BACKGROUND:Sleep quality is a critical component of health and recovery, yet it remains a significant challenge during hospitalization. Poor sleep among inpatients is common and worsens throughout hospital stays, adversely affecting health outcomes and patient wellbeing. Despite its importance, sleep often receives limited attention within hospital policies and nursing practices. AIM:To evaluate the impact of hospitalization and night-time nursing interventions on the sleep quality of noncritical patients in Spanish public hospitals. METHODS:An observational, multicenter study was conducted across 12 public hospitals. Data were collected from patients admitted to surgical and medical units between January 2020 and February 2022. Sleep quality was assessed using the Pittsburgh Sleep Quality Index at hospital admission and discharge. Night-time nursing interventions (including medication administration, vital signs monitoring, blood sample collection, and anxiety management interventions), sociodemographic, anthropometric, clinical variables, and self-reported disturbances were also recorded. Statistical analyses included descriptive statistics and linear regression models adjusted for potential confounding factors. RESULTS:The study included 383 patients. Most patients (71%) presented poor sleep quality upon admission, which worsened during hospitalization (85.9%). A significant association was found between the number of intervention days and poorer sleep quality. Collection of blood samples was significantly associated with worsened sleep quality in female patients, while anxiety management was associated with lower sleep quality in males. Discomfort with roommates and night-time nursing interventions were also related to worse sleep quality. LINKING EVIDENCE TO ACTION:Hospitalization exacerbates poor sleep quality in noncritical patients. Night-time nursing interventions, discomfort with the hospital environment, and anxiety management are key factors. Interventions addressing these modifiable factors could improve patients' sleep quality and recovery. Hospital policies should incorporate sleep as a key quality indicator, promoting strategies to reduce unnecessary night-time interventions and environmental disturbances. Nursing education must emphasize sleep-friendly care practices and appropriate planning of night-time activities.
BACKGROUND:Evidence-based practice (EBP) is essential in contemporary high-pressure healthcare environments, yet its implementation remains challenging. Despite the pivotal role of leadership, the lack of pooled quantitative evidence limits understanding of implementation leadership levels and the identification of development needs. AIM:To investigate the pooled mean levels of implementation leadership in EBP among healthcare professionals and managers. DESIGN:Systematic review and meta-analysis. METHODS:This systematic review followed the Joanna Briggs Institute methodology and utilized the PRISMA statement. Findings were synthesized using random-effects meta-analyses of mean levels. Heterogeneity was assessed using the I2 statistic. A systematic search was conducted in November 2025 in MEDLINE (Ovid), CINAHL, Scopus, Web of Science, ProQuest, and Medic with no date or geographical limits. Studies in English, Finnish, and Swedish were included. RESULTS:A total of 22 studies published between 2014 and 2025 across nine countries, involving 9970 participants, were included. The overall pooled mean level of implementation leadership in EBP, measured using the Implementation Leadership Scale (range 0-4), was 2.66 (95% CI: 2.49-2.83). Subscale pooled means were highest for supportive leadership (3.00, 95% CI: 2.83-3.16), followed by knowledgeable (2.78, 95% CI: 2.57-3.00), perseverant (2.77, 95% CI: 2.58-2.96), and proactive leadership (2.43, 95% CI: 2.25-2.61). Subgroup analyses showed pooled means of 2.47 (95% CI: 1.98-2.97) for managers and 2.70 (95% CI: 2.52-2.88) for professionals. Considerable heterogeneity was observed across studies. LINKING EVIDENCE TO ACTION:Strengthening implementation leadership to support EBP is needed across healthcare. Organizations should invest in structured, targeted leadership development initiatives that cultivate supportive, knowledgeable, perseverant, and especially proactive leadership behaviors, while ensuring programmes are context-sensitive and adaptable to variability across healthcare settings. In addition, role-based differences highlight the need for tailored support for managers that reflect the complexity and accountability of their leadership responsibilities. TRIAL REGISTRATION:PROSPERO ID: [CRD420251241584].
