BACKGROUND:Patients in the intensive care unit (ICU) require enteral nutrition (EN) to meet caloric requirements. Delivered via an enteral tube that can remain insitu for 30-90 days, manufacturers recommend EN giving sets (ENGS) are changed daily. Guidelines for EN are focused on nutritional support rather than clinical management. AIMS:Measure the frequency of ENGS replacement and describe practice patterns associated with EN, including time to commencement after enteral tube insertion; documentation and labelling of ENGS; type, duration and volume of EN administration; and incidence of EN-related complications. DESIGN:Exploratory descriptive study design, using a prospective non-participant observational audit. METHODS:A non-participant observational audit was conducted daily and compared to medical record data extraction for consecutive adult (>18 years) patients admitted to ICU requiring EN via an enteral tube. RESULTS:Over 6-weeks there were 110 observations for 30 patients receiving EN; 25 (83.3%) had an NGT and 5 had a naso-jejunal tube (16.7%) insitu. ENGS were changed 80 times on 73 (87.9%) observation days. The ENGS were used between 2 and 59 h (Med = 22.5, IQR = 10). Labelling and documentation occurred 58.5% and 60.6% of the time, respectively. Insertion duration was 1 day (IQR = 2, Range = 7) prior to EN commencement; EN was most often administered for 4 days (IQR = 5, Range = 28). Median 'target' rate was 40 (IQR = 20) millilitres per hour (mL/h), 12.5% more than the actual delivery rate of 35 mL/h (IQR = 25). Diarrhoea was the most common adverse outcome (n = 12, 40%). CONCLUSION:Observed practice is not consistent with manufacturers' recommendations. Weak evidence leaves a critical gap in recommendations for best practice at the bedside, where nurses are responsible for ongoing management. Without evidence-based protocols that incorporate nursing management, care may be inconsistent, reliant on individual experience, and ultimately sub-optimal.
BACKGROUND:The period of transfer from hospital to home is challenging for patients with coronary artery disease (CAD). Transitional care is an effective approach to bridge this gap, reduce readmission risk and improve secondary prevention. Components necessary for optimal models of transitional care in CAD are unknown. AIM:To synthesise evidence describing nurse-led transitional care model (TCM) for patients with CAD. The specific review objectives are: (1) To identify the components and characteristics of TCM for patients with CAD and (2) To evaluate the effectiveness of the TCM interventions compared with usual care. DESIGN:A systematic review (± meta-analysis) of randomised controlled trials. METHODS:Multiple databases including the Cumulative Index to Nursing and Allied Health Literature, Medical Literature Analysis and Retrieval System Online, Cochrane Central Register of Controlled Trials, the Excerpta Medica Database, PyscINFO and Emcare will be searched. Independent screening in Covidence, data extraction and quality assessment will be undertaken by two reviewers with a third available for arbitration of disagreements. Two reviewers will use the Consolidated Standards of Reporting Trials (CONSORT) checklist to assess methodological quality, and the Cochrane Risk of Bias 2 (RoB 2) tool to assess risk of bias in included trials. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework will be used to determine certainty in the evidence. Narrative synthesis will be used to describe model components. Approaches to meta-analyses to assess effectiveness of transitional care models will be determined by type and frequency of reported outcome measures. CONCLUSION:Identifying key model components and characteristics in the context of CAD management should reveal gaps in evidence for best practice, providing opportunities to improve outcomes associated with care transitions.Registration: PROSPERO International Prospective Register of Systematic Reviews, registration number CRD420251182328.
BACKGROUND:Building research capacity requires organisations to provide resources and infrastructure that meet the needs of their researchers. Periodic organisational self-assessment should be undertaken to reflect the current research support available and to guide future organisational planning. This study aimed to develop a checklist to help health organisations assess research preparedness. METHODS:A draft checklist of research preparedness items was constructed, with 64 items grouped into seven themes, based on existing tools and previous research. The Directors of Research (or delegate) from 17 local health districts/specialty health networks across New South Wales, Australia, were invited to participate in a two-round modified Delphi survey. They were asked to rate the importance and relevance of each checklist item and to identify whether each item should be left, deleted or modified in the final checklist. Consensus was set at a 70% or more level of agreement for items to be retained. RESULTS:Respondents (10 female:4 male) from 14 districts/specialty networks completed round one of the modified Delphi survey, and 13 completed round two. In round one, 58 items achieved consensus, and these items then progressed to round two. Eight new items were suggested and included for consideration in round two. In round two, 62 of the 66 items achieved consensus, including 19 items that obtained 100% agreement after two rounds. The final 62 items were grouped under six themes: infrastructure, communication, consumer engagement, outcomes, training and financial support. CONCLUSION:This research is the first study to develop a research preparedness checklist to guide Australian health organisations to better support and build research capacity. Further research is needed to determine the utility of the scale in other settings.
