BACKGROUND:The treatment of bladder cancer often involves radical cystectomy and urostomy, which increase survival rates but cause significant physical, psychological and social distress. While existing evidence emphasizes treatment and interventions to improve the quality of life, few studies have explored the continuous health management experience and needs of urostomy patients from diagnosis through recovery. OBJECTIVE:To construct a journey map of the healthcare management needs of urostomy patients to explore key pain points in their rehabilitation process and provide a reference for continuous health management. METHODS:A descriptive qualitative study was conducted. Using purposive sampling, 25 participants who underwent urostomies were recruited from a tertiary hospital in Tianjin, China. Data were collected through semi-structured face-to-face in-depth interviews. Conventional content analysis was used to analyse the data, extract themes and visualize dynamic changes in patient needs via a patient journey map. RESULTS:The patient journey map delineated four phases and extracted 12 themes. During the screening and diagnosis phases, participants experience symptom distress, information overload and fear of recurrence. The perioperative phase was marked by challenges in symptom management, frustration in learning stoma skills and abrupt transitions in caregiving models. During the transitional adaptation and continuing treatment phases, participants experience survival fatigue due to the dual burden of early complications, chemotherapy reactions and financial pressure. In the long-term self-management phase, participants struggle with cumbersome self-management routines, anxiety about recurrence and barriers to psychosexual and social reintegration. Fortunately, some participants show posttraumatic growth and resilience after urostomy. CONCLUSION:The rehabilitation of urostomy patients is a complex process accompanied by information overload, shifts in caregiving and the superimposition of physical and psychological symptoms. Healthcare professionals should prioritize these multidimensional needs across stages, establish an intelligent continuous care platform led by ostomy specialist nurses and be supported by multidisciplinary collaboration. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE:Healthcare professionals should establish an intelligent, continuous care platform led by ostomy specialist nurses to monitor home-based rehabilitation. The implementation of staged multimodal health education across all disease phases is crucial. Furthermore, clinical practice must actively provide psychosexual counselling, support social reintegration and deliver targeted interventions to alleviate the immense psychological burden on family caregivers. REPORTING METHOD:This study followed the COREQ guidelines for reporting qualitative studies. PATIENT OR PUBLIC CONTRIBUTION:No patient or public contribution.
ABSTRACT Introduction The foundation of nursing care is the nurse–client relationship. The Fundamentals of Care (FoC) Framework provides guidance on the core elements of this relationship: trust, focus, anticipate, know, and evaluate. A gap remains in understanding how older adults and nurses themselves engage with these relational elements in the context of long‐term community care. This may hinder nurses and their clients from collaborating in care practices. Aim To explore how older adults and nurses, through and within their ongoing relationship in community care, concretely enact and co‐construct the five elements of the nurse–client relationship and explore factors influencing this relationship. Design A qualitative descriptive research design was employed in 2022–2023, utilizing both individual and group interviews. Thirteen unique clients and relatives as informal care givers and 22 nurses participated. Results ‘Trust’ related to clients trusting the nurses' expertise and nurses enabling clients to feel confident and safe. ‘Focus’ was understood as a shared aim and actions towards maintaining independency and autonomy of clients. ‘Anticipate’ was characterized by nurses responding to clients' preferences and needs and clients and nurses making shared decisions regarding care. ‘Know’ was aimed at gaining a good understanding of clients' needs, which required clients to be open and committed to telling their needs, and nurses actively listening to their clients. Finally, ‘evaluate’, both formal and informal, revealed to be necessary to align and adjust care when necessary. Poor care coordination and continuity of care were contextual factors influencing the caring relationship. Conclusion We showed that nurses and clients in community care settings were engaged in a constructive relationship to collaborate for optimal nursing care. An empirical understanding was obtained about how the core elements of this relationship were put into practice. These elements develop over time, influenced by the nurse–client interaction and the specific context. Implications for the Profession and/or Patient Care This study highlights that both the client and the nurse have an active role in establishing the nurse–client relationship. Impact (Addressing) What problem did the study address? This study addressed how older adults and nurses themselves engage with the relational elements of trust, focus, anticipate, know, and evaluate in the context of long‐term community care. What were the main findings? An empirical understanding was obtained of how nurses and clients put these relational elements into practice. These elements evolve over time, influenced by nurse–client interactions and specific contexts. Where and on whom will the research have an impact? This research will impact community‐care nurses by offering them practical insights into establishing effective relationships with clients and engaging in dialogue about clients' responsibilities in shaping these relationships. Reporting Method We adhered to the Consolidated criteria for reporting qualitative research (Coreq) guidelines ( International Journal for Quality in Health Care , 2007, 19, 349). Patient or Public Contribution In the research team, two co‐researchers (J.A. and J.Z.) participated in the design of the study, data collection and analyses. These co‐researchers are older women with experiences in participating in qualitative research (collecting and analysing data) and community‐based nursing care (as informal care giver).
