搜索结果：Journal of research in nursing : JRN

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

To examine the clinical activity and workforce contribution of Advanced Nurse Practitioners (ANPs) working in general practice. Primary care systems internationally are experiencing increasing demand due to ageing populations, rising multimorbidity and workforce shortages. Advanced nursing practice has expanded globally as a strategy to strengthen service capacity, improve access and maintain quality outcomes. Although there is substantial evidence regarding patient outcomes associated with advanced practice roles, there is comparatively limited empirical data describing the day-to-day clinical activity of ANPs in primary care settings. This national cross-sectional descriptive study, conducted in Ireland and reported in accordance with the STROBE Statement, involved a 1-week activity capture of General Practice Advanced Nurse Practitioners (GP ANPs) and candidate ANPs (cANPs) working across general practice settings. Data collected included consultation type, prescribing activity, complexity of care and clinical outcomes. Data were analysed using descriptive statistics. Twenty GP ANPs/candidate ANPs recorded 1659 consultations, including 757 full episodes of care (45.6%). Practice spanned acute illness (adults and children), chronic disease management, women's health and preventive services. Medication optimisation activity included 503 medication reviews, 251 prescriptions issued and 59 medications deprescribed. About 15% of consultations were classified as complex and 14.8% involved multiple presenting complaints. Most consultations were independently managed. GP ANPs demonstrate broad clinical capability and contribute substantially to general practice capacity. The findings highlight the value of a holistic nursing approach, which is well suited to chronic disease management, health promotion, patient education and the management of multimorbidity, supporting access to care and strengthening primary care workforce capacity.

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

This study explores Turkish emergency nurses' experiences with climate-related health issues. Guided by Nightingale's Environmental Theory, it highlights nurses' frontline roles in recognising and managing environmental factors that influence patient outcomes during climate-related crises, with implications for public health systems and nursing policy. This research is a qualitative descriptive study using reflexive thematic analysis. Data were collected from 23 emergency department nurses using purposive and snowball sampling methods. Semi-structured interviews were conducted using an interview guide developed in consultation with experts. Thematic analysis was carried out based on Braun and Clarke's reflexive approach. Most participants were women with 5&#x2009;years or more of emergency department experience. The majority reported no formal training on climate change. Three main themes were developed: (1) Defining the storm - nurses described climate change as a disruption of natural patterns, observing increases in heat-related illnesses, respiratory exacerbations and vector-borne diseases; (2) Navigating the storm - nurses managed crises through symptomatic care and self-acquired knowledge in the absence of formal protocols or training and (3) We are not in the same boat - nurses identified resource shortages, socio-economic disparities and infrastructural vulnerabilities that disproportionately affected low-income patients. Emergency nurses are increasingly confronted with climate-related health challenges, yet lack adequate training and institutional support. These findings underscore the need for national-level reforms in nursing curricula, institutional preparedness and public health policy to strengthen climate resilience in emergency healthcare.

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

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

Reflective practice is essential in nursing, yet its role in hyper acute settings remains underexplored. Stroke presents unique challenges, combining time critical interventions with sudden trauma and disruption to patients' lives. To examine how nursing knowledge and theory shape reflective practice in hyper acute stroke care. This paper adopts a conceptual and reflective approach, drawing on Carper and Chinn and Kramer's patterns of knowing, alongside Judith Herman's three-stage trauma theory. These frameworks are critically explored and applied to lived practice within a hyper acute stroke unit. The integration of multiple patterns of knowing demonstrates how nurses balance empirical urgency with ethical sensitivity, emotional awareness and person-centred care. Herman's theory offers additional insight into safety, identity disruption and recovery following a stroke, highlighting the psychological dimensions of care often constrained by time and environment. Theoretical knowledge and diverse ways of knowing are essential to safe, ethical and holistic stroke nursing. Reflective practice is shown to be an active, present process that informs judgement, relationships and care delivery within complex clinical settings.

