ABSTRACT Background Postpartum psychosis (PPP) is a rare, yet severe, perinatal psychiatric disorder that typically presents abruptly within several days after childbirth and requires urgent in‐patient psychiatric care. Despite its severity, postpartum psychosis remains underrepresented in research and can be poorly understood in clinical healthcare settings, particularly regarding the detection of the disorder. Aims This exploratory qualitative analysis examines lived‐experience perspectives on help‐seeking, including barriers encountered when help‐seeking, to develop a clearer understanding of the current pathways to detection and diagnosis of PPP. Design A qualitative study design was used to analyse interview transcripts. Methods Semi‐structured interviews were conducted with 15 participants during 2024 which were thematically analysed. Findings Four key themes were identified: (1) recognising the unnameable (women's early insights and difficulties in articulating their experiences and symptoms), (2) invisible until visibly unwell (barriers to recognition of PPP healthcare professionals), (3) speaking without being heard (Frequency of misdiagnosis and lack of thorough medical investigation) and (4) falling through the cracks (the Australian healthcare systems inadequate capacity to support women experiencing PPP). Conclusion Unintentional medical gaslighting, which is the dismissal, reframing or invalidation of symptoms and or patient experiences, was evident through the frequent reframing and dismissal of the women's experiences and led to a disconnect between them and the Australian healthcare system. Misrecognition was evident across multiple dimensions including interpersonally and institutionally. It delayed access to care, fractured relationships and trust within the healthcare system and exacerbated psychological distress. Implications for the Profession and/or Patient Care This study emphasises that enhancing outcomes for women affected by postpartum psychosis requires increased focus within both research and clinical domains, ensuring that maternal distress is accurately identified, comprehended and validated. Impact This study examined the help‐seeking experiences of women experiencing postpartum psychosis in Australia. Medical gaslighting and frequent dismissal and reframing of the women's experiences by healthcare professionals were evident, which led to a disconnect between the women and the Australian healthcare system. This disconnect can impact the mother, the infant, the whole family unit by increasing psychological distress, the burden on family members, and disruptions to the mother‐infant attachment, and the healthcare systems collectively. It emphasises that research and clinical domains need to focus on ensuring maternal distress is accurately identified, comprehended and validated. Reporting Methods This study adhered to the COREQ for reporting interview‐based qualitative research. Patient or Public Contribution This study did not include patient or public involvement in its design, conduct or reporting.
ABSTRACT Aim To explore how nursing and midwifery (N&M) leaders draw on professional identity to navigate their role in relation to workforce wellbeing and psychological safety, and the consequences of this work when conducted within hostile organisational cultures. Design Constructivist Grounded Theory. Methods Eighteen participants holding current or recent formal leadership and management responsibilities within United Kingdom NHS settings were recruited via purposive sampling. Intensive semi‐structured interviews were conducted and analysed using initial and focused coding, constant comparative analysis and memo writing. Results Three interconnected themes were generated: (1) professional identity as the foundation for psychological safety work, with participants drawing on values of care, integrity and advocacy to build trust‐based team cultures; (2) professional credibility as the currency of trust, with leaders' demonstrable connection to frontline practice acting as the primary mechanism translating professional identity into team trust; and (3) the paradox: professional identity under threat, whereby the same professional values driving participants' commitment to psychological safety placed them at risk within their own organisational contexts, generating cumulative moral distress. This is conceptualised as the leadership and wellbeing paradox: fostering psychological safety from unsafe ground. Conclusion N&M leaders cannot sustainably foster psychological safety when they are operating on unsafe ground. Implications for the Profession and/or Patient Care Healthcare organisations must actively protect the psychological safety of N&M leaders for safe, compassionate care cultures. Failure to address the leadership and wellbeing paradox will continue to drive moral distress and attrition across the professions. Impact Professional identity was found to motivate and endanger leaders' psychological safety work, generating a paradox in which cumulative moral distress damages wellbeing and threatens retention. The findings have direct relevance for N&M leaders, healthcare organisations and policymakers addressing workforce attrition and culture change. No Patient or Public Contribution This study did not involve patient or public contribution. The research focused exclusively on the professional experiences and perceptions of nursing and midwifery leaders as study participants. Given the study's focus on leadership practice and workforce wellbeing from the perspective of professionals in leadership roles, patient, service user or public involvement in the design, conduct or analysis of the research was not applicable.
