Journal Of Advanced Nursing[JOURNAL]
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200 papers
Depression Beyond the 6-Month Postpartum Period: A Mixed-Method Study Among Women in Nepal.
Pudasainee-Kapri S, Shrestha T, Wunnenberg M … +5 more , Kapri K, Pandey A, Chapagai M, Chapagain RH, Gupta P
J Adv Nurs · 2026 Apr · PMID 41949274 · Publisher ↗
AIM: This study aimed to comprehensively examine social and clinical factors contributing to postpartum depression among women in Nepal and identify their perspectives/experiences regarding postpartum mental health. DESI...
AIM: This study aimed to comprehensively examine social and clinical factors contributing to postpartum depression among women in Nepal and identify their perspectives/experiences regarding postpartum mental health. DESIGN AND METHODS: The explanatory sequential mixed-method study was conducted in two phases. In the quantitative phase, data were collected via survey of 200 postpartum women at immunisation clinics of two hospitals in Kathmandu Nepal. Measures included sociodemographic and perinatal factors and the Edinburgh Postpartum Depression Scale. Regression models were conducted to analyse data. In the qualitative phase, in-depth interviews were conducted with 15 participants having depression scores ≥ 10. Data were analysed using the thematic content analysis method. Qualitative and quantitative findings were integrated using the joint display and the narrative weaving approach to generate results. RESULTS: Findings show that 28% of postpartum women screened positive for depressive symptoms, requiring referral for further evaluation. Integrated findings indicate that prenatal mental health problems, low birth weight or medical conditions among infants, intimate partner violence, partner substance abuse, and a lack of postpartum social support were major contributors to postpartum depression. CONCLUSION: Depression is highly prevalent among women 6-12 months postpartum in Nepal and is associated with several clinical and social factors. IMPLICATIONS: These findings have important implications, emphasising the need for routine screening using validated tools for early identification, timely treatment and referral of women at-risk for postpartum depression. Evidence-based clinical and community initiatives are needed to promote positive outcomes for women and their families. PATIENT OR PUBLIC CONTRIBUTION: External experts were consulted for survey questions and qualitative interview guide, then refined those instruments based on their feedback to improve construct validity. The immunisation clinic staff provided input during study design, for participant recruitment and data collection. Key findings were presented to stakeholders to validate the interpretation of findings.
Exploring Nurses' Practices in Supporting Sexual Wellbeing of People Living With Inflammatory Bowel Disease: An International Qualitative Study.
Wakai S, Fourie S, Kawakami A … +2 more , Nozawa M, Tanaka M
J Adv Nurs · 2026 Apr · PMID 41949267 · Publisher ↗
AIM: To explore how nurses across international settings support the sexual wellbeing of people living with inflammatory bowel disease through their clinical practice. DESIGN: Qualitative descriptive study. METHODS: Onli...
AIM: To explore how nurses across international settings support the sexual wellbeing of people living with inflammatory bowel disease through their clinical practice. DESIGN: Qualitative descriptive study. METHODS: Online semi-structured interviews and one focus group were conducted with nurses from Australia, Canada, Japan, the Republic of Ireland and the United Kingdom. The interviews were conducted in Japanese (for Japanese participants) and English (for the rest). A total of 28 nurses with extensive experience caring for people living with inflammatory bowel disease were recruited between May 2023 and December 2024 through snowball sampling. Data were analysed using thematic analysis. RESULTS: The overarching theme identified was 'careful exploration in real life practice' with the following primary themes: (1) building the foundation for sexual wellbeing care, (2) addressing sexual wellbeing issues as a team, (3) identifying sexual wellbeing needs and (4) providing personalised nursing support. These themes highlighted the lack of sexual wellbeing care education in nursing, leading to unpreparedness and low confidence among nurses who nonetheless strived to support people living with inflammatory bowel disease despite limited training and communication barriers. CONCLUSION: Nurses supported the sexual wellbeing of people living with inflammatory bowel disease by building trust and working collaboratively. They offered individualised care based on each patient's life context, fostering open communication. Despite cultural taboos surrounding sex, similar challenges and training needs were reported across target regions. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: This study highlights the importance of addressing sexual wellbeing as a key component of holistic care for people living with inflammatory bowel disease. To achieve this, sexual wellbeing should be treated as a routine and important aspect of everyday nursing practice. Furthermore, nurses need to be empowered to play an active role in supporting sexual wellbeing and work in environments that facilitate open and respectful discussions. IMPACT: This study addresses the long-neglected issue of sexual wellbeing in inflammatory bowel disease care, which has rarely been explored in nursing research. Drawing on qualitative data from multiple countries, primarily Japan, it offers a new international perspective by illustrating how nurses engage with and support sexual wellbeing. The findings have implications for clinical practice, nurse education and global research on holistic chronic illness care. REPORTING METHOD: The Consolidated Criteria for Reporting Qualitative Research checklist was followed. PATIENT OR PUBLIC CONTRIBUTION: This study did not include patient or public involvement in its design, conduct or reporting.
