Scandinavian journal of caring sciencesİlknur Özkan, Seçil Taylan
BACKGROUND: Caring behaviours constitute one of the most visible ways in which "caring" is translated into everyday nursing practice, yet the field has become increasingly heterogeneous across settings, outcomes, and conceptual traditions. A field-level map is therefore needed to clarify how the literature has evolved and where it is currently concentrating. OBJECTIVE: This study aimed to bibliometrically map the literature on caring behaviours in nursing, focusing on global research trends, thematic development, collaboration networks, citation performance, and the field's intellectual structure. METHODS: A bibliometric analysis was conducted on publications indexed in the Web of Science Core Collection between 1987 and 2025, following the SALSA framework. Analyses included performance indicators (publication growth; most productive journals and countries), Author Keyword-based frequency, trend-topic, co-occurrence, and thematic analyses following synonym merging and spelling harmonization, co-authorship network analysis (collaboration patterns), citation analyses, and co-citation mapping to examine the field's intellectual structure. RESULTS: A total of 351 documents from 158 sources (1987-2025) were included. The literature demonstrated steady growth, accelerating after 2016. Core source outlets included BMC Nursing, Journal of Nursing Administration, and Perspectives in Psychiatric Care. The USA, Iran, China, and Turkey were among the most productive countries, while international co-authorship remained limited (14.25%). Thematic signals suggested a shift from earlier emphases on patient satisfaction toward a more recent focus on nursing education, empathy, emotional intelligence, and, most recently, compassion fatigue. The thematic map positioned caring behaviours within the basic-themes quadrant, whereas work environment and related humanistic-care concepts showed greater thematic development. Foundational influences remained anchored in Watson and Swanson, and measurement-oriented works (notably Wu and Wolf) functioned as key intellectual bridges. CONCLUSIONS: Caring behaviours research appears to be a maturing but still expanding field with strong theoretical and measurement "anchors," yet comparatively constrained cross-national collaboration. Future work may benefit from more internationally coordinated programmes and greater attention to cross-cultural validation of measurement tools and to the emotional, organizational, and digitally mediated contexts in which caring behaviours are enacted.
Nursing & health sciencesDimitrios Kosmidis, Georgios Vlachopoulos, Abdulqadir J Nashwan, Rafael Lima Rodrigues de Carvalho, Breno Santos Araujo, Dimitra Armeni, Eleni Sertaridou, Soti…
Machine learning (ML) informs nursing practice, but prediction cannot establish intervention or workflow effects. Aim To map ML use within causal effect estimation and causal evaluations of ML-enabled interventions in nursing and midwifery. Eight electronic sources were searched for reports published January 2015-June 2026, followed by backward citation searching. Eligibility required a causal estimand, corresponding identification strategy, substantive ML role, and nursing or midwifery relevance. Two reviewers independently screened records and full texts. Fifteen studies (17 reports) were included. Five addressed acute deterioration or sepsis; others covered care prioritization, falls, post-discharge care, and nurse- or midwife-led services. Five used ML within causal effect estimation to examine longitudinal and spillover effects, treatment-effect heterogeneity, and targeting strategies. Ten evaluated ML-enabled interventions or workflows; reported favorable effects on mortality, care escalation, message-review time, and nursing processes, while several controlled estimates were null or imprecise. Evidence remains small and methodologically uneven. Future studies should align estimands, identification strategies, analytic methods, and workflows and evaluate model-plus-workflow effects on nursing processes and patient outcomes.
Nursing in critical careAbdullah Avcı, Mükaddes Avcı
BACKGROUND: Nurses working in intensive care units (ICU) are at high risk for stress and anxiety. Aromatherapy stands out as a non-pharmacological and easily implementable complementary approach for alleviating these symptoms. To our knowledge, this is the first systematic review specifically examining the effects of aromatherapy on stress and anxiety among ICU nurses. AIMS: This systematic review aimed to evaluate the effects of aromatherapy on stress and anxiety among ICU nurses and to assess the methodological quality of the evidence. STUDY DESIGN: In this systematic review, a literature search was conducted in the Scopus, PubMed, Web of Science and Cochrane Library databases without any time restrictions. The review includes randomised controlled, experimental and quasi-experimental studies evaluating the effects of aromatherapy interventions on stress and/or anxiety among ICU nurses. The selection of studies, data extraction and assessment of methodological quality were conducted independently by two researchers. RESULTS: This systematic review included five studies involving a total of 254 participants. Two of these studies are randomised controlled trials, and three are quasi-experimental studies. The studies included in the review demonstrate that aromatherapy is administered using various essential oils and application methods (inhalation, topical application, etc.). The findings suggest that aromatherapy interventions may reduce stress among ICU nurses, whereas evidence regarding anxiety reduction is mixed and less consistent across studies. CONCLUSION: Aromatherapy may have potential benefits for reducing stress among ICU nurses, whereas evidence for anxiety reduction remains limited and inconsistent. Further high-quality studies are needed before firm conclusions or routine clinical implementation can be recommended. RELEVANCE TO CLINICAL PRACTICE: Aromatherapy may be considered as an optional supportive intervention within staff well-being programs, provided that safety, scent sensitivity, infection-control procedures and individual preferences are taken into account. However, standardised protocols and further high-quality evidence are required to support its routine clinical use.
Nursing in critical careZahra Ahmed Sayed, Mohamed Ali Abdraboh, Eman Mohamed Ebrahim Abdelrazek
BACKGROUND: Early mobilisation is central to contemporary critical care, yet implementation remains inconsistent and ethically complex, particularly when patient safety, autonomy and resource constraints must be balanced. AIMS: To examine ICU nurses' perceptions of ethical concerns and implementation barriers related to early mobilisation in critically ill adults, including older adults, and their associations with professional characteristics. DESIGN: A single-centre analytical cross sectional study. METHODS: A convenience sample of ICU nurses completed a self-administered questionnaire comprising demographic and professional data and the researcher-developed Ethical Issues in Early Mobilisation-Critical Care Scale and Early Mobilisation Barriers Scale. Data were analysed using descriptive statistics, independent-samples t-tests, one-way analysis of variance, Pearson's correlation and multiple linear regression. RESULTS: A total of 100 ICU nurses participated in the study. The mean ethical-concern score was 113.41/150 (75.6% of the maximum possible score), and the mean barrier score was 69.94/90 (77.7%). Beneficence and Patient Well-being had the highest ethical-domain score. Patient-related barriers had the highest descriptive domain score, although all four barrier domains were closely distributed (76.6%-79.2%). Ethical-concern and barrier scores were modestly correlated (r = 0.292, 95% CI 0.103-0.461; p = 0.003), indicating limited shared variance. In mutually adjusted models, education level, ICU experience and previous early-mobilisation training were associated with both outcomes. The coded ICU-type term was associated with ethical-concern scores only, whereas professional nursing classification was associated with neither outcome. Age and gender were not associated with either score. CONCLUSIONS: Early mobilisation emerged as an ethical and organisational challenge, not merely a technical task. Ethical concerns and implementation barriers were related but largely distinct. Associations with education, ICU experience and training should be interpreted as correlational rather than causal. Integrated, context-sensitive approaches combining graded safety assessment, ethical decision-making, role clarity and organisational support warrant prospective evaluation. RELEVANCE TO CLINICAL PRACTICE: The findings support the development of evidence-based protocols, targeted educational initiatives and organisational strategies that strengthen nurses' clinical decision-making and facilitate the safe and consistent implementation of early mobilisation in critical care settings.
