搜索结果：International journal of nursing studies advances

Deficiencies in contraceptive knowledge among healthcare professionals persist worldwide, while existing assessment tools lack rigorous psychometric validation and standardized interpretation. Given nurses' central role in contraceptive counseling, a robust, profession-specific instrument is needed to accurately identify knowledge gaps and guide targeted training to improve clinical practice. To develop and psychometrically validate the Contraception Nursing Knowledge Questionnaire (CNKQ-15) in order to provide a standardized tool for assessing contraceptive knowledge and identifying training needs among nursing professionals. A methodological study conducted in two phases: qualitative instrument development and cross-sectional psychometric evaluation. A nationwide study conducted in Spain between February and April 2025. Data collection was distributed digitally through the General Council of Nursing and provincial official nursing colleges. A total of 1123 actively practicing nursing professionals (including generalist nurses and specialized nurses). Content validity was assessed by a multidisciplinary expert panel using Aiken's V index. Psychometric evaluation included item difficulty and discrimination analysis, known-groups discriminant validity (comparing specialists in Obstetrics and Gynecology with non-specialized nurses), and test-retest reliability evaluated in a subsample of 100 participants over a 14-day interval. Standardized cut-off points were also established. The final sample included 1123 nursing professionals, predominantly women (90.5%), with a mean age of 38.3 years (SD = 10.3). Most participants reported no specialization (58.2%), while 23.5% specialized in Obstetrics and Gynecology. The CNKQ-15 showed adequate item difficulty indices (0.30-0.94) and demonstrated strong discriminant validity, effectively distinguishing between professionals specialized in Obstetrics and Gynecology and those without specialization (mean scores 12.7 vs. 9.9; p < 0.001). Test-retest reliability was excellent, with an intraclass correlation coefficient of 0.85 (95% CI [0.77-0.91]). According to the established cut-off points, 48.3% of participants exhibited null or insufficient knowledge of contraception, 30.1% achieved only a minimal level, and fewer than one in five demonstrated good or very good knowledge. This proportion of inadequate knowledge increased to 59.3% among nurses without specialization in Obstetrics and Gynecology. The CNKQ-15 shows adequate content validity, discriminant validity, and reliability. Its standardization allows the accurate identification of knowledge gaps among nursing professionals, including midwives, and offers a practical tool for evaluating contraceptive training and guiding targeted educational interventions. The newly validated CNKQ-15 robustly assesses contraceptive knowledge in nurses and midwives, identifying critical gaps. @cris90due.

Approximately 10% of hospitalised patients experience adverse events. Older patients are particularly vulnerable to developing nursing-sensitive adverse events such as pneumonia, urinary tract infections, pressure ulcers and delirium. However, various predictors which further increase their risk of acquiring such adverse events are not well understood. To identify factors associated with nursing-sensitive adverse events in patients aged 65 and over in one acute Irish hospital and to determine the relationship between a nursing-sensitive adverse event, a patient's discharge destination and in-hospital mortality. A retrospective study using healthcare chart data. A cohort of 1000 admissions of inpatients aged 65 and over who were discharged from a single university, tertiary hospital in Ireland in 2022 were included. A two-stage retrospective chart review was conducted on each of the 1000 admissions to extract data pertaining to their hospitalisation and to identify the presence of pneumonia, urinary tract infections, pressure ulcers and delirium. Univariate analysis was used to screen 13 collected variables to identify those with significant relationships with the nursing-sensitive adverse events. Variables with a p value of <0.25 were included in the multivariate analysis which was used to identify significant risk factors for any nursing-sensitive adverse event and each of the studied events in isolation. A statistically significant association between medical speciality, an increase in age, length of stay, female sex, the number of diagnoses and procedures and a patient's admission situation and the nursing-sensitive adverse events investigated in this study was identified. Furthermore, time from first presentation to admission and number of ward moves were also associated with nursing-sensitive adverse events but yielded some contradictory findings. A significant association between in-hospital mortality and pressure ulcers was also identified. Patients who experienced nursing-sensitive adverse events were more likely to be discharged with home care packages or to be discharged to nursing homes, other hospitals, rehabilitation facilities or destinations within the 'other' category than be discharged home independently. This study offers valuable insights for the prevention of nursing-sensitive adverse events. Investment in strategies that are focused on medical patients, older patients, patients with multiple co-morbidities and those with longer lengths of stay is required to reduce nursing-sensitive adverse events. Further exploration of the association between waiting times from presentation to admission and ward moves and nursing-sensitive adverse events given that these factors may be potentially impacted by key nursing-modifiable interventions.

