BACKGROUND:Against the backdrop of global aging, the number of people with dementia is surging, with home-based care as the dominant model. Family members take on the core caregiving responsibilities, yet the long course and complex symptoms of dementia plunge caregivers into multiple role dilemmas. Existing studies lack comprehensive analysis of these dilemmas, leading to low efficiency in the utilization of resources for support programs. Guided by Role Stress Theory and adopting a constructivist lens, this study shifts the focus from specific caregiving challenges to underlying role dilemmas, aiming to inform comprehensive support design. OBJECTIVES:To comprehensively identify the types and manifestations of role dilemmas experienced by family caregivers of people living with dementia. DESIGN:A qualitative narrative inquiry guided by constructivism. SETTINGS:This study took place at the neurology department of a Grade A tertiary hospital in Xuzhou, China. PARTICIPANTS:Purposive sampling was employed to select participants. 21 family caregivers of people living with dementia were finally interviewed. METHODS:Semi-structured interviews were conducted from June to August 2025, using line-drawing tools to facilitate recall. Data were analyzed using a hybrid deductive-inductive thematic analysis approach based on Role Stress Theory. RESULTS:Four themes and 12 sub-themes were identified: (1) Role Incapacity (poor psychological regulation, insufficient caregiving skills, lack of disease knowledge); (2) Role Conflict (intra-role, inter-role, and extra-role); (3) Role Overload (time, physical strength, energy); and (4) Role Rigidity (negative perceptions of institutions, traditional family culture, gender stereotypes). CONCLUSION:Family caregivers of people living with dementia experience four role dilemmas that may be interrelated. These findings provide a comprehensive framework for developing targeted interventions to support caregivers in their role adaptation and alleviate care burden.
BACKGROUND:Vestibular schwannoma is a benign intracranial tumour with a generally favourable prognosis. However, many patients continue to experience persistent postoperative symptoms, functional limitations, and long-term medical follow-up after surgery. These experiences extend beyond physical recovery and may affect patients' sense of self, social roles, and everyday life. Limited research has examined how patients experience and make sense of these changes during long-term postoperative adaptation. OBJECTIVE:To explore how Chinese patients experience, interpret, and cope with bodily changes and uncertainty about future health during long-term adaptation after vestibular schwannoma surgery. DESIGN:A qualitative study using interpretative phenomenological analysis. SETTING(S):Online patient communities on Chinese social media platforms. PARTICIPANTS:Nine adult patients who had undergone surgery for vestibular schwannoma were recruited through purposive sampling. The sample included six women and three men, aged 24-72 years. Time since surgery ranged from 7 to 76 months. METHODS:The study was approved by the Medical Ethics Committee of Tianjin Medical University, China. In-depth semi-structured interviews lasting 60-90 min were conducted via encrypted video conferencing or telephone between March and April 2025. Data were analysed using interpretative phenomenological analysis. RESULTS:Three interrelated themes were identified: identity disruption amid bodily changes, fear of progression in the context of uncertainty about future health, and avoidance as self-protection. Persistent bodily symptoms and functional limitations undermined participants' trust in their bodies and disrupted their self-identity, confidence, and sense of social roles. Concerns about functional decline, tumour regrowth, and future health uncertainty persisted throughout long-term adaptation. These concerns were reactivated by follow-up reminders, medical encounters, waiting for results, and symptom fluctuations. Some participants reported avoiding situations related to follow-up care, illness-related information, socially demanding environments, and long-distance travel. These avoidance responses appeared to help manage distress in the short term, but could also limit engagement in ongoing care, rehabilitation, and social participation. CONCLUSIONS:Postoperative adaptation after vestibular schwannoma surgery involves not only physical symptom recovery and functional restoration, but also a long-term psychosocial process shaped by identity disruption, fear of progression, and avoidance responses. Healthcare professionals should attend to patients' subjective experiences and coping strategies during postoperative follow-up and long-term care. Identifying avoidance responses may help support more patient-centred rehabilitation and long-term adaptation. REGISTRATION:Not registered.
