INTRODUCTION:Missed nursing care threatens quality and safety, but patient counts may not capture shift-level demands. We examined associations of patient-count and perceived workload indicators with missed care, separating within- and between-nurse effects. DESIGN:A multicenter observational study using repeated shift-level measurements. METHODS:The study included 502 shift records from 213 nurses in 16 medical-surgical units across six Italian hospitals; the primary analysis included 480 records from 196 nurses. Patient-count indicators were nurse-reported numbers of assigned, isolated, and specialist-care patients; perceived workload included work rhythm/quantity, mental workload, emotional workload, and work organization. Grouped-binomial generalized estimating equations modeled the proportion of applicable activities missed, with nurse clustering, robust standard errors, exchangeable correlation, and hospital fixed effects. Workloads were decomposed into within- and between-nurse components, and four missed-care domains were examined. RESULTS:Nurses reported a mean of 6.5 missed activities per shift; 29.9% of shifts had no missed care. The seven workload indicators were jointly associated with missed care (robust Wald χ2[7] = 22.95, p = 0.002). Work rhythm/quantity was the only individual indicator with a nominal p-value below 0.05 (OR 1.24 per SD, 95% CI 1.03-1.49; p = 0.023), but it did not remain significant after Benjamini-Hochberg correction (q = 0.159). Assigned patient count was not clearly associated (OR 1.14, 95% CI 0.94-1.40; p = 0.192). In exploratory within-between analyses, the between-nurse work rhythm/quantity component was associated with missed care (OR 1.42, 95% CI 1.11-1.82; p = 0.005), whereas the within-nurse component was not (OR 1.03, 95% CI 0.90-1.17; p = 0.649). Domain-specific associations did not remain significant after multiplicity adjustment. CONCLUSION:The workload indicators were jointly associated with missed nursing care, with secondary analyses indicating that the global signal was evident in the perceived-workload block. However, no individual workload indicator remained statistically significant after multiplicity adjustment. Work rhythm/quantity and its between-nurse component should therefore be regarded as exploratory signals requiring confirmation in studies with denser repeated measurements. CLINICAL RELEVANCE:Workload surveillance research should evaluate patient-count and multidimensional perceived-workload indicators together. The present coefficient-specific findings are insufficient to support the operational use of work rhythm/quantity as a stand-alone workload indicator.
BACKGROUND:Progressive neurological disorders (PNDs) are life-limiting conditions with complex trajectories. PNDs require holistic, person-centred care that responds to the needs of both individuals and their families, including the provision of palliative and end-of-life (EOL) care. AIMS:This systematic review aimed to identify and synthesize existing international guidelines addressing palliative and EOL care in adult PND populations, with particular attention to their quality and scope. METHODS:We searched databases and gray literature sources for guidelines published between January 2013 and February 2026. Thirty-three guidelines were included for review. We appraised guidelines to assess quality and comprehensiveness against the World Health Organization's (WHO) domains of palliative care. We conducted inductive content analysis to identify key themes. RESULTS:Guidelines predominantly were published from high-income countries and focused on dementia. Overall guideline quality was high. Most addressed physical, psychosocial, and social dimensions of care of the WHO domains; however, spiritual wellbeing was inconsistently addressed. Six interrelated themes emerged: (i) holistic symptom management; (ii) recognition of families and caregivers as partners in care; (iii) early and ongoing communication; (iv) value-aligned decision-making; (v) multidisciplinary team expertise; (vi) navigation of medicolegal complexities. CONCLUSION:Findings indicate broad international consensus on the principles of high-quality palliative care in PND, while highlighting gaps in disease/diagnosis representation, spiritual care, and global equity. Future research could consider the importance of disease-specific guidelines, covering regions and countries from across a range of high-, middle-, and lower-income countries. CLINICAL RELEVANCE:Clinicians caring for people with progressive neurological disorders can draw on the internationally consistent principles identified in this review including early integration of palliative care, proactive and open communication, and recognition of families as partners in care to benchmark and strengthen their practice. Gaps in spiritual wellbeing, condition-specific guidance, clinical supports, and equitable access represent clear targets for workforce education, service development, and health policy advocacy.