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

There is limited evidence comparing differences in pain experienced during ventrogluteal (VG) muscular injections between the standing and lying-down positions. This study aims to compare pain and complications during VG injection (VGI) in standing versus lying positions in women. The study utilised a quasi-experimental design, a sample size (n&#x2009;=&#x2009;48), a crossover design and a 2-week interval between injections. The first VG intramuscular injection (IMI) site was administered according to the patient's preference for position. After the IMIs, the patients' pain and complication levels were assessed. Descriptive statistics and odds were used to evaluate the data. The level of significance was set at p&#x2009;<&#x2009;0.05. A paired design was used to compute the difference in visual analogue scale (VAS) scores in standing and lying positions. The difference between the mean pain in the standing position and lying position was -0.76 with CI&#x2009;=&#x2009;(-1.24, -0.27) and p-value&#x2009;=&#x2009;0.0012, indicating a significant pain decrease in the standing position with odds&#x2009;=&#x2009;3.67 and 95% CI (1.64, 8.25). The mean VAS scores (standing: 1.10; lying: 1.86) were obtained for the clinical context. This research suggests that the standing position may be a method for administering VGIs to reduce patient-perceived pain.

Hospital nurses frequently experience emotional and psychological strain that extends beyond ordinary workplace stress and cannot be fully explained by constructs such as burnout or compassion fatigue. This analysis seeks to conceptualise occupational distress as a system-originating phenomenon distinct from burnout. It intends to clarify the concept of occupational distress by identifying its defining attributes, antecedents and consequences. A concept analysis was conducted using Walker and Avant's eight-step approach. CINAHL, PubMed, PsycINFO and Scopus were searched for papers on occupational distress, burnout, moral distress, occupational stress and nurse wellbeing. Studies published between 1980 and 2025 were included if they explored occupational distress among hospital nurses, particularly in relation to workload, staffing and hospital systems. Studies outside healthcare settings or focused on psychiatric conditions unrelated to workplace stress were excluded. Eleven sources were identified and reviewed. Sustained emotional strain, perceived powerlessness, physical and psychological manifestations and systemic organisational aspects were identified as the four defining attributes. Antecedents clustered around structural conditions, leadership and governance factors, and cultural norms. Consequences emerged at individual, unit and system levels. Existing instruments capture related constructs but do not directly measure occupational distress. Clarifying this concept may help nurse leaders and researchers recognise occupational distress earlier, address organisational causes and design interventions to protect staff well-being and care quality. The absence of a dedicated measurement tool constitutes a critical gap and positions this analysis as a foundation for developing a nursing-specific instrument.

Increasing numbers of people are dying from liver disease, which often develops asymptomatically. A FibroScan is a portable, non-invasive device that measures liver stiffness via transient elastography to identify fibrosis associated with liver disease. A FibroScan can be used by nurses in outreach settings to make access easier for people from inclusion health populations at high risk of liver disease. However, there is limited research on individuals' perspectives of receiving a FibroScan in an outreach setting. This study explored the perspectives of individuals accessing outreach services to identify liver fibrosis and subsequent cirrhosis. A qualitative descriptive study was undertaken, utilising semi-structured interviews with people with Hepatitis C who received a FibroScan in an outreach setting (n&#x2009;=&#x2009;7). Interviews were transcribed verbatim and analysed thematically. Research Ethics Committee approval was gained. Overall, six themes were developed: historical experiences of healthcare, mental health and cognition, community integration, perceptions of the FibroScan, connection and health literacy and information seeking. The FibroScan was perceived as accessible and acceptable, provision by nurses through outreach settings facilitated access to wider healthcare. The findings will inform how health services plan future nurse-led outreach pathways for liver disease.

Adolescents with cancer experience substantial challenges that compromise quality of life (QoL). Evidence on QoL in conflict-affected settings, such as Palestine, remains extremely limited. To examine QoL among adolescents with cancer in Palestine and identify predictors to improved or compromised QoL. A cross-sectional study was conducted (March to May 2024) at a Palestinian tertiary paediatric oncology centre using consecutive sampling. QoL was assessed using a validated Arabic-translated scale (Cronbach's &#x3b1; = 0.88). Multiple linear regression identified predictors. This study was reported in accordance with STROBE guidelines. Among 145 participants (mean age 14.3 &#xb1; 1.4 years; 42.8% female), mean QoL was 103.1 &#xb1; 26.9, indicating a moderate level. Female gender was associated with lower QoL (B = -13.287, p = 0.002). Multimodal treatment was associated with higher QoL than chemotherapy alone (B = 36.111, p = 0.001), though this likely reflects clinical trajectory, not direct benefit. Female adolescents with cancer in Palestine report significantly lower QoL, whereas those receiving multimodal treatment report higher QoL, though this likely reflects clinical trajectory. For nursing practice, these findings underscore the need for routine QoL monitoring, particularly among female patients, and gender-responsive psychosocial support as integral to paediatric oncology nursing care. These findings contribute Palestine-specific evidence to the global literature.