Background Residents of long-term care facilities are vulnerable to respiratory infections, yet infection prevention and control strategies for these settings remain limited. While extensive infection control guidelines for hospitals are well established, few address long-term care facilities, where prevention efforts have largely prioritized pharmacological over non-pharmacological measures. Non-pharmacological strategies are therefore essential to prevent respiratory infection transmission, particularly during early outbreak stages or in settings where pathogen-specific treatments are limited, such as long-term care facilities. Objective To systematically review and synthesize non-pharmacological interventions used to prevent and control respiratory infections in long-term care facilities. Information sources Experimental and quasi-experimental studies sourced from PubMed, CINAHL, EMBASE, and Cochrane databases. Methods Systematic search for studies published in English between January 2008 and October 2025 was conducted. Eligible studies included those that implemented non-pharmacological interventions to prevent and control respiratory infections in long-term care facilities. The quality of included studies was assessed using the Cochrane Risk-of-Bias tool for Randomized control trials and the Risk of Bias in Non-randomized Studies of Interventions tool. Study characteristics and findings were extracted, and the World Health Organization’s Infection Prevention and Control Assessment Framework was applied for analysis to classify interventions and identify evidence gaps across its core components. For data synthesis, a narrative synthesis with vote counting was performed across each component of the framework. Results Of the 12,203 retrieved studies, 18 met the inclusion criteria. Nine studies broadly examined respiratory tract infections overall, whereas five focused exclusively on coronavirus disease. Based on the framework, interventions related to provision of materials and equipment necessary for infection control, built environments, education, and multimodal strategies were most frequently studied, whereas those addressing guidelines, surveillance methods, and workload, staffing, and bed occupancy received limited attention. Multimodal strategies combining environmental cleaning and education showed the most positive impact, while monitoring and feedback showed promising effectiveness in reducing the incidence of infection. Notably, no studies have addressed all eight components of the framework or fully accounted for the unique characteristics and needs of long-term care facilities. Conclusions The included studies had limited methodological quality and varied widely in study design, interventions, and outcome measures. However, by employing a globally recognized framework, this study provides a foundation for strengthening infection prevention and control measures in long-term care facilities and outlines key areas for future research. These findings emphasize the need for integrated, system-level multimodal strategies tailored to long-term care facilities to effectively control respiratory infections in vulnerable populations. Registration International Prospective Register of Systematic Reviews CRD42024544560, registered 08/05/2024.
Background Functional dependency is a key marker of loss of independence in older age, but comparable evidence on its prevalence and sociodemographic inequalities across countries remains limited. Objective To estimate the prevalence of functional dependency across severity levels, compare prevalence across countries and World Bank income groups, and quantify absolute and relative sociodemographic inequalities within individual countries. Methods A cross-sectional analysis of pooled, individual-level data from nine nationally representative surveys was conducted for older adults in 35 lower-middle-, upper-middle-, and high-income countries. Three dependency levels were defined based on activities of daily living and instrumental activities of daily living. The age-standardized prevalence of these three levels was estimated by country, World Bank per capita income category, and sociodemographic characteristics. Logistic regression models and marginal standardization were used to estimate adjusted prevalence ratios and average marginal effects, representing relative and absolute differences in predicted prevalence, respectively. Results The final sample included 121,201 adults aged 60 years or older. The age-standardized prevalence of level 1, level 2, and level 3 dependency was 19.9% (95% CI 19.4–20.4), 25.7% (25.1–26.2), and 32.6% (32.0–33.1), respectively. Differences across income groups generally became more pronounced at broader dependency thresholds. For level 3 dependency, prevalence was 44.7% (44.0%–45.3%) in lower-middle-income countries, 35.0% (34.0%–36.1%) in upper-middle-income countries, and 20.0% (19.5%–20.5%) in high-income countries. Level 3 dependency ranged from 9.2% in Malta to 44.5% in India. Absolute and relative inequalities varied substantially across countries, with the most pronounced disparities generally observed by age and educational attainment. Conclusions Functional dependency was common but varied across countries and population groups. These estimates provide cross-national benchmarks and can inform country-specific long-term care planning for disadvantaged groups.