BACKGROUND:Engaging frontline nurses in evidence-based practice (EBP) remains a challenge due to time constraints, variable experience levels, and competing priorities. Shared governance councils, particularly those grounded in a learner-centered approach, can serve as platforms for nurse-led EBP initiatives that influence practice and policy. AIM:To describe how a shared governance council at a large academic medical center successfully implemented a year-long EBP initiative focused on fall prevention, leading to practice and policy change. METHODS:Using the Advancing Research and Clinical Practice through Close Collaboration (ARCC) model and the Seven Steps of EBP, council members received mentorship and education from EBP experts. Members collaborated in small groups to develop a PICO(T) question, conduct literature searches, critically appraise evidence, synthesize findings, and disseminate results. RESULTS:The initiative resulted in high levels of nurse engagement, growth in EBP knowledge and confidence, and a formal change in the hospital's nursing fall prevention policy. Council members developed skills in critical appraisal and scholarly dissemination. The council's work was presented at multiple internal and external forums. LINKING EVIDENCE TO ACTION:This case demonstrates that shared governance councils can drive meaningful change to improve outcomes. EBP shared governance councils are important for engaging nurses at all levels to promote and sustain EBP in nursing at the bedside and beyond. Hospitals should support shared governance councils by offering protected time, mentorship, and integration into strategic priorities. Councils should focus on policy-relevant initiatives and use structured, learner-centered methods to promote engagement, confidence, and sustained impact. This model is replicable and highlights the role of structural support in fostering EBP capacity and practice transformation.
SIGNIFICANCE/BACKGROUND:Workplace violence is a persistent threat to nurses' safety, well-being, and retention, particularly in acute care settings where patient acuity, time pressure, and emotionally charged interactions can heighten the risk of aggression. De-escalation training is increasingly recommended as a workplace violence prevention strategy, while resilience-oriented support may help nurses cope with the psychological consequences of exposure. However, less is known about how nurses experience these forms of training in routine acute care practice and what contextual factors influence their uptake and usefulness. AIMS:To explore nurses' experiences with de-escalation training and resilience support in the context of workplace violence prevention and to identify factors influencing their perceived usefulness and sustained application in acute care settings. METHODS:A qualitative study guided by interpretive description and informed by the Consolidated Framework for Implementation Research was conducted in acute care facilities in the Al-Ahsa region, Saudi Arabia. Purposive sampling was used to recruit 20 registered nurses from emergency, medical-surgical, and critical care units who had participated in workplace violence-related training within the previous 12 months. Data were collected through semi-structured interviews and analyzed using reflexive thematic analysis. RESULTS/FINDINGS:Four themes were identified: (1) training as a foundation for confidence and psychological preparedness, (2) organizational climate as a determinant of training usefulness, (3) barriers to translating training into practice, and (4) the need for system-level integration for sustainable workplace violence prevention. Participants viewed de-escalation training as strengthening communication and situational response skills, while resilience support was perceived as helping nurses manage stress reactions and recover after difficult incidents. However, staffing pressures, inconsistent reporting pathways, and variable leadership support limited sustained application. LINKING EVIDENCE TO ACTION:Effective workplace violence prevention requires more than staff education alone. Healthcare organizations should embed de-escalation training within mandatory competency development, pair it with structured psychological support after incidents, and strengthen leadership engagement, reporting systems, and interdisciplinary coordination to promote safer acute care environments.
BACKGROUND:Given evidence that existing "one size fits all" diabetes self-management education approaches are not a universal fit for all people with type 2 diabetes mellitus, cultural tailoring of interventions is undertaken to better meet specific needs of underserved population groups. AIM:To evaluate the effectiveness of culturally tailored self-management interventions in people with type 2 diabetes mellitus. METHODS:The search retrieved 1402 articles of which 17 studies (15 randomized controlled trials and 2 quasi-experimental studies) were included, with 7 studies in the meta-analysis. RESULTS:Most studies (n = 9) were conducted in the United States of America among ethnic minority groups. Of the 17 studies, 14 measured self-management behaviors with 9 showing substantial improvements in adherence to self-management behaviors (i.e., diet, foot care, medication, physical activity, self-testing of blood glucose). The meta-analysis showed that there was significant improvement in Glycated Hemoglobin (HbA1c) levels (-0.57 [95% CI -1.15, -0.25] p < 0.01) post intervention. LINKING EVIDENCE TO ACTION:Culturally tailored interventions have the potential to improve HbA1c and self-management behaviors in people with type 2 diabetes mellitus. While maintaining a collaborative approach with experts including nurses, future interventions should adopt participatory approaches with persons living with T2DM and their families, considering their perspectives, unique needs, and priorities. TRIAL REGISTRATION:PROSPERO number: CRD42022375630.