What Does Psychological Wellbeing at Work Mean to Healthcare Professionals' and for Patients' Experiences of Care?
Bamforth K, Lloyd H, Kent B … +2 more , Maben J, Pearce S
J Adv Nurs · 2026 Apr · PMID 41947456 · Publisher ↗
AIM: To explore perceptions of healthcare professionals' psychological wellbeing at work and patients' experiences of care. DESIGN: Narrative interviews were undertaken as part of a wider experience-based co-design study...
AIM: To explore perceptions of healthcare professionals' psychological wellbeing at work and patients' experiences of care. DESIGN: Narrative interviews were undertaken as part of a wider experience-based co-design study. METHODS: Interviews were undertaken March to December 2022 with 19 participants (healthcare professionals n = 13 and patients n = 6) from a community hospital and analysed for emotional touchpoints using reflexive thematic analysis. RESULTS: Ten themes were synthesised into five categories: (1) What is psychological wellbeing at work? (2) Barriers to psychological wellbeing at work ('Misaligned NHS Culture' and 'Pressurised System'); (3) How negative psychological wellbeing at work impacts on staff and patients' experiences of care ('Staff Struggle to Survive' and 'Patients Suffer'); (4) Enablers of psychological wellbeing at work ('Nurturing Culture' and 'Teamwork'); and (5) How positive psychological wellbeing at work impacts staff and patients' experiences of care ('Staff Thrive' and 'Patients Benefit'). CONCLUSION: Poor psychological wellbeing negatively impacted healthcare professionals' health and their ability to provide care. In response, patients deliberately withheld requests for help, risking their recovery. Conversely, when psychological wellbeing was supported, staff provided more relational care with improved patient experience. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: A nurturing culture and teamwork are positive enablers of staff psychological wellbeing and can be used to improve staff and patients' experience. IMPACT: This is one of the first studies to demonstrate that patients modify their behaviour in response to perceptions of staff wellbeing, with implications for their recovery. REPORTING METHOD: COREQ. PATIENT OR PUBLIC CONTRIBUTION: Members of the public advised on the patient-facing materials and the overarching study design.
From Microfiche to Meta-Analysis: How Literature Reviewing Changed.
Aveyard H
J Adv Nurs · 2026 Jul · PMID 41940648 · Full text
Abstract loading — click title to view on PubMed.
Redefining Nursing Leadership: A Multilevel Competency Framework for Future Healthcare Challenges.
Fontanals-Jimenez A, Trapero-Bertran M, Gea-Sánchez M … +1 more , Insa-Calderón E
J Adv Nurs · 2026 Apr · PMID 41937440 · Publisher ↗
AIM: To examine the conceptual ambiguity of nursing leadership, particularly in relation to management roles, and to propose a multilevel competency framework that redefines leadership as a core dimension of nursing prac...