AIMS:To compare HPV vaccination policies across eight countries and examine how actors, context, policy content, and implementation processes influence program performance and coverage outcomes. DESIGN:Comparative policy analysis using a qualitative cross-case document analysis. DATA SOURCES:Official national HPV vaccination guidelines, technical advisory documents, WHO and UNICEF monitoring reports, and peer-reviewed literature published between January 2006 and December 2024. Sources were identified through structured searches of PubMed, CINAHL, Scopus, and Web of Science. METHODS:The Health Policy Triangle framework guided analysis across four domains: Actors, Context, Content, and Process. A standardized data extraction template was applied across eight countries: Australia, Brazil, Japan, Nigeria, Rwanda, Sweden, the United Kingdom, and the United States. Data were synthesized in comparative matrices and analyzed using iterative cross-case analysis, with coding verified by a second reviewer. RESULTS:Five policy archetypes were identified: school-based universal programs, decentralized federal models, gender-neutral vaccination strategies, resource-constrained but high-performing systems, and the policy recovery model exemplified by Japan. School-based delivery supported by nursing and school health workforces consistently achieved the highest and most equitable coverage. Rwanda achieved 98% coverage despite a girls-only, donor-supported model, indicating that governance quality and community trust may outweigh policy design alone. The global transition to single-dose HPV vaccination schedules requires country-specific adaptation that accounts for population-based eligibility exceptions and evidence gaps, including the absence of clinical trial data on single-dose protection in males and against non-cervical HPV-associated diseases. CONCLUSION:HPV vaccination outcomes are shaped by governance structures, implementation capacity, nursing workforce infrastructure, and public trust. Strengthening school-based delivery, expanding single-dose schedules where supported by evidence, and investing in nursing-led outreach are critical to accelerating progress toward WHO cervical cancer elimination targets. IMPACT:Nurses are central to HPV vaccination delivery worldwide. This analysis provides evidence to support nursing leadership in advocating for school-based models, workforce investment, and equitable immunization strategies across diverse health system contexts.
INTRODUCTION:Cancer-related symptoms including pain, fatigue, depression, anxiety, and malnutrition drive poor quality of life and adverse clinical outcomes in cancer patients. While machine learning (ML) models are increasingly developed to predict these symptoms, existing studies are marked by significant heterogeneity in algorithms, sample sizes, and predictors, and lack quantitative synthesis of model performance, methodological quality, and clinical applicability. This study aimed to comprehensively summarize the characteristics of models and predictors, evaluate the predictive accuracy, risk of bias, and clinical applicability of ML prediction models. DESIGN:Systematic review and meta-analysis. METHODS:A comprehensive literature search was conducted in PubMed, Web of Science, the Cochrane Library, CINAHL, PsycINFO, CNKI, WanFang, VIP, and SinoMed, from database inception to August 31, 2025. Data were extracted in accordance with the Checklist for Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modeling Studies (CHARMS), and the risk of bias and applicability of included models were assessed using the Prediction Model Risk of Bias Assessment Tool and Artificial Intelligence (PROBAST-AI). The quality of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. A random-effects model was employed for pooled analysis. Subgroup analyses were stratified by cancer type, geographic region, and algorithm type. RESULTS:A total of 11,217 records were retrieved, and 34 studies were included in the analysis. The pooled AUCs for predicting pain, fatigue, depression, anxiety, and malnutrition were 0.76 (95% CI: 0.69-0.83, I2 = 97.7%), 0.82 (95% CI: 0.76-0.88, I2 = 98.5%), 0.76 (95% CI: 0.70-0.82, I2 = 98.4%), 0.78 (95% CI: 0.69-0.86, I2 = 37.9%), and 0.86 (95% CI: 0.80-0.91, I2 = 94.9%), respectively. Subgroup analyses across cancer type, geographical region, and algorithm type revealed no statistically significant sources of heterogeneity. The certainty of evidence was moderate across all outcomes. CONCLUSION:This systematic review and meta-analysis showed that ML models achieved acceptable discriminative performance for predicting pain, anxiety, depression, fatigue, and malnutrition in patients with cancer in available datasets. Given predominant internal validation and observed heterogeneity, clinical utility requires further prospective validation and implementation studies. Future research may consider theory-driven predictors and clinically tailored algorithms to improve model performance. CLINICAL RELEVANCE:These pooled findings provide a preliminary foundation for the clinical translation of ML models to predict pain, anxiety, depression, fatigue, and malnutrition in cancer patients. Further prospective validation in diverse clinical settings and randomized controlled trials evaluating the effectiveness of model-guided symptom management strategies are needed to improve patient outcomes. PROSPERO REGISTRATION:CRD420251130183.
