ABSTRACT Background Evidence‐based practice is essential to high quality healthcare. Shared governance (SG) is vital to integrate evidence‐based practice findings into practice and empower frontline nurses through shared decision making. Research supports that SG fosters nurse engagement and satisfaction. This article outlines the first phase of a project aimed at improving council effectiveness, focusing on a current state analysis and development of a Nursing SG Toolkit (NSGT). Aims To assess the current state of nursing SG at a Veteran Affairs Medical Center and create a toolkit targeting identified gaps. Methods The project team utilized both quantitative and qualitative data. They distributed the Council Health Survey (CHS) to 20 of 31 active councils to assess council effectiveness through a five‐point Likert scale (higher score favorable). They followed with focused discussions. The team created the NSGT to address identified gaps and shared an early iteration with Nurse Practice Council before re‐distributing the “Membership” subscale of the CHS. The team disseminated a refined NSGT to all councils and administered the CHS 14 months later to 23 of 31 active councils. Results In the current state analysis, the lowest subscale of the CHS was “Membership” ( M = 2.82). The project team created the NSGT with a focus on this subscale. Mann–Whitney U tests were used to evaluate pre and post scores. After Nurse Practice Council received NSGT education, its scores improved in all five “Membership” questions, with three out of the five questions statistically significant ( p < 0.05). 14 months post implementation of the NSGT, overall CHS scores significantly increased (M = 3.62 to 3.83, z = −8.37, p < 0.001) with statistically significant increases in Nurse Practice Council scores in four of the five “Membership” questions. When data were filtered by those who indicated they used the NSGT, scores improved even more ( M = 3.63–4.0, z = −10.27, p = < 0.001). Linking Evidence to Action SG councils simply existing is not enough; they must be effective in supporting the shared decision‐making processes critical for evidence‐based changes. Developing a toolkit to address lower scoring CHS areas (e.g., Membership) demonstrates a successful strategy for promoting council effectiveness.
ABSTRACT Background Differences in perceptions of clinical nurses and nurse leaders have been observed and reported. Such differences can impact organizational outcomes and overall workplace environment. Objectives The objective of this study was to provide an integrative global review and synthesis of published literature comparing perceptions of clinical nurses and nurse leaders of the work environment in acute care settings. Methods Five databases were searched for quantitative, qualitative, and mixed methods studies published in English within the last 10 years; publications were peer reviewed. An appraisal of articles meeting review criteria was conducted using the Johns Hopkins method. Selected studies were reviewed both independently and collaboratively by the authors. Results The final sample consisted of 23 publications from five countries. The sample included 16 quantitative studies, five qualitative studies, and two mixed method studies. In articles, findings identified some similarities (22%) in perspectives of clinical nurses and nurse leaders of the work environment, but more differences were reported (78%). Areas identified were classified using the American Association of Critical Care Nurses standards established for a healthy workplace environment. Discussion A global phenomenon of differences in perceptions between clinical nurses and nurse leaders was supported by this integrative review. Such differences impact nurse satisfaction, turnover, and patient outcomes. Interventions to shrink the gap in perceptual differences between clinical nurses and nurse leaders warrant further research exploration. The value of leadership education, highlighting authentic leadership traits, is prioritized for consideration. To be effective globally, cultural practices must be taken into consideration. Importantly, objective outcomes following structured education must be reported.
ABSTRACT Background/Significance Breast biopsies are essential for cancer diagnoses and are often accompanied by heightened procedural anxiety. While local anesthesia addresses procedural pain, it does not lessen psychological distress. Virtual reality (VR) has been explored as a distraction‐based intervention that may reduce procedural anxiety. Aims This study evaluated the effects of standard care plus VR compared to standard care alone on patient anxiety, pain, and satisfaction during ultrasound‐guided breast biopsy. Methods A single‐site, two‐arm randomized controlled trial ( n = 80) compared standard care to standard care plus the use of VR during the ultrasound‐guided breast biopsy procedure. Data were collected between 9/2024 and 5/2025. Study participants were randomized 1:1 to receive either standard care (control group) or standard care plus VR use (intervention group). Anxiety and pain were assessed pre‐ and post‐procedure using 11‐point numeric rating scales; satisfaction was measured post‐procedure. Open‐ended responses from the intervention group were analyzed thematically. Results and Findings Study participants in the intervention group demonstrated significantly greater anxiety reduction compared to the control group ( p < 0.001). Pain scores did not differ significantly between groups ( p = 0.37). Satisfaction was uniformly high in both groups. Thematic analysis of open‐ended responses from the intervention group identified themes related to anxiety reduction, distraction, and perceptions of VR use during the breast biopsy procedure.