Background: The COVID-19 pandemic changed the care of older patients in hospitals, whether it was for COVID-19 or another reason for admission. Patients with delirium posed additional challenges to clinicians, particularly because they were in isolation and the family was unable to be present due to the rapidly implemented and strictly enforced infection control measures. Objectives/Aims: To explore nurses' experiences of caring for patients with delirium in an Australian acute care setting, with a focus on how infection prevention and control measures implemented in response to the COVID-19 pandemic impacted clinicians. Design: Descriptive qualitative study. Nurses from two acute aged care wards in a Sydney metropolitan tertiary hospital were invited to participate in semi-structured interviews to explore their overall experience of nursing patients with delirium. Eleven interviews were recorded and transcribed verbatim. Data were analysed qualitatively using human factors principles as an analytical lens. Experiences related to COVID-19 were extracted from the data. Findings: Participants experienced difficulties delivering patient-centred care, as the presence of family was restricted due to the public health orders and infection prevention and control policies imposed in hospitals. Enforcing isolation and excluding the family resulted in care failing to meet nurses' expected standards, with additional challenges in care provision and communication. Conclusion: Nurses described an overwhelming sense of responsibility and moral injuries. The advice to place patients with delirium in isolation was inconsistent with the national delirium clinical care standard. A deeper understanding of the complexity and barriers to managing delirium during a pandemic, where rapid and, at times, conflicting information was available, is needed. These findings will contribute to informing the implementation of controls in the event of future responses, including workforce preparation and support.
BACKGROUND:Cultural safety is a core value of nursing and midwifery practise however limited research has examined how students integrate and translate the principles of cultural safety into clinical practise. There is limited evidence exploring how curriculum content shapes students' attitudes and behaviours. AIM:This study aimed to explore nursing and midwifery students understanding of cultural safety and their perception of how that translated into their clinical practice. DESIGN:A two-phase qualitative exploratory design was employed comprising semi structured interviews followed by an online qualitative survey data were analysed deductively using the capability opportunity motivation (COM-B model). To our knowledge this is the first study to use this framework to explore the barriers and facilitators influencing students' translation of cultural safety into practice. FINDINGS:Seventeen nursing and midwifery students participated. Students' capacity to translate cultural safety principles were shaped by the interaction of capability opportunity and motivation capability was enhanced through understanding of cultural safety including historical an end to generational trauma and through critical self-reflection. Opportunity was strengthened by supportive educational and clinical environments including mentorship and role modelling. Motivation was influenced by increased awareness or colonisation a sense of humility and commitment to avoiding harmful practices with some students expressing willingness to question and challenge organisation systems. As participants with nonindigenous, the findings therefore reflect their perceptions and interpretations. CONCLUSION:Preparing students to meet professional expectations for culturally safe practice requires expanded culturally informed curricula an intentionally designed learning experiences across classroom and clinical context. When learning experiences support the application of cultural safety principles students have better position to translate theoretical knowledge into practise. Collectively these findings highlight the need for alignment between individual learning educational design and culturally safe clinical environments.
Background: Nurses' well-being at work is important for high-quality care and sustainable nursing careers. In care settings for older people, nurses face psychological, ethical, physical, and environmental demands in their early careers. However, little is known regarding how resilience, exposure to unethical conduct, physical work capacity, and the work environment are associated with early career nurses' well-being at work in this setting.Aim: To analyse early career nurses' well-being at work and associated factors in care settings for older people.Design: A cross-sectional, descriptive survey.Methods: Participants were qualified nurses (n = 262) at the national level in Finland. Inclusion criteria were graduation as a licensed practical nurse or registered nurse within the previous three years or during the data collection period and work experience in care settings for older people. Exclusion criterion was work experience that was limited to clinical placements. Data were collected electronically using the Nurses' Well-Being at Work Scale©, the Brief Resilience Scale©, and demographic and career questions. Associations between well-being at work and background variables were studied using linear regression models.Results: Early career nurses' self-assessed well-being at work was found to be moderate (3.39; SD 0.79; 5-point Likert scale). Univariate analyses revealed that better well-being at work was associated with having career plans in care services for older people, higher resilience, not observing unethical conduct, higher physical work capacity, and a better-fitting work environment; in multivariable analysis, never observing unethical conduct and higher physical work capacity remained significant.Conclusions: Early career nurses' well-being at work in care settings for older people was associated with psychological, ethical, physical, and environmental aspects, thus emphasising the need for educational, organisational, and political actions, and research to support sustainable nursing careers and high-quality care for aging populations.
