplier contracts may be effective at stabilising supply. Infrastructural improvements in storage space and inventory tracking systems may bolster medicine availability. Addressing staff skill gaps requires significant investment in training programmes to strengthen adherence to effective inventory management methods. This study mapped key determinants of medicine availability in hospitals, providing guidance on priority areas for intervention to policymakers, hospital leadership, and inventory personnel. Securing medicine supplies in hospitals requires practical inventory management guidelines that account for systemic constraints and infrastructural limitations while empowering staff to optimise pharmacy inventory management practices.
The Diabetes Prevention Program Outcomes Study (DPPOS) is an established cohort of aging persons with pre-diabetes and type 2 diabetes with 25 years of median follow-up. In 2022 DPPOS added Alzheimer's disease (AD), and AD related dementias (ADRD) phenotyping using the National Alzheimer's Coordinating Center (NACC) Uniform Data Set (UDSv3), which included a standardized neurological examination across 25 clinical sites, administered by clinical staff and interpreted centrally by clinicians. A DPPOS video-based asynchronous neurological examination (DPPOS-VANE) was developed iteratively through consensus from research clinicians and staff feedback to harmonize with UDSv3 to identify common neurological diagnoses aside from dementia including diabetic cranial neuropathies, stroke and parkinsonism. DPPOS-VANE was designed to be conducted without direct participant contact by the examiner, reproducible, and independent of clinical skills of PCs. An iPad™ camera recorded the video exam, comprised of assessments of extraocular and facial movements, visual fields, speech, gross motor strength, pronator drift, praxis and parkinsonism. A 10-minute training video demonstrated the examination step-by-step with scripts and instructions in English and Spanish. Site-specific performance review, feedback, and staff certification preceded central reading of video recordings by physicians.After two years of implementation, 1286 DPPOS-VANEs led to 1284 examination reviews. Of these, 1204 (93%) were completed by having the examiner follow the standard script. Overall, 1237 examinations (96%) were delivered as planned, 41 (3%) had minor errors but were still usable, and 6 (0.4%) had major deviations in exam technique; two additional recorded evaluations were not usable as recorded videos were inaccessible due to technical errors. Each examination was completed within 10-15 minutes. Each site on average completed 51.4 examinations (range 14-92). Engaging 55 research staff across 25 sites and 3 physician-reviewers, this study is the first to demonstrate feasibility of a VANE as an efficient neurological examination model enabled by commonly used devices. Such a multisite standardized VANE represents a novel paradigm for large epidemiological studies.
Operating rooms (OR) require precise management to ensure patient safety, with temperature regulation serving as one key factor in reducing surgical complications. This review explores the impact of OR temperature on staff performance, infection rates, and hypothermia outcomes, as well as strategies to minimize adverse effects. This literature review synthesizes findings from peer-reviewed studies, meta-analyses, and clinical guidelines identified through PubMed and Google Scholar. A focus was placed on publications written in the past 25 years to maintain the most updated information. The included articles emphasized the effects of OR temperature on staff performance, infection rates, and hypothermia-related outcomes, and all references were cross-checked by two authors for accuracy. Ambient temperature guidelines of 20-24°C (68-75°F) from the American Society of Heating, Refrigerating, and Air-Conditioning Engineers (ASHRAE) help reduce heat-related stress in the operating room (OR). Cooler environments minimize distractions, fatigue, and impaired performance among staff in the sterile field. Ambient temperatures above guideline ranges are associated with an increased risk of infection, particularly from gram-negative bacteria. Intraoperative hypothermia, however, poses its own risks, including altered pharmacodynamics, increased blood loss, and coagulopathies, while prolonged hypothermia can extend recovery times and hospital stays. OR temperature plays a critical role in maintaining surgical efficiency and patient safety. Multiple variables must be considered and several intervention methods exist to optimize surgical team performance and patient outcomes.
