ABSTRACT Background Online patient narratives may complement structured assessments of symptoms following heart valve replacement. Network analysis can describe conditional associations between symptom mentions, but its clinical interpretation depends on extraction validity and estimation stability. Aim To describe symptom mention proportions, conditional associations, centrality and community structure in Zhihu narratives concerning recovery after heart valve replacement. Methods This retrospective cross‐sectional text‐mining study screened 5040 entries and identified 1017 texts classified as patient self‐reports. Of these, 421 contained at least one mention from a 38‐item symptom dictionary. Fifteen items met the network inclusion criteria. An Ising model was estimated using L1‐regularized logistic regressions, EBIC γ = 0.25 and the AND rule. Edge uncertainty and centrality stability were assessed using 1000 nonparametric and 1000 case‐dropping bootstrap replications, respectively. Communities were explored using Leiden modularity optimization. Extraction was validated against adjudicated independent annotations of 38 items in 150 posts randomly sampled from the 1017 posts. Results Generalized pain (34.20%), anxiety (22.80%) and fatigue (16.39%) were the most frequently mentioned symptoms. The estimated network retained six positive edges and seven isolated nodes. Dyspnea–chest tightness was the strongest edge (2.43; 95% bootstrap interval 1.18–3.26); the intervals for the other five retained edges included zero. Dyspnea had the highest strength and one‐step expected influence (both 5.79). The CS(cor = 0.7) coefficient was 0.283 for both indices. Leiden partitioning identified three multi‐node communities and seven singleton communities. Automated extraction achieved precision of 97.35%, recall of 81.33% and an F1‐score of 0.886. Conclusion The symptom‐mention network was sparse, with dyspnea showing the highest estimated centrality. Frequent mention did not imply high network centrality. Limited centrality stability and residual extraction errors preclude firm identification of clinical intervention targets. External validation of extraction performance and prospective clinical validation are required. Relevance to Clinical Practice Generalized pain, anxiety and fatigue were frequently mentioned in the included narratives, whereas dyspnea had the highest estimated network centrality. These different findings may help frame questions for comprehensive postoperative symptom assessment, but neither mention frequency nor centrality establishes a treatment priority. The results do not demonstrate that intervening on a particular symptom improves recovery, and they require validation in clinically characterized cohorts before informing symptom management.
AIMS To synthesize evidence on the characteristics, implementation and effects of nurse-driven sepsis protocols on process-of-care indicators and clinical outcomes. DESIGN Systematic review without meta-analysis. METHODS Studies were included if they described and evaluated nurse-driven sepsis protocols in hospitals. Two reviewers independently screened titles, abstracts and full texts for eligibility. The Johns Hopkins Nursing Evidence-Based Practice model was used to appraise included studies. Data were extracted and narratively synthesized. DATA SOURCES Eight databases were searched from database inception to 30 June 2025. RESULTS Fifteen studies were included, most using before-and-after designs and conducted in the emergency departments (n = 7) and hospital-wide settings (n = 4). Protocols commonly used systemic inflammatory response syndrome criteria for screening (n = 12) and incorporated key Surviving Sepsis Campaign recommendations (n = 14). Most studies reported improved or comparable outcomes to baseline in overall sepsis bundle compliance and key process-of-care indicators, including timely antibiotic administration, blood culture collection, lactate measurement and fluid administration. All 11 studies evaluating mortality reported reductions, although only four were statistically significant. Findings for hospital length of stay were inconsistent. Common implementation strategies included nurse education and training, coupled with audit and feedback. CONCLUSIONS Nurse-driven sepsis protocols may improve adherence to and timeliness of key sepsis care processes. Effects on clinical outcomes are less certain, given the predominance of before-and-after designs and inconsistent findings for hospital length of stay. The review identifies implementation strategies that can guide future sepsis quality improvement initiatives. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Nurse-driven protocols may support nurses in initiating timely sepsis care and strengthening adherence to recommended care processes. Further high-quality studies are needed to establish effects on clinical outcomes and broader impacts, including healthcare costs, intensive care resource utilization, patient and nurse satisfaction, and safety outcomes. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
ABSTRACT Aims To explore stroke survivors' experiences of sense of agency and negative emotions during recovery, and to develop a patient journey map. Background Stroke can disrupt perceived control and cause emotional distress, but how these experiences relate during recovery remains unclear. Design Descriptive qualitative study nested within a longitudinal study. Methods Purposive maximum variation sampling recruited 13 stroke survivors from a tertiary hospital in Henan, China. Sampling was guided by changes and fluctuations in sense of agency scores across four assessments, from before discharge to six months afterwards. Retrospective semi‐structured interviews were conducted six months after discharge. Data were analysed using content analysis and a preliminary stage–theme framework. Reporting followed COREQ. Results Three themes and 12 subthemes were identified: illness shock, loss of sense of agency and distress marked by doubts and worries; further loss of sense of agency, intensified negative emotions and passive coping; and rebuilding sense of agency, alleviation of negative emotions and active coping. Physical limitations, disrupted roles, unclear information, rehabilitation setbacks and unmet support needs accompanied loss of agency and distress. Meaningful functional gains, clearer illness understanding, motivation and supportive relationships helped participants rebuild agency. Conclusions Stroke survivors described loss and rebuilding of sense of agency alongside changes in negative emotions and coping. The patient journey map highlights opportunities for continuous, individualised support during recovery. Relevance to Clinical Practice Nurses should assess agency and emotional distress throughout recovery, particularly during care transitions and setbacks. Understandable information, meaningful goals, feedback on progress and patient participation may support agency. Withdrawal should prompt exploration of emotional concerns and practical barriers rather than assumptions about motivation. Patient or Public Contribution No patient or public contribution.
ABSTRACT Aims To explore Australian nurses' experiences of grief in paediatric palliative and end‐of‐life care, its impact on professional practice and their utilisation of supports. Design Qualitative Interpretive description study. Methods In‐depth, semi‐structured, online interviews were conducted with ten Australian nurses experienced in palliative and end‐of‐life care in paediatrics. Interviews were audio‐recorded, transcribed and analysed using constant comparative thematic analysis. The COREQ checklist guided reporting. Results Six interconnected themes were identified, reflecting the evolving and pervasive experience of grief: ‘exposure to grief’; ‘impact on personal life’; ‘impact on professional role’; ‘coping with grief’; ‘workplace supports’; and ‘reflection, growth and adaptation’. Findings suggest that grief is an under‐recognised psychosocial phenomenon and potential occupational hazard in paediatric palliative and end‐of‐life care. Nurses valued informal supports, including peer support and compassionate leadership, more than formal debriefing. Barriers to organisational support persisted, yet many nurses reported increased resilience and growth through reflection. Conclusion Grief is an intrinsic yet often overlooked aspect of paediatric end‐of‐life care. Context‐sensitive, individualised supports and compassionate leadership can foster openness and reflection, recognising grief as both a natural process and potential occupational hazard and support nurses' resilience and long‐term wellbeing. Implications Acknowledging grief as a potential occupational hazard and psychosocial phenomenon requires organisational accountability and a systemic approach at leadership and policy levels. This aligns with clinical governance standards and occupational health principles while affirming nurses' right to emotional safety at work. When supported through compassionate leadership and open emotional dialogue, grief may become a source of personal and professional learning and resilience. Impact By acknowledging nurses' experience of grief, this study highlights the need for formal adjustments in policy frameworks, supervision and education at all levels to ensure safety, quality and staff support through competencies in grief and trauma management. Reporting Method The authors followed the Consolidated Criteria for Reporting Qualitative Research (COREQ). Patient or Public Contribution No patient or public contribution was made.