BACKGROUND:Limited knowledge exists about the impact and value of transition programs for newly graduated nurses (NGNs) during participation. Gaining insight into this phase can help improve strategies that support NGNs' learning, retention, and work satisfaction during the transition to professional practice. AIM:The overall aim was to investigate the experienced value of a hospital-based one-year transition program for NGNs after four months of participation. Specific aims were (1) to create and evaluate a tool to capture NGNs perceived value of the transition program and (2) to apply the tool to explore associations between NGNs experienced value of the transition program and factors related to work preparedness, future career as a nurse, work environment, and work satisfaction. DESIGN:Exploratory cross-sectional survey study. SETTING AND PARTICIPANTS:The study included 216 NGNs enrolled in a regional transition program across six hospitals in Sweden. METHODS:Data were collected using an online questionnaire with Likert-scale questions and analyzed by using the Kruskal-Wallis test. Prior to analysis, an exploratory factor analysis (EFA) of the nine Transition Program Variable (TPV) items was performed. RESULTS:The TPV scale demonstrated satisfactory psychometric properties, including high internal consistency and a one-factor structure. Higher perceived value of the transition program was associated with higher perceived practical and theoretical preparedness, higher reported clarity regarding work expectations, stronger reported employer support for professional development, and a higher intention to remain at the current hospital. CONCLUSION:Higher perceived value of the transition program was associated with higher reportedpreparedness and retention intentions for newly graduated nurses. Further qualitative exploration is recommended to inform future program development.
Background: Delirium poses a considerable clinical challenge in intensive care units (ICUs), imposing substantial burden on nurses caring for patients with delirium. The Strain of Care for Delirium Index (SCDI) measures nursing burden associated with delirium care.Objectives: This study aimed to translate the SCDI into Korean and evaluate the validity and reliability of the Korean version of the SCDI (K-SCDI).Design: Methodological study.Methods: This study translated and culturally adapted the SCDI into Korean in accordance with the World Health Organization guidelines. Six experts assessed content validity (average scale-level content validity index = 0.92). Data were collected from 234 ICU nurses at tertiary hospitals in Busan and Changwon, South Korea. Construct validity was assessed through confirmatory factor analysis, discriminant validity testing, and known-group validity examination. Reliability was evaluated using Cronbach's α and intraclass correlation coefficients (ICCs).Results: Confirmatory factor analysis supported the original four-factor structure (hypoactive behavior, hypoalert behavior, fluctuating course and psychoneurotic behavior, and hyperactive/hyperalert behavior), achieving acceptable model fit indices (χ2/df = 2.25, Tucker-Lewis index = 0.93, comparative fit index = 0.94, root mean square error of approximation = 0.07). Similarly, discriminant validity was supported, with squared correlations between all factors lower than their respective average variance extracted values. Known-group validity was demonstrated in the hyperactive/hyperalert behavior domain, with nurses with and without delirium care education showing significant differences (t = -2.75, P<.05). Internal consistency reliability was excellent (Cronbach's α = 0.91), and test-retest reliability was strong (ICC = 0.87).Conclusion: The K-SCDI is a valid reliable instrument for measuring strain in ICU nurses caring for patients with delirium. This tool can inform the development of nurse support programs, tailored educational interventions, and workplace improvements based on delirium behavioral subtypes.