There is a large and increasing shortage of nursing staff. To alleviate this problem, healthcare systems should prioritize healthcare interventions that improve nurse retention over healthcare interventions that reduce it or leave it unchanged. One way to do so is to evaluate interventions on their anticipated impact on nurse intention-to-stay, which is an important precursor of retention. An overview of available instruments to quantify nurse intention-to-stay is lacking, resulting in researchers re-inventing the wheel. This review aims to fill this gap. A systematic literature search was performed in the databases Medline ALL via Ovid, Embase.com, Web of Science Core Collection, CINAHL Plus, PsycINFO, the Cochrane Central Register of Controlled Trials via Wiley, and Google Scholar (200 highest-ranked references only). The search string consisted of terms and associated synonyms for 1) nursing staff, 2) personnel intent to stay/leave, and 3) surveys. Articles were included when there was a quantitative method mentioned for measuring the intention of nurses to stay or quit nursing and/or their job/position/organization. Information was extracted on the year of publication, study design, study population, number of participants, instrument used for measuring intention-to-stay, and whether the instrument was focused on leaving the job, organization, or profession. In addition, we checked whether the instrument was used to evaluate the (expected or realized) impact of an intervention and if an association was determined between intention-to-stay (measured through the instrument) and retention. The protocol was not registered. 967 articles fulfilled our inclusion criteria, most of which were published in recent years. A total of 485 instruments were found. Nine regularly used instruments were identified, differing in their respective popularity over time, their size, the population for which they were developed and the strength of their link to actual retention. Notably, compared with the large body of literature on nurse intention-to-stay generally, the number of studies specifically measuring the impact of an intervention on nurse intention-to-stay is limited (n=20). Most of these intervention studies focused on changes in nurse training/mentorship or mental health support. Many different instruments exist to measure nurses' intention-to-stay. To add to our identified instruments, a comparative study is needed to identify which instrument offers the strongest predictive value for nurse retention. The absence of studies specifically evaluating the impact of interventions on nurses' intention-to-stay creates a critical gap in understanding how health interventions influence retention. Dutch Research Council, 406.XS.04.151.

With millions of suicide attempts occurring worldwide each year, suicide prevention is crucial. Brief intervention and contact, particularly a safety plan, provided in health care settings is effective in reducing suicide risk. However, little is known about the training of professionals in safety plan implementation and the impact of this training. To describe the characteristics and impact of safety plan training for nurses and other health care professionals in health care settings. Systematic review. The Medline, Embase, CINAHL, PsycInfo, Cochrane Library and ScienceDirect databases were systematically searched in October 2025 for including studies published since 2008.Two authors independently screened titles and abstracts, then assessed full texts for eligibility and extracted data. Disagreements were resolved through discussion with a third author. The Joanna Briggs Institute critical appraisal tools were used to assess the quality of the included studies. PRISMA recommendations were followed for this reporting. Among the 484 identified studies, four observational studies were included. Three studies were conducted in the United States and one in Argentina. They involved 666 participants including medical students, nurses, qualified health care professionals, and social workers.In three studies, training durations ranged from 2 and to 3 hours. In all studies, the training was conducted in person and combined theoretical inputs, practical safety planning recommendations and role plays.Knowledge assessed in one study seemed to improve immediately after training (mean: 3.45 (standard deviation (SD): 2.35) vs.: 5.98 (SD: 2.92), p < 0.0001) but declined at 6 months (5.98 (SD: 2.92) vs. 4.08 (SD: 2.77), p < 0.001).An improvement was observed immediately following the training or at 6 month in attitudes (two studies), behavioral change variables (three studies), and related factors including attitudes (three studies), perceived behavioral control (three studies), intention (two studies), emotions (one study), and behavior (two studies) and emotions (one study).Participants' satisfaction evaluated in two studies was positive in relation to the perceived usefulness of the training. Safety plan training programs have been described in few studies. The evaluation criteria varied. Studies findings suggested a positive impact of training, but attention should be given to a potential decrease in knowledge 6 months after training.

Background: Therapeutic education encompasses cognitive, psychomotor, emotional, and educational components, and is considered a fundamental tool in the management of chronic respiratory diseases. Its implementation during hospitalisation has been shown to have a positive impact on inhalation technique, patients' perceived sense of control, and the reduction of inappropriate use of healthcare resources. However, health interventions involving therapeutic education are mainly integrated within primary care, with hospital-based activity often limited to episodes of exacerbation or acute illness. Objective: The aim of this study was to synthesise the evidence on the effectiveness of educational interventions delivered during the hospital stay of adult patients with chronic respiratory disease. Methods: A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, using the GRADE methodology to assess the quality of evidence for each outcome analysed, as well as the Revised Cochrane risk-of-bias tool for randomised trials to evaluate the methodological quality and risk of bias. Results: Eleven studies, comprising a total of 1,925 participants, were included. Interventions encompassed educational programmes, motivational interviews, physical training plans, specific inhalation technique training, video interventions, and mobile apps for self-management. Thirteen clinical and patient-reported outcomes were analysed, with contradictory findings; consistently positive effects were observed only for quality of life. According to the GRADE methodology, all outcomes were supported by low or very low quality of evidence due to methodological limitations of the included studies, including risk of bias related to lack of blinding in educational interventions, small sample sizes, heterogeneity in intervention design and outcome measurement, and imprecision of effect estimates. Conclusion: Educational interventions conducted during hospitalisation for patients with chronic respiratory disease are limited and demonstrate a low or very low quality of evidence for all evaluated outcomes. It is imperative to design research studies that minimise the risks of bias and identify activities that can improve outcomes. Registration: PROSPERO identifier number CRD42022358094; https://www.crd.york.ac.uk/ registered 19/09/2022.

