Background: Nepalese nurses have increasingly sought employment abroad, primarily in high-income countries where the demand for skilled healthcare professionals is high. It is estimated that more than one third of nurses registered with the Nepal Nursing Council have initiated the process to practice abroad.Aim: This systematic review examines the motivations and aspirations of Nepalese nurses towards international migration, highlighting the socio-economic, professional, and personal determinants that influence their decisions.Methods: A comprehensive search was conducted on PsyInfo, CINAHL, MEDLINE, and Web of Science focusing on studies published in English before March 2025 that explored Nepalese nurses' migration intention and associated push and pull factors. Exploratory meta-analysis was conducted on quantitative outcomes like migration intention, starting migration planning, timeline for future migration, destination country, plan to return, push and pull factors for migration, and impact of nurse migration. Qualitative findings were analyzed using thematic synthesis. A mixed-methods synthesis approach was used to integrate findings from both the quantitative and qualitative studies.Results: Meta-analysis showed that 87% of nursing students and qualified nurses intended to migrate internationally. Australia (46%) was the most preferred destination, followed by the United States (38%), the UK (27%), and Canada (23%). Key motivations included higher income, advanced education and training opportunities, better working conditions, and career advancement. Personal goals, such as achieving financial stability for families and improved quality of life, and desire for personal freedom influenced the decision. Push factors in Nepal included low pay, limited professional growth, and poor workplace environments.Conclusion: To retain nurses, Nepal should prioritize fair compensation, professional development, and job security. Destination countries should uphold ethical recruitment, strengthen health systems in resource-limited areas, and support nursing education and retention.
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.