BACKGROUND: Delirium is a common neuropsychiatric complication among critically ill patients, particularly those who are mechanically ventilated. Evidence suggests family involvement may improve delirium-related outcomes in adult intensive care units (ICUs). However, limited evidence exists on intensive care nurses' (ICNs) experiences and attitudes towards family involvement in delirium care in South Africa. AIMS: The study aimed to explore intensive care nurses' experiences and attitudes towards family involvement in the care of mechanically ventilated patients with delirium in adult ICUs. STUDY DESIGN: A descriptive qualitative study design was utilised. Four focus group discussions were conducted with 32 ICNs from two adult ICUs at a tertiary academic hospital in Johannesburg between April and August 2022. Participants who had at least 2 years of intensive care experience were purposively sampled. Data were analysed using inductive qualitative content analysis. The study adhered to Consolidated Criteria for Reporting Qualitative Studies guidelines. FINDINGS: Three categories were identified: emotional burden and psychological demands of delirium care, communication and psychosocial support for families in delirium care and barriers to effective family involvement in delirium care. While recognising the therapeutic value of family engagement, the nurses reported experiencing emotional stress related to family expectations and anxiety. They adopted strategies such as structured communication, empathetic listening and technology-assisted contact to support families. However, barriers such as time constraints, limited intensive care space, staffing shortages and restrictive policies limited sustained involvement. CONCLUSIONS: This study provides context-specific insight into how ICNs facilitate family involvement in the care of patients with delirium in a public tertiary ICU. ICNs recognise the therapeutic value of family involvement in the care of patients with delirium and are willing to facilitate engagement. However, systemic and environmental barriers limit consistent implementation. Therefore, strengthening institutional policies and supporting nurses through structured training and team-based approaches may enhance sustainable family-centred delirium care. RELEVANCE TO CLINICAL PRACTICE: This study's findings demonstrate the need for ICNs to adopt structured communication strategies, flexible visitation policies and empathy towards families and their patients in the ICU. Perhaps incorporating family-centred care into daily intensive care practices could strengthen family involvement in critical care, particularly for patients with delirium.
Nursing in critical careShaimaa Mohamed Amin, Ibrahim Alasqah, Mostafa Mohamed Zanaty, Sameer A Alkubati, Eman Yasser Hammouda, Mohamed H R Atta, Amira Abdelraheem, Suebsarn Ruksakulp…
BACKGROUND: Effective nursing handover is essential for ensuring patient safety and continuity of care, particularly in critical care settings where patients are highly complex and clinical decisions must be made rapidly. Occupational stress is prevalent among critical care nurses and has been associated with impaired performance and communication failures. Clinical decision-making is a core professional competency that may influence how stress affects handover quality; however, limited evidence has examined its combined effects. AIMS: To examine the impact of job stress and clinical decision-making on handover competency among critical care nurses and to test the mediating role of clinical decision-making in this relationship. STUDY DESIGN: A multicentre cross-sectional descriptive study was conducted in six hospitals in Egypt. Using a convenience sampling approach, participants completed self-administered, self-report questionnaires. Data were analysed using descriptive statistics, correlation analysis, multiple linear regression and mediation analysis with Hayes' PROCESS Macro (Model 4). RESULTS: A total of 410 critical care nurses were recruited for the study. They reported moderate levels of job stress, strong clinical decision-making abilities and high handover competency. Job stress was negatively correlated with both clinical decision-making (r = -0.242, p < 0.001) and handover competency (r = -0.218, p < 0.001), while clinical decision-making was positively correlated with handover competency (r = 0.332, p < 0.001). Regression analysis showed that higher educational level, rotating shifts and stronger clinical decision-making predicted higher handover competency, whereas higher job stress predicted lower competency. Mediation analysis revealed that clinical decision-making partially mediated the relationship between job stress and handover competency, with significant direct, indirect and total effects. CONCLUSIONS: Clinical decision-making plays a pivotal mediating role in the relationship between job stress and handover competency among critical care nurses. Job stress directly and indirectly impairs handover performance by diminishing nurses' decision-making capacity. RELEVANCE TO CLINICAL PRACTICE: Interventions aimed at reducing job stress and strengthening clinical decision-making, such as stress-management programs, simulation-based training and structured handover protocols, may enhance communication quality and patient safety in critical care settings.
Nursing in critical careMarte-Marie Wallander Karlsen, Lena Günterberg Heyn, Monica Evelyn Kvande, Pia Dreyer, Judith Ann Tate, Mary Beth Happ, Anna Holm
BACKGROUND: Communication with mechanically ventilated patients in intensive care is complex. Decades of research demonstrate that communication barriers are commonly experienced and one of the most challenging experiences during an intensive care stay. Support for the health care providers in these situations could be a model for communication, guiding the interaction. AIM: The aim of this study was to examine critical care nurses' (CCNs') perspectives of the clinical relevance and applicability of a communication model for mechanically ventilated patients. STUDY DESIGN: Qualitative, explorative design in accordance with Im & Meleis' phases of development of situation-specific theories. We conducted six focus group interviews with CCNs from Denmark, Norway and the United States, two in each country, lasting between 58 and 90 min. The interviews were analysed by a content analytic approach with both inductive and deductive phases. FINDINGS: Twenty-nine CCNs participated in the focus group interviews. The main category was identified during the analysis, which was: 'Relationship-building as a starting point for meaningful communication'. The main category was further described by three subcategories: (1) Patients' abilities and challenges in communication while being mechanically ventilated. (2) Nurses' competencies and strategies for effective communication with mechanically ventilated patients and (3) Tools and resources in practice. CONCLUSIONS: The nurses' perspectives yielded a deeper understanding of how clinical practice both corresponds to and departs from a theoretical lens. Given that the interviews with nurses revealed the relational component as a critical starting point of communication, the model should highlight this specific element more explicitly. To understand the complexity occurring in the daily practice of an ICU, a situation-specific theory will be useful for providing examples of good practice. RELEVANCE TO CLINICAL PRACTICE: Communication in an ICU setting requires the establishment of a relationship to find effective ways to communicate. Integrating clinical perspectives can refine and adapt the preliminary model to the real communication encounters and improve care.