INTRODUCTION:Diabetic peripheral neuropathy (DPN) among older people is associated with significant gait and balance impairments, postural instability, and an increased fall risk. Virtual reality (VR)-based interventions have been shown to be effective in improving balance and mobility; however, their design features and applicability for older people with DPN remain unclear. This systematic review was conducted to examine the effectiveness of VR systems on clinical outcomes in individuals with DPN and translate the findings into geriatric-specific VR design recommendations. METHOD:A systematic review design was employed. Five electronic databases (Scopus, PubMed, CINAHL, Web of Science, and Embase) were systematically searched. Guided by the Synthesis Without a Meta-Analysis (SWiM) approach, a narrative synthesis was conducted. RESULTS:A total of eight studies met the inclusion criteria, with a pooled sample of 341 participants (mean age = 49 to 72). VR systems were primarily used as intervention modalities (6 of 8 studies). Most VR systems employed non-immersive, screen-based platforms with real-time visual biofeedback. Progression algorithms were clinician-guided rather than adaptive. VR-based interventions demonstrated consistent improvements in postural sway, mediolateral stability, and functional mobility measures in adults with DPN. CONCLUSION:VR systems, used as either intervention and assessment modalities, were found to be effective in assessing and improving balance and functional mobility in adults with DPN. CLINICAL RELEVANCE:Based on these findings, the SAFE STEP PLAN Framework, a geriatric-specific design guidance for VR-based and other technology-assisted rehabilitation interventions in DPN, was developed to inform the design, implementation, and clinical integration of technology-assisted interventions for older people.
INTRODUCTION:Reports of evidence-based practice (EBP) and quality improvement (QI) in nursing journals often vary in reporting quality, hindering translation into practice. A critical appraisal tool for evidence-based practice quality improvement (EBPQI) has recently been made available on the EQUATOR Network. METHODS:A descriptive cross-sectional study of full-length articles (Jan-Jun 2025) from 28 nursing journals that accept reports of EBP and/or QI (per submission guidelines); each article was scored by two authors using the open-access critical appraisal tool for EBPQI. RESULTS:Collectively, these journals published 86 issues and 949 full-length articles; 30 (3.2%) articles were identified as EBP or QI reports and were published among 10 (33%) journals. Of these 30 articles, only 6 (20%) used appropriate EBP and/or QI methods and were therefore appraised using the EBPQI critical appraisal tool. Based on the EBPQI critical appraisal tool, the EBP and QI reports varied in how and to what extent they met EBPQI criteria. CONCLUSION:Variation exists in journal guidance and reporting of EBP/QI initiatives. Consistent use of EBPQI criteria highlights the need for standardized reporting to improve transparency, transferability, and translation into practice. CLINICAL RELEVANCE:Transparent, standardized reporting of EBP and/or QI initiatives enables clinicians to appraise relevance and transferability to practice. Reporting aligned with recognized guidelines (or clear justification for deviations) is warranted.
INTRODUCTION:The incidence of breast cancer (BC) is increasing in women younger than 40 years of age. In this age group, BC is the most frequent cancer-related cause of death. These women are also ineligible for regular mammogram screening programs and often present with more aggressive cancer subtypes with worse clinicopathologic features, and these women are rarely diagnosed preclinically. Yet many young women are not aware that they may be at risk for this cancer. The aim of this study was to provide an in-depth understanding of an early onset breast cancer diagnosis by interviewing women who have this lived experience. DESIGN:This study used a qualitative descriptive design. METHODS:Women were recruited through collaboration with a community breast cancer coalition and an urban cancer center. The eligibility criteria were women who had been diagnosed with breast cancer before the age of 40, who spoke English, and who lived within proximity to the cancer center. A semi-structured interview guide was developed by two of the researchers who have previously collaborated on qualitative studies of women diagnosed with BC. The interview guide included 25 questions beginning with a broad request for the women to describe their breast cancer journey. Content analysis was used to analyze the data. RESULTS:Thirty women were interviewed for this study. The average age at diagnosis was 34.4. The themes that were found included: (1) Finding a Lump; (2) Finding Out You Have Breast Cancer; (3) Telling Your Parents and Children; and (4) Making Decisions: Fertility. CONCLUSION:Emotional, psychological, and socio-cultural factors are different in young women diagnosed with BC, as compared to older women. Delays in diagnosis were common, as almost all were symptomatic when diagnosed. Research is needed to understand the patient, provider, and system-related factors that lead to delays in diagnosis and treatment. These young women, who will likely live a much longer portion of their lives beyond their cancer diagnosis, are asking for this research to be done. CLINICAL RELEVANCE:Screening guidelines exclude women under 40 years of age in all countries with organized screening programs; therefore, few women under the age of 40 are diagnosed preclinically. These often late diagnoses lead to worse prognoses in young women with breast cancer. Additionally, young women diagnosed with breast cancer have age-specific care needs that are currently unmet in the continuum of breast cancer care.
INTRODUCTION:The aim of this study was, with regard to the state of Poland's pediatric healthcare, to assess user experiences from the perspective of caregivers of pediatric patients and to provide a comprehensive picture of its quality. The research involved cooperating pediatric oncology and hematology wards across Poland. DESIGN:Cross-sectional, multicentre instrument validation study and caregiver's experience survey in Poland. METHODS:In-patient study was conducted at 14 pediatric oncology and hematology wards. The cooperating wards represented all of Poland's voivodeships, and the study was coordinated by trained nurses. The reliability and validity of the research conclusions were obtained based on assessments provided by a representative population of 813 (adult) primary caregivers of pediatric patients. Two tools were used: the Pediatric Patient Experience Questionnaire (PPEQ) (the Polish adaptation of the CAHPS Child Hospital Survey (Child HCAHPS)); collected sociodemographic and clinical data. RESULTS:The highest percentage of Top Box scores, 84.30%, was recorded for the "Responsiveness to the call button", and the lowest for "Preventing mistakes and helping you report concerns" (25.66%). The presence of verified hospital infrastructure elements ranged from 85% to 99%. Moreover, 68.39% of all respondents gave the Top Box rating to the pediatric oncology and hematology hospital where their child was treated, and 63.22% stated that they would recommend it. CONCLUSIONS:Overall, the quality of healthcare in Poland's pediatric oncology and hematology centers is high. Caregivers evaluated hospitals mainly based on staff communication with the child and caregiver-and on the sense of comfort during the stay. The aesthetics of the interior and accessibility for people with special needs were also important, while ensuring comfort and safety remains an area for improvement. CLINICAL RELEVANCE:The use of the PPEQ supports the development of healthcare based on communication, empathy, and partnership with pediatric patients and their families, notably their primary caregivers. Frequent measurement of experiences can provide reliable guidance on adjustments that should be made to the healthcare system.
BACKGROUND:Measuring intimate partner violence (IPV) remains a challenge in health research due to the wide range of available measures, with each designed for different purposes, populations, and types of violence. Selecting the most appropriate IPV measure requires careful alignment with a study's overall goals while balancing conceptual, ethical, and pragmatic considerations. OBJECTIVES:To introduce a decision-making framework to guide researchers in selecting IPV measures for use in health-focused research. METHODS:A targeted review was completed to identify all published systematic reviews focused on IPV measures. Using a consensus-driven approach, systematic reviews were appraised to determine the criteria and characteristics most commonly used to categorize and evaluate measures. A set of commonly recurring measurement characteristics was identified across reviews, including shared challenges in IPV measurement. RESULTS:We identified six domains characterizing variation across IPV measures, including: purpose, populations, types of violence, time frame, context, and data collection methods. Some reviews considered additional characteristics including psychometric evidence and cultural relevance. Others discussed practical considerations, such as language availability and respondent burden. Based on these findings, we developed a decision-making framework and accompanying checklist designed to support researchers in evaluating the fit and appropriateness between available IPV measures and the specific aims, populations, and contextual considerations of their studies. CONCLUSIONS:Structured guidance that draws on the broader IPV field can support intentional and transparent decision-making, improving the quality and fit of IPV measurement. CLINICAL RELEVANCE:The proposed framework, along with the IPV measure checklist, supports both researchers and clinicians in selecting the strongest IPV measure for their study. By offering structured guidance on navigating the wide variety of available IPV measures, this framework supports more consistent, interpretable, and methodologically rigorous IPV measurement.