Fundamental care-encompassing relational, psychosocial, and physical needs as outlined in the Fundamentals of Care Framework-is a multifaceted yet essential component of nurses' scope of practice. Despite its significance, fundamental care remains underrepresented in research within home-based care. Consequently, limited knowledge exists regarding how nurses address older people's fundamental care needs, the practical applicability of the Framework, and the influence of contextual modulators. To explore nurses' scope of practice, fundamental care, and contextual modulators in relation to older people with complex health care needs in home-based care. Exploratory design. Four home-care sites in Western Sweden. Structured direct observations were conducted using a protocol informed by the Fundamentals of Care Framework and concepts relevant to nurses' scope of practice. Quantitative data were analysed using descriptive statistics and contextualised by qualitative field notes. A total of 3042 care activities were recorded across 230 observations involving 46 nurses (registered and non-registered). On average, participants performed 13.23 activities per observation, often addressing multiple dimensions of the Fundamentals of Care Framework. Physical needs typically served as the entry point for care, which frequently expanded to include relational and psychosocial aspects. Registered nurses' involvement in clinical decision-making-structured around the five phases of the nursing process-was primarily concentrated on assessment and implementation. Non-registered nurses also engaged in decision-making and independently initiated activities. Nurses' scope of practice appeared to be related to several contextual modulators, including interruptions and a lack of supportive work environments. We are among the first to explore nurses' scope of practice in home-based care using the Fundamentals of Care Framework as a conceptual foundation. We have underscored the complexity and multifaceted nature of nurses' scope of practice, including clinical decision-making, the activities' functional and performance levels, and the presence of contextual modulators. Task-shifting from registered nurses to non-registered nurses was evident in clinical decision-making. We suggest that future Models of Care grounded in the Framework and tailored to the specific contextual conditions of home-based care may support nurses in delivering high-quality fundamental care.

Diabetic foot ulcers are a chronic complications of diabetes associated with substantial morbidity, amputation risk, and reduced quality of life. Promoting the patients' capacity for independent wound care is a key component of long-term management. Although health promotion and supportive-educative nursing approaches are widely advocated in nursing, empirically informed models specifically addressing independent wound care in diabetic foot ulcer patients remain limited, particularly in low-income and middle-income countries. To develop a supportive-educative nursing model based on health promotion for independent wound care in patients with diabetic foot ulcers. A cross-sectional study was conducted during the model development phases. Twenty-two community health centers in Bandar Lampung, Indonesia. A total of 130 patients with grade 1-2 diabetic foot ulcers were recruited using purposive sampling, based on predefined inclusion and exclusion criteria. This study represents the development phase of this model. Quantitative data were collected using validated questionnaires assessing individual factors, support and facilities factors, nursing factors, supportive-educative nursing, patient commitment, and independent wound care behaviors. Structural equation modeling using partial least squares was applied to examine associations among constructs and inform model development. Individual (&#x3b2; = 0.399, p = 0.002), support and facilities (&#x3b2; = 0.227, p = 0.022), and nurse (&#x3b2; = 0.296, p < 0.001) factors were significantly associated with supportive-educative nursing. Supportive-educative nursing was strongly associated with patient commitment (&#x3b2; = 0.724, p < 0.001), which in turn was associated with independent wound care behaviors (&#x3b2; = 0.486, p < 0.001). Direct associations between support and facilities and nurse factors and independent wound care were not significant, consistent with an indirect pathway through supportive-educative nursing and patient commitment. This study proposes a health promotion-based supportive-educative nursing model in which patient commitment functions as a key mediating pathway linking nursing support to independent wound care. These findings provide an empirically informed framework to guide nursing practice and support future longitudinal and interventional research. The Health Research Ethics Committee of Universitas Airlangga (Ref. No. 3664-KEPK), Investment and One-Stop Integrated Services Agency (Reference number 1871/070/06354/SKP/III.16/II/2025), and Bandar Lampung City Health Agency (Reference number B/400.7.22/III.02.V/02/2025).