Background Chronic obstructive pulmonary disease is the fourth leading cause of death worldwide, causing 3.5 million deaths in 2021, approximately 5% of global deaths. Its burden remains high because no disease-modifying therapy can halt progression. Current treatments mainly alleviate symptoms and reduce exacerbations. Self-care is therefore fundamental to long-term management, improving symptom control, exacerbations, and quality of life. However, chronic obstructive pulmonary disease self-care is defined and operationalized inconsistently across studies and programs, with widely varying components. Grounded in the tripartite structure of maintenance, monitoring, and management, a consolidated synthesis is needed to clarify core components, assess alignment with international guidance, and identify evidence gaps to support standardized practice and comparable research. Objectives To (1) identify the core components of chronic obstructive pulmonary disease self-care; (2) map these components to international chronic obstructive pulmonary disease guidelines to determine areas of consensus and gaps; and (3) construct a standardized chronic obstructive pulmonary disease self-care framework for clinical practice and research. Design An umbrella review with a two-stage synthesis method, first extracting core components from international guidelines and then supplementing evidence gaps using systematic reviews. Methods We searched eight electronic databases (including PubMed, Web of Science, Scopus, Embase, and the Cochrane Library) from inception to April 20, 2026, for eligible reviews addressing chronic obstructive pulmonary disease self-care components. Two reviewers independently screened records, appraised methodological quality, and extracted data. Using a best-fit framework approach, guideline-derived self-care recommendations were organized within the maintenance, monitoring, and management structure and supplemented with evidence from systematic reviews to address gaps. Results From 8660 records identified, 14 reviews met the inclusion criteria. Ten core components of chronic obstructive pulmonary disease self-care were synthesized: (i) lifestyle modification; (ii) psychological coping and social support engagement; (iii) preventive vaccination uptake; (iv) adherence to medication and inhaler technique; (v) management of acute exacerbations; (vi) active participation in scheduled follow-up; (vii) acquisition and application of health literacy; (viii) daily monitoring and tracking of symptoms; (ix) proactive consultation for unplanned healthcare issues; and (x) self-directed access to health information and resources. Most components, particularly (i) to (vii), were broadly consistent with international chronic obstructive pulmonary disease guideline recommendations, indicating consensus on key self-care maintenance and management. In contrast, monitoring and patient-initiated engagement components, including (viii) to (x), were emerging components that are less explicitly represented in guidelines, highlighting gaps between formal recommendations and emerging practice. Conclusion This umbrella review established a comprehensive, evidence-based framework comprising ten core self-care components for chronic obstructive pulmonary disease, bridging the gap between guideline recommendations and real-world practice. Registration PROSPERO CRD42023464435, registered 14/5/2025.
BACKGROUND:Hip fracture is a major public health concern among older adults, often resulting in prolonged disability, institutionalization, and increased healthcare burden. Early mobilization has been widely recommended to enhance postoperative recovery; however, there is a lack of consolidated evidence quantifying its impact on clinical and functional outcomes. This study aimed to synthesize and evaluate the impact of early mobilization following hip fracture surgery in older adults and to explore potential sources of heterogeneity to better inform clinical and nursing practice. METHODS:A comprehensive literature search was conducted across seven databases (PubMed, Embase, Scopus, Web of Science, Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, and Emcare) from inception to June 15, 2025. Eligible studies included randomized controlled trials and observational cohort studies comparing early mobilization (defined as ambulation within 24 to 48 h postoperatively) to delayed or usual mobilization in patients undergoing hip fracture surgery. Primary outcomes included mortality, discharge destination, and length of hospital stay. Secondary outcomes included postoperative complications, functional recovery, and readmission. Risk of bias was assessed using funnel plots and Egger's test. RESULTS:Twenty-six studies involving 297,435 patients were included. Compared with delayed mobilization, early mobilization significantly reduced 30-day mortality (relative risk = 0.40, 95% confidence interval: 0.25-0.64) and 1-year mortality (relative risk = 0.57, 95% confidence interval: 0.40-0.80) (both p < 0.05). In regional analyses of pooled mortality, similar reductions were observed across Asia-Pacific, North America, and Europe. Patients receiving early mobilization were more likely to be discharged home and had shorter hospital stays. Early mobilization also resulted in a reduced risk of postoperative complications (relative risk = 0.79, 95% confidence interval: 0.74-0.84, p < 0.05), with specific improvements in pneumonia and thromboembolism rates. Functional independence was significantly improved, as shown by higher Barthel Index scores and increased odds of achieving Functional Independence Measure ≥5 at discharge. No significant difference was observed in readmission rates. CONCLUSIONS:lization within 24 to 48 h following hip fracture surgery was associated with favorable outcomes, including reduced mortality, improved functional independence, higher rates of discharge to home, shorter hospital length of stay, and fewer postoperative complications. Although heterogeneity across studies and the predominance of observational evidence warrant cautious interpretation, these findings support current recommendations for early mobilization and highight the potential value of structured and standardized mobilization protocols in routine postoperative hip fracture care.