BACKGROUND:Thirty-day hospital readmissions remain a persistent challenge, undermining patient safety, disrupting care continuity, and straining healthcare system performance. Ineffective discharge education and weak care transitions leave patients vulnerable after hospitalization. Evidence suggests that structured follow-up calls within 24-72 h can reduce preventable readmissions and strengthen care transitions. AIM:This study aimed to evaluate the effectiveness of structured, nurse-led follow-up telephone calls, guided by the AHRQ RED Toolkit, in reducing 30-day hospital readmissions. METHODS:This study was conducted in a 200-bed urban medical center. It was reviewed and classified as a quality improvement initiative with minimal ethical risk and did not require informed consent. Over a 12-week implementation period, registered nurses used a standardized script to conduct follow-up calls within 24-72 h of discharge. Calls addressed health status, medication use, follow-up appointments, and home support. Pre- and post-intervention readmission data were collected from the electronic health record. Analysis included descriptive statistics and Chi-square testing. RESULTS:Among 287 patients who received standard care, 17% were readmitted within 30 days of discharge. In contrast, only 3.5% of 112 patients who received structured follow-up calls were readmitted, representing an absolute reduction of 13% (χ2 = 12.05, p = 0.0005). Patients also reported improved satisfaction and confidence in managing their care. LINKING EVIDENCE TO ACTION:Structured, nurse-led post-discharge follow-up telephone calls within 24-72 h should be integrated into standard discharge workflows to reduce preventable hospital readmissions. Nursing leadership can leverage this low-cost, scalable intervention to strengthen transitional care, improve patient safety, and support value-based care outcomes across diverse healthcare settings. CONCLUSIONS:Nurse-led post-discharge follow-up calls significantly reduced 30-day readmissions while enhancing patient safety and care transitions. Findings support incorporating structured follow-up calls into standard discharge planning as a cost-effective, evidence-based intervention for broad implementation.
BACKGROUND:The diagnosis of cancer results in psychophysiological distress in patients, significantly reducing quality of life (QoL). Currently, self-management interventions based on e-health have been used to improve QoL among cancer patients, but the overall effects remain inconsistent. OBJECTIVE:To assess the impact of self-management interventions based on e-health on the QoL of cancer patients. METHODS:Studies were retrieved from six databases up to November 6, 2024. The methodological quality assessment was performed via ROB 2. Data synthesis and subgroup analyses were performed in Review Manager 5.3. Meta-regression was conducted using Stata 15.0. RESULTS:Thirty RCTs were included. The results of meta-analysis revealed self-management interventions based on e-health significantly improved QoL (SMD = 0.18, 95% CI: 0.08 to 0.28, p < 0.01). Subgroup analyses showed that long-term, mixed-mode, theory-supported, or facilitator-supervised interventions were more effective, with greater improvements in QoL observed among patients with breast cancer than among other types. LINKING EVIDENCE TO ACTION:Self-management interventions based on e-health were valuable supplements for enhancing the QoL of cancer patients. Intervention duration, delivery modes, cancer types, theoretical frameworks, and facilitators' involvement should be considered in the design of future interventions. However, additional high-quality studies are needed to confirm these findings. TRIAL REGISTRATION:The protocol was registered on PROSPERO (Registration number: CRD420251017709).
