Critical Access Hospitals (CAHs) are essential to health care access in rural communities but face persistent staffing shortages, financial strain, and difficulty recruiting physicians. Current Centers for Medicare and Medicaid Services (CMS) Conditions of Participation (CoPs) require physician-led medical oversight in CAHs, despite substantial changes in the rural health care workforce over the past three decades. During this time, nurse practitioners (NPs) have expanded significantly in number, education, scope of practice, and geographic distribution, particularly in rural areas where physician shortages are most severe. This article examines how outdated CMS CoPs exclude NPs from critical medical leadership roles, increasing administrative burden and limiting organizational flexibility without demonstrable improvements in quality of care. Through analysis of federal regulations, workforce trends, and professional competencies, this article argues that CMS should modernize staffing requirements in CAHs to defer to state scope-of-practice laws and allow qualified NPs to serve in medical oversight and leadership roles. Such reforms would improve staffing sustainability, reduce costs, mitigate liability, and strengthen the provision of high-quality care in underserved rural communities.
This study aimed to examine the association between perceived managerial care and reflective ability in newly graduated nurses and to investigate the longitudinal mediating role of feedback-seeking behavior, providing a theoretical basis for managerial interventions. Reflective ability is a critical competence for newly graduated nurses to adapt to complex clinical environments and promote professional development. Managerial care has been shown to influence nurses' learning-related behaviors; however, the longitudinal mechanisms through which perceived managerial care enhances reflective ability remain unclear. A three-wave longitudinal survey design was employed, with data collected at three time points (T1, T2, and T3) over 6 months. Newly graduated nurses from 10 tertiary general hospitals in China were recruited using simple random sampling. Validated scales were used to assess perceived managerial care, feedback-seeking behavior, and reflective ability. Structural equation modeling and bootstrapping analyses were conducted to examine longitudinal mediation effects. Perceived managerial care, feedback-seeking behavior, and reflective ability were positively correlated at T1, T2, and T3 (p < 0.01), with mean scores increasing over time. Feedback-seeking behavior played a significant longitudinal mediating role between perceived managerial care and reflective ability, accounting for 44.02% of the total effect. The structural equation model showed acceptable fit indices. Feedback-seeking behavior mediates the relationship between perceived managerial care and reflective ability in newly graduated nurses. Strengthening managerial care and encouraging feedback-seeking behaviors may effectively promote reflective ability and support early career development. The findings suggest that nursing managers may enhance new nurses' reflective ability by fostering supportive managerial environments and encouraging feedback-seeking behavior. Strengthening managerial care and establishing effective feedback mechanisms could facilitate professional development and improve early career adaptation among new nurses.
Critically ill patients in intensive care units (ICUs) require specialized care, and inadequate pain management remains a prevalent issue that contributes to long-term complications and adversely affects recovery. The aim of the study was to evaluate the impact of nurse-led interventions on pain related to critical care and the prevention of ICU-related complications among patients. A quasi-experimental pretest posttest control group design was adopted for this study, which was conducted at a tertiary care hospital in Mangaluru, Karnataka State, India. Patients admitted to the ICU (n = 60) were selected using purposive sampling and were divided equally into intervention and control groups. The intervention group received structured nurse-led care focused on ICU-related pain and strategies to minimize complications through supportive communication and a range of motion (ROM) exercises every morning for 1 week. In the intervention group, 53.3% of patients were aged 60-69 years, whereas in the control group, 40.0% of them were between 50 and 59 years. The intervention and control groups reported a reduction in critical care pain scores and ICU-related complications (p < 0.05). Notably, the participants in the intervention group showed a greater reduction in the parameters of study outcomes compared to the control group, indicating a clinically significant positive impact of the nurse-led interventions (p < 0.05). There was a significant association between pain and age, type of family, and basal metabolic index (BMI), as well as ICU-related complications and age. The findings underscore the effectiveness of nurse-led interventions in mitigating critical care pain and reducing ICU-related complications, demonstrating their potential as an evidence-based strategy to improve patient outcomes. Naik MG, Barboza HR, Rao J. Effectiveness of Nurse-led Interventions on Pain and Complications among Patients Admitted to Intensive Care Unit: A Quasi-experimental study. Indian J Crit Care Med 2026;30(5):408-413.