AIMS AND OBJECTIVE:To compare the diagnostic accuracy of diagnostic predictors of successful weaning in mechanically ventilated adults using network meta-analysis. BACKGROUND:Timely liberation from mechanical ventilation is linked to patient outcomes, but the comparative performance of available predictors remains unclear. DESIGN:A systematic review and network meta-analysis. METHODS:We searched PubMed, Embase, the Cochrane Library, the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Web of Science from inception to April 8, 2026. Eligible diagnostic accuracy studies evaluated predictors of successful weaning in mechanically ventilated adults. The reference standard was successful liberation or extubation without reintubation or reinstitution of invasive ventilatory support within the study-defined window, most commonly 48 h. Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool, and certainty was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. RESULTS:Twenty-seven studies involving 2938 participants were included in the network meta-analysis and evaluated eight predictors. Four additional eligible studies were not synthesised quantitatively because each evaluated a predictor reported in only one study. The extubation predictive score (ExPreS) was excluded from the connected network because it was evaluated in two single-method studies without head-to-head comparisons, leaving seven predictors. Diaphragmatic excursion, diaphragm thickening fraction, and rapid shallow breathing index formed the core evidence network, and no significant threshold effect was detected. The network meta-analysis showed no clear statistical superiority of any single predictor. Surface under the cumulative ranking curve (SUCRA) rankings suggested that mechanical ventilation duration and diaphragmatic excursion tended to rank higher for overall discrimination and specificity, whereas rapid shallow breathing index and negative inspiratory force ranked higher for sensitivity. CONCLUSION:Current evidence does not support a single universally optimal predictor. Diaphragmatic excursion showed a relatively balanced diagnostic profile, but this should be interpreted as a comparative signal rather than definitive superiority because certainty was generally low or very low. Weaning decisions should rely on comprehensive clinical assessment rather than any single index alone. IMPACT:What problem did the study address? Clinicians caring for mechanically ventilated adults have multiple candidate predictors of weaning success, but their comparative diagnostic accuracy has remained uncertain, making bedside weaning decisions variable and potentially inconsistent. What were the main findings? Across 27 studies involving 2938 participants included in the network meta-analysis, no single predictor showed clear statistical superiority across all comparisons. Diaphragmatic excursion showed a relatively balanced diagnostic profile, whereas rapid shallow breathing index and negative inspiratory force ranked higher for sensitivity and mechanical ventilation duration ranked higher for overall discrimination and specificity; however, the certainty of evidence was generally low or very low. Where and on whom will the research have an impact? The findings are most relevant to critical care nurses, intensivists, respiratory therapists and multidisciplinary intensive care unit (ICU) teams caring for mechanically ventilated adults. They support a multidimensional weaning assessment strategy and may improve the safety and consistency of liberation decisions in adult critical care settings. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE:The findings suggest that no single index should be used in isolation to guide weaning decisions. Diaphragmatic excursion may be a useful adjunct because of its relatively balanced diagnostic profile, but bedside decisions should continue to integrate ultrasound-based measures, conventional respiratory indices, spontaneous breathing trial performance and overall clinical assessment to support safer, more individualised patient care. REPORTING METHOD:This manuscript adhered to relevant Enhancing the QUAlity and Transparency Of health Research (EQUATOR) reporting guidance, specifically the Preferred Reporting Items for Systematic Reviews and Meta-Analyses of Diagnostic Test Accuracy Studies and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses incorporating Network Meta-analyses. NO PATIENT OR PUBLIC CONTRIBUTION:Patients, service users, caregivers or members of the public were not involved in the design, conduct, analysis, interpretation or manuscript preparation for this systematic review and network meta-analysis. TRIAL REGISTRATION:The protocol for this systematic review was prospectively registered in PROSPERO (registration number CRD420261362977). Because this study was a systematic review and network meta-analysis rather than a clinical trial, trial registration was not applicable.