Patient classification systems (PCSs) are frequently used to estimate hours of nursing care to support budgeting and guide staffing decisions. However, despite a clear clinical need, there is as yet no validated and reliable PCS designed specifically for gastroenterology wards. To develop a PCS tailored to gastroenterology wards that can accurately quantify nursing workload and support evidence-based nurse staffing decisions. This study used Orem's self-care theory and Henderson's human needs theory as a foundation and applied machine learning techniques to construct a PCS for a gastroenterology ward in a general tertiary hospital. Patients were enrolled using convenience sampling, and information on their demographic characteristics, together with daily nursing activities and frequencies, was retrospectively extracted from the hospital information system (HIS) between July 1, 2019, and June 30, 2020. A workload measurement method was used to calculate the amount of nursing care received by each patient over a 24-hour period, thereby forming the study database. A decision tree model was developed to classify patients. The PCS was subsequently refined and validated using a prospective observational study of 357 patients conducted from December 1, 2022, to March 31, 2023. The final PCS included two primary categories and five subcategories, each of which was defined by specific patient characteristics and their corresponding 24-hour nursing time requirements: Category 1: "Day of surgery and first postoperative day," in which patients were subdivided into three levels based on surgical complexity, self-care capacity, and illness severity (Surgery 1, Surgery 2, and Surgery 3), requiring 1.66, 2.82, and 4.15 nursing hours per 24 h, respectively, and Category 2: "Other days" patients, who were subdivided into two groups based on critical illness, self-care ability, and disease severity (Category 1 and Category 2), with each requiring 0.96 and 3.42 nursing hours per 24 h, respectively. Internal and external validation demonstrated good model fit and acceptable predictive performance. Patients could be rapidly classified using defined indicators, enabling accurate prediction of their 24-hour nursing care requirements. The PCS exhibited strong internal consistency, stability, and generalizability, thereby supporting the reliability of its results. This PCS provides a scientific basis for nurse staffing decisions and may support hospital administrators and health authorities in the development of data-driven nurse workforce allocation policies.
Background Person-centeredness is espoused in many national and international policies and standards and are viewed to inform cultures of care in nursing homes and influence mental health of older adults. In spite of this, studies have shown mixed results regarding the impacts of person-centred cultures on depression with outcomes depending on contexts and implementation approach. In addition, the prevalence of depression in nursing homes remains high. Objective This review aimed to understand how, why and in what contexts person-centred cultures, the expected cultures of care in nursing homes, contribute or not to the management of depression among older adults using a realist review. Method Realist review is a theory-driven review which explains whether or not an intervention works, how, why and in what contexts, in forms of theories. The theories are in forms of contexts, mechanism, and outcome configurations - CMOCs. This review followed four -step design by Pawson and colleagues and was informed by four initial programme theories. This is a phase two of a wider study. A systematic search of eight data bases including grey literature was conducted to gather evidence to refine the initial programme theories in collaboration with expert and local reference panels. Results Forty context, mechanism and outcome configurations derived from thirty relevant and rich papers were theorized, generating demi-regularities which informed the refinement/development of six programme theories. The programme theories highlight: the importance of staff education and leadership support for person-centred care. (ii) the importance of supporting older persons' autonomy through care planning and communication. (iii) supporting social connection and engagement for older persons through staff relationships. (iv) promotion of independence for older persons through environmental and relational support. (v) the importance of organisational enablers for sustainable person-centred cultures. (vi) the importance of environmental and organisational designs for social and psychological wellbeing of older persons. These show that person-centred cultures can mitigate against depression through individual (e.g. staff's confidence and competence), relational (trust, mutual familiarity) and organisational mechanisms. Conclusion This realist review highlights that person-centred cultures do contribute to the management of depression among older persons in nursing homes. These findings provide actionable insights into how organisational, relational and individual mechanisms interact within nursing homes to support the mental health of older persons. This study was prospectively registered with PROSPERO, ID CRD42024568251 on July 11, 2024.