Nursing in critical careBerna Köktürk Dalcalı, Aleyna Semiz Büyükaltay, Seçil Erden Melikoğlu, Yılda Arzu Aba, Güzin Eşme
BACKGROUND: Intensive care nurses frequently encounter death as part of their clinical practice, which may evoke complex emotional and cognitive responses. Understanding how nurses perceive death is essential, as these perceptions can influence care delivery, decision-making processes and the quality of end-of-life care. Although previous studies have explored nurses' experiences with death, research examining these perceptions through metaphors remains limited. AIM: This study aimed to explore intensive care nurses' perceptions of death through the use of metaphors. STUDY DESIGN: This study was conducted using a qualitative design. Data were collected using a metaphor-based approach and analysed using content analysis to identify common themes and categories. FINDINGS: Intensive care nurses expressed their perceptions of death using a variety of metaphors, which were grouped into five main categories: 'End', 'Peace', 'Beginning', 'Uncertainty' and 'Unclassifiable'. The findings revealed that death was most commonly perceived as an 'End', often associated with inevitability and finality. However, some nurses described death as a peaceful transition or a new beginning, while others emphasized its uncertain and ambiguous nature. CONCLUSIONS: The findings suggest that intensive care nurses hold multidimensional perceptions of death, shaped by both emotional and experiential factors. These perceptions reflect not only the finality of death but also its potential meaning as a transition or a source of peace. RELEVANCE TO CLINICAL PRACTICE: Understanding nurses' perceptions of death may contribute to improving end-of-life care practices, supporting their emotional coping strategies, and enhancing communication with patients and families in intensive care settings. Addressing these perceptions through education and supportive interventions may strengthen nurses' ability to provide holistic and compassionate care.
Nursing in critical careQinjian Liu, Puqiong Wang, Yujuan Hou
This case report summarizes the surgical nursing experience of a patient with 70% total body surface area (TBSA) second- to third-degree flame burns complicated by Pseudomonas aeruginosa infection. Key nursing interventions included intraoperative temperature management, use of a turning bed for safe positional changes during back debridement, and prevention of pressure injuries at prone-position high-risk sites (forehead, chest, bilateral hips, lower limbs and toes). Following intensive treatment and meticulous nursing care, most of the patient's wounds healed and her physical function recovered satisfactorily. She was discharged after 63 days of hospitalization. This report systematically details standardized turning bed procedures and comprehensive warming strategies, providing quantitative operational guidance for surgical nursing in similar cases.
BACKGROUND: Person-centred care (PCC) recognises patients as unique individuals and provides care through person-centred communications. AIM: This study aimed to examine the combined associations of nursing competency (prerequisite), positive organisational culture (care environment) and delirium care burden (contextual barrier) with PCC among intensive care unit (ICU) nurses, based on McCormack and McCance's Person-Centred Nursing Framework. STUDY DESIGN: This descriptive cross-sectional study included nurses working in the ICUs of a university hospital in South Korea. The data were collected between 30 June and 17 July 2023. The survey assessed general characteristics, nursing competency, positive organisational culture, delirium care burden and PCC. Data were analysed using descriptive statistics, independent t-tests, one-way analysis of variance, Pearson's correlation coefficients and multiple regression analysis. RESULTS: PCC was significantly and positively correlated with nursing competency (r = 0.37, p < 0.001) and positive organisational culture (r = 0.46, p < 0.001). Multiple regression analysis revealed that positive organisational culture (β = 0.39, p < 0.001) and nursing competency (β = 0.27, p < 0.001) were significantly associated with PCC, whereas delirium care burden was not significantly associated with it. CONCLUSIONS: To enhance PCC in ICUs, it is essential to strengthen nursing competency (prerequisite) and foster a positive organisational culture (care environment). The lack of a significant association between delirium care burden and PCC suggests that ICU nurses maintain person-centred practices despite care strains. RELEVANCE TO CLINICAL PRACTICE: To improve nursing competency and organisational culture, competency development programmes tailored to the professional characteristics of ICU nurses are necessary, along with adequate resource allocation and human resource management. Furthermore, organisational-level efforts such as improving policy and reward systems are required to create a supportive care environment.
Nursing in critical careSeher Ünver, Seda Cansu Yeniğün Akbulut
BACKGROUND: Delirium is a common and serious postoperative complication in intensive care units, associated with increased morbidity, mortality and long-term cognitive impairment, and despite the pivotal role of nurses in its assessment and management, variations in prevalence and gaps in intervention-focused nursing research persist, underscoring the need for a bibliometric evaluation of the literature. AIM: The aim of the study was to quantitatively analyse and visually map trends, citations, key terms and country contributions in nursing research on postoperative delirium in intensive care as well as to characterize the overall structure of the literature. STUDY DESIGN: This study was conducted as a retrospective and descriptive research using the bibliometric analysis method on December 1, 2025. No time restrictions were imposed on the literature. Data analysis was performed using R Studio software. RESULTS: The earliest study on postoperative delirium in intensive care units within the field of nursing was published in 2001, and the analysed publications covered the period from 2001 to December 2025. In addition, 55.96% of all publications have been released in the past 7 years. The journal with the highest number of publications is Nursing in Critical Care, while the United States stands out as the country with the highest research output. It can be suggested that topics such as 'cardiac surgery', 'nursing care', 'postoperative delirium', 'postoperative care' and the 'Confusion Assessment Method for the Intensive Care Unit' represent areas that warrant further investigation and development in future research. CONCLUSIONS: The analysis showed a marked increase in publications on postoperative delirium in intensive care nursing in recent years. The United States and the Journal Nursing in Critical Care were identified as the leading contributors to the literature. Thematic mapping indicated that the literature primarily focused on delirium assessment and intensive care nursing, with several interconnected research areas. RELEVANCE TO CLINICAL PRACTICE: The findings emphasize the critical role of nurses in delirium screening and management in intensive care units. While assessment tools are well represented in the literature, further research is needed to develop and evaluate nurse-led interventions aimed at delirium prevention and care. Enhancing nursing education and institutional support may contribute to improved patient outcomes and quality of postoperative intensive care.
Nursing in critical careMetin Tuncer, Cemal Özalp, Azra Keskin
BACKGROUND: Maintaining privacy in intensive care units (ICUs) is challenging because of high workload, invasive procedures, continuous monitoring and shared care environments. Patients with impaired consciousness may be particularly vulnerable because their ability to express privacy preferences, assert personal boundaries and advocate for themselves is limited. AIM: To explore intensive care nurses' experiences of protecting privacy when caring for patients with impaired consciousness. STUDY DESIGN: A descriptive qualitative study was conducted with 20 intensive care nurses in Türkiye between March and April 2026. Data were collected through semi-structured online interviews and analysed using inductive thematic analysis. The study was reported in accordance with the Consolidated Criteria for Reporting Qualitative Research guidelines. FINDINGS: Four themes were identified: the marginalisation of privacy under clinical priorities; structural and process-related constraints on privacy in intensive care; loss of subjectivity and the mechanisation of care in patients with impaired consciousness; and ethical and psychosocial implications of privacy violations. CONCLUSIONS: Privacy in intensive care is shaped not only by individual ethical awareness but also by workload, environmental conditions, care routines and communication practices. Patients with impaired consciousness have the same rights to privacy and dignity as other patients; however, their reduced ability to express preferences, assert personal boundaries and advocate for themselves may make privacy violations less visible and increase their dependence on nurses for protection. RELEVANCE TO CLINICAL PRACTICE: Protecting the privacy of patients with impaired consciousness in ICUs requires structured care routines, standardised bedside communication, minimisation of unnecessary exposure during procedures and targeted ethical awareness training to support dignity in everyday practice.