BACKGROUND:The COVID-19 pandemic highlighted the need for alternative healthcare delivery models, leading to the development of Continuous Remote Patient Monitoring (CRPM). CRPM allows for real-time monitoring of high-risk patients, reducing the burden on hospital resources. The integration of virtual nursing into CRPM has enhanced remote care capabilities, though it has also introduced new challenges related to patient safety and staffing, that is, nurse-to-patient ratios. OBJECTIVE:This scoping review aims to explore the current evidence on virtual nursing using CRPM and identify challenges or barriers that help further future research and healthcare practices. METHODS:This scoping review followed the PRISMA-ScR guidelines. Eligible studies focused on virtual nursing with physiological monitoring in either remote hospital or home-based care settings, with explicit examination of nursing care and its impact on patient and nursing outcomes. Peer-reviewed articles published in the past 10 years in English were included. Four databases (Ovid, PubMed, CINAHL, and Medline) were searched with support from a medical librarian. After screening 207 records using Covidence, 17 studies met the inclusion criteria. Two reviewers independently screened all records, with a third resolving discrepancies. Data was charted using a standardized extraction template. RESULTS:Seventeen studies were included in this review. CRPM was associated with reported benefits in managing chronic conditions, extending acute care into home settings, and enhancing healthcare system adaptability, particularly during the COVID-19 pandemic. Clinical benefits included early detection of health deterioration, reduced hospital readmissions, and improved patient satisfaction. Nurses played a pivotal role in physiologic data interpretation and intervention, highlighting the importance of continuous oversight in achieving favorable outcomes. However, implementation challenges, such as alert fatigue, data overload, user interface complexity, and financial sustainability were consistently reported. These findings underscore the need for improved data management systems, targeted nurse training, and sustainable funding models to support broader CRPM adoption. LINKING EVIDENCE TO ACTION:Virtual nursing within CRPM demonstrates strong potential to improve patient outcomes and reduce hospitalizations by extending inpatient-level physiologic surveillance into home-based and hospital-at-home settings through continuous, nurse-led monitoring. Successful integration of this model into routine practice will require addressing challenges related to data management, clinician workload associated with 24/7 surveillance, and sustainable funding mechanisms to support continuous virtual nursing coverage.
BACKGROUND:Burnout is associated with adverse physical and psychological health outcomes in civilian nurses. Among military populations, these adverse health outcomes have the potential to degrade readiness at both individual and system levels. There are few scientific studies about burnout among military nurses. AIM:The purpose of this systematic review was to critically examine the evidence regarding the prevalence and individual characteristics associated with burnout among active-duty military nurses. METHODS:A systematic review was conducted using a comprehensive, iterative search. Peer-reviewed reports of studies that included burnout in the stated aim or research question and used a validated instrument to measure burnout were included. RESULTS:Five studies met inclusion criteria. The reported prevalence of burnout among military nurses was between 1.7% and 13.8%. Scoring, measurement, and operational definitions differed, so results should be interpreted with caution. Increased military and nursing experience, a higher volume of work hours, and working on non-day shifts may contribute to burnout among military nurses. Differences in burnout based on sex and military versus civilian status are mixed. LINKING EVIDENCE TO ACTION:Researchers should consider alternative theoretical frameworks and measurement instruments when studying burnout among military nurses. Inconsistency in measurement methods from previous studies limits current understanding. Military-specific cultural concepts may play a role in mitigating burnout among military nurses. TRIAL REGISTRATION:CRD420251036405.
BACKGROUND:Growing numbers of clinicians are dealing with mental and behavioral health issues, including burnout, depression, and suicidal ideation. Prevalence of these conditions in pediatric critical-care (PCC) nurses is reported to be as high as 42%-77%. PURPOSE:The purpose of this evidence-based quality improvement project was to implement a cognitive behavioral skills-building (CBSB) program to improve well-being and resiliency in PCC nurses. IMPLEMENTATION PLAN:The 7-week MINDBODYSTRONG (MBS) program was implemented with two cohorts of neonatal/PCC nurses in a 222-bed academic, tertiary care pediatric hospital, using a virtual platform and offering 1 sequential session per week. Each participant was asked to complete an anonymous baseline and post-program survey that included the following measures: Generalized Anxiety Disorder (GAD-2), Perceived Stress Scale (PSS4), Patient Health Questionnaire (PHQ-2), and a Single Item Measure of Burnout. Post-program surveys also included a MBS program evaluation. OUTCOMES:Fifteen RNs registered for and completed the MBS program. 93.3% completed both the baseline and post-program survey. Results demonstrated positive clinical effects across all four mental health measures with large effects noted in the GAD-2 and PSS-4, and small effects noted in the PHQ-2 and the Single Item Measure of Burnout. 100% of participants found MBS helpful and recommended that it be offered to a wider audience. LINKING EVIDENCE TO ACTION:Implementation of the MBS CBSB program demonstrated clinical effectiveness on measures of anxiety, perceived stress, depression, and burnout in PCC nurses. The program was well received by participants. Strategies for broader implementation should be explored.