AIMS:To explore the association between fluid balance and the occurrence of pressure injury in patients with sepsis during ICU stay. DESIGN:Retrospective cohort study. METHOD:Patients were categorised based on cumulative fluid balance percentage: fluid negative balance (< 0%), neutral fluid balance (≥ 0% and ≤ 10%), and fluid overload (> 10%). Cox proportional hazard regression models were used to assess the associations between fluid balance and pressure injury occurrence. RESULTS:A total of 10,669 patients with sepsis were included, 2346 (22.0%) developed pressure injuries. Patients with pressure injury had higher cumulative fluid balance within the first 3 days. In multivariable models, fluid overload on Days 1, 2, and 3 after admission was independently associated with a higher hazard of pressure injury occurrence during ICU stay, with hazard ratios of 1.30, 1.30, and 1.39, respectively. CONCLUSIONS:Fluid overload occurs in 21.7% of patients with sepsis by day 3 of ICU admission and is independently associated with a higher hazard of pressure injury occurrence. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE:Integrating fluid management into nursing practice may support earlier identification and prevention of pressure injuries in the ICU. IMPACT:This study examines the association between cumulative fluid balance and pressure injury occurrence in patients with sepsis during ICU stay. The findings may inform ICU nursing practice and pressure injury prevention strategies. REPORTING METHOD:Following STROBE guideline: PATIENT OR PUBLIC CONTRIBUTION: This study utilised data from the Medical Information Mart for Intensive Care-IV 3.0 database. TRIAL AND PROTOCOL REGISTRATION:This retrospective study used the publicly available database and did not require trial registration.
AIM:To describe all nursing home staff members' confidence in engaging in complex clinical communication with residents and family carers, and to explore factors affecting their attitudes. METHODS:A convergent mixed-methods study used questionnaires (n = 288) and 15 group-based discussions involving 278 professionals across nine nursing homes between April and May 2025. Quantitative data were analysed descriptively, and qualitative data underwent inductive thematic analysis. Findings from the two strands were compared and integrated to develop mixed-methods inferences, with qualitative data given priority to confirm, expand or contrast the survey results. RESULTS:Staff members reported limited confidence in sustaining complex clinical communication, mainly because of uncertainty in responding to family carers' questions, difficulty managing emotional reactions, lack of training and unclear role responsibility. Qualitative findings identified barriers at the facility (chronic understaffing, limited physician presence, structural limitations), team (hierarchical asymmetries, limited information sharing, intraprofessional conflicts) and resident/family levels (sensory/cognitive impairments, unrealistic expectations, distrust, role confusion, intra-family conflict). Integrated findings showed convergent and divergent patterns. Qualitative data added information on communicative and relational challenges with residents/families, understaffing-driven system barriers and structural limitations. Questionnaires suggested good leadership relationship and group cohesiveness, but group discussions revealed interprofessional and intraprofessional conflicts. CONCLUSION:Limited confidence in complex clinical communication was linked to interacting barriers at the organizational, team and resident/family levels. Effective improvement requires combining education that builds communication skills and strategies for emotionally intense conversation, protected time and spaces, team and organizational initiatives that strengthen wellbeing and collaboration, and strategies that support residents' involvement, foster family trust, and reduce unrealistic expectations and role confusion. IMPACT:Findings highlight the factors that undermine professionals' confidence in sustaining complex clinical communication in nursing homes, and offer targets that policymakers, nursing home managers and educators should consider to strengthen staff-resident/family interactions. REPORTING METHODS:Mixed methods reporting checklist. PATIENT/PUBLIC CONTRIBUTION:None.