BACKGROUND:Rural populations experience persistent inequities in access to palliative care. Existing evidence often describes individual barriers separately, with less attention to how access breaks down across the care pathway or how different service configurations shape access. OBJECTIVES:To synthesise evidence on access to palliative care in rural settings and examine how access barriers, service models, and implementation conditions interact across the care pathway. METHODS:A mixed-methods systematic review using a convergent integrated approach searched nine databases (PubMed, Embase, CINAHL, Web of Science, Scopus, PsycINFO, CNKI, WanFang, SinoMed) from inception to 15 March 2026, supplemented by hand-searching. Eligible studies were primary qualitative, quantitative, and mixed-methods studies on access to palliative care for adults in rural or non-urban settings. Two reviewers independently screened studies, extracted data, and assessed quality using the Mixed Methods Appraisal Tool. Findings were mapped to the Levesque access framework, analysed using the updated Consolidated Framework for Implementation Research, and integrated through mixed-methods synthesis, with additional coding of service models. RESULTS:Thirty-four studies were included, of which 26 were conducted in high-income countries and eight in low- and middle-income countries. Service configurations included specialist or hospice-oriented care, generalist or primary-care-oriented care, mixed specialist-generalist models, home-based and caregiver-centred care, nurse-coordinated services, telehealth-supported care, and community or implementation-oriented approaches. Access broke down cumulatively across four interdependent stages: recognition, entry, reach, and use and continuity, with affordability constraining every stage. Recognition was limited by low awareness, poor service visibility, and delayed identification of need. Entry was shaped by stigma, trust, family expectations, and unclear referral processes. Reach was constrained by distance, transport, workforce shortages, limited specialist capacity, and weak infrastructure. Use and continuity were affected by fragmented coordination, weak transitions, unstable follow-up, and reliance on family caregivers. Access problems varied across service configurations. Evidence on service innovations was methodologically less certain, and the overall evidence base remained concentrated in high-income countries. CONCLUSIONS:Access to palliative care in rural settings is best understood as a pathway and service-configuration problem rather than simply a deficit in service availability. Improving access requires earlier recognition, clearer referral routes, stronger specialist-generalist and nursing links, better support for family caregivers, and greater attention to affordability, continuity, and rural settings with limited resources. REGISTRATION:International Prospective Register of Systematic Reviews: CRD420261340783.
Background The rising prevalence of chronic conditions has heightened the challenges of managing individuals with complex care needs within health systems. Objective To explore the scope and efficacy of nurse navigators in caring for individuals with complex care needs associated with chronic conditions. Design A mixed-method systematic review was conducted following the Joanna Briggs Institute convergent segregated integration methodology. Method The review included qualitative, quantitative, and mixed-methods primary studies. Six databases were searched from inception to April 23, 2025. The databases were searched using Medical Subject Headings and keywords such as ‘nurse navigator’, ‘chronic conditions’ and ‘complex care needs’. The methodological quality of included studies was assessed using the Mixed Methods Appraisal Tool. Randomised controlled trials were evaluated using the Cochrane risk-of-bias tool version 2 and non-randomised studies using the Cochrane risk of bias in non-randomised studies-of interventions tool. Narrative synthesis of quantitative data, and qualitative content analysis were undertaken, followed by a convergent segregated integration of quantitative and qualitative data. Results In all, 49 studies were included, of which 22 were quantitative, 17 qualitative, and 10 were mixed methods. Data synthesis identified three overarching themes: (1) perceptions of nurse navigator scope and efficacy, (2) healthcare utilisation, and (3) organisational challenges. The scope of the nurse navigator role was broad and variably defined, however core functions such as care coordination, continuity, and improving access to services and providers, were consistently described. Evidence of nurse navigator efficacy was centred on patient empowerment, education, comprehensive care and caregiver support. However, healthcare utilisation outcomes, including hospital admissions, emergency department presentations, and length of stay, were inconsistent, indicating nurse navigator involvement was not reliably associated with measurable improvements. Blurring of role boundaries and responsibilities, variability in team integration, and diverse outcome measures, limited comparability across studies, making robust evaluation of nurse navigator efficacy challenging. Conclusion Nurse navigators combine advocacy, holistic support, and coordinated, relationship-based care to reduce fragmentation and strengthen continuity for individuals with complex care needs associated with chronic conditions. Realising the full potential of nurse navigator roles requires a standardised definition, that protects role boundaries and recognises their contribution to complex, chronic condition management. By clarifying the core scope of nurse navigators and highlighting the organisational factors that shape their impact, this review offers a foundation for strengthening design of the role, integration into practice, and evaluation. The review protocol was registered on PROSPERO (2025 CRD420251025064).