Recent medical advances have led to longer lives, shifting end-of-life care from families to healthcare institutions. Despite the critical need to identify factors influencing end-of-life care competency among nurses in high-mortality departments, this area remains underexplored. This study aimed to determine the factors associated with end-of-life care competency among nurses in high-mortality departments, with a focus on preserving patient dignity and quality of life. An explanatory sequential mixed-methods design. A survey was administered to 204 nurses across three general hospitals in G City, Korea, from June 13 to July 11, 2024, and data were analyzed using hierarchical regression. Subsequently, focus group interviews were conducted with nine participants between August 21 and October 10, 2024, followed by thematic analysis. Quantitative analysis revealed that the perception of shared decision-making (β = 0.20, p = 0.002), ethical nursing competency (β = 0.31, p < 0.001), and positive psychological capital (β = 0.19, p = 0.030) significantly influenced end-of-life care competency among nurses working in high-mortality departments. The regression model demonstrated an explanatory power of 46.8% (F = 14.04, p < 0.001, R2 = 0.468, Adj-R2 = 0.435). Thematic analysis yielded five themes and twelve subthemes. This study identifies key factors to enhance end-of-life care competency among nurses in high-mortality departments. The findings provide specific evidence to improve care quality and optimize nurse deployment in high-demand settings. This study highlights important implications for nursing leadership in improving end-of-life care. Nurse managers play a key role by providing structured training and fostering an ethical, supportive organizational climate. They must also promote effective communication and shared decision-making within clinical teams. Especially in high-mortality settings, leaders should prioritize workforce development strategies that strengthen nurses' psychological resilience and reduce burnout.
The United States declared endemic measles eliminated in 2000. However, outbreaks continued, with resurgences in 2019 and 2025. In 2025, more than 2200 cases across 48 outbreaks, the most since 1992, were reported. In the first half of 2026, 2073 cases were reported. Declining measles, mumps, and rubella vaccination rates have increased susceptibility among children. Acute and critical care nurses are central to early recognition and management of measles for optimal outcomes. To summarize current evidence on measles epidemiology, pathophysiology, clinical presentation, complications, treatment strategies, and acute and critical care nursing implications, emphasizing preparedness amid rising case numbers. A literature review was conducted using PubMed and CINAHL databases and websites of Centers for Disease Control and Prevention, World Health Organization, professional organizations, and pediatric hospitals. English-language sources published from 2015 to August 2025 were prioritized; relevant earlier studies were included. Reference lists were searched for additional articles. Measles is among the most contagious human diseases. Typical features include fever, cough, coryza, conjunctivitis, and morbilliform rash. Severe respiratory and neurological complications may require critical care hospitalization. Complications like encephalitis may present weeks to years after acute infection. Management remains supportive, with vitamin A supplementation recommended. Acute and critical care nursing priorities include early recognition, isolation precautions, specimen collection, respiratory and hemodynamic support, neurological monitoring, serial assessments, hydration, nutrition, and caregiver education. Measles is resurging in the United States despite being vaccine preventable. Nurse preparedness, including knowledge of clinical features, complications, and infection control, is essential to mitigate morbidity and mortality and to support outbreak prevention. (Critical Care Nurse. Published online ahead of print July 17, 2026).
Nurses' ethical competence and the ethical climate of healthcare settings are critical in promoting high-quality and individualised care. However, these factors may also contribute to various stereotypes that healthcare professionals hold towards older adults, potentially hindering the recognition of patients' individuality. The aim of this study was to investigate possible associations between nurses' characteristics, ethical competence, perceived ethical climate and stereotypes towards older adults in long-term care settings. This was a cross sectional survey study. Nurses working in long-term care settings for older adults in Finland participated in the study between 2024 and 2025. The survey included three self-administered instruments: the Ethical Competence Questionnaire, [Hospital] Ethical Climate Survey and Stereotype Content and Strength Survey. The data were analysed using multiple regression models to identify associations between nurses' characteristics, ethical competence, perceived ethical climate and stereotypes regarding older adults. A total of 409 nurses participated. The participants rated their ethical competence and perceived ethical climate of their workplace as moderate or good. Both factors were statistically significantly associated with positive stereotypes towards older adults but not with negative stereotypes. Most participants (89%) held employee positions and had vocational degrees (65%). Younger age was associated with stronger stereotypes. When the independent variables of ethical competence and ethical climate were tested together, ethical competence alone no longer explained positive stereotypes, but ethical climate did, even after adjusting for age. This study confirms that nurses' ethical competence and perceived ethical climate support each other. Strengthening these elements can help alleviate stereotypes about the residents in long-term care settings. Maintaining and developing these factors can promote the delivery of high-quality, individualised care. To mitigate stereotypes regarding LTCS residents, the nurse manager can create structures that strengthen ethical competence and support an ethical climate. Further research is needed to clarify the determinants that inform nurses' assessments of stereotypes towards older adults in long-term care settings. Ethical climate is associated with the content and strength of stereotypes that nurses have towards older adults. Therefore, maintaining and developing an ethical climate is important. Every nurse can promote an ethical climate by improving their ethical competence and promoting positive relationships with different stakeholders. In addition, it is worth creating structures in organizations that strengthen nurses' ethical competence and ethical climate.