The demand for home-based palliative care is increasing, driven by ageing populations and a rise in multiple long-term conditions. Community health nurses are pivotal to enabling people to be cared for and die at home, yet their contributions to palliative and end-of-life care remain under-recognised and poorly understood. Previous international reviews have focused on specific themes but in-depth synthesis of evidence from one national health system has not been undertaken. This scoping review aimed to identify, map and synthesise evidence within a single national health system on the community health nursing workforce in palliative and end-of-life care provision for adults living at home (including their role and responsibilities, and identifying challenges and potential solutions). This scoping review followed the Joanna Briggs Institute methodology and the PRISMA-Scoping Review checklist statement. We systematically searched thirteen electronic databases and grey literature sources, from 2009 to 2025. UK-evidence reporting on community health nurses' provision of palliative and end-of-life care to adults living at home was included. Data were charted using a structured data extraction form and grouped thematically to understand the nature of their roles and responsibilities, the challenges faced in providing such care, and potential solutions to mitigate these challenges. A total of 250 items/reports reflecting 239 included items/reports (11 merged as same project) were included. The main challenges community health nurses are facing in palliative and end-of-life care provision are driven by the rising demand and increasing complexity of the needs of persons dying at home. This requires rapid role evolvement, expertise, and effective integration with multiple providers and services, and impacts on staff wellbeing and morale. To mitigate these challenges, requires recognition of and training to support their rapidly evolving roles in palliative and end-of-life care and to meet the increasingly complex needs of persons dying at home and their families. There is limited understanding of safe caseloads and data to demonstrate the extent of palliative and end-of-life care provided by community health nurses. Community health nurses are essential to the delivery of palliative and end-of-life care at home. Addressing workforce capacity, role clarity, and training gaps is critical to meeting future demand and ensuring equitable, high-quality care. This review highlights the urgent need for these challenges in community health nursing to be addressed to support sustainable palliative and end-of-life care delivery.

The Gulf Cooperation Council countries are experiencing a significant nursing workforce shortage, compounded by rapid population growth, a rising burden of chronic diseases, and heavy dependence on expatriate nurses. With the World Health Organization forecasting a global shortfall of 4.5 million nurses by 2030, this review aims to systematically explore the key factors contributing to nursing workforce shortages in the Gulf Cooperation Council region and offer evidence-based recommendations for improving retention. A systematic review was conducted in accordance with PRISMA guidelines. A comprehensive literature search was performed across PubMed, Embase, Web of Science, and Scopus databases to identify relevant primary research published in English up to January 2025. Studies focused on nursing workforce issues in Gulf Cooperation Council countries were included. A total of eight eligible studies were critically appraised using the Newcastle-Ottawa Scale and the Critical Appraisal Skills tool. The findings highlight a complex interplay of factors influencing nurse shortages in the Gulf Cooperation. A poor work environment, lack of interprofessional collaboration, and inadequate leadership support were strongly associated with high turnover intention. Excessive workloads, reported by 59.4% of nurses, and emotional exhaustion, affecting over 60%, were key stressors. Additional barriers included cultural challenges, limited access to professional development, and weak organizational support systems. Leadership was identified as the most influential factor negatively correlated with nurse retention. Addressing the nursing workforce crisis in the Gulf Cooperation Council requires multifaceted interventions. Priority areas include leadership development, structured career pathways, and improved cultural integration efforts. Further longitudinal and regionally inclusive research is recommended.

Ageing is a multifactorial and progressive process that leads to a gradual decline in mental and physical function, directly impacting the ability to perform daily living activities and health-related quality of life. Thus, it is essential to develop strategies that prioritize the maintenance of the functional capacity and the enhancement of the quality of life and well-being of older adults. This scoping review intends to map the rehabilitation programs, used by rehabilitation nurses, for promoting mobility and self-care, among older adults, to identify the main health gains resulting from the rehabilitation programs implemented. This scoping review follows the JBI methodology and the results obtained are described according to the PRISMA-ScR guidelines, and was registered in the OSF (osf.io/zqkp3/). The electronic databases CINAHL Complete; Complete MEDLINE; Cochrane Central Register of Controlled Trials; Web of Science, Scopus, and Google Scholar, were searched in March 2025, for papers published in the last 10 years. Two researchers independently analyzed the papers for eligibility and extracted the data. Data on health gains whose association with the intervention was described were collected and synthetized, through narrative synthesis. The initial search yielded a total of 15,347 records, and after screening, 12 papers were included. The evaluation of the methodological quality and levels of evidence of the studies, according to the JBI Critical Appraisal Tool, concluded that the average quality score of the studies ranged from 67% to 100%. The results revealed a variety of interventions implemented, targeting different aspects of rehabilitation, with a wide range in the duration (15 to 60 min) and frequency of sessions (three to 56), as well as the use of diverse instruments to assess the effectiveness of the interventions. The health gains associated with the musculoskeletal system were reported most frequently, followed by those related to neurocognitive enhancements. Respiratory and renal gains were only reported by one study each. This scoping review reinforces the evolving vision of nursing rehabilitation as a cornerstone of comprehensive healthcare, demonstrating its significant impact on enhancing health gains at several physiologic systems among older adults. Adopting a multiple physiological system-based framework for the analysis and implementation of these interventions may enhance the precision, accountability, and efficacy of care. Such poses nursing rehabilitation as an essential strategy in the continuum of care, advocating for its integration into healthcare systems and policies to support the health and sustainable recovery of the older population.