Research priorities for intensive care nursing have been set internationally but not in Japan. We aimed to identify national priorities and compare them with those reported elsewhere. Focus group interviews with 10 expert intensive care unit (ICU) nurses generated 65 categories, which 50 nurses rated over three modified Delphi rounds (consensus, median ≥ 70, then ≥ 80). Categories were restructured into 20 topics; 16 reached consensus. Five independent nursing researchers who had taken no part in the interviews or the Delphi rounds then appraised every topic for validity, applicability, utility and clarity; all 16 were endorsed, and one was reworded. Symptom management, post-intensive care syndrome prevention and ICU nurse education ranked highest, and education- and system-related topics formed about one-third of the agenda, suggesting workforce regulation shapes national research priorities alongside clinical need. The agenda gives Japanese academic societies, funders and post-graduate programmes an explicit basis for targeting research investment.
Nursing in critical careNana Wu, Xia Chen, Jie Fu, Liwen Ding, Hong Zhou, Tiantian Xiao
BACKGROUND: Point-of-care ultrasound (POCUS) is increasingly used in paediatric and neonatal critical care, but evidence on nurse-led bedside POCUS remains limited and fragmented. AIMS: This scoping review aimed to map the evidence on nurse-led bedside POCUS in paediatric and neonatal critical care nursing practice, examine implementation factors and identify evidence gaps relevant to nursing research, education and clinical practice. METHODS: Following JBI methodology and PRISMA-ScR guidance, we searched PubMed, Embase, CINAHL, Web of Science, Cochrane Library and CNKI from inception to October 2025. Eligibility followed the PCC framework. Two reviewers independently screened records and extracted data using a standardized form. Study characteristics were synthesized descriptively, and implementation factors were deductively analysed using the COM-B framework. RESULTS: Thirty-four studies were included, mainly from the United States and China. Nurse-led POCUS applications included vascular access, respiratory assessment, catheter localization, cardiac or hemodynamic evaluation, bladder assessment and education or competency development. Outcomes included clinical (procedural success and diagnostic accuracy), process (timeliness and workflow efficiency) and nurse-related (competency, confidence and role development). Safety-related outcomes were the least reported. Implementation was influenced by training, equipment, protected time, institutional support, collaboration and patient safety concerns. The automatic motivation domain, referring to unconscious drivers such as habits and emotional responses, was not addressed by any study. CONCLUSIONS: Nurse-led POCUS is an emerging but unevenly developed component of paediatric and neonatal critical care. Brief training may support initial competency, but sustained implementation is constrained by underdeveloped quality assurance, unclear career pathways and limited attention to motivational processes. RELEVANCE TO CLINICAL PRACTICE: Future nursing research and clinical programmes may look beyond short-term training outcomes to consider competency standards, longitudinal supervision, quality assurance, educational approaches combining foundational POCUS training with structured workplace supervision and sustainable integration into routine care delivery.
BACKGROUND: Emotional intelligence (EI) is critical in intensive care unit (ICU) nursing, where nurses face high stress, clinical instability and emotionally demanding situations. EI helps nurses manage emotions, improve communication and support clinical performance. It has also been linked to lower burnout and more adaptive coping among ICU nurses. AIM: This scoping review aimed to map the available evidence on emotional intelligence among nurses working in ICUs, including its key dimensions, associated professional outcomes and current knowledge gaps. STUDY DESIGN: A scoping review was conducted in accordance with the Joanna Briggs Institute (JBI) methodology and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. A structured search was conducted in MEDLINE, CINAHL, PubMed and Scopus for studies published in the past 10 years in Portuguese, English or Spanish. RESULTS: In total, this review included nine studies. The evidence highlights the crucial role of EI in emotional regulation, communication and clinical performance among ICU nurses. Key dimensions of emotional intelligence, including empathy, emotional clarity and self-regulation, were consistently identified as important. Training programmes demonstrated significant improvements in EI and reduced burnout symptoms, and EI was also associated with more adaptive coping strategies and improved professional performance. CONCLUSIONS: Emotional intelligence is an important competency in ICU nursing and has been linked to improved communication, clinical decision-making and lower burnout among nurses. Despite these benefits, research still shows gaps, particularly in standardising EI assessment tools and in the need for longitudinal studies. Targeted emotional intelligence training programmes may strengthen ICU nurses' emotional resilience and enhance care quality. RELEVANCE TO CLINICAL PRACTICE: Integrating EI development into ICU nursing education and institutional policies can help reduce burnout, improve communication with patients and families, and enhance overall clinical performance, thereby supporting a healthier work environment and strengthening nurses' communication and professional performance in intensive care settings.
Nursing in critical careAyda Kebapcı, Begum Yalçın, Deniz Eşim, Gülşah Doğan, Şahika Mert
BACKGROUND: During the orientation process in the intensive care unit (ICU), the experiences and challenges of new nurses and their mentor nurses often differ, leading to potential incompatibilities. AIMS: This descriptive qualitative research aimed to determine the opinions and experiences of newly recruited nurses and their mentor nurses on the adaptation to the ICU. STUDY DESIGN: Semi-structured interviews were conducted with 21 nurses (10 mentors and 11 mentees) who worked in an ICU. Data were collected between March and May 2025. Four focus group interviews were conducted with mentors and mentees. Data were analysed using content analysis. Consolidated Criteria for Reporting Qualitative (COREQ) was used for reporting. FINDINGS: In the mentor group, three themes emerged: (1) mentor challenges in mentee conflicts, (2) helpful or harmful: a mentor's dilemma and (3) double duty: the rising workload of nurse mentors; in the mentees group, two themes emerged: (1) mentee challenges in mentor conflictsand (2) a good system with operational gaps. CONCLUSIONS: The study reveals the complex challenges faced by both new nurses and their mentors in the ICU. Although mentorship supports professional growth and patient safety, issues such as poor communication, mismatched expectations and emotional strain can hinder its effectiveness. These findings highlight the need to view mentorship as both an educational and an emotional process that requires mutual support. RELEVANCE TO CLINICAL PRACTICE: The study demonstrates that ICU mentorship must be recognized as a high-intensity clinical responsibility, requiring dedicated time to prevent mentor burnout and ensure patient safety. By addressing the identified communication gaps and 'double duty' burdens, healthcare managers can create a more resilient orientation system that improves the retention of newly recruited nurses.
International journal of nursing education scholarshipTeresa Martins, Ana Paula Cantante, Pedro Melo, Sílvia Silva, Marta Valadar, Paula Santos, Carlos Pinto, Marta Sá, Diana Rodrigues, Elisabete Borges
OBJECTIVES: To develop and examine the content validity of a competency assessment tool for clinical teaching in community nursing, essential for high-quality nursing education, while addressing the lack of clarity and consistency in existing methods. METHODS: A qualitative, iterative methodological development and validation study was conducted with 10 clinical teachers. The process included: (1) identification of competency domains and competencies based on national nursing regulations and Vygotsky's sociocultural perspective (71 criteria); (2) refinement of the competency assessment criteria via focus groups (20 criteria); (3) development of a 5-point Likert scale with behavioural descriptors; and (4) creation of methodological guidelines for evaluators. RESULTS: The tool comprises 6 competency domains and 20 criteria, described across five performance levels (poor to excellent), considering performance quality, autonomy, and application in complex contexts. CONCLUSIONS: The instrument enhances fairness, consistency, and feedback, clarifies expectations, promotes student self-regulation, and provides a transparent tool for formative and summative assessment, with potential for adaptation in diverse community nursing settings involving individuals, families, groups, communities, and populations. Implications for an International Audience: Although developed within a Portuguese educational context, the tool addresses competencies relevant to community nursing education internationally. Its structured competency domains and behavioural descriptors provide a framework that can be adapted to different educational and clinical contexts to support transparent, consistent, and development-oriented assessment of nursing students.