AIM: To examine the conceptual ambiguity of nursing leadership, particularly in relation to management roles, and to propose a multilevel competency framework that redefines leadership as a core dimension of nursing practice. The paper introduces an innovative hybrid Iceberg-Alles model that integrates observable competencies with deeper motivational, ethical and personality-based attributes. DESIGN: Integrative review. METHODS: Two-stage evidence identification process informed by theoretical reflection and existing evidence on nursing leadership and management. DATA SOURCES: A literature search was conducted in targeted databases such as PubMed, Scopus, Web of Science, CINAHL and extended to Google Scholar and grey literature. IMPLICATIONS FOR NURSING: Current understandings of nursing leadership are fragmented and often limited to managerial skills, overlooking crucial aspects such as ethical commitment, personal values, interpersonal skills and relational capacities. The hybrid Iceberg-Alles model reconceptualizes leadership as a multidimensional construct that balances visible skills with underlying drivers such as motivation, self-awareness and value alignment, offering a more comprehensive basis for leadership development. CONCLUSIONS: Nursing leadership should be understood as a relational and value-based process embedded across all levels of practice, not confined to formal administrative positions. The proposed model enhances conceptual clarity and provides a transferable framework that can be adapted across diverse health systems, roles and organisational structures. IMPACT: Broadening the scope of nursing leadership can reduce role ambiguity, highlight the unique contribution of nurses to healthcare systems, and strengthen the profession's influence in policy and decision-making. The hybrid model provides concrete guidance for educational programmes, competency-based curricula and organisational strategies aimed at preparing future nurse leaders to manage complexity, promote collaboration and improve patient care. REPORTING METHOD: This manuscript followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines (PRISMA-ScR). PATIENT OR PUBLIC CONTRIBUTION: This study did not include patient or public involvement in its design, conduct or reporting.
Relatives' Experiences of Circulatory Death Following Out-of-Hospital Cardiac Arrest and Their Hypothetical Perspectives on Organ Donation: A Qualitative Study.
Vogel G, Hildebrand K, Ringh M … +1 more , Joelsson-Alm E
J Adv Nurs · 2026 Apr · PMID 41937429 · Publisher ↗
AIMS: To explore relatives' experiences of the circulatory death of a family member following out-of-hospital cardiac arrest and to explore their hypothetical perspectives on being asked to decide about organ donation in...
AIMS: To explore relatives' experiences of the circulatory death of a family member following out-of-hospital cardiac arrest and to explore their hypothetical perspectives on being asked to decide about organ donation in this situation. This study forms part of a broader initiative undertaken to assess the prerequisites for implementing uncontrolled donation after circulatory death in Sweden with a focus on ethical issues. DESIGN: A qualitative design, using semi-structured interviews with open-ended questions. METHODS: Data were collected in Sweden between March 2024 and September 2024 and analysed using reflexive thematic analysis with an inductive, descriptive approach. Included were 13 bereaved relatives, four men and nine women. FINDINGS: The analysis generated three themes: 'Fluctuating between hope and despair', which describes relatives' experiences of their family member's sudden cardiac arrest; 'Exposed to vulnerability', concerning their experiences of death and their perspectives on reasoning about the deceased person's wishes regarding donation; and 'Balancing a major life change', which involves experiences of facilitators and barriers to dealing with the loss. CONCLUSIONS: Awareness of the deceased family member's wishes regarding organ donation facilitates relatives' ability to support the deceased's known or presumed wishes. Compassionate and communicatively competent healthcare professionals influence relatives' capacity to reason about the deceased's wishes and cope with their experience of loss. Ensuring sufficient time for goodbyes and providing follow-up may facilitate emotional processing and should be considered when implementing uncontrolled donation after circulatory death. IMPLICATION FOR THE PROFESSION: Policies and clinical practice should ensure that relatives are adequately informed and supported in reasoning on their family members' wishes regarding organ donation. To achieve this, nurses and other healthcare professionals require training in compassionate and empathetic communication strategies. Such training is essential both for guiding relatives through reasoning about their family preferences and for providing emotional support during the grieving process. IMPACT: What is already known? ○ Organ donation after sudden death in out-of-hospital cardiac arrest is a complex process that raises ethical issues concerning both the timing and the content of conversation with the deceased's relatives, as well as the relatives' capacity to reason about the deceased's wishes in the context of sudden death. ○ Knowing the wishes of the deceased person, personal beliefs, and receiving clear, direct, and honest information from nurses and other healthcare professionals prepares relatives to reason about the deceased's known or presumed wishes regarding organ donation. What were the main findings? ○ The quality of nurses' and healthcare professionals' communicative competence and their behaviours influence relatives' ability to reason and reflect on organ donation. ○ Factors that facilitate family members' experiences of donation following out-of-hospital cardiac arrest and death include awareness of the deceased's wishes regarding organ donation, being able to see with their own eyes that their family member is dead, and having sufficient time to say farewell. ○ Follow-up from health care services could have an impact on relatives' experiences and their processing of loss. Where and on whom will the research have an impact? ○ This research has an impact on organ donation services, pre-hospital emergency care, and emergency department operations. It can assist nurses and physicians in planning ethical and family-centred care in cases of out-of-hospital sudden death and uncontrolled donation after circulatory death. REPORTING METHOD: COREQ-checklist. PATIENT OR PUBLIC CONTRIBUTIONS: No patient or public involvement in design, conduct or reporting.
Experiences of LGBTQ+ Healthcare Providers in Workplaces in Taiwan: A Cross-Sectional Survey.
Wang YC, Miao NF, Du SC … +5 more , You MH, Wang FTY, Hsu CY, Lee PH, Tran NM
J Adv Nurs · 2026 Apr · PMID 41928402 · Publisher ↗
AIMS: To examine workplace experiences, perspectives on coming out at work, organisational climate and mental health status of lesbian, gay, bisexual, transgender, queer/questioning and other sexual, and gender minority...
AIMS: To examine workplace experiences, perspectives on coming out at work, organisational climate and mental health status of lesbian, gay, bisexual, transgender, queer/questioning and other sexual, and gender minority healthcare providers (LGBTQ+ HCPs) within an East Asian cultural context. DESIGN: Observational, cross-sectional study. METHODS: An online cross-sectional survey was conducted among 173 Taiwanese LGBTQ+ HCPs between May and August 2024. RESULTS: Most of the 173 respondents did not disclose their LGBTQ+ identities to any colleagues, and approximately two-fifths met the clinically significant threshold for depressive symptoms. Furthermore, compared to LGBTQ+ HCPs who disclosed to all, most, about half or a few colleagues, those who had not disclosed to any colleagues reported higher levels of depressive symptoms, lower self-esteem, less comfort with disclosure, greater perceived necessity to conceal their LGBTQ+ identities, lower scores for job stability or security, poorer interpersonal relations and lower agreement that an LGBTQ+-inclusive workplace climate would influence their willingness to remain in their current jobs. Although approximately 80% of the LGBTQ+ HCPs reported that they were familiar with national workplace antidiscrimination laws and that their organisations had grievance mechanisms, nearly two-fifths did not trust the grievance systems or procedures within their organisations. CONCLUSION: Results emphasise the urgent need to create an LGBTQ+-inclusive workplace environment with clear and enforceable antidiscrimination policies and inclusive organisational practices to improve both disclosure safety and mental health outcomes for LGBTQ+ HCPs. IMPACT: The study results extend existing knowledge by identifying the relationship between different levels of disclosure and mental health status among LGBTQ+ HCPs. They also highlight the importance of establishing support groups, a comprehensive mental health referral system and enforcement mechanisms that safeguard legal rights without compromising the privacy or safety of LGBTQ+ HCPs. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.
Discovering the Self: A Grounded Theory of Women's Recovery From Gender-Based Religious Harm.