Parkinson's disease (PD) caregivers face significant emotional, physical, and social challenges that result in poor health outcomes. Despite their critical role, caregivers receive limited support from health care systems. The current study explored the feasibility and acceptability of a student-led virtual support group for PD caregivers. The goal of the support group was to provide a safe space for peer connection, emotional processing, and health education. Feasibility was assessed through participation metrics alongside program surveys measuring loneliness, self-care engagement, satisfaction, and student learning. Results indicated that caregivers reported moderate levels of loneliness and inconsistent self-care but expressed satisfaction and perceived benefit from the group. Students reported gains in empathy, active listening, and confidence in group facilitation. This model provided meaningful caregiver support and valuable experiential student learning. Findings offer a delivery model to address the unmet mental health needs of caregivers and psychiatric-mental health nurse training.
There is ongoing tension in healthcare where certain types of knowledge are privileged above others to the detriment of patient outcomes. This hierarchy marginalizes nursing knowledge and patient perspectives, reinforcing systemic inequities in care delivery. Revisiting Stein's (1967) "doctor-nurse game," in which nurses were expected to influence care indirectly while preserving physician authority, this paper examines how hierarchical patterns of communication and knowledge recognition continue to shape practice. Nursing standpoint theory serves as a framework for critically examining power dynamics within the healthcare setting, providing a means to critically examine how power operates within healthcare structures and interprofessional relationships. Applying nursing standpoint theory reveals how systemic power imbalances shape provider interactions and affect the ability of nurses to advocate for patients. The analysis demonstrates that nurses' embeddedness in patient care positions them uniquely to recognize and respond to gaps in care. Understanding the ways nurses and physicians are situated in relation to power helps explain persistent tensions and offers a path toward more equitable care delivery. Rather than treating advocacy as an individual reactive task, centering the nursing standpoint reframes it as a relational and structural practice that depends on reciprocal recognition of professional knowledge. Empowering nurses to navigate and reshape power relations is therefore essential to improving outcomes. This theoretical reorientation benefits patients, teams, and health systems by shifting the "game" from deference to deliberation in support of patient-centered care.
The transition from hospital to home is a critical period for patients with coronary heart disease (CHD), and inadequate post-discharge care can adversely affect recovery. Continuing care models have been proposed to address these challenges, but their relative effectiveness compared with standard care still requires further evaluation. Therefore, this study evaluated the impact of continuing care on quality of life and recovery of cardiac function in patients with CHD. This single-center, retrospective cohort study included 135 discharged CHD patients. Based on nursing plans, patients were allocated into two groups: a Continuing Care Group (n = 61) and a Routine Care Group (n = 74). The Continuing Care Group received a structured, nurse-led 3-month program, while the Routine Care Group received standard post-discharge instructions. Various parameters, including cardiac function, quality of life, psychological well-being, self-care capacity, medication adherence, overall comfort, and nursing satisfaction, were compared between groups at 3-month follow-up. At 3 months, the Continuing Care Group showed significantly greater improvement in left ventricular ejection fraction (LVEF, 58.31% vs. 54.88%), six-minute walk distance (6MWD, 399.34 m vs. 382.25 m), 36-Item Short-Form Health Survey Physical Component Summary (SF-36 PCS, 67.94 vs. 63.92), and 36-Item Short-Form Health Survey Mental Component Summary (SF-36 MCS, 71.46 vs. 66.87). Patients in the Continuing Care Group also reported lower Depression Anxiety Stress Scales-21 (DASS-21, 17.24 vs. 18.31) and Perceived Stress Scale-10 (PSS-10) scores (22.01 vs. 23.14), higher Psychological General Well-Being Index (PGWBI, 85.95 vs. 83.47), Exercise of Self-Care Agency Scale (ESCA, 116.03 vs. 113.72), and Post-Traumatic Growth Inventory (PTGI) scores (74.81 vs. 72.31), along with superior medication adherence (84.16 vs. 82.35), comfort (87.06 vs. 84.91) and nursing satisfaction (86.94 vs. 84.89). At 3-month follow-up, Seattle Angina Questionnaire (SAQ) scores improved significantly from baseline in both groups, but no significant between-group difference was observed. Continuing care is associated with potential improvements in cardiac function, quality of life, psychological well-being, self-management, medication adherence, and patient-reported experiences compared with routine care in patients with CHD.