Many perinatal substance use disorder (PSUD) programs are providing services to women with substance use disorders (SUDs) in the United States. Breastfeeding is associated with improved maternal and infant outcomes, yet breastfeeding rates are low in this population, and our understanding of breastfeeding support in PSUD programs is limited. To describe breastfeeding support services, and barriers and facilitators to improving breastfeeding support and breastfeeding outcomes within PSUD programs in the United States. From January to April 2024, a 61-item survey was sent electronically to a convenience sample of PSUD programs. Quantitative survey responses were analyzed using descriptive statistics to report frequencies. Open-ended survey responses were analyzed using content analysis. Representatives from 35 programs across 16 states reported limited within-program lactation support with 10 (29%) having a lactation consultant on staff. Barriers to breastfeeding support include: complex medical and social challenges individuals with SUDs face, lack of provider/staff education, referral-based lactation consultants not attuned to the specific challenges of SUDs, disagreement among providers regarding breastfeeding support, and no or outdated policies which restrict breastfeeding. Suggestions for enhancing breastfeeding support included increasing postpartum support, inclusion of peer support, increasing provider/staff education on breastfeeding and SUDs, increasing understanding of lactation support during the birth hospitalization, and updating policies to allow more individuals with SUDs to breastfeed. Programs reported limited support for breastfeeding individuals with SUDs. More research is needed to explore how breastfeeding interventions tailored for programs may improve outcomes for individuals with SUDs.
Aging populations, multimorbidity, and rapid medical progress have expanded treatment options in old age, but also intensified ethical and organizational challenges in everyday care. Little is known about how nurses, as key frontline professionals, experience these structural developments specifically in the context of medical and nursing care for older adults in Germany. Therefore, this study aimed to examine how nursing staff perceive structural conditions in the German healthcare system and their effects on medical and nursing care for older patients. This study employed a qualitative analysis of five focus group discussions with 28 nurses from hospitals, nursing homes, and home-based nursing services in Germany. Participants with diverse qualifications and work settings were purposively and conveniently sampled, and discussions were stimulated by case vignettes on elective surgery and life-prolonging interventions in very old age. Data were analyzed using Kuckartz's Qualitative Content Analysis. Nurses described medical progress as simultaneously enabling better symptom control, mobility, and end-of-life care, while also prolonging phases of frail survival with high care dependence. They reported strong treatment pressures and financially driven incentive structures that foster overtreatment and can conflict with older patients' wishes and perceived quality of life. Chronic staff shortages and time constraints led to "shortcuts" such as tube feeding or increased use of psychotropic medication, which were experienced as undermining person-centered care and professional ethics. Across settings, nurses highlighted a loss of professional influence in medical decision-making, feelings of powerlessness, and moral distress linked to implementing decisions they had not shaped but were responsible for carrying out. From a nursing perspective, good medical care in old age depends not only on technological advances and geriatric expertise but also on structural reforms of financing, staffing, and decision-making processes. Strengthening nurses' autonomy, involvement in treatment decisions, and ethical support within interprofessional teams may help align medical interventions more closely with older people's concepts of a good life and a good death. DRKS00027076, 05/11/2021. https://www.drks.de/search/de/trial/DRKS00027076/details .
Critical care nurses work in demanding clinical environments where professional values, staffing conditions, ethical climate, workload and burnout may influence job satisfaction. Understanding these relationships is important for supporting nurse retention and stable, safe intensive care practice. To assess professional nursing values, perceived work environment, and job satisfaction among critical care nurses in Palestine. This descriptive cross-sectional study included 263 nurses working in critical care units across 15 hospitals in the West Bank, using a convenience sampling approach, with a response rate of 87.7%. Job satisfaction was treated as the primary dependent variable. Descriptive statistics, multiple linear regression, and mediation analyses were performed using SPSS 26.0. Nurses reported strong professional values (116.25 ± 9.55), moderate perceptions of the work environment (2.42 ± 0.30) and moderate job satisfaction (89.17 ± 10.57). Work environment was the strongest predictor of job satisfaction (β = 0.576, p < 0.001), while workload (β = -0.166, p = 0.021) and intention to leave (β = -0.163, p < 0.001) were negative predictors; the model explained 47.4% of variance. Mediation analyses indicated significant indirect association between professional values and job satisfaction through work environment (B = 0.152), between the work environment and intention to leave through job satisfaction (B = -0.533), and between workload and intention to leave through job satisfaction (B = 0.082; All p < 0.001). Professional values were indirectly associated with job satisfaction through the perceived work environment. However, workload and intention to leave were associated with lower satisfaction. These findings highlight the need for adequately staffed, collaborative, well-resourced critical care environments, including workload monitoring, shared decision-making, supportive leadership and nurse recognition systems. Nurse Managers should monitor workload, ensure adequate nurse-patient ratios, involve nurses in unit-level decisions, provide recognition and strengthen interprofessional collaboration in critical care units. No Patient or Public Contribution.