Schwartz BK, Cone PH
J Adv Nurs · 2026 Apr · PMID 41919678 · Publisher ↗
AIM(S): This study defines adverse religious experiences (AREs), describes how these gendered harms affect women and develops a Classical Grounded Theory (CGT) model of women's recovery and inform trauma- and gender-resp...
AIM(S): This study defines adverse religious experiences (AREs), describes how these gendered harms affect women and develops a Classical Grounded Theory (CGT) model of women's recovery and inform trauma- and gender-responsive nursing practice. DESIGN: Using the CGT design, the study explores women's lived experiences with AREs, focusing on their primary concern and the strategies they used to address it. METHODS: Fifteen North American women participated in open-ended, semi-structured interviews conducted between May and June 2023. Data collection and analysis occurred concurrently by using constant comparison. Theoretical saturation was reached by approximately 12 interviews and was confirmed through three additional interviews. Theoretical coding was guided by Glaser's Six Cs. RESULTS: The central issue was Loss of Self, with limited agency, embodiment and autonomy due to internalised religious control. This study conceptualises AREs as a gendered determinant of health and introduces a nursing-generated explanatory model of women's recovery from religious harm. The Basic Social Process, Discovering Self, includes six cyclical phases: Living with Toxicity, Loss of Self, Recognizing Woundedness, Leaving Negativity, Seeking Restoration and Awakening to Wholeness. Analytic integration with the Six Cs showed that doctrinal rigidity, gendered hierarchies, conditional belonging, turning points and psychological, spiritual and relational consequences shaped individual recovery paths. Recovery proved a nonlinear, whole-person process spanning spiritual, physical, sexual and relational domains. CONCLUSION: Discovering Self offers the first explanatory model of women's recovery from religious harm, identifying mechanisms of oppression and pathways for reclaiming agency, embodiment and voice. IMPACT: This study provides a roadmap for trauma- and gender-responsive nursing care, education and policy. The findings align with global priorities in health and gender equality. REPORTING METHOD: This study followed the SRQR guidelines and used CGT methodology. PATIENT OR PUBLIC CONTRIBUTION: Patients or the public were not involved in the study.
"We're All in This Together": A Mixed-Methods Study of Provider and Patient Perceptions of Emergency Care for Opioid Use Disorder.
McFarland A, Chan L, Lalwani P … +4 more , Chapman BP, Davis-Martin R, Kapadia N, Carreiro S
J Adv Nurs · 2026 Apr · PMID 41919671 · Full text
AIMS: To compare attitudes and perceptions towards opioid use disorder among people with opioid use disorder and emergency providers, describe interactions between the two groups, and identify barriers to providing and r...
AIMS: To compare attitudes and perceptions towards opioid use disorder among people with opioid use disorder and emergency providers, describe interactions between the two groups, and identify barriers to providing and receiving care. DESIGN: Mixed methods observational study. METHODS: Participants were recruited from an academic, tertiary care hospital and a community-based harm reduction agency in New England. Emergency healthcare providers (nurses, physicians, and paramedics) and adult people with opioid use disorder were enrolled. Electronic surveys were administered to providers, and semi-structured interviews were conducted with people with opioid use disorder and a subset of providers. Descriptive statistics were calculated for surveys, and directed content analysis was used to analyse semi-structured interviews. RESULTS: Sixty-eight providers completed the survey, 11 of whom also completed a semi-structured interview. Twenty-two people with opioid use disorder completed the semi-structured interview. Both providers and people with opioid use disorder agreed that addiction is a disease; however, opinions differed on the extent to which personal choice played a role in the onset of opioid use disorder. Participants described how factors such as experiencing homelessness, alongside other personal or familial challenges, contributed to ongoing substance use and presented barriers to accessing healthcare. There was discordance in priorities between providers and people with opioid use disorder, which often drove conflict and perceived stigma. Both groups described physical and emotional trauma from prior interactions, which shaped expectations of future interactions and biases towards each other. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Educational initiatives should arm providers not only with clinical knowledge about opioid use disorder but with skills to recognize implicit biases, navigate unique barriers related to social determinants of health, and effectively deploy shared decision-making techniques. Healthcare organizations should provide support for trauma that emergency care providers are exposed to in caring for people with opioid use disorder. REPORTING METHOD: Consolidated criteria for reporting qualitative studies (COREQ)-32 item checklist. PATIENT OR PUBLIC CONTRIBUTION: This study did not include patient or public involvement in its design, conduct, or reporting.