Intensive Care Unit-Acquired Weakness and Post-Intensive Care Syndrome are common among critically ill patients, substantially impairing quality of life after discharge. Intensive Care Unit rehabilitation has been shown to mitigate these outcomes, and physiotherapists contribute by systematically assessing patient progress using standardized measurement tools such as the Norwegian version of Chelsea Critical Care Physical Assessment Tool (the CPAx-NOR). However, implementing such tools in intensive care settings is often challenging. This study explored the perceived applicability of the CPAx-NOR and examined facilitators and barriers to its use in Norwegian ICUs. A qualitative exploratory design was applied. Three focus group interviews were conducted with ten physiotherapists, one physician, one nurse, and one former ICU patient recruited from five Norwegian hospitals. Data collection was guided by a semi-structured interview guide. The Consolidated Framework for Implementation Research informed the thematic analysis. Participants perceived the CPAx-NOR as being well aligned with physiotherapy practice, adaptable to ICU rehabilitation, and important when developing a shared professional language within multiprofessional teams. Barriers included tension for change, difficulties in grip strength assessment, organizational constraints, and concerns about professional autonomy. The identified facilitators and barriers highlight the need for tailored implementation strategies to promote successful implementation of the CPAx-NOR in Norwegian ICUs. Measurement tools in the intensive care unit are vital for guiding rehabilitation and identifying patients at risk of physical morbidity.Integrating the Norwegian version of the Chelsea Critical Care Physical Assessment Tool into clinical workflows enables the multidisciplinary team to plan and communicate individualized rehabilitation strategies from admission to discharge.By systematically identifying the barriers to implementing the Norwegian version of Chelsea Critical Care Physical Assessment Tool in the intensive care unit, targeted implementation strategies can be developed to facilitate the successful implementation of the tool.The primary barriers to implementing the Norwegian version of Chelsea Critical Care Physical Assessment Tool were tension for change, difficulties with grip-strength assessment, organizational constraints, and concerns about professional autonomy.
Integrating telenursing into health care offers opportunities and challenges, but gaps remain in understanding nurses' perceptions, implementation barriers, and practical use across clinical settings. This study aimed to assess nurses' perceptions of telenursing implementation and identify key barriers in various health care settings in Egypt, providing insights from a resource-limited, middle-income country undergoing digital transformation. A convergent mixed-methods design was employed, involving 240 nurses from 42 private hospitals across Egypt, selected via multistage random and convenience sampling. The study was conducted between January and May 2025. Quantitative data were collected using a 12-item structured questionnaire measuring perceptions across 4 dimensions (methods, patterns, advantages, and disadvantages of telenursing). Qualitative data were gathered through open-ended questions exploring implementation barriers, which were analyzed using inductive thematic analysis following Braun and Clarke's 6-phase framework. The findings indicated a generally positive perception of telenursing among participating nurses, with a mean perception score of 36.4±11.3; 62.9% of nurses held favorable views. A statistically significant association was found between nurses' perceptions and age, educational level, years of experience, and prior training in telenursing. Regression analysis revealed that these factors explained 18.5% of the variance in perception scores (R2=0.185, adjusted R2=0.164). Thematic analysis of qualitative responses identified 5 major barrier themes: (1) lack of institutional support and unclear policies, (2) technological infrastructure deficits, (3) training and competency gaps, (4) patient-related challenges, including digital literacy limitations, and (5) privacy and ethical concerns regarding data security. While nurses in this resource-limited Egyptian context demonstrate positive perceptions of telenursing (mean 36.4±11.3), successful implementation hinges on addressing multilevel barriers that are more acute than those reported in high-income systems. Implications include developing clear institutional policies, providing comprehensive training programs, establishing standardized protocols, and creating supportive technological infrastructure to optimize telenursing adoption and patient outcomes.