BACKGROUND:Social frailty is a multidimensional determinant of adverse outcomes in later life, yet existing measures often lack clear conceptual foundations, cultural relevance, and psychometric rigour. OBJECTIVE:To develop and evaluate the psychometric properties of a co-designed social frailty assessment tool and its short forms for community-dwelling older adults, and to establish the SF-10 as a brief screening instrument. DESIGN:Cross-sectional psychometric study. METHODS:Using a structured three-phase scale development framework, items were generated deductively from the social needs framework and social vulnerability concepts, informed by a scoping review and co-design workshops with older adults, caregivers, and professionals in Hong Kong. Content validity was refined through stakeholder workshops and cognitive interviewing. The initial 15-item Social Frailty Index (SF-15) was administered to 234 adults aged ≥60 years. Confirmatory factor analysis within a Bayesian bifact or structural equation model evaluated fit, latent structure, and reliability. A 10-item short form (SF-10) was then developed and tested for internal consistency, structural validity, and domain coverage. RESULTS:The SF-15 aligned with the proposed dimensions but showed poor fit (PPp = 0.001). The SF-10 demonstrated acceptable fit (PPp = 0.216), excellent composite reliability (ω = 0.913), strong internal consistency (α = 0.824; ordinal α = 0.869), moderate reliable variance attributable to the general factor (ωH = 0.625), and high factor score quality (ρη^,η = 0.94). Retained items covered resources, participation, connections, relationships, and self-management. Subscale scores may support domain-specific profiling, though interpretation requires further validation. CONCLUSION:The SF-10 is a theoretically grounded, culturally sensitive brief screening tool with promising psychometric properties among Hong Kong Chinese older adults. Its total score can identify overall social vulnerability, while domain-level data may guide tailored assessment, referral, and intervention. Independent, longitudinal, and cross-cultural validation is needed before clinical use.
Background: Attitudes toward medical communication play a crucial role in shaping nursing professionals' communication behavior. To date, there is no German measure that assesses attitudes towards communication in nursing professionals.Objective: The aims were (a) to translate and adapt the Attitudes Towards Medical Communication Scale for nursing professionals, and (b) to perform a preliminary evaluation of its psychometric properties.Design: We conducted a mixed-methods study.Methods: First, the 12-item measure was translated and adapted following the TRAPD team translation protocol. Then, data for psychometric testing were collected via an online survey involving nursing professionals from Germany working in clinical settings. We assessed item characteristics (e.g. corrected item-total-correlations, inter-item correlations, item difficulty), construct validity through confirmatory factor analysis and testing correlation with self-efficacy regarding clinical communication (hypothesizing a moderate correlation between r = 0.3 and r = 0.5), and internal consistency using McDonald's Omega.Results: The translation and adaptation process resulted in the Attitudes Towards Medical Communication Scale - German version for nursing professionals. N = 173 nursing professionals participated in the online survey. Due to low variance and/or low factor loadings as well as uncertainties about the match between the items' content and the construct of attitudes toward medical communication, we removed three items. The 9-item version yielded inconsistent results for model fit of our data (CFI = 0.91, TLI = 0.87, RMSEA = 0.11; factor loadings <0.4). Subsequent analysis demonstrated a moderate correlation with self-efficacy regarding clinical communication (r = 0.38) and adequate internal consistency (ω = 0.76).Conclusion: To our knowledge, the Attitudes Towards Medical Communication Scale - German version for nursing professionals is the first German measure assessing attitudes toward medical communication. Given the inadequate results regarding item characteristics and psychometric properties, further research is needed. This should include further exploration of the corresponding construct for the target group, as well as refinement of existing items or the addition of new ones.
Background: Frailty and multimorbidity frequently coexist among older adults, amplifying risks of disability, hospitalization, social isolation, and reduced quality of life. In Indonesia, the prevalence of frailty among community-dwelling older adults is increasing, yet little is known about how cultural, social, and familial contexts shape the lived experiences of those facing both conditions.Purpose: This study aimed to explore the lived experiences of Indonesian community-dwelling older adults with multidimensional frailty and multimorbidity.Method: A qualitative descriptive design with an interpretive orientation was employed on 20 older adults aged 60 years and above, identified as frail using the Clinical Frailty Scale (scores 4-7) and with at least one chronic illness. The participants were recruited from six Indonesian PHCs. Semi-structured interviews were conducted from February to July 2022. Data were analyzed using qualitative content analysis through iterative steps of decontextualization, recontextualization, categorization, and theme development to capture shared and individual meanings.Results: Three main themes with nine subthemes emerged: (1) Lived realities of functional decline, reflecting physical, cognitive, emotional, and social deterioration; (2) Multimorbidity as a trigger for frailty, highlighting the cumulative impact of chronic illness and pain; and (3) Day-to-day adjustment to health problems, describing coping strategies related to nutrition, mobility, and daily functioning.Conclusions: Frailty among Indonesian older adults is multidimensional, with multimorbidity acting as a catalyst for its progression. Holistic, culturally sensitive, and community-based nursing interventions are essential to address physical, emotional, nutritional, and social dimensions of care, thereby supporting functional independence, adaptive coping, and improved quality of life in later years.