AIMS:This review aims to synthesize qualitative evidence on patients' lived experiences of advanced practice nursing. DESIGN:Qualitative systematic review. DATA SOURCES:The studies included in this review were sourced from PubMed, Web of Science, The Cochrane Library, Embase, and CINAHL. Studies were limited to those published from database inception to March 5, 2026. REVIEW METHODS:The review adhered to the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) guidelines. Two independent reviewers screened titles, abstracts, and full-text articles to assess eligibility for inclusion. Data were extracted and analyzed using thematic synthesis. Confidence in findings was assessed using the CERQual approach. RESULTS:Thirty-seven studies were included. Five themes emerged from patients' accounts: (1) feeling seen and heard through therapeutic presence; (2) understanding illness through explanation and dialogue; (3) building trust through competence and respect; (4) gaining confidence and agency in self-management; and (5) experiencing coherent and coordinated care across services. CONCLUSIONS:Patients experienced advanced practice nursing as a relational, educational, and coordinating form of care. APNs were valued not only for their advanced clinical expertise but also for the way they listened, explained, built trust, supported patient agency, and helped patients navigate fragmented healthcare systems. These findings suggest that the effectiveness of APN care is closely linked to relational continuity, individualized communication, and system-level coordination. CLINICAL RELEVANCE:Understanding patients' lived experiences of advanced practice nursing can help nurses and healthcare organizations strengthen patient-centred care. The findings highlight the importance of protecting time for listening, supporting clear and individualized communication, building trustful partnerships, encouraging patient participation, and recognizing APNs' role in coordinating care across complex healthcare systems.
AIM:Identify similarities and differences in genomics-informed nursing across five countries to support the development of actionable interventions that will facilitate the implementation of genomics in nursing practice and education globally. INTRODUCTION:The integration of genomics in nursing practice and education is a global challenge which can be addressed through effective policy and leadership that guide the integration of genomics into education and practice. In this study, cross-country comparisons were conducted using secondary data derived from studies that employed the Genetics and Genomics in Nursing Practice Survey (GGNPS). This approach enabled us to analyze results accumulated over a 12-year period and describe global trends in the development of genomic competencies within the nursing workforce. Identifying global trends in the development of genomic competencies and support within the nursing workforce could help unify efforts to strengthen cross-country collaboration and address this long-standing challenge. METHODS:A comparative secondary analysis of the data from 10 studies that used the Genetics and Genomics in Nursing Practice Survey (GGNPS) and the Canadian Adaptation of the Genetics Genomics Nursing Practice Survey (GGNPS-CA) was conducted between 2013 and 2025. RESULTS:Over the past 12 years, the GGNPS/GGNPS-CA survey results have remained largely unchanged. In all five countries utilizing the instrument, the majority of nurses recognized the importance of genomics. However, most nurses self-rated their knowledge as poor, even with the average knowledge score of 8.62 out of 12. Nurses also consistently reported a lack of support from managers and senior staff for integrating genomics. CONCLUSION:Nurses were critical or uncertain of their knowledge, and they were not satisfied with the support they received. The similarity in results across the GGNPS/GGNPS-CA surveys reinforces the global nature of nurses' challenges, underscoring the need for innovative educational approaches, strengthened leadership support, and coordinated global collaboration to address these issues. CLINICAL RELEVANCE:Understanding the international nursing landscape in genomic education, competency, and practice serves as an evidence-based foundation for cross-country collaboration that can focus leadership, education, policies, and research to better support genomics-informed nursing education and practice.