There are limited studies directly exploring transition to the UK based specialist community public health nurse-health visitor role. This contrasts with abundant evidence exploring transition to a newly qualified nurse which is recognised as difficult and influencing retention to the nursing profession. However, transition to the health visitor role differs fundamentally to transition to the newly qualified nurse as it involves moving from a role where individuals are typically already highly skilled and autonomous practitioners, into a new professional role. To develop a substantive theory of the transition to the health visitor role, to support future aspirant health visitors and their educators. Using constructivist grounded theory, this longitudinal study provides an in-depth understanding of this important transition. It incorporates focus group and interview methods over a series of data collection points, throughout the period of the health visitor course and at 6 months post-completion, with eighteen student/newly qualified health visitors based in a UK university. This demanding and multifaceted transition is influenced by a range of factors, including role identity, community of practice, individual resilience and the support provided by the wider health visitor team. Data analysis led to the development of a substantive theory incorporating the three core categories of Role Identity, Way of Working and Living the Journey which are illustrated through a conceptual model, providing a visual framework to support this complex transition process. This research provides a rich evidence-base for the multifaceted and challenging transition to the health visitor role. The greater understanding provided will support future health visitor students, educators and workforce development, potentially enhancing future retention. The findings resonate with similar role transitions, especially those involving a move from expert to novice, extending the relevance outside of the health visitor profession. Future research should include further evaluation of the substantive theory and model with further participants including a wider range of healthcare professional roles, exploration of managing multiple role identities and heightened definition of the health visitor role.

The nursing shortage is influenced by an often-reported transition shock among newly graduated nurses, and transition programmes may support both retention and improve the quality of nursing care. To measure patients' and nursing staffs' perceptions of missed nursing care in study wards following a two-year transition programme for newly graduated nurses compared to wards following a standard transition program. A comparative cross-sectional survey design was used. Three medical inpatient wards with a two-year transition program and three comparable medical inpatient wards with a standard transition programme. Data collection started March 3rd 2025. Based on a power calculation, 206 hospitalised patients, comprising 103 from the study wards and 103 from the standard wards, were included. 239 nursing staffs was invited to participate; of these, 159 responded to the survey. The validated MISSCARE Survey-Patient and MISSCARE Survey were used to collect data from patients and nursing staff. The responses were dichotomised and compared using the Chi-squared test. The sum scores were compared using the Wilcoxon Rank Sum test or the Student's t-test. The study was not registered. Patients in wards with a two-year transition programme reported less missed psychosocial care (p=0.03), particularly for involvement in decisions (p=0.02), receiving needed information (p=0.03), and being treated with dignity (p=0.05), but they reported with more missed care related to help with walking (p=0.03).Nursing staff in study wards reported less missed nursing care for patient teaching (p=0.01), complete documentation (p=0.04), and timely medication administration (p= 0.05), but more missed care in responding to call lights within 5 minutes (p=0.01). They also rated urgent patient situations (p=0.02,) lack of team backup (p=0.03) and insufficient assistive personnel (p<0.001) as less important reasons for missed care than staff in standard wards. The results indicate that a longer and more comprehensive transition programme may contribute to improved psychosocial care and a supportive clinical environment, potentially at the expense of assistance with ambulation or call-light response times. Further research on patient outcomes is needed.