BACKGROUND:Near-falls, defined as events in which individuals momentarily lose their balance but avoid falling, are strong predictors of subsequent falls. Wearable technologies have the potential to accurately detect near-falls in both laboratory and real-world settings, providing opportunities for early intervention in geriatric nursing practice. AIMS:This study has a two-fold aim: (1) to appraise and synthesize current evidence on wearable sensor technologies for near-fall detection, and (2) to discuss their potential applications for monitoring near-fall risk and implementing prevention strategies in older adults. METHODS:This is a systematic review. Articles were searched in five electronic databases (PubMed/MEDLINE, Embase, CINAHL, Web of Science, and IEEE Xplore) that explored wearable sensors for near-fall detection. The review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS:A total of 18 studies, mostly experimental or observational, were included. Inertial Measurement Units (IMUs) were the most commonly used wearable technology, and the most frequently captured biomarker was linear acceleration. Lower-body placements (feet, ankles, and lower back) demonstrated superior performance in detecting near-falls. Single-sensor systems achieved sensitivities of 80%-98%, whereas multi-sensor configurations achieved 100% sensitivity, 99% specificity, and 100% accuracy. LINKING EVIDENCE TO ACTION:Integrating wearable technologies for near-fall detection into geriatric nursing practice may enhance early identification of older adults at high risk for falls and enable timely, personalized interventions. Future research should validate these technologies in real-world settings and assess their acceptability among nurses, caregivers, and older adults.
SIGNIFICANCE/BACKGROUND:Ensuring transparency in research dissemination and confidence in published findings is essential for advancing nursing science. Open science provides a framework for achieving this by promoting practices that make scientific knowledge openly accessible, rigorous, reproducible, and inclusive, thereby strengthening trustworthiness and accountability in scholarly work. AIMS:This study aimed to evaluate the extent to which nursing journals require pre-registration and reporting guidelines, assess adherence to these practices in published research reports and systematic reviews, and explore their relationship with journal impact factors. METHODS:We conducted an observational cross-sectional survey of nursing journals indexed in the Journal Citation Reports database. After applying inclusion criteria, a 25% random sample (n = 35) was selected. Author guidelines were reviewed for pre-registration and reporting guideline requirements. For each journal, the first original research article and first systematic review from the most recent issue were examined for evidence of adherence. RESULTS:Among sampled journals, 54% recommended or required pre-registration for original research and 14% for systematic reviews. Reporting guidelines were recommended or required by 71% of journals for original research and 74% for systematic reviews. In sampled articles, pre-registration occurred in 8.6% of original research papers and 35.7% of systematic reviews, while reporting guideline use was documented in 20% of original research and 64.3% of systematic reviews. Journal impact factors were slightly higher among journals that recommended or required these practices, but differences were not statistically significant. CONCLUSIONS:Pre-registration remains underutilized in nursing research despite journal recommendations. Reporting guidelines are more commonly used, especially in systematic reviews. LINKING EVIDENCE TO ACTION:Improving research integrity requires collaboration among all stakeholders beyond journal policy enforcement. Key strategies include training researchers, screening submissions for pre-registration and reporting guidelines, involving peer reviewers in compliance checks, and leveraging librarians for comprehensive searches.
BACKGROUND:Workplace incivility, characterized by low-intensity, disrespectful behaviors, undermines nurses' job satisfaction, retention, and patient care quality in high-stress settings, such as emergency departments. OBJECTIVES:To measure workplace incivility from patients, physicians, colleagues, and supervisors among nurses, assess professional attitudes, analyze correlations, and recommend staff development strategies. METHODS:A quantitative, cross-sectional study surveyed 256 nurses using the Nursing Incivility Scale and Attitude Scale for Nursing Profession. Data were analyzed with IBM SPSS, SmartPLS for PLS-SEM, and chi-squared tests. RESULTS:Nurses reported moderate incivility, with physicians as the primary source (M = 4.86 ± 0.000, p < 0.001), followed by patients, visitors, and colleagues; supervisors were least aggressive (M = 2.05 ± 0.689, p = 0.015). Younger (20-30 years, χ2 = 31.868, p < 0.001), less experienced (0-5 years, χ2 = 31.921, p < 0.001), Saudi (χ2 = 10.808, p = 0.004), and single nurses (χ2 = 30.436, p < 0.001) perceived higher incivility. Attitudes were positive, with "Characteristics of the Nursing Profession" (M = 3.83) and "General Attitude" (M = 3.73) scoring higher than "Preference for the Nursing Profession" (M = 3.58). Females (χ2 = 12.261, p = 0.002), nurses aged 31-40 (χ2 = 23.731, p < 0.001), those with bachelor's degrees (χ2 = 34.008, p < 0.001), and those with 11-15 years' experience (χ2 = 18.606, p = 0.017) reported more positive attitudes. PLS-SEM showed "Disrespect from Patients" (path coefficient = 0.951) and "Lack of Respect" (path coefficient = 0.932) reduced "Preference" (R2 = 0.41), with negative correlations (r = -0.430, p = 0.011; r = -0.381, p = 0.015). LINKING EVIDENCE TO ACTION:The evidence points to a critical need for targeted interventions focusing on physician-nurse professional dynamics to mitigate incivility. Educational and policy initiatives must be developed to protect younger, less experienced, and Saudi nurses who are disproportionately affected. Given the direct and significant link between disrespect and reduced preference for the profession, hospitals must implement zero-tolerance policies and comprehensive support systems to foster an environment of mutual respect to improve nurse retention and well-being.