BACKGROUND:Despite guideline-recommended multicomponent programs, fall-prevention efforts in nursing homes often show variable uptake because residents differ in their perceptions of fall risk and their responses to preventive support. Standardized approaches may therefore fail to account for differences in how residents appraise fall risk and cope with prevention-related challenges, making it difficult to tailor strategies to different resident profiles. User personas, defined as profiles that integrate salient characteristics across key dimensions, offer a practical way to capture this heterogeneity and inform more tailored, person-centered fall-prevention strategies in institutional care. OBJECTIVE:To characterize nursing home residents' fall-risk perceptions and prevention-related responses, construct representative user personas, and inform more personalized fall-prevention strategies. METHODS:We conducted semi-structured interviews with 30 nursing home residents using purposive sampling to ensure variation in demographic characteristics, fall experience, and functional status. Data were analyzed using qualitative content analysis. Personas were developed by identifying recurring patterns of salient individual characteristics, followed by cross-case comparison and refinement through team discussion and consensus. RESULTS:Five key dimensions shaping fall-risk perception and prevention-related responses were identified: physical function, risk perception, self-efficacy, psychological appraisal, and coping style. Based on these dimensions, four distinct user personas were developed: the overconfident risk-takers, the anxious limiters, the compliant dependents, and the active self-managers. CONCLUSION:Fall-risk perception and prevention-related responses among nursing home residents are heterogeneous and shaped by interacting functional and psychosocial factors. Persona-informed fall prevention may support more tailored communication and support strategies that better fit residents' differing needs and response patterns. Future research should assess whether persona-based assessment and intervention approaches can improve both safety and resident-centered outcomes.
BACKGROUND:Depression among nurses is an important occupational health concern, but identifying nurses at higher risk remains challenging because work-related exposures are heterogeneous and often measured separately. Occupational trauma-related experiences, including adverse clinical events, workplace violence, bullying, threats and sexual harassment, may differ in frequency and severity, and simple event counts may not adequately capture their relevance to mental health risk. OBJECTIVE:To derive a weighted occupational trauma exposure burden score among female nurses and examine its association with moderate-to-severe depressive symptoms. DESIGN:Large-scale, cross-sectional analysis using baseline data from the Nurses' Mental Health Study in China. SETTING:67 tertiary hospitals across 31 provincial-level regions in China. PARTICIPANTS:90,196 registered female nurses. METHODS:Fourteen occupational trauma exposure indicators were analysed using item response theory to derive a weighted trauma exposure load index. Depressive symptoms were assessed using the nine-item Patient Health Questionnaire, with scores of 10 or higher indicating moderate-to-severe depressive symptoms. Logistic regression and Light Gradient Boosting Machine models were developed using a stratified 7:3 training-testing split. RESULTS:The derived trauma exposure load index summarised heterogeneous occupational trauma exposures, with workplace violence and sexual harassment emerging as highly informative indicators of the overall exposure burden. The index showed greater variation across occupational contexts than across most demographic characteristics, with higher burden observed among psychiatry and emergency nurses. In the prediction model, the trauma exposure load index was the highest-ranking predictor, and higher scores were associated with greater predicted risk of moderate-to-severe depressive symptoms. The calibrated Light Gradient Boosting Machine model showed acceptable discrimination in the independent testing set, with an area under the receiver operating characteristic curve of 0.830 (95% confidence interval 0.824-0.836). CONCLUSIONS:The trauma exposure load index provided an empirically weighted summary of heterogeneous occupational trauma exposures among female nurses and was associated with moderate-to-severe depressive symptom status. These findings support further evaluation of weighted exposure measures to examine the relationship between complex occupational trauma exposure and nurses' mental health. Longitudinal studies are needed to assess temporal relationships and the generalisability of the index. REGISTRATION:The Nurses' Mental Health Study was registered prospectively with the Chinese Clinical Trial Registry (ChiCTR2300072142) on 5 June 2023; participant recruitment began in December 2023.
Background Generative artificial intelligence is increasingly embedded in graduate nursing research environments. Within this context, patterns of reliance on these tools, extending in some cases to dependency, have emerged among nursing graduate students, raising concerns about the impact on the development of foundational research competencies. Yet, limited qualitative evidence exists regarding how such reliance manifests, evolves, and is experienced by students at different training stages. Objectives To explore how nursing graduate students in China experience and navigate generative artificial intelligence use in their research practice, including the conditions under which such use becomes dependency. Design Qualitative descriptive study. Setting Data were collected from nursing graduate programs at 10 universities across China. Participants Seventeen nursing graduate students (9 doctoral, 8 master's) were recruited using purposive sampling supplemented by snowball sampling. All participants had documented use of generative artificial intelligence tools for research-related tasks for a minimum of three months. Methods Semi-structured in-depth interviews were conducted between March and April 2026. Data were analyzed using Braun and Clarke's six-phase reflexive thematic analysis, supported by NVivo 12.0 software, and interpreted through cognitive offloading theory. Results Data analysis identified four themes: (1) pervasive generative artificial intelligence integration across research workflows; (2) how generative artificial intelligence simultaneously augments output and erodes capability; (3) emotional and evaluative responses to generative artificial intelligence dependency; and (4) self-regulation strategies and structural gaps. Cross-case analysis yielded a typology of four user profiles: tool-rational, collaborative self-regulating, efficiency-oriented explorer, and deeply dependent user. Doctoral students predominantly occupied profiles characterized by higher metacognitive control, suggesting an “experience-buffering effect” from prior research training. Conclusions Generative artificial intelligence integration among nursing graduate students simultaneously enhances research productivity while risking the covert erosion of foundational competencies. The central challenge shifts from prohibiting artificial intelligence use to ensuring that metacognitive control keeps pace with integration depth. These findings advocate for the implementation of differentiated, stage-sensitive artificial intelligence governance frameworks tailored to nursing graduate education.