Mass casualty events (MCE), such as campus shootings, can severely impact the mental health of students, faculty, and staff. This study examined the psychological effects of an MCE at a minority-serving institution and explored how sense of belonging, cardiorespiratory fitness, and treatment preferences influenced recovery. To measure the impact of the MCE on mental health an anonymous survey was administered four to five months post-MCE to university students, faculty and staff. Within the survey, participants were asked to retrospectively report their depression (PHQ-9) and anxiety (GAD-7) symptoms as they recalled them two weeks prior to the MCE, and as they experienced them in the two weeks preceding survey completion. The survey also included current measures of sense of belonging (SBS), perceived discrimination (PEDQ), estimated cardiorespiratory fitness (eCRF), and intervention preference to cope with the impacts of the MCE. Participants reported significant perceived increases in PHQ-9 and GAD-7 scores from the pre-MCE recall to current time-periods. Increases in depression (PHQ-9 scores) from pre-MCE to recent recall were larger among respondents with lower pre-MCE anxiety (GAD-7 scores), higher perceived discrimination (PEDQ), and those currently receiving treatment for anxiety or depression; respondents not receiving treatment showed no significant change. Among students, lower belonging scores were associated with greater increases in depression. Neither belonging nor perceived discrimination were strongly linked to individual variables, indicating their multifactorial nature. Most participants reported a preference to learning about alternative interventions such as exercise or meditation over pursuing university counseling services.
Transdiagnostic group interventions targeting emotion regulation (ER) are commonly offered to individuals with severe mental illness (SMI). Previous feasibility studies have provided insufficient information to support progression to effectiveness evaluation of scaled-up delivery. We aimed to address this gap. We conducted a feasibility randomised controlled trial of a protocolised group ER intervention for individuals with SMI, delivered online and facilitated by a trained junior workforce. Feasibility markers were recruitment, retention, data completeness, intervention uptake and completion (≥50% sessions), adherence to the intervention protocol, and participant satisfaction. Participants were recruited from community mental health services and randomly allocated (1:1) to intervention or waitlist control groups. Feasibility was demonstrated, with 6/7 markers categorised 'green' and 1/7 'amber' against predetermined progression criteria. Recruitment targets were met (n = 34 service users; n = 9 junior facilitators), retention was 85.3%, and paired outcome completion was 82.4%. Staff self-reported high adherence and participant satisfaction was 89.6%. Intervention completion was 61.1% (green target=>80%; amber target=>60%), suggesting scope to improve engagement. Participants dropping out of the intervention were lost to follow-up, limiting assessment of reasons for non-continuation. Implications of unblinded researchers at post-assessment are discussed. Group-level and contextual treatment data were not routinely collected due to naturalistic intervention delivery. An effectiveness trial of a protocolised group ER intervention for SMI, delivered online by junior staff, is feasible. A larger multi-site pilot trial to estimate sample size for a confirmatory trial, incorporating methodological refinements to increase intervention completion, is the next step.