AIM:To develop a practice-based understanding of how everyday hospital routines, professional norms and organizational conditions influence the provision of palliative care for patients approaching the end of life. DESIGN:Focused ethnography informed by practice theory. METHODS:This study involved approximately 311 h of observation of healthcare professionals across several departments of a Dutch university hospital from January to September 2024. Data analysis followed an inductive, iterative process informed by a practice theory lens. REPORTING METHOD:This study is reported in accordance with the Standards for Reporting Qualitative Research. RESULTS:Although healthcare professionals valued palliative care and generally oriented care toward enabling patients to die in their preferred place, most often at home, palliative care was frequently characterized by evasiveness. Communication remained predominantly biomedical and focused on the present moment. Four tensions were identified: (1) Medical security versus personal intimacy; (2) system logic versus lifeworld experience; (3) information clarity versus patients' capacity to take in information and (4) medical intervention versus emotional attunement. CONCLUSION:This study shows how evasiveness in hospital-based palliative care is produced and sustained through biomedical routines, organizational pressures and professional and personal orientations. These factors make it difficult to realize the holistic ideals of palliative care in everyday practice. As a result, patients' fears, uncertainties and end-of-life wishes often remain insufficiently explored, whereas organizational routines shape what is considered appropriate and possible in clinical interactions. IMPACT:The findings help to illuminate the complexity of everyday palliative care practices in hospital settings. Despite policy emphasis and professional commitment to palliative care, routines and organizational pressures can impede change. Efforts to improve palliative care can therefore require sustained attention to everyday practice and to the organizational and interactional conditions that constrain change. PATIENT OR PUBLIC CONTRIBUTION:No patient or public contribution.
AIM:To scope and synthesise qualitative literature relating to nurses' experiences of providing care to consumers with alcohol and other drug issues and explore how meaning is constructed in practice. DESIGN:Scoping review. METHODS:A scoping review was conducted following Arksey and O'Malley's framework. Findings were analysed using thematic analysis. DATA SOURCES:Systematic searches were conducted between September and November 2025 across Medline, Emcare, CINAHL and Google Scholar, using controlled vocabulary and keywords relevant to nurses' experiences of providing care to consumers with alcohol and other drug issues. RESULTS:Twenty-four studies from 12 countries were included. Seven themes were identified: emotional aspects of care, education, training and skills in practice, the spectrum of stigma, ethical issues in professional practice, navigating pain management, limited support, and how meaning is constructed in practice. CONCLUSION:Nurses' experiences of providing care to consumers with alcohol and other drug issues are shaped by multiple intersecting factors influencing care delivery and professional practice. Further research is needed to examine how workplace culture, language and interpersonal interactions influence healthcare experiences, and inform education, service development and support needs. REPORTING METHOD:Reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist. PATIENT OR PUBLIC CONTRIBUTION:No patient or public contribution.
AIM:To explore factors influencing the transfer of simulation-based training to clinical practice among nurse anaesthetists. DESIGN:An exploratory descriptive qualitative study guided by Transfer of Training Theory. METHODS:Semi-structured, in-depth interviews were conducted with 23 nurse anaesthetists from tertiary hospitals across five Chinese provinces between October 2025 and January 2026. Participants were recruited using purposive and snowball sampling. The interview guide was informed by Transfer of Training Theory, relevant literature and team deliberation. Data were analysed using primarily deductive content analysis while allowing inductive categories to emerge. RESULTS:Three themes were identified: individual readiness for transfer, training design characteristics, and workplace contextual conditions. Transfer was facilitated by patient-safety motivation, self-efficacy, and reflective adaptability and constrained by limited contextual realism, insufficiently individualised debriefing, weak follow-up evaluation, and limited organisational support. CONCLUSION:Transfer from simulation to clinical practice is shaped by interacting individual, training and workplace factors. Clinically aligned scenarios, individualised debriefing, follow-up evaluation and organisational support may strengthen clinical application in anaesthesia nursing. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE:Simulation-based training should be organised as a pathway to clinical application rather than as an isolated educational event. At the unit level, scenarios should reflect actual anaesthesia nursing workflows and structured, individualised debriefing may involve appropriately prepared senior physicians and experienced nurse anaesthetists. Nursing managers can hold regular post-training meetings, assess clinical application at 3-6 months and incorporate key practices into departmental protocols or standard operating procedures. IMPACT:This study identifies actionable multilevel factors that can inform simulation design and post-training support for nurse anaesthetists. REPORTING METHOD:The study adhered to the COREQ checklist. PATIENT OR PUBLIC CONTRIBUTION:No patient or public contribution.