Background: Health technology assessment (HTA) increasingly informs reimbursement, adoption, scale-up, and disinvestment decisions, yet many evidentiary traditions remain best suited to discrete, attributable interventions. Continuous, multidisciplinary care processes can therefore become systematically undermeasured, producing structural blind spots that undermine decision validity. Nursing is a paradigmatic test case: much nursing work is preventive, temporally diffuse, and inconsistently represented in routine datasets, so successful prevention can appear as "nothing happened." Objectives/Aims: To propose a pragmatic policy architecture for nursing-visible HTA that strengthens validity, equity, and implementability without increasing documentation burden, positioning artificial intelligence (AI) as an enabling method rather than a substitute for measurement design or causal reasoning. Methods Design: discursive discussion paper. Data Sources: targeted searches of PubMed, CINAHL, and Scopus, supplemented with key HTA, governance, and AI policy/standards documents and citation chaining. Search dates: databases were searched in January 2026. Literature used: English-language sources prioritised from 2015-2025 were screened for conceptual and policy relevance, then organised into three analytic themes aligned with the architecture: scoping, governance, and evidence generation. Findings: The architecture links three actions. Action 1 (Scoping) requires a small, feasible set of nursing-sensitive outcomes and implementation consequences, preferring measures already available from routine data to avoid new documentation. Action 2 (Governance) prevents surveillance harms and inequity through nursing decision authority, limits on punitive workforce surveillance, and equity checks with ongoing monitoring of unintended effects. Action 3 (Evidence) translates routine data into policy-grade evidence via transparent reporting and cautious causal claims; analytics (including ML/NLP when appropriate) are used as enablers rather than shortcuts. Conclusion: Integrating scoping, governance, and routine-data evidence can improve HTA validity, equity, and implementability for team-based care models where outcomes are co-produced by multidisciplinary work.
OBJECTIVE:To examine the relationship between depression, frailty, and successful aging among older adults receiving primary healthcare services in Türkiye. METHODS:A descriptive, cross-sectional design was used with 263 community-dwelling adults aged 65 years and older who visited primary healthcare centers between April and June 2024. Data were collected through a sociodemographic and health information form, the Geriatric Depression Scale-5 (GDS-5), the Edmonton Frail Scale (EFS), and the Successful Aging Scale (SAS). Statistical significance was accepted at p < .05. RESULTS:The mean age of participants was 71.05 ± 6.51 years; 55.1% were female and 73.4% had chronic illness. The mean GDS-5 score was 2.30 ± 1.13, with 74.9% at risk of depression. The mean EFS score was 5.30 ± 3.64, with 51.3% classified as frail at varying levels. The mean SAS score was 49.77 ± 11.35, indicating moderate successful aging. Regression analysis revealed that physician-diagnosed depression (B = -7.103, p < .001), depression risk (B = -3.222, p = .011), and frailty (B values ranging from -5.987 to -19.322, p < .001) were significant negative predictors of successful aging, explaining 42.0% of the variance (Adjust R2: 0.420, p < .001). CONCLUSION:Depression and frailty significantly reduce successful aging in older adults. Routine screening, early diagnosis, and nursing interventions targeting these geriatric syndromes are essential for enhancing the quality of aging. Policymakers should also implement educational, social, and economic support programs to foster successful aging at the community level.
Background: TikTok has become a popular platform for healthcare communication, with #Nursetok enables nurses to share experiences, education, and professional insights. Research on the content, engagement, and educational value of these videos remains limited.Objective: To analyze #Nursetok video content, creator demographics, engagement metrics, and information quality, assessing the role of TikTok in nursing practice and education.Methods: On April 30th, 2024, 100 English-language nursing-related TikTok videos under #Nursetok were selected. Metadata included publisher type, gender, views, likes, comments, shares, and saves. Videos were evaluated for understandability and actionability using PEMAT-A/V and quality using DISCERN. Each video was independently reviewed by two healthcare professionals, with a third resolving discrepancies.Results: Most videos (96%) were created by registered nurses; 68% by females. Content was primarily entertainment (45%) and healthcare professional perspectives (29%), with educational content comprising 10%. Average video length was 0.58 min, with mean views of 5.1 million, 533,803 likes, 2,632 comments, 21,707 shares, and 26,715 saves. PEMAT-A/V scores indicated moderate understandability (57%) but low actionability (13%). DISCERN ratings averaged 23.6%, reflecting moderate to poor quality.Conclusions: #Nursetok is predominantly nurse-driven and entertainment-focused, with limited actionable or educational content. Future directions include diversifying contributors, incorporating interprofessional perspectives and developing evidence-based, simulation or case-based content to enhance its value for professional development in nursing.