Ka Muri, Ka Mua Indigenous Nursing: How the Past Can Inform Moving Into the Future.
Wilson D
J Adv Nurs · 2026 Jul · PMID 41906459 · Publisher ↗
This reflection examines the past 50 years of Indigenous nursing, highlighting both progress and persistent inequities. Fifty years ago, Indigenous nurses were largely invisible within the profession, their voices margin...
This reflection examines the past 50 years of Indigenous nursing, highlighting both progress and persistent inequities. Fifty years ago, Indigenous nurses were largely invisible within the profession, their voices marginalised and their cultural backgrounds undervalued. Although numbers have grown, Indigenous nurses, particularly Māori in Aotearoa New Zealand, remain significantly underrepresented in the workforce relative to population need. Enduring structural and systemic barriers continue to impede recruitment, retention and the integration of Indigenous worldviews into nursing curricula and practice. This commentary refers to historical and contemporary contexts that shaped this landscape, including colonisation, racism and the suppression of Indigenous knowledge. It acknowledges significant milestones such as Dr. Irihapeti Ramsden's leadership in establishing Kawa Whakaruruhau and Cultural Safety, while also noting the political backlash that diluted its original focus on Māori health inequities. Indigenous nurses, past and present, bring culturally grounded, relational and holistic approaches to care, bridging the clinical and cultural worlds and building trust with Indigenous communities. Their growing scholarly contributions and international collaborations-such as the Indigenous Global Research Alliance in Nursing-are advancing Indigenous methodologies and evidence. While gains have been made, the future requires culturally responsive pipelines and collective commitment to addressing inequity, racism and structural injustice in nursing.
Occupational Well-Being of Nurse and Social Care Educators in the Era of Hybrid Work-A Cross-Sectional Study.
Vauhkonen A, Saaranen T, Bhurtun H … +1 more , Kähkönen O
J Adv Nurs · 2026 Mar · PMID 41906455 · Publisher ↗
AIMS: To explain the relationship between occupational well-being dimensions and overall occupational well-being among nurse and social care educators, with particular focus on hybrid work status. DESIGN: A cross-section...
AIMS: To explain the relationship between occupational well-being dimensions and overall occupational well-being among nurse and social care educators, with particular focus on hybrid work status. DESIGN: A cross-sectional survey study. METHODS: The quantitative data were collected from Finnish nurse and social care educators (n = 367) in autumn 2023 and analysed using multiple regression with interaction analysis. RESULTS: Overall personal occupational well-being was rated higher than work community occupational well-being, especially among hybrid-working educators. In models including all occupational well-being dimensions (working conditions, work community, worker's resources and work, and professional competence), only work community and worker's resources and work remained statistically significant positive relationships with occupational well-being. Hybrid work status moderated these relationships: the relationship between work community and occupational well-being was stronger among on-site educators, and professional competence was associated with work community occupational well-being only among them. CONCLUSION: Voluntary hybrid work may support personal occupational well-being among nurse and social care educators, yet the enduring importance of work community-particularly for on-site educators-highlights the need to sustain work community resources across all work modalities. IMPLICATIONS FOR THE PROFESSION: Occupational well-being strategies in educational institutions could benefit from reflecting diverse work arrangements. For hybrid models, emphasis might be placed on combining flexible work options with support for self-leadership and virtual community-building to ensure equitable well-being across modalities. Strengthening team-based collaboration can help maintain connection, competence, and resilience regardless of work setting. IMPACT: This study provides evidence on the factors supporting occupational well-being among nurse and social care educators depending on the hybrid work status. Work community and individual resources are key predictors, with implications for tailoring support strategies in institutions adapting to hybrid work models. REPORTING METHOD: The Strengthening the Reporting of Observational Studies in Epidemiology STROBE guidelines. PATIENT OR PUBLIC CONTRIBUTION: No Patient or Public Involvement.