The SELF-program is an interactive, tailored and theory-based training program that aims to improve nurses' activity encouragement behavior and indirectly to optimize nursing home residents' self-reliance in activities of daily living. The aim of this process-evaluation study was to evaluate the implementation, mechanisms of impact and contextual factors influencing the implementation and outcomes of the SELF-program. A process-evaluation with a mixed-methods design was conducted alongside a two-arm (SELF-program vs. care as usual) cluster randomized trial of nine months, examining the effectiveness of the program in Dutch nursing home care. Nurses from various qualification levels - registered and non-registered - were eligible to participate. Guided by the Medical Research Council framework, data on implementation parameters, mechanisms of impact and contextual factors were collected using checklists, evaluation forms, (attendance) logbooks, questionnaires and focus-group interviews among nurses and trainers. Quantitative data was analysed using mixed linear regression analyses, qualitative data using a deductive coding approach. Twenty-eight nursing home wards - fourteen in each condition - from three care organizations across the Netherlands were included in the trial. Nurses were highly satisfied with the program and particularly valued its interactive content and team approach. The program was implemented with high fidelity, with 90% of all sessions completed and attendance rates averaging 60%. Attendance varied between organizations and declined over time. Improvements were observed in nurses' attitudes, perceived social influence, self-efficacy beliefs and intentions towards performing activity encouragement behavior, of which most were statistically significant, corresponding with small to medium effect sizes. These results were endorsed by data derived from focus-group interviews with trainers and nurses. Still, time constraints, staffing shortages and lack of motivation were put forwards as factors leading some nurses to still take over tasks. The presence of organizational policy regarding activity encouragement behavior, family member support, motivation of nurses, involving other disciplines and the interactive approach facilitated program implementation and outcomes. Contextual barriers to program implementation and outcomes included staffing shortages, low program attendance, time constraints, lack of manager support, and delivery of the program during the COVID-19 pandemic. Overall, the SELF-program was well received and implemented, with favourable improvements in mechanisms known to impact nurses' activity encouragement behavior. The program and its implementation could benefit from minor adjustments, as well as an improved attendance. Considering the results of this thorough process-evaluation as well as the positive results of the program on nurses' activity encouragement behavior, a widespread implementation is recommended.

Switzerland faces challenges in long-term care due to its high life expectancy and the resulting increased prevalence of non-communicable diseases and functional dependence among older adults. Nursing homes are addressing increasingly complex acute care needs amid healthcare professional shortages. The nurse practitioner role has emerged globally as a key strategy to enhance the accessibility, quality, and coordination of care in these settings. While the role was recently legislated in the canton of Vaud, there's a scarcity of solid scientific data on nurse practitioner implementation and impact in Switzerland. The aim of this study is to assess the implementation of the nurse practitioner role in nursing homes in order to develop a toolkit that supports the sustainability of this new role's deployment in Switzerland. This two-phase study will evaluate the implementation of the nurse practitioner role in two distinct nursing homes in the canton of Vaud, using the PEPPA Plus model (based on Donabedian's framework) as a guide. Phase 1 employs an embedded mixed-method case study design across three work packages (WPs). WP1 uses Rapid Ethnography (observations, interviews, document analysis) to assess structural elements influencing implementation before and one year after nurse practitioner deployment. WP2 uses a prospective descriptive quantitative design where NPs log their activities per act daily or five consecutive days each month over the course of one year. WP3 uses a longitudinal multi-method approach, combining a pre-post quasi-experimental quantitative component to measure resident, staff, and institutional outcomes (e.g., hospitalizations, pressure sores) at 3, 6, and 12 months, with qualitative interviews. Phase 2 (WP4) will use Thoele's three-step methodology-data preparation, focus group evaluation, and toolkit design-to develop a best practices toolkit to support the nurse practitioner role's sustainability based on Phase 1 results. For Phase 1 analysis, data from each nursing home will be analyzed separately (intra-case analysis) and then compared (inter-case analysis). Qualitative data (interviews) will be analyzed using thematic content analysis and triangulated with quantitative data for a comprehensive understanding. Quantitative outcomes will be analyzed using descriptive statistics and generalized linear models (e.g., Poisson regression) for pre-post comparisons over two six-month periods. All procedures will comply with the ethical principles outlined in the Declaration of Helsinki. Given the nature of the study, ethical approval from the Ethics Commission of the Canton of Vaud was not required, according to the latter. Data and material will be available on request from the authors. 10.17605/OSF.IO/7FX8M.