OBJECTIVE:To synthesize randomized controlled trials (RCTs) regarding the effectiveness of pre-pregnancy weight loss interventions on the risk of gestational diabetes mellitus (GDM) in women with overweight or obesity. METHODS:Comprehensive literature searches were conducted across nine databases from inception to May 2024. RCTs comparing pre-pregnancy weight loss interventions with blank control or active control among adult women with overweight or obesity were included. Meta-analyses, using a random-effects model, were performed to pool results of RCTs. RESULTS:Six studies, including 1632 participants, were included. The effectiveness of pre-pregnancy weight loss interventions on changes in weight and body mass index (BMI) was statistically significant (mean difference [MD] = -6.02, 95% confidence interval [CI] [-8.94, -3.10], I2 = 98%; MD = -2.22, 95% CI [-3.44, -1.00], I2 = 98%). However, there was no statistically significant difference in the risk of GDM in women receiving pre-pregnancy weight loss interventions compared with controls (Odd Ratio [OR] = 0.70, 95% CI [0.48, 1.03], I2 = 2%). LINKING EVIDENCE TO ACTION:Pre-pregnancy weight loss interventions do not significantly impact the risk of GDM in women with overweight or obesity. Due to the small number of studies, small sample size, and large heterogeneity of pre-pregnancy weight loss interventions, further research is required. TRIAL REGISTRATION:ClinicalTrials.gov identifier: CRD42023482808.
BACKGROUND:Evidence-based practice (EBP) programs for nurses are a strategy to influence the culture of an organization to value and use EBP. It is critical to demonstrate their impact during this time of uncertainty and economic unrest. AIMS:This project describes and evaluates a Practicing Nurse EBP Fellowship Program for Registered Nurses (RNs) and Advanced Practice Registered Nurses (APRNS) on (1) cost, (2) participants' retention, dissemination of work, and application for an advanced degree; (3) impacts using the Institution of Healthcare Improvement (IHI) Quintuple Aim framework, and (4) EBP culture. METHODS:Direct costs were described using actual costs incurred, and salary estimates were pulled from the literature for indirect costs. Secondary data analyses were used to examine retention of the Fellows and the EBP culture. A survey was used to measure participants' self-reports of the dissemination of projects and applications for an advanced degree. The Program Director associated IHI Quintuple aims to each project. Descriptive statistics were utilized to analyze the data. RESULTS:Forty-seven nurses (RNs and APRNs) participated in the EBP Fellowship Program over 8 years. Annual costs for the program were $106,294.00. All five of the IHI's Quintuple Aim were addressed across the 47 EBP projects. The retention rate was 76.6% for these Fellows who averaged 5 years since completing the program. Twenty-nine percent of respondents had presented their work externally, and 21% had enrolled in or completed a doctoral program (DNP or PhD). There was a decrease observed in the employee engagement question measuring EBP culture. LINKING TO EVIDENCE TO ACTION:EBP Fellowship Programs are a cost-effective strategy to invest in clinicians and improve patient and clinician outcomes. Continued support from Chief Nurse Executives for such programs is still needed.