BACKGROUND:With the integration of large language models into nursing education, nursing students' patterns of use have attracted growing attention and concern. While existing research focuses on determinants such as attitudes and intentions, it lacks insight into their actual patterns of use. OBJECTIVE:To identify the tailored behavioral personas of nursing students regarding large language models and explore the characteristics of interaction patterns within different personas, thereby clarifying the potential risks associated with these patterns of use. METHODS:From October to December 2025, a descriptive qualitative study was conducted involving 22 nursing students in China via semi-structured interviews. Purposive sampling with a maximum variation strategy was employed to select nursing students. Data were analyzed using content analysis. Through the extraction of interaction tags and behavioral dimensions, user personas were constructed to characterize students' patterns of use. RESULTS:Five key dimensions of students' interactions with large language models were extracted: cognitive relationships, interaction strategies, verification strategies, psychological experiences, and risk perceptions. Based on these dimensions, four user personas were identified: the efficiency-quality trade-off persona, the capability-compensating persona, the prudent-assistance persona, and the cognitive outsourcing persona. CONCLUSION:Multiple factors shape nursing students' diverse patterns of interaction with large language models. Future interventions should be tailored to these specific personas, combining critical thinking training with technical and ethical support to mitigate the risks of cognitive outsourcing and foster the responsible integration of large language models into nursing education.
BACKGROUND:Informal caregivers play a growing role in clinical care, yet the relational dynamics between nurses and caregivers remain understudied. In healthcare systems shaped by time scarcity, institutional pressures, and identity-based assumptions, trust-building with informal caregivers is a complex and emotionally demanding process for nurses. PURPOSE:This study explores how nurses perceive and navigate trust-building with informal caregivers, particularly in the context of structural constraints and prior caregiver mistrust. METHODS:Seventeen nurses practicing in inpatient and acute care settings across four U.S. states participated in semi-structured interviews. Interviews were audio-recorded, transcribed, and analyzed using reflexive thematic analysis. Relational Cultural Theory was used to interpret how trust is shaped through systemic and interpersonal dynamics. RESULTS:Three interrelated themes were identified: (1) structural barriers constrain nurses' capacity for relational care, (2) trust is mediated by identity-based perceptions and caregivers' prior negative experiences with healthcare systems, and (3) trust is actively constructed through relational labor, including cultural attunement, consistency, and respectful communication. Nurses described emotional fatigue, scrutiny, and the need to continually establish credibility within constrained hospital settings. CONCLUSIONS:Trust between nurses and informal caregivers develops through ongoing interaction shaped by institutional structures, visible identity, and caregiver history. As informal caregiving becomes more central to healthcare, nurses require organizational support and training that prepare them to build trust through responsive, consistent, and relationally grounded care.
BACKGROUND:Social and community engagement is a modifiable factor that may influence healthcare use and mental health in older adults. However, existing evidence has rarely integrated the examination of association, mechanism, and population heterogeneity within a single analytical framework. From a nursing perspective, understanding these relationships is crucial for developing holistic care plans that address the social determinants of health. AIM:This study aimed to investigate the association between the intensity of social and community engagement and key health-related outcomes, including healthcare utilization and depressive symptoms, from a nursing-centric viewpoint. METHODS:The study utilized linked data from the RAND Health and Retirement Study Core (2004-2022) and the Consumption and Activities Mail Survey (2003-2021), which comprised 47,604 person-wave observations. Two-part models were employed to estimate associations with healthcare utilization (doctor contacts, hospital admissions, and hospital nights). As exploratory secondary analyses, mediation by depressive symptoms (Center for Epidemiologic Studies Depression scale) was tested using a product-of-coefficients framework, and a random-forest T-learner was used to describe individual-level heterogeneity in the estimated associations. Both analyses are interpreted as descriptive given timing limitations and the absence of cross-validation. RESULTS:Higher social and community engagement was associated with a greater likelihood of initiating any doctor contact (odds ratio = 1.09) but was not associated with the number of visits. It was also linked to lower depressive symptoms (β = -0.043). No significant mediation by depressive symptoms was detected for the relationship between engagement and healthcare utilization. CONCLUSION:Social and community engagement is associated with the initiation of healthcare contact and better mental health but not with the intensity of healthcare use or inpatient services. The benefits of engagement appear to be greater for individuals with more significant health challenges and those from specific ethnic groups, suggesting that nurse-led interventions to promote engagement could be a valuable strategy for improving well-being in vulnerable populations.