Registered nurses (RNs) in municipal home care (MHC) encounter patients with illnesses and/or disabilities. When these patients suffer a stressful event, such as the loss of a loved one, there is an increased risk of suffering further ill health. It is unclear whether RNs are aware of patients' grief and how to support and promote their well-being and health. The aim was to explore RNs' experiences of paying attention to and encountering patients receiving MHC, who are grieving due to the death of a loved one. This is an exploratory qualitative study with focus groups (n&#x2009;=&#x2009;2) and individual interviews (n&#x2009;=&#x2009;13) with RNs (n&#x2009;=&#x2009;22) in MHC. The data were analysed inductively through reflexive thematic analysis. The results show three themes: Becoming aware that the patient's health is declining, Feeling responsibility for listening to memories and experiences of loss and Dealing with one's own emotions, with six corresponding sub-themes. RNs encountered emotional patients in grief, while they themselves felt inadequate and emotionally affected. Further training in grief and communication, along with organisational support that enables sufficient time with patients and interprofessional collaboration and reflection, is needed to enable holistic, person-centred care.

Multi-agency public health interventions to address violence, including hospital-based initiatives, are increasingly being implemented. Nurses occupy a critical early-intervention role, identifying at-risk individuals, facilitating referral to community support and contributing to ongoing care pathways. However, evidence relating specifically to children and young people remains limited. To examine the relationships between age, referral reasons, engagement and Emergency Department (ED) reattendance of the multi-site Hospital Navigator scheme implemented in five EDs in the United Kingdom. Two hundred and nineteen participants (6-24&#x2009;years) presenting to EDs with violent injuries or vulnerabilities associated with violence (including mental health needs, substance misuse or homelessness) participated between March 2021 and July 2022. Variables included age, index ED attendance reason, scheme referral reason, engagement and future ED reattendance. Descriptive and exploratory analyses were undertaken. Mental health and violence were the most common referral reasons. Over half (55%) engaged with the scheme, most on a short-term basis, with younger participants less likely to engage. Although most (87.7%) did not reattend the ED, mental health was the predominant reason for those who did. Policy and practice should prioritise EDs as early-intervention hubs, embedding Hospital Navigator Schemes and co-locating voluntary sector partners, with nurse-led coordination.

Surgical care increasingly shifts pre- and postoperative care responsibility to patient self-care at home. By using the capability, opportunity, motivation-behaviour (COM-B) framework, patient determinants influencing self-care can be explained. The aim was to describe patients' experienced facilitators of and barriers to self-care in surgical fast-track programmes related to capability, opportunity and motivation. A qualitative design study with semi-structured interviews was conducted among 27 general and orthopaedic surgery patients at three Swedish hospitals. Data were analysed deductively using the COM-B framework. The patients' self-care experiences were explained by capability, opportunity and motivation and the dynamic interaction between these factors. A key analytical finding was the pivotal role of family and friends, whose emotional and practical support strengthened patients' capability and motivation. Facilitators for behaviour change included prior surgical experience, clear information, physical ability, social and professional support, optimism and realistic goals. Barriers included cognitive and physical limitations, pain, fatigue and emotional distress. Findings highlight family involvement as an underused resource and support policy development of person centred pre- and postoperative self-care strategies. This study advances nursing theory by applying the COM-B model to illuminate interdependent behavioural processes in surgical self-care; themes could occasionally overlap.