Early detection and treatment of hepatitis B and C virus (HBV/HCV) infection, along with regular monitoring for hepatocellular carcinoma (HCC), are critical strategies for improving health outcomes and reducing disease burden. An integrated care pathway should encompass person-centred approaches to prevention, diagnosis, treatment, and surveillance for HCC. Despite global efforts in hepatitis control, how hepatitis and liver cancer services connect at a population level remains unclear. Semi-structured interviews were conducted with 42 public health staff, nurses, and medical specialists (February 2023 to December 2024). Participants represented hepatitis and hepatology/gastroenterology clinical services across all 15 Local Health Districts in New South Wales (NSW), Australia. Inductive thematic analysis explored perceptions of service integration and person-centred care for hepatitis and HCC. A service mapping exercise was conducted to explore the population-level landscape of hepatitis-HCC service delivery, identifying key stakeholders, resources, care pathways, and models of care. The study identified nine strategic/system-level stakeholders, including HIV and Related Program units, Public Health Units, Specialist Liver Services, primary care and community services. Participants described hepatitis-HCC care journeys and pathways that were adapted to varied local level contexts, populations and resources. Three dominant service models emerged: (1) rural service model, (2) integrated care model, (3) integrated multidisciplinary partnership model. Despite fragmented pathways, complex care needs, and ongoing resource constraints, notable innovations were described, including nurse-led outreach clinics in the community, and multidisciplinary liver cancer teams offering tele-mentoring to rural clinicians. Five interrelated system-level challenges emerged: (1) inadequate and insecure workforce, (2) fragmented care pathways, (3) misaligned funding, (4) inconsistent data and information systems, and (5) stigma and limited community awareness. This is the first jurisdiction-wide mapping of hepatitis-HCC service pathways in NSW. The findings offer actionable insights to strengthen service integration, promote person-centred care continuity, and inform strategic planning for hepatitis and liver cancer services. Supporting these efforts can transform isolated innovations into cohesive, equitable liver health services, accelerating progress toward World Health Organization's hepatitis elimination targets and serving as a scalable model for integrated liver care globally.
Pediatric intensive care unit (PICU) nurses spend the most time with patients and families during a critical illness. However, nurses, families, and other clinicians conceptualize suffering differently, leaving some types of suffering when a child is nearing the end-of-life (EOL) unaddressed. PICU nurses are thus well-positioned but underequipped to address suffering during EOL. We aimed to 1) characterize distinctive features that indicate the presence and/or absence of suffering; and 2) identify nursing care responses that help attend to EOL suffering. Using qualitative interpretive description, we collaborated with a purposive sample of bereaved parents and interdisciplinary health professionals, including nurses, to develop a conceptual model to better equip nurses to notice and respond to EOL suffering. The sample participated in 3 focus group discussions. Two coders generated descriptive codes from each focus group, which were revised with participants at subsequent sessions and then arranged into overarching categories. Categories and sub-categories were then co-designed into a conceptual model that was iteratively refined by participants and the research team. Participants (N = 25) included 8 parents, 6 PICU nurses, 3 PICU physicians/advanced practice providers (APPs), 3 palliative care physicians/APPs, and 5 allied health professionals. Together with the research team, participants co-designed A Conceptual Framework to Guide Bedside Nursing Care to Address EOL Suffering, which relates four overlapping categories: 1) Noticeable Indicators for Acknowledgement and Validation, 2) Responsive Indicators for In-the-Moment Interventions, 3) Collaborative Responses, and 4) Dynamic Contextual Factors. Participants described that some indicators of suffering may be acknowledged and/or validated (such as shattered assumptive world) but not always eased. Whereas other indicators (such as physical and emotional expressions) may be responsive to in-the-moment interventions (such as facilitating opportunities for connection). Collaborative Responses included nurse strategies to address suffering such as partnering with parents, promoting connection and comfort, and connecting with resources. Dynamic Contextual Factors included external influences beyond the patient, family, and nurse, that shaped how nurses notice and respond to suffering, such as uncertainty. This study helped operationalize indicators of and nurse-led responses to EOL suffering using a parent and clinician collaborative approach. The conceptual model can inform nurse-led, parent-partnered interventions to acknowledge and ease suffering among children nearing EOL and their families. Some manifestations of suffering during EOL in the PICU may be readily addressable through nursing care while others may be witnessed and validated by nurses. Partnership between parents and nurses is a cornerstone of holistically addressing suffering.