Artificial intelligence (AI) is playing an increasingly important role in nursing care, including wound management. Differentiating pressure injuries from incontinence-associated dermatitis is clinically challenging, often leading to misclassification. Although AI-based wound assessment is advancing, few models specifically address incontinence-associated dermatitis, and clinical evidence remains limited. The KIADEKU project developed and piloted a transformer-based AI app to support care for these wounds. The aim of this pilot intervention study was to assess the impact of the AI-based app on duration of wound assessment, dressing changes, documentation, nursing staff task load, and guideline adherence. Secondary aims included evaluating the AI's accuracy and app usability compared to standard systems. This monocentric, non-randomized controlled study was conducted in two sequential phases: a control phase with conventional wound management, followed by an intervention phase utilizing the AI-based app. The study included 88 voluntary nurses caring for pressure injuries and incontinence-associated dermatitis in adult patients on seven participating wards of LMU Hospital. Wound care was systematically observed, and nurses completed questionnaires on task load, usability, and covariates. Outcomes were measured using standardized protocols, validated tools (NASA Task Load Index (NASA-TLX), Usability Metric for User Experience (UMUX-LITE)) and expert-defined indicators. Statistical analyses included descriptive statistics, group comparisons (t-test, Mann-Whitney U test), and multivariate linear regression adjusting for covariates. An independent wound assessment validated AI-generated predictions, with accuracy evaluated using F1-scores. A total of 88 wound care sessions were analysed. The intervention group had a statistically significantly longer mean duration of care and documentation (12.84 vs. 9.20 min; p = 0.002; 95 % CI: -5.59; -1.41 min) and higher guideline adherence (mean rank = 50.91 vs. 38.38; p = 0.017). Nurse task load showed no statistically significant group differences. Regression analysis identified AI app use, nurse qualification, and wound severity as statistically significant predictors of care duration, while AI use did not predict task load or guideline adherence. Usability ratings were similar to standard systems. Model performance showed high accuracy in identifying wound types, but lower accuracy in classifying their categories. This pilot study is the first to evaluate an AI-based app supporting nursing wound management for pressure injuries and incontinence-associated dermatitis. While the app did not reduce care duration or nurse workload, it may have potential to improve guideline adherence. Limitations included limited user experience and sample bias. Future multicentre studies with larger samples and randomized trials are needed to validate findings and support clinical integration. www.drks.de DRKS00031355. Registered 05/04/2023, first recruitment 31/05/2023.

The use of accurate and targeted measurement instruments is critical for better understanding and supporting participation in advance care planning. However, it remains unclear which instruments are available and if they are psychometrically sound. To systematically review existing measurement instruments within the framework of advance care planning and to evaluate their psychometric properties. Systematic review of measurement instruments. A literature search was conducted in five databases (CINAHL, PsycInfo, PubMed, Scopus, and Web of Science), from inception to January 2025. Studies aiming to develop, validate, or adapt a measurement instrument in advance care planning were included. The psychometric properties of reported instruments were thoroughly appraised using a consistent set of criteria, and those demonstrating the most robust properties for each population were highlighted. A total of 50 studies and 27 instruments were identified. Of these instruments, 14 (51.9 %) were designed for care recipients, 13 (48.1 %) for healthcare professionals, 4 (14.8 %) for caregivers, and 1 (3.7 %) for the general population. Notably, 5 instruments (18.5 %) were designed for use across multiple target populations. The instruments primarily assessed attitudes, readiness, and knowledge. Internal consistency was the most frequently examined psychometric property and generally demonstrated acceptable values. However, many studies did not assess dimensional structure, and among those that did, the results were often unsatisfactory. The Advance Care Planning Engagement Survey and the Advance Care Planning Self-Efficacy Scale emerged as the most promising instruments for assessing, respectively, care recipients' engagement in advance care planning and healthcare professionals' self-efficacy in implementing advance care planning. This review provides a comprehensive reference for selecting psychometrically sound instruments suited to specific populations, measurement aspects, and health contexts. It highlights key gaps in the assessment of advance care planning, including the lack of tools for caregivers and the general population, limited cross-cultural validation, and insufficient psychometric support. By identifying these shortcomings, the review lays the groundwork for future research aiming at enhancing the evaluation and implementation of advance care planning practices. Not registered.

Managing stress is crucial for the success and well-being of undergraduate nursing students, yet little is known about how interpersonal relationships influence their stress levels. This study explores the impact of parent and peer attachments on stress, focusing on the mediating role of self-esteem. Understanding these dynamics can help educators and counselors develop targeted strategies to support students' mental health and academic performance. A cross-sectional survey was conducted from August to November 2023 at three medical institutions in Ho Chi Minh City, Vietnam. Using a structured self-reported questionnaire, we collected data from 612 nursing students on sociodemographic characteristics, attachments to parents and peers (Inventory of Parent and Peer Attachment), self-esteem (Rosenberg Self-Esteem Scale), and stress levels (Student Nurse Stress Index). Descriptive statistics, correlation analyses, and mediation modeling were employed to examine relationships between these factors. Pearson's correlation analyses showed significant associations between parental attachment, peer attachment, self-esteem, and stress, with stress negatively correlated with parental attachment (r = -0.42, p < 0.001), peer attachment (r = -0.38, p < 0.001), and self-esteem (r = -0.56, p < 0.001). Mediation analysis indicated that self-esteem fully mediated the relationship between parental attachment and stress (Sobel test: Z = -2.36, p < 0.05) and partially mediated the relationship between peer attachment and stress (Sobel test: Z = -3.41, p < 0.001). Counselors and school officials could promote parental attachment, peer attachment, and self-esteem in nursing students to reduce stress and improve students' psychological well-being during their training. Educators should also identify students with insecure attachments to parents or peers to provide timely and appropriate interventions.Fostering strong parent and peer attachments, along with promoting self-esteem, can serve as a protective factor against stress in nursing students. Educational institutions should implement interventions that enhance supportive relationships and self-worth among students. Identifying those with insecure attachments early on can enable timely psychological support, ultimately improving well-being and academic success in nursing education.