AIM:To gain consensus and prioritise barriers to effective pressure injury prevention for at-risk patients and to collaboratively generate, discuss and recommend intervention strategies that could address these prioritised barriers in the acute medical-surgical hospital context. DESIGN:Nominal Group Technique. METHODS:Participants involved in pressure injury prevention across acute medical-surgical services in a tertiary hospital in Australia were purposively sampled. Pre-reading materials informed the discussion on barriers to prevention. Participants ranked 11 barriers that were collaboratively developed and identified practical context-specific solutions. Data were analysed using inductive content analysis. RESULTS:Nine multidisciplinary participants prioritised three final barriers to effective pressure injury prevention: inadequate skin assessment and monitoring, competing priorities and workflow pressures and insufficient education and inconsistent knowledge. Proposed solutions focused on developing concise, accessible decision support tools such as quick reference flowcharts to enhance confidence, consistency and timeliness of appropriate pressure injury prevention practices. CONCLUSIONS:The Nominal Group Technique enabled consensus-building, guided the development of actionable priorities and informed targeted intervention strategies to address key barriers in acute care nursing practice. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE:Findings from this study offer nurse leaders and researchers practical insights to co-create an intervention that drives evidence-based pressure injury prevention practice change in acute medical-surgical settings. Adoption of these targeted approaches may enhance hospital patient safety through pressure injury prevention implementation. REPORTING METHOD:Reporting guideline for PRIority Setting on health research (REPRISE). PATIENT OR PUBLIC CONTRIBUTION:No patient or public contribution.
BACKGROUND:The incidence of head and neck cancer (HNC) is rising globally, with patients undergoing extensive surgical resection for advanced disease frequently requiring prophylactic tracheostomy to secure the airway in the early postoperative period. Specialised HNC nurses undertake extended scope tracheostomy procedures, including tube changes and decannulations, yet practice varies widely between institutions and no standardised training framework exists. AIMS AND OBJECTIVES:To benchmark the roles and responsibilities of specialised HNC nurses in tracheostomy management across Australia, and to explore the facilitators, barriers and enablers of nurse-led extended practice. DESIGN:National mixed-methods study. METHODS:An online REDCap questionnaire was distributed to nurses with inpatient HNC tracheostomy experience within the past 5 years (n = 22). A subset participated in semi-structured interviews (n = 11), analysed using inductive thematic analysis. RESULTS:Most participants were senior metropolitan-based nurses with over 12 years of HNC experience. Nine (41%) performed tracheostomy tube changes and 14 (64%) conducted decannulations. Thematic analysis identified six themes: the central role of the multidisciplinary team; education and patient support; training and skill acquisition; extended scope of practice; challenges to nurse-led management; and benefits of nurse-led management. Skill acquisition was facilitated by mentoring and high-volume exposure; barriers included collegial resistance, equipment access and workload pressures. CONCLUSIONS:Specialised HNC nurses report undertaking extended scope tracheostomy procedures across a range of Australian centres, with mentoring, high-volume clinical exposure and multidisciplinary collaboration described as key enablers. Standardised competency frameworks may help to reduce inter-institutional variation; however, the safety, efficiency and patient-level outcomes of these models were not directly evaluated in this study and warrant formal investigation in future research. RELEVANCE TO CLINICAL PRACTICE:This study provides the first national descriptive data on the role of nurses in tracheostomy management for patients with HNC in Australia and offers a foundation for the development of standardised training pathways. The potential impact of such pathways on efficiency, length of stay and nursing workforce capacity warrants formal evaluation in future studies.