There is growing evidence that routinization in nursing care is a concerning issue that directly affects the quality of nursing care and nurses' ability to be creative and innovative in care, flexibility, and ability to provide individualized care, and comprehensiveness in care at the global level. This study aimed to identify factors associated with routinization in nursing care. The method of Whittemore and Knafl was employed to conduct this integrated review, which consisted of five stages: identification and determination of the purpose, search for sources, data evaluation, data analysis, and results presentation. Evidence search was conducted using the keywords nursing care, routine, routines, routinization, and their Persian equivalents separately or in combination using the AND and OR operators in the databases PubMed, Web of Science, CINAHL, Scopus, SID, Medex, Magiran, and IranDoc from the beginning to October 2024. After screening and checking for eligibility, the articles were evaluated using the Joanna Briggs Institute's critical appraisal tools. A total of 23 articles met the inclusion criteria and were included in the final review. The most important factors affecting routinization were categorized into 4 categories: individual factors, organizational factors, communication factors, and patient-related factors. The results of this study indicate the need for critical interventions to address factors that can influence routinization in nursing care. Overall, studies highlight the complexity and dependence of routinization in care on various factors, including workload, work environment, and nurse characteristics.
Atrial fibrillation is a primary cause of ischemic stroke, necessitating early detection, particularly in patients with embolic stroke of undetermined source. While nurseled continuous electrocardiogram monitoring allows real-time rhythm assessment in acute stroke units, its specific clinical impact remains insufficiently clarified. To evaluate the impact of nurse-led notification of suspected atrial fibrillation in patients with cryptogenic stroke. A retrospective medical record review was conducted on patients with cryptogenic stroke admitted to a stroke unit between January and December 2022 in a tertiary general hospital in South Korea. Clinical characteristics and outcomes were compared based on the presence of nurse-led atrial fibrillation notifications. In total, 235 patients were included. Nurse-led notifications for suspected atrial fibrillation occurred in 24 (10.2%) patients of whom 95.8% were confirmed to have overt atrial fibrillation. The nurse-led notification group experienced a shorter time to anticoagulation initiation (3.7 vs. 5.6 days; p = 0.015), shorter hospital stay (7.2 vs. 12.9 days; p = 0.015) and lower overall medical costs ($5889.6 vs. $8487.6; p = 0.021) among the group of newly confirmed atrial fibrillation. Nurses with ≥ 10 years of neurology experience were associated with atrial fibrillation detection (RR = 17.70, 95% confidence interval = 4.64-67.70, p < 0.001). Nurse-led notification was independently associated with reduced hospital stay (B = -5.08, 95% confidence interval = -8.33 - -1.83, p = 0.002). Nurse-led notification of suspected atrial fibrillation was associated with shorter hospital stays and a potential benefit in the early initiation of anticoagulation. Integrating experienced nurses into structured cardiac monitoring protocols may improve the efficacy of care for patients with embolic stroke of undetermined source. Nurse-led atrial fibrillation detection significantly improves clinical and economic outcomes. These findings underscore the critical role of clinical expertise in cardiac monitoring, suggesting that such initiatives can optimise resource allocation and improve clinical outcomes in stroke units.