ABSTRACT Aim To examine factors associated with advance directive (AD) completion among nursing home residents in Taiwan, focusing on family visitation patterns and the perceived meaning of family involvement. Design A cross‐sectional study. Methods Data from 134 family caregivers and their corresponding nursing home residents from seven nursing homes in northern Taiwan were analysed. Family caregiver data were collected using validated questionnaires, including the Family Meaning of Nursing Home Visits (FMNHV) scale. Multiple logistic regression was conducted, with candidate variables specified based on the study's conceptual framework and prior literature and refined using AIC‐based forward and backward stepwise selection. Results The AD completion rate was 34.3%. Completion was associated with residents' prior expression of end‐of‐life preferences (OR = 14.33, 95% CI = 4.39–46.80) and caregivers' awareness of ADs (OR = 4.20, 95% CI = 1.29–13.65). Compared with daily visits, weekly visits were associated with lower odds of completion (OR = 0.23, 95% CI = 0.07–0.81), as were visits lasting 61 min or longer compared with those lasting less than 30 min (OR = 0.16, 95% CI = 0.03–0.79). Higher scores on the FMNHV responsibility for care quality subscale were associated with greater odds of completion (OR = 1.24, 95% CI = 1.11–1.39). Conclusion Family involvement in AD completion extends beyond visitation patterns to include the perceived meaning of involvement. Both behavioural and interpretive dimensions should be considered when understanding AD completion in nursing homes. Implications for the Profession and/or Patient Care Nurses should consider both visitation patterns and the perceived meaning of family involvement when facilitating discussions about AD completion with residents and their families. Impact This study identifies family involvement‐related factors associated with AD completion and provides insights for nursing practice, staff training and advance care planning in long‐term care settings. Reporting Method We adhered to the STROBE guidelines. Patient or Public Contribution No patient or public contribution.
ABSTRACT Aims To examine the interconnections among artificial intelligence literacy, self‐regulated learning strategies, and academic resilience in undergraduate nursing students, and to conduct an exploratory comparison of network characteristics between students with and without clinical practice experience. Design A cross‐sectional survey. Methods Using convenience sampling, 1784 undergraduate nursing students were recruited from five universities in Hunan Province, China, between March and May 2026. Participants completed a demographic questionnaire and three validated scales. Network analysis estimated node strength, bridge strength, and predictability. Bootstrap procedures assessed network accuracy and stability, and the Network Comparison Test was used to conduct an exploratory comparison between students with and without clinical practice experience. Results The 10‐node network contained 35 non‐zero edges and had a mean predictability of 62.6%. Artificial intelligence evaluation showed the highest node strength, followed jointly by monitoring learning strategies and cognitive maturity. Evaluating and revising learning strategies showed the highest bridge strength, followed by cognitive maturity. In the exploratory subgroup analysis, the overall network structure differed between students with and without clinical practice experience, whereas global strength did not. Conclusions Artificial intelligence evaluation, monitoring learning strategies and cognitive maturity showed relatively high node strength, whereas evaluating and revising learning strategies and cognitive maturity showed relatively high cross‐domain bridge strength. Implications for the Profession Findings may inform nursing curricula integrating artificial intelligence literacy, learning regulation, and academic adaptation. Impact This study addressed fragmented understanding of these capacities. It identified dimensions with relatively high node strength and bridge strength, providing exploratory evidence for future nursing education research. Reporting Method This study was reported in accordance with the STROBE statement. No Patient or Public Contribution This study did not involve patients, service users, caregivers, or members of the public.
ABSTRACT Aim To systematically map factors associated with male nurses' professional status using the Socio‐Ecological Model (SEM) and describe reported outcomes and evidence gaps across multiple ecological levels. Design Scoping review. Data Sources We searched five databases (CINAHL, Cochrane Library, MEDLINE, PubMed, Web of Science) through December 2025, supplemented by searches of ProQuest, Google Scholar, and manual ancestry searching. Review Methods We extracted and mapped data from 97 quantitative, qualitative, and mixed‐methods studies using a four‐level SEM framework (individual, interpersonal, organizational and sociocultural levels). Results The studies in this review showed that factors related to male nurses' professional status mapped across ecological levels, suggesting that opportunities and gender constraints coexist at the individual, interpersonal, organizational, and sociocultural levels. Reported aspects included career motivation, economic factors, patient preferences for nurse gender, perceptions of intimate care, task distribution, working relationships, and societal stereotypes. These patterns differed across healthcare practices, cultural backgrounds, and career stage. Reported outcomes for professional status included professional identity, burnout, clinical practice adaptations, career development and turnover intention. Evidence primarily focused on male nursing students and male clinical nurses. Conclusions Ecological‐level factors are associated with male nurses' professional status. Future research and practice should recognize the various contexts that may shape the professional identity and career trajectory of men in nursing. Implications for the Profession This literature review maps current evidence to inform gender‐inclusive educational and organizational strategies that support professional development and workforce retention among men in nursing. Impact This review identifies gaps in the evidence on career development and gender in relation to male nursing across contexts. Reporting Method PRISMA‐ScR and Joanna Briggs Institute (JBI) methodology for scoping reviews. Patient or Public Contribution None.