AIM:To explore the cultural challenges and complexities faced by researchers conducting studies with cancer patients in the Chinese cultural context. DESIGN:A descriptive qualitative study. METHODS:Semi-structured interviews were conducted with 22 nurse researchers from tertiary hospitals, medical universities, and secondary nursing colleges from all six regions in China between April 2023 and December 2024. Data were analysed using inductive thematic analysis as described by Braun and Clarke. RESULTS:From the analysis, two themes were developed: (i) sociocultural factors, and (ii) strategies to navigate cultural complexities. Nearly all participants reported significant difficulties in conducting research with cancer patients, stemming not only from the vulnerability associated with a cancer diagnosis, but also from the cultural taboo surrounding cancer and death, and the influential role of family members in decision-making and patient protection. Researchers emphasised the need to carefully balance family members' roles as gatekeepers, manage power dynamics with healthcare professionals, uphold patient autonomy, and communicate sensitively while maintaining research integrity. To address these challenges, participants recommended consulting family members before approaching patients, involving both patients and families throughout the research process, improving ethical training for researchers, and developing culturally sensitive ethical guidelines specific to China. CONCLUSIONS:Cultural traditions and norms play a significant role in shaping cancer research practices in China. IMPLICATIONS FOR THE PROFESSION:Developing culturally sensitive ethical guidelines specific to the Chinese context is essential to support research personnel and ensure the ethical integrity of cancer research. IMPACT:China's taboos surrounding cancer and death, and deeply embedded cultural traditions and norms, family-centred decision-making, and filial piety profoundly shape the conduct of research involving patients with cancer, particularly when a tension exists with universal ethical principles. REPORTING METHOD:The Consolidated Criteria for Reporting Qualitative Research. PATIENT OR PUBLIC CONTRIBUTION:No patient or public contribution.
AIM:To examine the association between nursing experience and paediatric adverse nursing event (ANE) harm risk, and whether SOP accessibility modifies this association. DESIGN:Retrospective cohort study, 2015-2024. METHODS:We analysed paediatric ANEs reported from 2015 to 2024 at a tertiary children's hospital in western China. The primary outcome was whether an ANE resulted in harm (yes/no). The exposure was years of nursing experience, grouped into five categories (< 1, 1-< 3, 3-< 5, 5-< 10 and ≥ 10 years), and SOP accessibility served as an effect modifier. Multivariable logistic regression models and stratified analysis with interaction tests were applied. RESULTS:Among the 3199 paediatric ANEs, 1341 (41.92%) resulted in harm. Harm risk was highest among nurses with ≥ 10 years of experience (adjusted OR = 1.93, 95% CI: 1.33-2.81 vs. < 1 year), with no significant elevation in the intermediate nurses (1-10 years). SOP accessibility modified this association (p for interaction = 0.004). When SOPs were accessible, the elevated risk in the ≥ 10-year group persisted (adjusted OR = 1.95, 95% CI: 1.33-2.87); when SOPs were inaccessible, it was no longer evident, and a protective association appeared in the 3-< 5-year group (adjusted OR = 0.15, 95% CI: 0.03-0.76). CONCLUSIONS:Nursing experience exhibited nonlinear association with paediatric ANE harm risk, and this relationship was significantly modified by SOP accessibility. Harm risk was highest among nurses with ≥ 10 years of experience. However, given the retrospective observational design, causal inference is precluded, and the underlying mechanisms remain to be elucidated. PATIENT OR PUBLIC CONTRIBUTION:No patient or public contribution.
AIMS:To determine the prevalence and characteristics of urinary catheter blockage in older patients using objective indicators and to characterize obstructive materials and microbiota. DESIGN:A cross-sectional study. METHODS:Patients aged ≥ 65 years with an indwelling catheter for ≥ 24 h were recruited from a long-term care hospital. Blockage was defined using objective indicators including residual urine volume, leakage, reinsertion urine volume and resistance to saline injection. Samples were analysed for composition and microbiota. RESULTS:Among 77 patients, 29.9% experienced catheter blockage. Blockage was associated with shorter catheterization duration and greater intraluminal narrowing. Proteus mirabilis and Campylobacter ureolyticus were more abundant. Most blockages occurred at the catheter tip (81.0%), with struvite as the predominant material (71.4%). Microbiota varied by material composition. CONCLUSION:Catheter blockage occurred in 29.9% of patients, mainly at the catheter tip and associated with struvite. Microbiota differed by blockage status and material composition. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE:Objective identification of catheter blockage supports early detection and targeted management and provides a basis for research on mechanisms. These findings provide a foundation for future research to develop and evaluate evidence-based nursing interventions for preventing catheter blockage in older adults. IMPACT:This study addressed the lack of objective criteria and limited understanding of catheter blockage. It showed that about 30% of patients experienced blockage and identified distinct microbiota and material characteristics. These findings may improve catheter management and support future research on mechanisms and prevention. REPORTING METHOD:STROBE checklist. PATIENT OR PUBLIC CONTRIBUTION:Patients contributed to data collection by providing information on symptoms related to catheter blockage through structured assessments, while nurses during the study period facilitated data collection and conducted clinical assessments.