ABSTRACT Background Place of death is a key indicator of quality in end‐of‐life care, reflecting how well care aligns with patients' values and preferences. Advance care planning (ACP) has been proposed to support goal‐concordant care, yet evidence regarding its association with actual place of death remains inconsistent. Objective To examine the association between participation in ACP and place of death and to explore whether this association varies according to ACP implementation method. Methods In this systematic review and meta‐analysis, we searched five databases (PubMed, Embase, PsycInfo, CINAHL, and ProQuest) for studies published in English from inception to September 2025. Studies of adults engaged in ACP and reporting actual place of death were included. Random‐effects meta‐analyses were conducted, with subgroup analyses by documentation‐based or discussion‐based ACP implementation methods. Risk of bias and certainty were assessed using RoB 2, ROBINS‐I V2, and GRADE. Results Of 4216 records, 13 studies were included. ACP was associated with increased home death and reduced hospital death, with considerable heterogeneity. For home death, discussion‐based implementation showed a significant association, whereas documentation‐based implementation did not. For hospital death, both implementation methods were associated with reduced odds. Linking Evidence to Action ACP is associated with place of death, but its impact appears to depend on how it is implemented. These findings suggest that ACP should be approached as a communication‐centered process rather than solely as documentation. Clinicians should prioritize facilitated discussions that clarify patient values and preferences, and integrate them into care planning. Future implementation efforts should focus on strengthening communication processes and care coordination to support goal‐concordant end‐of‐life care, particularly in enabling home‐based death. Protocol Registration PROSPERO (CRD420251236312).
ABSTRACT Objective To synthesize evidence on the effectiveness of hospital sensor‐based fall prevention systems and examine whether technology type, patient risk, and implementation strategy modify their impact. Methods We searched MEDLINE, Embase, CINAHL, CENTRAL, Web of Science, and trial registries through April 30, 2025. Interventional studies evaluating hospital sensor‐based fall prevention systems were eligible, including randomized controlled trials and quasi‐experimental designs. Two reviewers independently extracted data and assessed risk of bias using the Cochrane Risk of Bias tools. Random‐effects meta‐analyses applied the Paule–Mandel estimator with Hartung–Knapp–Sidik–Jonkman adjustment. Incidence rate ratios (IRR) were pooled for fall rates and fall‐related injuries, and odds ratios (OR) for patients with at least one fall. Subgroup analyses examined technology generation and risk profile, with restricted analyses for mandated implementation. Certainty of evidence was rated with the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Results Sixteen studies were included, seven in meta‐analysis. No significant impact was found for fall rates (IRR 0.77, 95% CI 0.38–1.58; I 2 = 92%), fallers (OR 1.24, 95% CI 0.76–2.02; I 2 = 73%), or fall‐related injuries (IRR 0.98, 95% CI 0.81–1.18; I 2 = 0%). Machine learning–based systems reduced fall rates (IRR 0.50, 95% CI 0.32–0.79), while rule‐based systems did not. Mandatory implementation was associated with lower fall rates (IRR 0.51, 95% CI 0.37–0.70) but not fewer fallers. Certainty of evidence ranged from very low to low. Conclusion Sensor‐based systems showed no consistent benefit for preventing hospital falls or injuries, though machine learning and mandated use appeared more promising. Given the limited number of trials, heterogeneity, and low certainty, further research should focus on rigorous evaluation, workflow integration, and cost‐effectiveness. Register This review was registered with PROSPERO (CRD420251123960; registered on 11 August 2025). Clinical trial number: not applicable.