This quality improvement (QI) project aimed to develop, implement and evaluate a nurse-led, evidence-based central venous catheter (CVC) maintenance flowchart to reduce central line-associated bloodstream infection (CLABSI) rates across five adult intensive care units (ICUs). A prospective, pre-post intervention QI project was conducted. A nurse-led, multidisciplinary expert panel systematically reviewed the literature and graded evidence using the Joanna Briggs Institute (JBI) system. Recommendations were further evaluated for Feasibility, Appropriateness, Meaningfulness and Effectiveness (FAME), resulting in the development of an evidence-based CVC Maintenance Flowchart. The flowchart was implemented across five ICUs comprising 116 beds and 267 nurses. Pre- and post-intervention data on CLABSI rates (per 1000 CVC-days), CVC utilisation and compliance with the maintenance bundle were collected and compared. The mean CLABSI rate across five ICUs significantly decreased from 4.55 per 1000 CVC-days in the pre-intervention period to 1.68 per 1000 CVC-days in the post-intervention period (p < 0.001), representing a 63.2% reduction. Overall nurse adherence to the CVC maintenance flowchart components increased from a baseline average of 78% to 94.4% (p < 0.001). The central line utilisation ratio remained stable, indicating that the reduction in infections was attributable to improved care practices rather than decreased device usage. This nurse-led QI initiative was associated with a substantial reduction in CLABSI rates among ICU patients and improved adherence to CVC maintenance practices. The project demonstrates that empowering frontline nurses with a structured implementation framework can bridge the gap between evidence and clinical practice, thereby enhancing patient safety in the ICU. Structured, nurse-led implementation strategies help ICU nurses transform evidence-based CVC maintenance recommendations into consistent bedside practices and may provide a practical framework for improving other nurse-sensitive clinical outcomes. Patients or members of the public were not involved in the design, conduct or reporting of this study.
The COVID-19 pandemic accelerated digital communication adoption in intensive care units when traditional bedside visits became restricted. Understanding multi-stakeholder satisfaction with digital communication is essential for optimizing family-centred care in the post-pandemic era. To examine satisfaction with digital communication among physicians, nurses and families in intensive care units, identify influencing factors and analyse implications for practice. A cross-sectional study using purposive sampling was conducted from August 2023 to May 2024 in intensive care units at a medical center in Taiwan. In total, 300 participants (100 physicians, 100 nurses, and 100 family members) participated in this study. Family members reported significantly higher satisfaction (mean 84.6, 95% CI: 82.4-86.8) than physicians (mean 80.6, 95% CI: 78.5-82.7) and nurses (mean 77.8, 95% CI: 75.2-80.5). Communication perception was the strongest predictor of satisfaction (β = 0.34, p < 0.001), explaining 34.0% of variance. Nurses scored significantly higher on communication regulations than physicians (F = 3.39, p = 0.035) and uniquely identified privacy concerns (10 mentions), workload issues and team coordination challenges. Communication perception is the primary determinant of digital communication satisfaction across all stakeholder groups. Nurses demonstrated significantly lower satisfaction and unique concerns regarding workload, privacy and team coordination, requiring targeted institutional support. Optimizing ICU digital communication requires integrated strategies addressing communication quality, workforce support and organizational infrastructure. Healthcare institutions should implement empathetic communication training focussed on positive attitudes (the most valued factor across all groups), establish dedicated communication staff to reduce nurse workload burden, address technical infrastructure barriers (the most frequently cited concern), develop clear protocols for privacy protection and workflow integration and provide simplified medical explanations to enhance family comprehension in ICU digital communication.
Pressure injuries among critically ill patients are complications that may lead to increased morbidity, prolonged hospital stays, and higher healthcare costs. Despite this fact, there is limited national data on the prevalence of pressure injuries in Norwegian intensive care units (ICUs). This study describes the prevalence, characteristics of, and associated risk factors for ICU-acquired pressure injuries in Norway. A secondary analysis of the Norwegian data from the international one-day prevalence study, DecubICUs, conducted on 15 May 2018. Data on pressure injuries, patient characteristics, and exposure to potential risk factors were analyzed. Prevalence was calculated based on the presence of one or more ICU-acquired pressure injuries on the study day. This multicenter cross-sectional study included 119 patients from 25 Norwegian ICUs. The prevalence of ICU-acquired pressure injury was 24% (28/119). These 28 patients had 52 ICU-acquired pressure injuries. Of these, the majority were stage I (71%), followed by stage II (27%), and one was categorized as suspected deep tissue injury (2%). The most common locations were the heels (23%), buttocks (23%), ears (17%), nose (12%) and mouth (10%). The risk factor associated with ICU-acquired pressure injuries was LOS-ICU (OR = 1.06/day increase, 95% CI: 1.02-1.11, p = < 0.001). The prevalence of ICU-acquired pressure injury was surprisingly high considering Norway is a high-income country, with a high nurse-to-patient ratio and well-educated critical care nurses. These findings highlight the need for continued focus on early prevention strategies, such as thorough skin assessments, "floating heels" and repositioning of medical devices. This subgroup analysis for Norwegian cases reported in a point-prevalence study presents intensive care unit patients with pressure injuries along with selected case factors. Pressure injuries are complications that appear to remain an intensive care unit challenge, even in units with high nurse to patient ratios.