Clinical nurse specialist CNSWafa Alsaadi, Hodan Abdullah, Reni Anil, Shaikhah Al Keldi, Zeinab Idris, Asma Younus, Gulfama Abidullah, Parvin Ghasemi, Nima Ali, Khadra Yassin, Wafaa Shehad…
PURPOSE/AIM: This report aims to describe the evolution, achievements, and impact of the clinical nurse specialist (CNS) role within cancer services in the State of Qatar from 2011 to 2024. DESCRIPTION: A descriptive design guided by Hamric's Integrative Framework for Clinical Nurse Specialists was used to explore the multifaceted CNS role across 3 spheres of influence, patient, nursing practice, and the healthcare system. The report outlines the progression of the CNS role at the National Center for Cancer Care and Research (NCCCR), from the early stages of implementation to the establishment of locally trained CNSs covering oncology, hematology, palliative, and cardio-oncology services. CNSs have significantly contributed to advancing cancer care through clinical expertise, patient advocacy, research, education, and leadership. Their roles have enhanced patient satisfaction, supported multidisciplinary collaboration, and fostered a culture of evidence-based and patient-centered care. OUTCOME AND CONCLUSION: The introduction and expansion of CNS roles have strengthened Qatar's cancer care continuum, improving quality outcomes and professional nursing standards. Continued investment in CNS development, recognition, and policy integration is essential to sustain these achievements and advance the national vision for excellence in healthcare.
PURPOSE/OBJECTIVE: This project aimed to educate nurses on teaching patients about the safe management and removal of Jackson-Pratt (JP) drains at home. Using a multimodal learning approach allowed staff and patients to practice the procedure and build confidence to independently perform a JP drain removal. The project objective was to ensure that patients safely remove their own JP drain at home without complications. DESCRIPTION: After 2 extensive literature searches on the adverse effects of a delayed drain removal and the benefits of an at-home drain removal, a teaching plan was developed, which included a handout for the nurses with key teaching points, a patient education handout, and face-to-face education with staff for hands-on practice. OUTCOMES: This is an ongoing project that was initiated in February 2025. Although this is a new project, close to 100 drains have been successfully removed at home with no complications reported. CONCLUSIONS: By teaching nurses to educate their patients on JP drain management and removal at home, our staff was able to ensure patient safety and comfort. By educating patients on proper care and removal of their JP drains, bedside nurses improved patient satisfaction, reduced the risk of complications, decreased resource utilization, while not compromise patient outcomes.
PURPOSE/OBJECTIVES: To deliver evidence-based, high-quality end-of-life care through a collaborative initiative led by geriatric and palliative clinical nurse specialists in partnership with an interdisciplinary team and hospital administration. DESCRIPTION: After identifying inconsistent end-of-life care within an academic medical center, geriatric and palliative clinical nurse specialists synthesized best practices to develop a "comfort care" initiative. Operating across the 3 clinical nurse specialists' spheres of influence, the team collaborated with administrative and interdisciplinary stakeholders to pilot the model on a specialized geriatrics unit. OUTCOMES: Implementation led to consistent use of individualized care plans, accurate pain assessments, and timely execution of EOL orders. In the designated unit, nurses achieved compliance rates of 80% to 100%, significantly outperforming other system settings. This successful pilot served as a catalyst for system-wide improvements, including the standardization of evidence-based nursing care plans, comfort care code status protocols, and end-of-life order sets throughout the hospital system. CONCLUSIONS: This project demonstrates that clinical nurse specialists-led interdisciplinary collaboration can drive sustained, significant improvements in end-of-life care quality and system-wide practice standardization.
British journal of community nursingSandra Lawton, Momodou Bojang
Skin infections and infestations represent a significant burden on public health, accounting for a substantial proportion of consultations in primary care and community settings. This article provides a comprehensive overview of common bacterial, viral, fungal and parasitic skin conditions, covering their definitions, clinical features, recommended investigations, management principles and evidence-based treatment options. Emphasis is placed on the critical role of infection prevention and control protocols in reducing transmission, alongside the importance of patient education in minimising recurrence and safeguarding public health. The article also highlights the necessity of multidisciplinary collaboration and adherence to clinical guidelines to optimise outcomes. In the context of rising antimicrobial resistance and evolving epidemiological trends, ongoing vigilance and robust community interventions are essential for effective management and prevention of skin infections and infestations.
BACKGROUND: The undergraduate stage is critical for developing nursing students' disaster nursing competencies; however, traditional lecture-based teaching often fails to promote active learning, and innovative instructional models remain underused in this field. The BOPPPS (Bridge-in, Objective, Preassessment, Participatory Learning, Postassessment, and Summary) model is a student-centered, closed-loop instructional framework that emphasizes active participatory learning and real-time feedback. OBJECTIVE: This study aimed to evaluate the effects of a BOPPPS-based blended teaching model on disaster nursing competencies and academic outcomes among undergraduate nursing students. METHODS: This study used a quasi-experimental design with 77 undergraduate nursing students allocated to 3 groups: an experimental group receiving BOPPPS-based blended teaching (n=27), a control group with traditional lecture-based teaching (n=25), and a comparison group without systematic instruction (n=25). Questionnaires were used to assess students' self-perceived disaster nursing knowledge, professional operational skills, and overall comprehensive competencies. The final examination assessed students' mastery of theoretical knowledge and applied reasoning. RESULTS: All 3 groups showed significant within-group improvements in disaster competence (all P<.001, n=77). Intergroup comparisons revealed significant differences (H=8.843, P=.01, η²=0.093); post hoc analysis showed that the experimental group (mean rank=48.79) scored significantly higher than the comparison group (mean rank=29.76, Padj=.009), but not significantly higher than the control group (mean rank=38.32, Padj=.34). The experimental group had a significantly higher overall course score than the control group (86.93, SD 5.08 vs 81.60, SD 6.90; t50=-3.186, P=.002). CONCLUSIONS: The implementation of a disaster nursing curriculum positively impacts students' disaster nursing competency. Since the BOPPPS-based blended teaching model promotes active student engagement and improves teaching quality, we recommend its integration into disaster nursing education.