AIMS:This review aimed to systematically examine the application of digital patient decision aids in patients with chronic obstructive pulmonary disease, clarify the main decision-making themes and core content of current digital patient decision aids for patients with chronic obstructive pulmonary disease, and summarise the scope and characteristics of reported outcome evidence related to these tools. DESIGN:Existing research on digital patient decision aids for patients chronic obstructive pulmonary disease was summarised. DATA SOURCES:We retrieved the PubMed, Web of Science, Cochrane and Embase databases from their establishment to 31 July 2025. METHODS:This scoping review was reported in accordance with the PRISMA Extension for Scoping Reviews reporting guideline. Search terms included decision-making support technology, chronic obstructive pulmonary disease and related topics. The inclusion standard is based on the principle of PCC. The study population is chronic obstructive pulmonary disease patients, the core concept is digital patient decision aids and the environment is family, community or hospital. RESULTS:A total of nine studies were included. The results showed that the digital patient decision aids mainly focused on the two major decision-making topics of pulmonary rehabilitation and mechanical ventilation. These measures are mainly implemented through web pages, recordings or clinical decision support systems. In terms of result indicators, most studies choose decision-making conflict as an indicator of decision-making quality. In addition, satisfaction, acceptability, knowledge and other result indicators have also received some attention. CONCLUSION:Preliminary evidence indicates that digital patient decision aids show promise for supporting shared decision-making in COPD. Current data suggest a positive trend in decision-making quality, but the evidence base is limited by few included studies and heterogeneous designs. Large, well-designed trials are required to confirm their sustained effects on decision-making outcomes and long-term clinical impact. NO PATIENT OR PUBLIC CONTRIBUTIONS:This scoping review did not include any patients or public involvement.
AIM:This review examines the psychosocial impact on families and their resilience strategies during their children's in-hospital bridge-to-transplant while using Long-Term Mechanical Circulatory Support devices to reduce families' uncertainties. DESIGN:A qualitative systematic review. DATA SOURCES:PubMed, CINAHL, ASSIA, Embase, Scopus, and ProQuest (dissertations and theses). METHODS:The search (concluded on 1st March 2025) identified English-language published and unpublished qualitative studies exploring families' experiences of their children's in-hospital bridge-to-transplant from their perspectives. Studies were critically appraised using the Critical Appraisal Skills Programme qualitative tool. Findings were analysed using Braun and Clarke's reflexive thematic analysis (2022). FINDINGS:Six qualitative studies (49 pooled participants) were included. The review synthesised four themes: (1) Commencing the families' journey with Long-Term Mechanical Circulatory Support. (2) Navigating the Long-Term Mechanical Circulatory Support for paediatric patients' families through bridging. (3) Crossroads of blessings and challenges: Long-Term Mechanical Circulatory Supported children's families await a new heart. (4) The power stations (supportive networks) of Long-Term Mechanical Circulatory Supported children's families. Findings were interpreted through the lens of Mishel's Uncertainty in Illness Theory (1981), yielding significant recommendations; however, the review also highlighted secondary data analysis limitations, notably the incomplete reporting of theoretical constructs. CONCLUSION:This review highlights the profound psychosocial impacts and uncertain families' experiences during their children's bridge-to-transplant journey. Interventions are called to mitigate these uncertainties during this period. IMPACT AND IMPLICATIONS FOR THE PROFESSION:This review identified significant implications, including tailoring clinical education for parents of children with end-stage heart failure (congenital versus acquired), technology utilisation, and better organisation of the supportive networks. Additionally, it emphasised the multidisciplinary teams' early involvement policies. Moreover, future research should broaden perspectives by including non-Western participants, siblings, families of children with cancer-related cardiomyopathies, and grieving families to better capture diverse families' psychological impacts and help alleviate their uncertainties during the waiting journey. REPORTING METHOD:Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). PATIENT OR PUBLIC CONTRIBUTION:No patient or public contribution.