BACKGROUND:Ethics education for pre- and post-licensure nurses is inconsistently delivered. In clinical practice, nurses report feeling inadequately prepared to address ethical challenges, which decreases their ability to take ethical action and creates moral distress. AIMS:To understand nurses' perceptions of an innovative, experiential ethics education program, its benefits, and limitations to enhancing ethical patient care. METHODS:Using a descriptive qualitative design and focus group interviews, data were collected from 2 cohorts of hospital-based nurses who completed a multimodal ethics education program (the Moral Spaces program). Participants were recruited from a quaternary care medical center and nine small- to -mid-size regional acute care hospitals within one healthcare system in the Midwest United States. Data were analyzed using conversation analysis. RESULTS:Eleven nurses participated. Three themes were identified: 1. Recognition of Diverse Values and Perspectives, 2. Critical Distance to Neutralize Strong Negative Emotions and Address Burnout, and 3. Enhanced Advocacy Prompting Greater Expectations. LINKING EVIDENCE TO ACTION:Ethics education programs can positively influence nurses and their clinical practice. By empowering nurses with ethical knowledge and communication skills, they describe a greater ability to identify and address ethical issues, thereby mitigating moral distress and burnout. When empowered to advocate more effectively for patient values, the ethical delivery of patient care can be optimized. However, if interprofessional collaboration and practices are not aligned, nurses may encounter barriers to enhancing ethical patient care and positively influencing unit culture. Leadership support for ethics education programs is crucial for participation and implementation.
BACKGROUND:Non-pharmacological interventions (NPIs) have been shown to be effective in reducing fatigue, depression, and improving quality of life (QoL) in patients with lung cancer. However, given the diversity of NPIs, the most effective intervention remains to be confirmed. OBJECTIVES:To compare the efficacy of different NPIs in reducing fatigue, depression, and improving QoL in patients with lung cancer. METHODS:Six databases were searched from inception to May 10, 2025. Two reviewers independently screened studies and extracted data. A pairwise meta-analysis and a network meta-analysis were performed sequentially to determine the efficacy of different NPIs in improving fatigue, depression, and QoL in patients with lung cancer. RESULTS:A total of 58 studies involving 13 NPIs were included. The top three NPIs for reducing fatigue were acupuncture, acceptance and commitment therapy (ACT), and nutritional intervention. Meanwhile, ACT, cognitive behavioral therapy, and body-mind-spirit intervention ranked among the top three in improving depression. ACT emerged as the most effective intervention in improving QoL, followed by nutritional intervention and mind-body exercise. LINKING EVIDENCE TO ACTION:This study revealed the efficacy ranking of different NPIs in reducing fatigue, depression, and improving QoL in patients with lung cancer. Clinical healthcare professionals should be encouraged to utilize these potentially effective NPIs to improve health outcomes in patients with lung cancer. TRIAL REGISTRATION:Registration Number: PROSPERO (CRD420251087360).
BACKGROUND:Despite the evidence for the efficacy of lifestyle interventions for type 2 diabetes prevention, there remains a gap in translating this evidence-based practice into real-world settings. AIMS:To summarize current evidence regarding the relationship between participant characteristics, intervention components, and the effect of lifestyle interventions for individuals with prediabetes. METHODS:The initial search of PubMed, Embase, the Cochrane Library, and Web of Science was performed on 6th December 2023 and was subsequently updated on 5th October 2025. Randomized controlled trials on lifestyle interventions (diet and/or physical activity), compared to usual care, no intervention, or wait-list control, in adults with prediabetes were eligible. Outcomes included the incidence of type 2 diabetes and normoglycemia, fasting plasma glucose (FPG), 2-h plasma glucose, hemoglobin A1c (HbA1c), fasting insulin (FI), and Homeostatic Model Assessment for Insulin Resistance (HOMA-IR). Random-effects meta-analyses were performed to estimate relative risks (RRs) and mean differences. Subgroup analyses and meta-regressions were conducted by participant characteristics and intervention components. RESULTS:Seventy-seven studies (n = 22,629 participants) were included. Greater weight loss (%) was associated with larger reductions in diabetes incidence (β = 0.07 [0.02, 0.12], p = 0.010). Achieving ≥ 5% (vs. < 5%) weight loss was associated with higher reversion rates to normoglycemia (RR = 1.80 [1.55; 2.08] vs. 1.32 [1.03; 1.70]; psubgroup = 0.036). Interventions with supervised exercise training more effectively reduced diabetes incidence than those without this component (RR = 0.40 [0.24; 0.65] vs. 0.69 [0.63; 0.76]; psubgroup = 0.031). Younger participants showed greater improvements in FPG, HbA1c, FI, and HOMA-IR. Higher baseline HbA1c levels were associated with a greater reduction in HbA1c but a smaller FI improvement. LINKING EVIDENCE TO ACTION:This meta-analysis provides valuable insights into the implementation of diabetes prevention programs. Weight loss is a critical determinant for diabetes prevention, and weight loss goal setting and progress monitoring are recommended. Adding supervised exercise sessions can enhance the program's effectiveness. Early interventions for younger individuals with lower HbA1c levels may prevent diabetes more effectively. TRIAL REGISTRATION:PROSPERO (CRD42024486361).