Social prescribing involves referring patients to community-based facilities that provide social support. Community nurses can play a crucial role in social prescribing; however, there is limited knowledge about their experiences in this area. This study explored the experiences of community nurses in Australia regarding social prescribing. Twenty community nurses were recruited and interviewed using snowball and purposive sampling. The nurses held various roles, including crisis management, case manager, team leader, general practice nurse, counsellor and mental health nurse. Thematic analysis was used. The common social prescribing activities nurses referred to were men's sheds, coffee groups, walking groups and art therapy. Four themes were identified: (1) a broader view of patient care, (2) barriers to considering social prescribing referrals, (3) barriers to implementing social prescribing referrals and (4) their recommendations. Community nurses prefer social prescribing activities that are affordable and achievable, help clients deal with isolation and keep clients physically active. However, not all nurses were aware of the term 'social prescribing'. Community nurses do recognise the social aspects of health. However, they encounter considerable challenges that hinder the implementation of social prescribing. Addressing these challenges is essential for integrating social prescribing into community nursing care.

Nurses constitute the largest segment of the healthcare workforce, yet they are frequently undervalued within health systems and society. This study explored how nurse managers empower registered nurses and how such empowerment shapes nursing practice, professional identity and care delivery within a resource-constrained Ghanaian hospital. A qualitative descriptive exploratory design was used. Seventeen registered nurses were purposively sampled. Data were collected through semi-structured, face-to-face interviews and analysed using qualitative content analysis, supported by reflexivity, peer debriefing and data saturation. The Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist guided the reporting of the study. Two themes were identified: (1) Nurse Empowerment in Low-Resource Clinical Settings and (2) Organisational and Leadership Influences on Empowerment. Empowerment enhanced retention, advocacy, autonomy and quality care. Supportive leadership, recognition, training and shared decision-making facilitated empowerment; whereas autocratic leadership, favouritism, limited resources and gender-related challenges hindered empowerment. Nurse manager-led empowerment strengthens nurses' confidence, autonomy and care quality. Culturally responsive leadership, equitable recognition, staff development and inclusive decision-making are essential for sustaining the nursing workforce and improving patient outcomes through advocacy, high-quality care and error reduction in Ghana.

Neonatal resuscitation is critical for survival, yet data on NICU nurses' competency in Palestine are lacking. To assess knowledge and self-reported practice of neonatal resuscitation among NICU nurses in West Bank hospitals and identify associated factors. A cross-sectional study was conducted across 10 West Bank hospitals. Using proportional convenience sampling, 200 NICU nurses completed a validated questionnaire assessing knowledge (16 items) and self-reported practice (12 items) based on AHA/NRP guidelines. This study is reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Among 182 respondents (91% response rate), mean knowledge was 69.8%; 40.7% demonstrated high knowledge (&#x2a7e;80%). Critical gaps included ventilation indicators (36.8%), compression-to-ventilation ratio (48.4%) and epinephrine dosing (47.8%). Self-reported practice was high (mean&#x2009;=&#x2009;91.4%), with 90.7% reporting 'good' practice. Knowledge correlated moderately with practice (r&#x2009;=&#x2009;0.429, p&#x2009;=&#x2009;0.001). Female gender predicted higher knowledge (&#x3b2;&#x2009;=&#x2009;0.187, p&#x2009;=&#x2009;0.021); prior training paradoxically predicted lower knowledge (&#x3b2;&#x2009;=&#x2009;-0.241, p&#x2009;=&#x2009;0.003). Educational level and experience predicted better practice. A significant disconnect exists between self-reported practice and verified knowledge. Findings underscore the inadequacy of one-time interventions. Simulation-based training and regular competency assessment are urgently needed.

Nurse shortages are intensified by retirement and early career exits. Well-being at work is critical for retention, yet research has primarily focused on burdensome factors at work: stress and burnout. Positive aspects of well-being and the role of employment relationships remain underexplored. To describe nurses' experiences of resources that promote well-being at work. A qualitative interview study was conducted in Finland in 2021. Seventeen nurses participated in individual interviews, and data were analysed using content analysis. Resources enhancing well-being at work were grouped into four main categories: Professional fulfilment and growth, Supportive and sustainable working conditions, Organisational resources and culture and Employment flexibility. These categories included 11 subcategories, reflecting factors such as opportunities for career advancement, moderate workload, benefits and flexible employment contracts. Nurses' well-being at work can be supported at individual, working community and organisational levels. Policies should promote flexible employment relationships, enable professional development and strengthen organisational practices that foster well-being. Legislative frameworks and organisational strategies are essential to improve retention and address workforce sustainability in nursing.