JMIR nursingMariana Luisa Firmiano, Ana Paula Assunção Moreira, Flaviana Vely Mendonça Vieira, Carla Sa-Couto, Alexandrina Cardoso
BACKGROUND: Technologies such as virtual reality (VR) and augmented reality (AR) have been increasingly incorporated into nursing education to support the development of cognitive, psychomotor, and behavioral competencies. In midwifery, immersive environments offer opportunities to simulate high-risk or low-frequency clinical scenarios, strengthening students' confidence and preparedness for professional practice. However, there is still significant variability in how VR and AR are pedagogically implemented, with limited understanding of their theoretical grounding, instructional design, and educational outcomes. OBJECTIVE: This systematic review aimed to synthesize and critically evaluate the characteristics of educational programs using VR and AR to develop competencies among nursing and midwifery students and professionals. METHODS: This review followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 and Synthesis Without Meta-Analysis (SWiM) guidelines and was registered in PROSPERO (International Prospective Register of Systematic Reviews). A comprehensive search was conducted in August 2024 across PubMed, Web of Science, Scopus, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases. Eligible studies were experimental, quasi-experimental, or observational, and involved undergraduate or postgraduate students in nursing, obstetric nursing, or midwifery, as well as certified midwives or nurse-midwives. Two independent reviewers conducted screening, data extraction, and quality appraisal using Joanna Briggs Institute (JBI) tools and the Medical Education Research Study Quality Instrument (MERSQI) scale. Data were synthesized narratively according to predefined thematic categories. RESULTS: Four studies published between 2021 and 2024 met the inclusion criteria, encompassing 634 participants (360 midwifery students and 274 midwives or nurse-midwives). Two randomized controlled trials and 2 quasi-experimental studies were included. Interventions used VR in 3 studies and AR in one, simulating scenarios such as normal and complicated childbirth, neonatal resuscitation, and emergency obstetric procedures. Most interventions focused on developing technical competencies, while one also addressed teamwork and communication. Only 2 studies explicitly reported theoretical or pedagogical frameworks, and 2 mentioned alignment with the INACSL Healthcare Simulation Standards of Best Practice. Structured briefing or debriefing was rarely described. All studies assessed learning outcomes (Kirkpatrick level 2), and 3 included participants' satisfaction (level 1). Methodological quality, measured by MERSQI, ranged from 10.0 to 14.5, with a mean score of 12.9 (SD 2.0), indicating moderate to high quality. CONCLUSIONS: Evidence suggests that VR and AR can enhance learning in obstetric nursing and midwifery education by providing safe, experiential, and interactive learning environments. However, the limited use of theoretical frameworks and structured instructional design highlights the need for more pedagogically grounded interventions. Future research should prioritize the integration of learning theories, validated assessment tools, and best-practice simulation standards to strengthen the educational impact and curricular integration of immersive technologies in nursing and midwifery education.
The government's first Men's Health Strategy outlines a comprehensive framework for improving health outcomes among men by addressing preventable morbidity, reducing health inequalities and enhancing engagement with health services. Within community settings, the strategy emphasises early intervention, accessible care pathways and the promotion of health-seeking behaviours among diverse male populations. This article discusses how community-based provision delivered through primary care, public health initiatives, outreach programmes and multidisciplinary collaboration supports the implementation of the Men's Health Strategy in practice.
British journal of community nursingKaren Harrison Dening
Oral health is recognised as an essential component of a person's overall wellbeing, increasingly so in people with dementia. As dementia progresses, a person diagnosed with the condition may become more dependent on the support of the family carer to meet their personal care needs. Similarly, community nurses may be one of the first health professionals that a family carer may call on when difficulties in maintaining good oral care become a concern. An understanding of some of the main concerns and resources available can be helpful for community nurses in helping their patients and their carers. This article discusses some of the common issues using case examples to illustrate possible rationales and considerations for further action.
British journal of community nursingCrystal Oldman
This article discusses the opportunities and challenges of neighbourhood working, and the important role district nurses can play in understanding and improving the health of local communities.
With an increasing focus on shifting care into community and home settings, it is crucial that the community and home nursing workforce is adequately equipped to meet growing demand and complexity. Nursing education must reflect the changing landscape of care delivery, ensuring that community and home nursing are strongly and consistently represented and that nurses are prepared for the evolving demands of practice. The Caring Beyond Walls international conference provided an important opportunity to share learning, innovation and research, while bringing the nursing community together at a critical point in the development of community and home nursing, both nationally and internationally.
MedicineDu Hong, Xiaoping Zhu, Ying Xu, Yao Jiang, Xinmiao Xiang, Feng Xu, Juan Sha
This study aimed to develop and validate a self-assessment scale based on the Environment-Technology-Task Model to evaluate operating room nurses' readiness for intraoperative rescue and to evaluate its psychometric properties. A methodological study focusing on the development and psychometric validation of the scale was conducted. The initial item pool was generated through an integrative literature review (11 core articles) and field observations of 7 real intraoperative rescue videos. A 2-round Delphi consultation with 20 experts, followed by pilot testing, was carried out to refine the items. Subsequently, a survey of 280 operating room nurses was performed to evaluate construct validity using exploratory factor analysis and to assess reliability. The final 21-item scale comprised 3 dimensions: task (11 items), environment (5 items), and technology (5 items). Exploratory factor analysis confirmed the 3-factor structure, explaining 73.83% of the total variance. Content validity was satisfactory (item-level content validity index: 0.875-1.000; scale-level content validity index, averaging method: 0.932). Internal consistency was high (Cronbach α = 0.970 for the total scale; 0.962, 0.912, and 0.865 for the 3 subscales). Split-half reliability was 0.931, and test-retest reliability was 0.847 for the total scale (0.725-0.872 across the subscales). The Environment-Technology-Task Model-based scale showed high internal consistency, a theoretically coherent 3-factor structure, and acceptable-to-good temporal stability. It is the first instrument specifically designed to assess operating room nurses' intraoperative rescue readiness, and it holds practical utility for self-assessment, targeted training, and quality improvement initiatives to enhance perioperative patient safety.
International journal of mental health nursingMichelle Glascott, Philip Hodgson, Wendy Hope, Nicola Clibbens, Luke Aston, Laura Fleming, Alison Innerd, Michael Graham
Adult acute mental health wards operate under sustained pressure, characterised by high patient acuity, workforce shortages and a focus on risk management that can limit opportunities for therapeutic engagement. Although physical activity is increasingly recognised as beneficial for mental and physical health, there remains limited evidence to guide its implementation within acute inpatient settings. The purpose of this study was to generate practice-relevant insights to inform the design and implementation of feasible physical activity interventions in adult acute mental health wards. A qualitative study was conducted using focus groups across two National Health Service mental health trusts in England. Thirty participants took part, including mental health nurses, multidisciplinary staff and people with lived experience of acute ward care. Data were analysed using reflexive thematic analysis within a multidisciplinary and lived-experience-informed research team. Three interrelated themes were identified. Barriers to implementation reflected the interaction between patient acuity, medication effects, restrictive practices, workforce pressures and ward organisation. Enablers and opportunities included nursing leadership, flexible and relational delivery approaches, staff participation and active involvement of patients in the design of activities and care planning. Participants also highlighted the importance of evaluation approaches that balance feasibility with meaningful patient-centred and ward-level outcomes, including staff wellbeing and ward atmosphere. Physical activity was perceived as both desirable and achievable when adapted to the realities of acute ward environments. These findings address an important evidence gap and can inform the development of context-sensitive, recovery-oriented physical activity interventions aligned with acute inpatient mental health nursing practice.