Nurses are central to palliative care, yet their community contributions remain undervalued. This study aimed to clarify how political and professional documents conceptualize nursing autonomy in community palliative care. Using the READ (Reading materials, Extracting data, Analyzing data, Distilling findings) methodology, a comparative documentary analysis was conducted in the Netherlands, Portugal, Spain, and the United Kingdom. Sixty-eight strategic documents, identified through systematic searches and expert consultation, underwent targeted qualitative content analysis, combining deductive coding with inductive theme generation. Results reveal a multilevel framework of professional representation: (1) micro-level interventions; (2) meso-level contextual determinants; and (3) macro-level systemic dimensions. A critical tension exists between technical visibility and formal authority. In Portugal and Spain, robust taxonomic infrastructures provide high clinical visibility, yet legal frameworks prioritize "system breadth" over specialized nursing roles. The UK and the Netherlands emphasize "vertical career trajectories," where specialty recognition and advanced education act as levers for clinical agency and nurse-led care. While all country policies prioritize home-based care, differences in how they improve autonomy may influence workforce sustainability and professional migration. These findings suggest that failing to formalize-specialized roles creates "gray zones" of responsibility. Strengthening the structural conditions that support nursing autonomy, including clear role recognition and aligned policy mechanisms, is essential for ensuring timely access to care and the long-term viability of community-based models. This study provides a roadmap for policymakers to reconcile professional agency with the universal right to high-quality care at the end-of-life.
Nurse talent management is critical for workforce stability amid shortages and burnout. Scientifically assessing nurses' perceptions of talent management strategies is significant for optimizing human resource management and enhancing retention. This study translated the Nurse Perceived Talent Management Scale (NPTMS) into Chinese and evaluated the psychometric properties of the Chinese version (NPTMS-C) among clinical nurses from tertiary hospitals in Liaoning Province, China. A convenience sample of clinical nurses was recruited from 12 tertiary hospitals. The 26-item NPTMS-C was evaluated through item analysis (normality testing, critical ratio, CITC), structural validity (EFA with promax rotation and CFA), convergent validity (AVE and CR), criterion-related validity (POSS as criterion), reliability (Cronbach's α, McDonald's ω, split-half, test-retest ICC), and measurement invariance (MG-CFA across gender). Item analysis retained all 26 items (critical ratio: 27.487-63.484, P < 0.001; CITC: 0.512-0.792). EFA yielded KMO = 0.989, Bartlett's χ² = 15009.908 (P < 0.001), factor loadings = 0.610-0.893, explaining 55.480% of variance. CFA showed good fit: χ²/df = 1.300, RMSEA = 0.020, CFI = 0.993, TLI = 0.992, GFI = 0.966, NFI = 0.967, IFI = 0.970. Convergent validity: AVE = 0.500, CR = 0.954. Criterion correlation (NPTMS-C vs. POSS) = 0.631 (P < 0.001). Reliability: Cronbach's α = 0.956, ω = 0.955, split-half = 0.902, test-retest ICC = 0.887. MG-CFA supported configural, metric, scalar, and strict invariance across gender, though caution is warranted due to sample gender imbalance. The NPTMS-C demonstrates sound item quality, stable factor structure, and good reliability and validity among tertiary hospital nurses in Liaoning. It is a culturally adapted, scientifically rigorous tool suitable for nursing human resource management research and practice in similar Chinese clinical settings. Future studies with probability-based sampling across diverse regions and hospital levels are needed to confirm broader generalizability. Not applicable.