To investigate the status of early ambulation (within24 h) among patients undergoing surgery for pelvic floor disorders (PFDs) and to identify its independent influencing factors aims to provide evidence-based support for establishing an enhanced recovery (ERAS) nursing pathway for gynecological pelvic floor surgery, and Promote postoperative recovery of PFDs patients and improve their quality of life. A cross-sectional study was conducted, enrolling 161 patients with PFDs who underwent pelvic floor reconstructive surgery at multiple tertiary hospitals in Chongqing from December 2024 to April 2025. According to the International ERAS Society guidelines for gynecological surgery, early ambulation was defined as "patients independently or with assistance from medical staff and auxiliary devices performing out-of-bed activities within 24 h postoperatively, including: sitting in a chair for ≥20 min after bed-to-chair transfer, and/or standing beside the bed for ≥3 min, and/or walking distance ≥5 meters". Data were collected through questionnaire surveys, including general patient information, surgical information, self-efficacy, and kinesiophobia scores. Univariate and multivariate Logistic regression analyses were employed to identify factors influencing early ambulation. Among the 161 patients, 39% (n = 63) successfully completed early ambulation within 24 h post-surgery. Multivariate logistic regression analysis revealed that the presence of vaginal packing postoperatively (OR = 3.8, 95%CI:1.6∼9.0, P = 0.003); low patient willingness to be active active (OR = 12.3,95%CI:3.6∼41.7, P < 0.001); lack of guidance on early ambulation (OR = 4.9,95%CI:1.1∼21.5, P = 0.036) were significant risk factors for the failure to ambulate early. Additionally, the incidence of postoperative kinesiophobia among PFDs patients was 84% (135/161), with a TSK-11 score of (29.9 ± 3.1) points, suggesting that kinesiophobia may be a psychological barrier to early ambulation. The completion rate of ambulation within 24 h after surgery for PFD patients is relatively low postoperative vaginal packing gauze; insufficient willingness to be active; lack of early ambulation guidance, and postoperative kinesiophobia are the main barriers. Clinical medical staff should seek the best evidence, optimize the ERAS strategy, scientifically manage the vaginal packing strategy, strengthen health education for patients and caregivers during the perioperative period, promptly guide patients' phobia, implement individualized early ambulation programs, improve the compliance of early ambulation activities, and thereby accelerate the postoperative recovery of patients.
Did not attend (DNA) and short notice cancellation (SNC) in outpatient (OP) clinics waste scarce capacity and delay care. We undertook a quality improvement project in general surgery OP clinics with the aim to reduce DNA below the baseline 12.2% and SNC below the baseline 5% using telephone and text reminders to increase OP appointment (OPA) slot utilisation from around 83% towards 85%-90%.We studied DNA and SNC in four consecutive phases in a general surgery clinic. Phase 1: a retrospective baseline OPA attendance; Phase 2: a prospective diagnostic where non-attenders were telephoned within 3 days to complete a questionnaire on reasons for DNA/SNC; Phase 3: Preappointment telephone reminders 72 hours before OPAs; Phase 4: one-way text reminder.Across four phases, 1500 OPA slots were analysed. Baseline utilisation was 82.8% in phase 1 (360 slots; DNA 12.2%, SNC 5.0%) and 83.3% in phase 2 (420 slots; DNA 11.7%, SNC 5.0%). Questionnaire responses: most non-attendees were forgetting their appointment or unable to get through to the hospital to cancel. Phase 3 (360 slots): 286 patients (79.4%) were successfully contacted, 251 confirmed attendance and 35 wanted to cancel, creating potentially reusable slots; DNA fell to 9.4% and SNC to 0.6%, but only 20 of the 35 freed slots were re-booked due to limited booking staff (utilisation; 85.8%). Phase 4: 360 slots, utilisation was 84.7% (DNA 8.1%, SNC 7.2%). Statistical process control charts suggested a favourable trend in DNA and SNC over time but did not demonstrate consistent special cause variation.Telephone reminders led to fewer SNCs and created opportunities to reallocate appointments, but impact was constrained by limited staff. One-way text reminders appeared to reduce DNA but higher SNC, suggesting that reminder systems alone are insufficient. Sustainable improvement in OPA utilisation requires reliable contact information, simple two-way routes for patients to cancel or rearrange, and adequate administrative capacity.