Hu li za zhi The journal of nursingWei-Ting Lai, Hsin-Tien Hsu, Pei-Yu Lee, Hsiu-Fen Hsieh
In this paper, the impacts of climate change on cancer-related health risks and oncology care systems are examined, with a particular focus on the evolving professional role of oncology nurse navigators within climate-adaptive care. Although not a direct cause of disease, climate change reshapes the distribution of cancer risks and increases the vulnerability of treatment safety and continuity through multiple environmental pathways. Beyond the acute disruptions triggered by extreme weather events, climate change produces chronic and recurrent instability in cancer care, resulting in treatment delays, interregional referrals, and sustained psychological stress. In response, the role of the oncology nurse navigator must evolve to become highly attuned to the practical health risks and changing healthcare needs brought about by changing climatic conditions. This transformation involves conducting vulnerability assessments and risk stratification across environmental, disease-related, and socioeconomic dimensions; integrating climate and environmental signals into clinical judgments and decision-making; and implementing anticipatory interventions supported by innovative and digital tools. A climate-adaptive care network grounded in cross-sector collaboration is proposed to strengthen feedback mechanisms and system-level coordination. Finally, climate adaptation-related competencies should be integrated into oncology nurse navigator education and training using clearly defined and measurable competency-based modules that encompass climate-sensitive clinical judgment, telehealth practice, cross-sector governance, and quality improvement, with the aim of strengthening continuity and equity in cancer care under conditions of climate change.
Hu li za zhi The journal of nursingChia-Jung Lin, Mei-Chih Huang
In this paper, how cultural care may be operationalized in clinical nursing practice in Taiwan is examined by integrating the Giger-Davidhizar transcultural assessment model with the Narayan cultural assessment framework, with Leininger's Theory of Cultural Care Diversity and Universality serving as the central theoretical framework. Using a case exemplar (a Taiwanese woman living with type 2 diabetes), we examine the influence on health behaviors and treatment decisions of multiple cultural factors, including education, economic conditions, politico-legal context, biological characteristics, cultural values and lifestyle, kinship relationships, religious beliefs, and acceptance of health technologies. Guided by Leininger's three strategies of cultural care preservation/maintenance, accommodation/negotiation, and repatterning/restructuring, we illustrate how culturally sensitive assessments may inform the development of individualized and integrated care plans. Moreover, we argue that strengthening cultural competence enables clinicians to better identify patients' embedded cultural beliefs and life contexts, facilitate interprofessional collaboration, and promote health equity through the provision of culturally congruent care. Practice-oriented implications for nursing education and clinical practice in Taiwan are provided with the goal of strengthening culturally responsive, patient-centered care and enhancing the quality of personalized care in local healthcare settings.
Critical care nurseJulie Miller, Mary Stahl, Sara Grieshop, Devin Bowers
BACKGROUND: An evidence-informed competence framework, with measurable performance outcomes and knowledge, skills, and abilities metrics, and an implementation toolkit were developed and beta tested to determine nurse readiness for transitioning from orientation to autonomous practice. OBJECTIVE: To evaluate satisfaction and toolkit implementation and impact, and to identify opportunities for improvement. METHODS: Sites replaced their orientation methods with the competence framework, and beta testing took place over a 1-year period. Surveys before and after implementation measured orientee and nurse leader confidence in orientees' ability to recognize a change in stability, intervene for a change in stability, advocate on behalf of the patient, and provide safe patient care. Comparisons of length of orientation, satisfaction, and opportunities for improvement were assessed. Nurse retention at 1 year was determined. RESULTS: Thirteen progressive care and critical care units with 49 orientees completed the beta test; 24 orientees completed the before and after surveys. After beta testing, orientees reported increased confidence levels in all polled performance outcomes compared with before orientation. Most (92%) orientees reported the framework performance outcomes and knowledge, skills, and abilities metrics were moderately to completely effective in preparing them to work with minimal supervision. Most (88%) nurse leaders, educators, and preceptors rated these same outcomes and metrics as moderately to completely effective. Nurse retention at 1 year was 90%. CONCLUSION: The beta test demonstrated improvement in confidence in all polled areas, and 1-year retention outperformed the national average. The competence framework is effective in answering the question, How do leaders know when the nurse is ready to transition from orientation to more independent practice?
Critical care nurseNoor Hasmee, Bhupendra Singh, Hema Joshi
BACKGROUND: Acute motor and sensory axonal neuropathy is a rare, severe variant of Guillain-Barré syndrome marked by rapid progression, autonomic dysfunction, and delayed recovery. The patient in this report was treated in a resource-limited intensive care unit and had coexisting tropical infections that complicated diagnosis and treatment. CLINICAL FINDINGS: A 40-year-old man presented with acute quadriparesis, respiratory distress, and autonomic instability following a febrile illness. Laboratory tests revealed anemia, electrolyte imbalance, and methicillin-resistant Staphylococcus aureus bacteremia. Serology test results were weakly positive for dengue virus, typhoid, and scrub typhus. Nerve conduction studies confirmed acute motor and sensory axonal neuropathy. DIAGNOSIS: Acute motor and sensory axonal neuropathy was complicated by polyinfection and tuberculous pleuritis, confirmed via cartridge-based nucleic acid amplification testing. Imaging showed bilateral pleural effusion and right lung collapse and consolidation. INTERVENTIONS: Despite 5 cycles of intravenous immunoglobulin therapy, the patient showed no initial improvement and received 7 plasmapheresis cycles. Additional interventions included tracheostomy, vasopressors, bromocriptine for central fever, and antitubercular therapy. Nursing care grounded in the Roy Adaptation Model emphasized airway management, prevention of secondary complications, emotional reassurance, caregiver communication, and coordination of interprofessional care. OUTCOMES: The patient demonstrated steady neurological improvement, was successfully weaned from ventilation, and transitioned to rehabilitation. Nurse-led, theory-informed interventions were key to patient stabilization and long-term recovery. CONCLUSION: This case illustrates the complexity of acute motor and sensory axonal neuropathy with multiple infections and the role of structured nursing care for positive outcomes in intensive care units.
International journal of mental health nursingEuna Si, Ki Han Kwon
AI is increasingly being integrated into mental health support, with applications spanning chatbots, large language models, digital therapeutics and clinical decision-support systems. Although these technologies have demonstrated potential to improve access to care and support clinical practice, their implications for psychiatric mental health nursing (PMHN) remain insufficiently synthesized. This scoping review aimed to examine how AI is being applied in mental health care and to synthesize its implications for psychiatric mental health nursing practice and related nursing-relevant outcomes. A scoping review was conducted following established scoping review methodology and reported in accordance with the PRISMA Extension for Scoping Reviews (PRISMA-ScR). Searches were conducted across four databases for studies published between January 2022 and May 2026. A total of 42 sources of evidence met the inclusion criteria. Five overarching themes were identified: (1) AI-based psychosocial interventions and mental health care delivery; (2) suicide prevention and risk management; (3) therapeutic relationships and human-centred care; (4) ethics, safety and governance; and (5) nursing readiness, education and professional transformation. AI applications were associated with improved accessibility of mental health support, enhanced symptom management and more efficient risk assessment. However, concerns regarding privacy, algorithmic bias, transparency and the preservation of therapeutic relationships were consistently reported. AI demonstrates considerable potential to support care delivery, suicide prevention and clinical decision-making, yet raises important ethical, relational and professional challenges. AI should be viewed as a complementary tool that supports rather than replaces psychiatric mental health nursing practice. Educational programmes should strengthen AI literacy, digital ethics and critical appraisal skills to support safe and person-centred AI integration.