BACKGROUND:The literature has reported conflicting findings regarding the association between frailty and cognitive impairment in patients with chronic kidney disease (CKD). This systematic review and meta-analysis examined the association between frailty and cognitive impairment in patients with CKD. METHODS:A comprehensive search of Embase, PubMed, Scopus, Web of Science, CINAHL, and the Cochrane Central Register of Controlled Trials was conducted from database inception to February 2026. Eligible studies comprised cross-sectional, cohort, case-control, randomized controlled trials, and quasi-experimental studies that reported associations between frailty and cognitive impairment in patients with CKD, with no time or language restrictions. RESULTS:A total of 17 studies (9 cross-sectional and 8 cohort) involving 129,868 patients with CKD (mean age 60.88 years) were included in the meta-analysis. The findings indicated that patients with frailty with CKD had significantly higher odds of cognitive impairment than robust patients (odds ratio = 3.13, 95% CI 1.92-5.12). Heterogeneity in association size was influenced by study region, frailty measurement methods, and whether covariate adjustments were made during data analysis (all p < 0.05). CONCLUSIONS:This systematic review and meta-analysis identified a significant association between frailty and cognitive impairment in patients with CKD. Future prospective cohort studies should assess the causal relationships between frailty and cognitive impairment in this population. CLINICAL RELEVANCE STATEMENT:This study systematically assessed the association between frailty and cognitive impairment in patients with CKD, addressing inconsistent findings in prior research. The results highlight the importance of implementing targeted interventions, particularly for nonfrail CKD patients, to reduce the burden of cognitive impairment and improve patients' outcomes.
BACKGROUND:Sleep problems are common among primary care nurses and are closely associated with psychological stress and maladaptive cognitive processing. Understanding the complex interplay among these psychological factors is critical for improving health outcomes and care quality. OBJECTIVE:This study aimed to examine the relationships between perceived stress, rumination (both positive and negative), and sleep quality in primary care nurses using a network analysis approach. METHODS:A cross-sectional study was conducted among 316 primary care nurses in public primary healthcare institutions in Shapingba District, Chongqing, China. Participants completed standardized self-report measures assessing perceived stress, rumination tendencies, and sleep quality. Network analysis was used to model the associations between these variables and to identify the most influential components. RESULTS:Approximately 64.6% of participants reported poor sleep quality. Network analysis revealed that sleep latency and perceived tension were the most central nodes within the network. Sense of tension and enjoy happiness showed the highest bridge strength, indicating their roles in connecting different psychological domains. Negative rumination-particularly suppression of positive emotions and negative attribution-showed strong links to sleep-related variables, suggesting its importance in the network structure. CONCLUSION:Perceived stress and negative rumination were closely related to sleep problems among primary care nurses. The findings suggest that stress reduction and cognitive-emotional interventions targeting maladaptive rumination may be effective strategies to improve sleep quality and overall well-being in this population. PATIENT OR PUBLIC CONTRIBUTION:No patient or public contribution.
INTRODUCTION:Advance care planning is a complex process and requires a culturally sensitive communication approach. Competence in initiating advance care planning requires specific education and training for healthcare providers. This qualitative descriptive study aims to explore the experiences and perspectives of healthcare providers across 12 Regional Health Sectors in Thailand regarding impacts of communication training on advance care planning implementation. DESIGN:A qualitative descriptive study. METHODS:The participants were healthcare providers who had attended the communication training workshop and engaged in advance care planning from across 12 Regional Health Sectors in Thailand. Focus group discussions were conducted and transcriptions were analyzed following the qualitative framework approach. Several strategies were used to enhance trustworthiness. RESULTS:Sixty healthcare providers participated in the study. Two main themes were identified: (1) a ripple effect of communication training; and (2) key components for successful advance care planning implementation. The communication training enhanced participants' knowledge and skills, and participants gained more confidence to initiate conversations with patients who had serious illnesses and families. The participants shared knowledge with and mentored junior nurses on conducting advance care planning. The participants also extended services to other advanced chronic diseases and advocated for early advance care planning. Finally, the participants took proactive action to raise public awareness of advance care planning in communities. The participants identified key components for successful advance care planning implementation. These included healthcare providers' knowledge, skills, and attitudes towards palliative care, knowing the patients, sufficient and dedicated time, continuity of care and institutional support. CONCLUSION:The communication training had a ripple effect, enhancing health professionals' competence and efficacy. The effects are beyond individual benefits. The training transformed clinical practices and extended to raise public awareness on advance care planning. Essential components for successful advance care planning should be used as a framework to guide clinical practice.