BACKGROUND:Qualitative inquiry is central to nursing and health research, yet many established analytic approaches require substantial time and expertise. These demands can pose challenges for researchers working within constrained timelines and multidisciplinary teams. RRITA, a Rapid, Reflexive, Integrated approach to Thematic Analysis, was developed to address the persistent tension between rigour and feasibility. AIM:To introduce RRITA as a reflexive qualitative analysis method, providing a theoretically grounded and practically actionable guide to its implementation. DESIGN:Methodological paper outlining the conceptual foundations, analytic workflow, and applied features of RRITA, illustrated with data from a study on gratitude in palliative care. METHODS:RRITA comprises seven steps organised around an alternating expand-compress cadence. In steps 1 and 2, researchers formulate a paradigm-aligned research question and define domains to populate the initial structure of the RRITA matrix, the method's central analytic instrument, maintaining a direct line of sight between raw data and analytic output while preserving subtle meanings and complexity. Researchers generate raw data in step 3 and refine them in step 4. Steps 5 and 6 shift to line-by-line inductive coding grounded in participants' accounts, iterative theme construction supported by theme warrants, and active engagement with analytic tensions and discordance. Step 7 culminates in a coherent narrative that integrates thematic articulation and interpretation, illustrative data, the reflexive pivot, and scholarly literature. Throughout the research journey, RRITA supports the systematic scrutiny of researcher subjectivity through the embedded practices of reflexive anchoring and notes. RESULTS:RRITA supports rigorous qualitative analysis through a structured workflow that synthesises key features of reflexive thematic analysis and rapid qualitative approaches. It introduces three integrative analytic innovations: embedded, situated reflexive practices, systematic engagement with discordant data and analytic tensions, and a versioned matrix trail documenting the analytic process from the initial reflexive anchor to final theme construction. CONCLUSION:RRITA proposes that rigour and accessibility are complementary when supported by thoughtful methodological design. It offers a theoretically grounded approach to qualitative inquiry that fosters interpretive depth while accommodating the practical constraints of nursing and health research. IMPACT:RRITA is particularly suited for clinical inquiry, teaching, and student supervision. Its versioned matrix trail renders analytic reasoning visible and discussable at each step, supporting the development of interpretive competence and the timely generation of high-quality evidence to inform contemporary nursing practice and policy.
BACKGROUND:Patient aggression is a pervasive challenge in global mental healthcare. Although de-escalation is a cornerstone of non-coercive care, a significant theory-practice gap persists. This is often attributed to a research focus on fragmented techniques rather than on de-escalation as a continuous, relational process embedded in clinical practice. This gap is particularly pronounced in China's unique socio-cultural context, characterized by high-context communication and pronounced hierarchical power dynamics, which directly shape trust-building and authority navigation during de-escalation. OBJECTIVE:This study aimed to bridge this gap by exploring the lived experiences of psychiatric nurses in China, reconceptualizing de-escalation, and generating an integrated practice framework. METHODS:A qualitative descriptive study with interpretive thematic analysis was conducted using semi-structured, in-depth interviews with thirty registered psychiatric nurses from multiple tertiary hospitals across China. Data were analyzed using reflexive thematic analysis. RESULTS:The analysis yielded a novel four-phase process model: pre-emptive prevention ('building a defensive levee'), an in-the-moment operational trilogy ('Stabilise, Connect, Resolve'), and post-intervention consolidation ('achieving a therapeutic closed-loop'), all sustained by an organizational ecosystem. The model repositions effective de-escalation not as an isolated skill but as a multidimensional outcome of relational, cognitive, and systemic factors. The model's novelty lies in its integration of discrete skills into a temporal, phase-based process, emphasizing the cyclical nature of relational work and the foundational role of the organizational ecosystem. Thus, it moves beyond a 'technocratic' training focus on fragmented skills in isolation. The core operational trilogy ("Stabilise, Connect, Resolve") provides a cognitive-behavioral framework for in-the-moment clinical reasoning. CONCLUSIONS:This study provides a robust, experience-based framework that addresses the theory-practice gap by capturing de-escalation as a complex, continuous process. The findings underscore the necessity of moving beyond technocratic training towards systemic, relationship-centered support, offering a critical foundation for safer and more therapeutic mental healthcare environments.