In July 2026, OpenAI disclosed that models under evaluation had escaped the environment in which they were tested, reached the open internet without permission and taken data useful to their own improvement. The episode marks a practical shift: from systems that answer questions to systems that pursue goals over time with little supervision. Scholarly work on AI in nursing has grown quickly, centring on capability, readiness and how existing theory might be reinterpreted as these technologies arrive. This paper argues that agentic systems raise a further question. What should such a system be trying to achieve, and who decides? The question is not new; it is the latest form of an old problem about who sets collective ends, and on whose behalf. Drawing on an illustration from nurse staffing, the paper asks whether nursing theory could inform such a specification-not by being reinterpreted, but by being translated into a form an autonomous system can act on. It then takes seriously the strongest objection to its own proposal: that what nurses know may resist codification and that earlier attempts to formalise it cost more than they returned. The paper does not resolve this tension, but argues that it needs attention.
Tokenism has become an increasingly visible feature of contemporary research and scholarship, particularly in contexts where expectations of diversity and inclusion are institutionally embedded. While often presented as evidence of progress, tokenism raises critical questions about power, participation and the conditions under which knowledge is produced. Tokenism is more than simply a failure of inclusion, it is a functional feature of contemporary research systems, enabling the appearance of equity while preserving existing distributions of power. This paper examines tokenism as a form of inclusion that is more symbolic than substantive, projecting an image of progress while leaving existing hierarchies intact. We argue that tokenism in nursing research is not simply a problem of representation, but a form of epistemic injustice that shapes who participates, whose contributions are recognised and what knowledge is legitimised. In doing so, tokenism can obscure expertise, distort perceptions of competence and position individuals as representatives of identity rather than as authoritative contributors. These dynamics have ethical and epistemic consequences, including the reproduction of marginalisation, the generation of partial knowledge and the erosion of trust. Addressing tokenism requires a reorientation towards collaborative and justice-oriented practices in which participation and epistemic authority is shared.
International journal of mental health nursingIvana Felicia Angkawijaya, Celine Joy Jing Hsia Gan, Ziqiang Li, Yong Shian Goh
The rising prevalence of mental health conditions (MHCs), coupled with increased public awareness, has led to greater help-seeking behaviours and heightened demands on nurses across healthcare settings. However, many general trained nurses report feeling inadequately prepared to care for individuals with MHCs due to limited training and clinical exposure. This lack of preparedness may result in compromised quality of care, reduced professional satisfaction and poorer recovery outcomes for clients. Existing systematic reviews have predominantly focused on psychosocial interventions for psychiatric nurses, limiting insights into interventions relevant to the broader nursing workforce. This review aimed to map the available evidence on interventions that prepare general trained nurses to care for individuals with MHCs. A comprehensive search was conducted across eight electronic databases between August and September 2024, alongside grey literature sources, including ProQuest Dissertations and Theses and ClinicalTrials.gov, searched between September and October 2024. A total of 7646 records were identified. Following title and abstract screening, 38 full-text articles were reviewed, of which 24 met the inclusion criteria. A narrative synthesis was undertaken, with findings organised into delivery methods, intervention domains and implementation challenges. The review found that interventions targeting mental health literacy, stigma reduction, interpersonal and communication skills, and nurse safety and resilience were associated with improved confidence, empathy, therapeutic relationships and willingness to provide care. Overall, the findings underscore the importance of multifaceted, contextually relevant approaches, including digital literacy training, ongoing evaluation and stronger organisational support, to enhance nurses' preparedness and well-being in mental health care.
Perioperative nurses use evidence-based practice to achieve optimal outcomes when caring for patients. Translating evidence-based guidelines into practice, however, can be difficult, especially when barriers to compliance are present. Compliance barriers may arise from organizational culture, knowledge deficits, absence of policy, shortcuts, competing priorities, time constraints, physician pushback, or system-level barriers. When evidence-based practices are not followed, patient safety events and suboptimal outcomes may occur. This article addresses how legislative advocacy and policy provide solutions when barriers prevent full compliance or efforts fail. Even with organizational policy solutions, barriers to implementation may still exist. Perioperative nurses should therefore advocate in policy arenas to promote change that results in optimal quality and safety outcomes for themselves, their team, and their patients. Compliance, barriers, and advocacy are explored to navigate the intersections of policy, quality, and safety.
Critical care nurseWei Jun Dan Ong, Eleanor Dela Peña, Faheem A Khan, Woon Hean Keenan Chong, Lawrence Ace Azul
BACKGROUND: Noninvasive ventilation is increasingly delivered outside intensive care units; however, ventilator alarm management, documentation, and competency validation remain inconsistent when paper-based processes are used. Delayed or inconsistent responses to actionable alarms may contribute to clinical deterioration and escalation of care. LOCAL PROBLEM: Nurses and respiratory therapists reported fragmented documentation, limited access to standardized troubleshooting guides, and time-consuming competency tracking for noninvasive ventilation devices in acute medical units that provide intermediate-level care. METHODS: This quality improvement project, which used a pre-post design, involved implementation of a digital ventilator safety workflow using QR code-linked alarm guidance and a secure online checklist. Data were collected during a 6-month baseline period and a 6-month postimplementation period. Clinical content, workflow mapping, and alarm-guidance pathways were developed in-house by the respiratory therapy department and deployed through AskVijay, a digital clinical guidance platform. Competency validation was conducted during onboarding and annual assessment. RESULTS: Digital implementation was associated with an increase in checklist completion compliance from 80% to 100% and a reduction in checklist completion time from a median of 8.5 minutes to 3.9 minutes. Use of required digital fields supported more complete documentation. Centralized electronic records enabled consolidated competency documentation and facilitated tracking of checklist and competency completion. CONCLUSION: A digital ventilator safety workflow supported standardized documentation, point-of-care access to alarm guidance, and competency tracking for unit-based noninvasive ventilation care. In-house clinical development enabled iterative refinement to align with local practice needs and workflows.
International journal of mental health nursingNovia K N Mak, Bridget Dibb, Nicholas Stokes, Emerita Elizabeth Alexandra Barley, Magdalena Zasada
Approximately 80% of individuals in secure mental health units are overweight or obese, yet nurses often lack practical guidance on how to initiate and sustain weight-related conversations in these complex settings. This study aimed to co-design an evidence-based, nurse-led weight talk tool with service users and nursing staff, and to evaluate its acceptability and usability in low- and medium-secure inpatient care. A multi-stage, iterative design was undertaken. Initial evidence informed development, followed by a person-centred co-design process involving service users and staff through workshops, structured discussions and repeated feedback. The tool was subsequently evaluated using a think-aloud approach with 19 nurse-service user pairs, enabling real-time exploration of usability, understanding, and emotional responses. Co-design produced a structured, visually engaging tool tailored to the sensitivities and constraints of secure mental health settings. Service users and staff shaped key refinements, including simplified language, removal of potentially stigmatising elements, enhanced visual design, and the inclusion of structured opening and closing components to support psychologically safe conversations. Evaluation findings demonstrated high acceptability and usability. Service users valued the respectful, collaborative approach, while nurses reported increased confidence in addressing weight-related issues. These findings highlight the value of co-design as a method for developing acceptable, contextually relevant interventions for sensitive clinical topics. Embedding collaborative approaches within mental health nursing practice may strengthen therapeutic engagement and support more effective, person-centred care across diverse international settings.