Aim To examine nurse practitioner opioid prescribing authority across three countries, analyzing safety outcomes, workforce distribution patterns, access equity, and service to vulnerable populations using integrated nursing policy and patient-centered access frameworks.Design Comparative policy analysis employing Russell and Fawcett's nursing policy framework overlaid on Levesque's access framework.Methods We analyzed regulatory documents, national prescribing databases, and published literature from New Zealand, United States, and Australia. Systematic searches identified 14 studies meeting inclusion criteria. We synthesized evidence across four policy analysis levels: efficacy, effectiveness, equity, and social justice. Data collection occurred January through December 2024.Results Evidence demonstrated safety and quality outcomes comparable to physician prescribing, with population-level prescribing decreases and no increase in overdose mortality. Nurse practitioners concentrated in rural areas at 34% compared to the 23% national average, with growth occurring during physician workforce decline. Patient panels showed 44% Medicaid coverage compared to 31% for physicians, with 88% versus 71% new Medicaid patient acceptance despite lower reimbursement. However, racial prescribing disparities persisted across all provider types, indicating systemic rather than individual-level determinants.Conclusion Expanded prescriptive authority advanced multiple policy objectives while revealing distinctive nursing contributions beyond physician substitution. Workforce distribution and patient panel patterns reflected professional values translating into measurable practice serving vulnerable populations.Impact Evidence does not support restrictive policies based on safety concerns. Findings position the nursing workforce as an essential solution for health equity goals, requiring regulatory reform combined with institutional barrier removal and continuing attention to systemic inequities.
INTRODUCTION:The integration of robots into clinical practice requires careful consideration of their alignment with nursing workflows, patient needs, and clinical contexts. This scoping review aimed to support effective technology adoption by systematically identifying and classifying how robots are used in hospital-based nursing practice using standardized nursing terminology. DESIGN:A scoping review following Arksey and O'Malley's five-stage framework. METHODS:A structured search was conducted in five peer-reviewed databases (PubMed, Web of Science, Cochrane Library, CINAHL, and EMBASE) for studies published between January 2019 and July 24, 2025. The data were analyzed to classify the types of nursing tasks supported by the robots. Robotic functions were classified into direct care, indirect care, and associated work using standardized nursing terminology, Hurst's framework, and the Clinical Care Classification system to provide a codified and structured analysis of nursing tasks. RESULTS:A total of 40 studies were included in the final review. Thirty-three focused on direct care with robots, primarily supporting psychological, physiological, and functional care. The key interventions included coping support, emotional support, infection control, and vital sign monitoring. Only one study involved indirect care, and nine focused on associated work, such as errands and cleaning. CONCLUSIONS:Robots are primarily used for direct care, such as emotional support and monitoring, while their role in indirect care-requiring professional judgment including documentation-remains limited. This suggests that future development should prioritize user-centered designs and ethical guidelines aligned with actual clinical needs. Properly implemented robotic technology will serve as a strategic tool to enhance nursing efficiency and improve practice environments amidst chronic workforce shortages. CLINICAL RELEVANCE:By categorizing robotic functions using standardized nursing terminology, this review offers a structured understanding of how robots can support nursing. These insights help identify tasks that can be delegated to robots during crises, such as pandemics or staffing shortages, allowing nurses to focus on essential patient care.
BACKGROUND:Parenting stress among clinical nurses has been associated with turnover-related outcomes. For many nurses, critical periods of career development and accumulated clinical responsibility overlap with reproductive and early parenting years. Features of nursing work may shape parenting stress through demands related to scheduling, workload, and limited flexibility. DESIGN:Integrative literature review. METHODS:An integrative literature review was conducted following the methodological framework of Whittemore and Knafl. The final searches across three databases (CINAHL Complete, Medline, and Embase) were completed on May 14, 2026. Eligible articles were published in English, addressed parenting stress, and, when empirical, included nurses as a distinct population. Reporting followed PRISMA guidelines. RESULTS:Eight articles met all inclusion criteria. Countries of origin included South Korea, Turkey, and China. Approximately 1667 nurse-parent participants were represented across the included studies. Main themes included as follows: (1) Work-Family Role Conflict and Parenting Stress, (2) Parenting Stress Across Career and Family Life Stages, (3) Parenting Stress and Nurse Workforce Outcomes, and (4) Organizational and Structural Contributors to Parenting Stress. CONCLUSION:Parenting stress appears to be a relevant nursing workforce issue shaped by structural conditions of practice. The structure and demands of patient care may intensify parenting stress. Additional research is needed to examine the effects of parenting stress in clinical nurses and the implications for nurse retention. IMPLICATIONS:Organizational and policy-level interventions (including family-friendly scheduling, accessible childcare, and structured peer support programs) may support workforce sustainability among nurse-parents.