BACKGROUND:Patient safety is important when evaluating a healthcare organization's ability to control and eliminate patient dangers when implementing evidence-based practice (EBP). There is limited understanding of how EBP affects safety culture. PURPOSE:The purpose of this study was to assess nurses' perceptions of EBP utilization and its effect on patient safety culture. METHOD:A cross-sectional, descriptive design was employed utilizing self-report questionnaires. A convenience sample of 381 registered nurses was recruited from four major hospitals in Jordan. Descriptive and multivariate linear regression analyses were used. RESULT:EBP knowledge/skills had the highest positive score. Meanwhile, organizational learning and continuous improvement were the greatest positive scores of patient safety culture among nurses. Nurses who perceived greater knowledge/skill associated with EBP reported higher levels of organizational learning and continuous improvement (β = 0.15, p < 0.001), increased teamwork within units (β = 0.11, p < 0.05), lower perceptions of nonpunitive responses to error (β = -0.15, p < 0.001), greater communication openness (β = 0.16, p < 0.001), and improved feedback and communications about errors (β = 0.13, p < 0.01). LINKING EVIDENCE TO ACTION:The association between EBP and patient safety underscores the importance of systematically implementing EBP in healthcare settings. As scientific evidence informs clinical practice, it is crucial for hospitals to integrate EBP into their policies and strategies to sustainably foster a culture of safety and optimize nursing practices.
BACKGROUND:Oncology nurses are frequently subjected to significant psychological stress due to the demanding nature of cancer care, which negatively impacts their mental and physical health as well as the quality of patient care. Although Mindfulness-Based Stress Reduction has been demonstrated to be effective in alleviating stress, practitioners often encounter barriers such as limited engagement and difficulty maintaining regular practice. AIM:To enhance engagement and adherence, we integrated art elements into the Mindfulness-Based Stress Reduction framework, creating the Mindfulness-Based art therapy program, and evaluated its effectiveness among oncology nurses. DESIGN:A three-arm randomized controlled trial. METHODS:90 oncology nurses participated (Mindfulness-Based Art Therapy group = 30, Mindfulness-Based Stress Reduction group = 30, waitlist controls group = 30) in an 8-week program. Stress, anxiety, depression, fatigue, and mindfulness levels were assessed at baseline, immediately after the fourth week of intervention, and immediately after the intervention concluded. Compliance and satisfaction were evaluated using attendance rates and satisfaction questionnaires. Descriptive statistics were used to analyze general data; intervention effects were compared using one-way ANOVA and generalized estimating equations, and compliance and satisfaction were compared using independent samples t-test. RESULTS:Both Mindfulness-Based Art Therapy and Mindfulness-Based Stress Reduction significantly improved stress, physiological markers, and mindfulness vs. controls. Mindfulness-Based Stress Reduction better reduced depression (β = -2.980, 95% CI: -5.427, -0.533, p = 0.017), while Mindfulness-Based Art Therapy was superior for fatigue (β = -11.582, 95% CI: -20.615, -2.550, p = 0.012). Mindfulness-Based Art Therapy had higher adherence (93.3% vs. 73.3%, p < 0.05) and satisfaction (3.27 ± 0.45 vs. 2.40 ± 0.52, p = 0.01). LINKING EVIDENCE TO ACTION:For oncology nurses, Mindfulness-Based Art Therapy is as effective as Mindfulness-Based Stress Reduction for improving stress and mindfulness, while providing greater adherence, satisfaction, and more consistent fatigue reduction. TRIAL REGISTRATION:Chinese Clinical Trial Registry, ChiCTR2300078124 (http://www.chictr.org.cn), 30/11/2023.