The concept of adult social care nursing is poorly articulated in the literature. This study explores and defines adult social care nursing by examining its antecedents, attributes, and consequences. By clarifying this concept, the research aims to enhance understanding among policymakers, educators, service providers, and the public, fostering greater recognition of social care nurses' roles, workplaces, and contributions. A qualitative hybrid concept analysis model was used. This approach combined theoretical examination with empirical inquiry to develop a comprehensive understanding of the concept. The study was structured in four phases: concept identification, literature review, empirical data collection, and integrative analysis. A comprehensive literature search was conducted using CINHAL, Medline, APA PsycInfo, Wiley Online, OVID, and The King's Fund library. Grey literature was explored through the Department of Health and Social Care's adult social care collection, expert consultation, and reference handpicking. Nineteen participants took part via four focus groups, two 2:1 interviews, and one 1:1 interview. Eighteen participants were registered nurses, and one participant was a registered social worker with experience of working with nurses. Using a hybrid concept analysis approach, the study progressed through multiple phases. A preliminary exploration (Phase 1) provided an initial conceptual framework, which was refined through a literature review (Phase 2). Empirical fieldwork (Phase 3) involved focus groups and interviews, thematic content analysis was utilised to identify key attributes, followed by integrative analysis to synthesise findings and refine the conceptual model. The study was not registered in a trial registry given it is a qualitative study. This study identified that adult social care nursing is present when people have a combination of health and social care needs that require registered nurses' care. Attributes include a career of choice, independent and autonomous nursing, with professional and business skill development including advanced practice. This supports social care nurses in their goal to be dynamic change agents who empower people to be active participants in their own care, with improved quality of life, being able to live well with their health needs in a social context. This paper proposes an initial definition of nursing within adult social care, which serves as a foundation for further discussion and development. It highlights nurses' vital role, diverse skill set, and equal partnership in the social care landscape, reinforcing their significant contributions to integrated, person-centred care across diverse settings. Defining adult social care nursing: A dynamic field where registered nurses manage complex needs, and drive person-centred, evidence-based care across diverse settings.

There is growing interest in online psychosocial interventions to address burden and self-efficacy among informal caregivers of people with dementia. However, their effectiveness remains unclear, especially given ongoing debates and limited evidence of online delivery modes. We aimed to synthesize evidence on these online psychosocial interventions, highlight the current state of research, and identify priorities for future studies. A systematic review with meta-analyses was conducted. We included randomized controlled trials comparing online psychosocial interventions to usual care or waitlist control for burden and self-efficacy. Six electronic databases were searched for studies published over the last two decades. Two reviewers evaluated eligibility, extracted data, and assessed risk of bias and quality of evidence. Patient and Public Involvement, as a means to contextualise the results in the lived experience of caregivers, was employed to aid interpretation of the findings. The review protocol was registered in PROSPERO (CRD42023392232). Nineteen articles involving 2,264 participants were included. Of these, 15 reported caregiver burden, seven reported self-efficacy, and three studies reported both outcomes. Most interventions were multi-component online psychosocial programs delivered via web-based platforms, mobile applications, or videoconferencing tools. They incorporated asynchronous, synchronous, or blended delivery modes and were delivered either individually or in groups. Core components of the psychosocial intervention included information provision and education, caregiving tasks support, and caregiver self-care. Meta-analysis of 13 studies showed no statistically-significant post-intervention effect on reducing burden (Standardized Mean Difference [SMD]: -0.06, 95 % Confidence Interval [CI]: -0.25, 0.12, p =0.50; I&#xb2; = 47 %), yet analysis of three studies indicated an effect on improving self-efficacy (SMD: 0.20, 95 % CI: 0.03, 0.37, p =0.02; I&#xb2; = 0 %). The evidence grade for both outcomes was low due to risk of bias, inconsistency, and imprecision of the results. We suggest that online psychosocial interventions have little to no short-term effect on caregiver burden but may enhance self-efficacy, though the evidence grade remains low. Online psychosocial interventions featured diversity in their design, content, and delivery characteristics. From the findings, we have identified key areas for development of future research within this field, with a particular focus on addressing methodological limitations and ensuring rigorous design. Sustained support incorporating interactive and real-time elements, tailored approaches, and the integration of lived experience throughout the research process should be considered to improve both the effectiveness and relevance of these interventions.