BACKGROUND:Digital nudging uses technology-based modifications to subtly influence health-related decisions without restricting choice. However, no review has systematically examined digital nudge strategies for cardiovascular disease health behavior promotion through a dual-process theoretical lens that distinguishes between automatic and deliberative cognitive processes. OBJECTIVE:To synthesize evidence on digital nudge strategies promoting cardiovascular disease-related health outcomes from a dual-process perspective. DESIGN:A scoping review. REVIEW METHODS:Nine databases were searched from inception to November 2025 using terms related to digital nudges and cardiovascular disease. Study selection and data extraction were conducted independently by two reviewers. Identified interventions were classified as Type I (automatic) or Type II (reflective) nudges, and findings were narratively synthesized. RESULTS:Seventeen studies were included. Digital nudges targeted patients or caregivers, healthcare professionals, or both, and were delivered through short message service, email, electronic health record systems, instant messaging apps, patient portals, voice calls, chatbots, and specialized digital platforms. Twelve nudge types were identified, including environmental cues, reminders, default options, feedback, framing, social norms, social/peer comparison, highlighted suggested choices, pre-commitment, accountability justification, expert authority, and gamification. Reported outcomes included medication adherence, prescribing, follow-up attendance, vaccination or prophylaxis uptake, physical activity, dietary behavior, cardiovascular risk assessment, and preventive care engagement. Study designs, sample sizes, follow-up duration, outcome measures, and reported effect estimates were heterogeneous. CONCLUSIONS:Digital nudges are increasingly used to support cardiovascular health management across patient-facing and clinician-facing contexts. Current evidence is heterogeneous, and stronger long-term, implementation-focused, and equity-sensitive studies are needed to identify which nudge components work for which behaviors, recipients, and settings. REGISTRATION:Open Science Framework (https://osf.io/4pyks).
BACKGROUND:Nurse scheduling is a complex workforce management task that directly influences nurses' fatigue, job satisfaction, and retention, as well as patient safety. Traditional rule-based or manually constructed schedules may not fully accommodate increasing workforce complexity, diverse nurse preferences, and organizational constraints. Recent advances in artificial intelligence have enabled the development of intelligent nurse scheduling systems intended to optimize staffing decisions while balancing organizational efficiency and workforce well-being. However, the scope, functional characteristics, and empirical outcomes of artificial intelligence-based nurse scheduling solutions in healthcare remain to be comprehensively synthesized. OBJECTIVE:This scoping review aimed to systematically map the existing literature on artificial intelligence-based nurse scheduling solutions in healthcare settings by identifying (1) the types of artificial intelligence-driven scheduling approaches and systems; (2) their key functional features and underlying algorithmic foundations; and (3) the empirical outcomes at organizational, workforce, and patient levels. INFORMATION SOURCES:Five electronic databases (PubMed, Embase, CINAHL, Web of Science, and IEEE) were searched for English-language, peer-reviewed studies published from January 2000 to December 2025. METHODS:A scoping review was conducted following the Joanna Briggs Institute methodology and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. Studies describing artificial intelligence-based or algorithm-driven nurse scheduling approaches applied in healthcare settings were included. Data were charted and synthesized to capture system characteristics, algorithmic approaches, functional capabilities, and empirical outcomes. RESULTS:Eleven studies were included, comprising six algorithm-level and five system-level approaches. Most studies employed artificial intelligence-inspired metaheuristic or hybrid optimization methods, predominantly genetic algorithms, with no use of machine learning or data-driven approaches. System-level studies showed greater functional maturity, particularly in automation and explicit modeling of nurse preferences and fairness, whereas real-time adaptability and integration with hospital information systems were rare. Empirical outcomes were mainly assessed using algorithmic or simulation-based metrics, focusing on technical performance and operational efficiency. Nurse-related outcomes increasingly incorporated user-reported measures, whereas organizational and patient-related outcomes were assessed exclusively through simulation-based indicators. CONCLUSIONS:Although artificial intelligence-based nurse scheduling research has advanced technically, most approaches focus on optimization rather than clinical integration. Limited interoperability, real-time functionality, and real-world outcome evaluation suggest that translation into routine practice is still in the early stages. Future research should explore implementation-oriented, human-in-the-loop approaches supported by robust nursing data infrastructure and longitudinal real-world evaluation. REGISTRATION:Open Science Framework Registries (Registered on December 26, 2025; https://osf.io/67tsd). SOCIAL MEDIA ABSTRACT:To solve workforce complexity, artificial intelligence-based nurse scheduling must go beyond algorithms to consider organizational factors.