Public Health Nurses' Experiences of Child Maltreatment Preventive Work in Primary Healthcare: A Qualitative Metasynthesis.
Hansen S, Svendsen SJ, Hulgaard-Bruvold SZ … +1 more , Rasalingam A
J Adv Nurs · 2026 Mar · PMID 41906452 · Publisher ↗
AIM: To explore public health nurses' experiences of child maltreatment preventive work in primary healthcare. DESIGN: The metasynthesis approach was based on the guidelines by Sandelowski and Barroso for synthesising qu...
AIM: To explore public health nurses' experiences of child maltreatment preventive work in primary healthcare. DESIGN: The metasynthesis approach was based on the guidelines by Sandelowski and Barroso for synthesising qualitative research. METHODS: The quality of the included studies was appraised using Joanna Briggs Institute Checklist for Qualitative Research. The analysis followed Braun and Clarke's reflexive thematic analysis. DATA SOURCES: Searches were conducted in five electronic databases: Cinahl, Medline, PsychINFO, Web of Science and SocINDEX in May and July 2024, and updated in April and December 2025. RESULTS: Thirteen qualitative studies were included, and five themes were developed: Insufficient knowledge about when and how to act, building a therapeutic relationship with parents, keeping the child's best interest in focus, in need of better interdisciplinary support and ambivalence in addressing child maltreatment. CONCLUSION: Public health nurses face challenges in child maltreatment preventive work, including insufficient knowledge and limited interdisciplinary support. Even so, public health nurses demonstrate a strong commitment to children's safety and well-being and to building relations with families. IMPLICATIONS FOR THE PROFESSION: The findings suggest an increased focus on strengthening public health nurses' knowledge of child maltreatment and improved interdisciplinary collaboration. IMPACT: The findings are of interest to healthcare professionals and health authorities to improve child maltreatment preventive work in primary healthcare. REPORTING METHOD: This review adhered to relevant EQUATOR guidelines. PATIENT OR PUBLIC CONTRIBUTION: This study did not include patient or public involvement in its design, conduct or reporting. TRIAL AND PROTOCOL REGISTRATION: PROSPERO registration number: CRD42025637855.
Integrating Care for Aging Populations: Dual-Framework Policy Analysis of the United States Program of All-Inclusive Care for the Elderly (PACE).
Kyei EF, Mumba M
J Adv Nurs · 2026 Mar · PMID 41906429 · Publisher ↗
AIM: To critically analyse the federal Program of All-Inclusive Care for the Elderly (PACE) using the Integration Continuum Framework and the Conceptual Model for Nursing and Health Policy, identifying system-level stren...
AIM: To critically analyse the federal Program of All-Inclusive Care for the Elderly (PACE) using the Integration Continuum Framework and the Conceptual Model for Nursing and Health Policy, identifying system-level strengths, equity gaps and nursing implications for long-term care reform. BACKGROUND: The U.S. long-term care system remains fragmented and institutionally biased, disproportionately affecting dual-eligible older adults who account for outsized healthcare expenditures despite comprising just 17% of Medicare beneficiaries. Permanently authorised under the Balanced Budget Act of 1997, PACE delivers fully integrated, community-based care for individuals aged 55 and older who qualify for nursing home-level services but prefer to remain in their communities. DESIGN: A policy analysis guided by dual conceptual frameworks assessing PACE structure, implementation and impact across four policy outcome levels: efficacy, effectiveness, equity and justice. METHODS: This policy analysis was conducted between May and July 2025. Two conceptual frameworks were applied to examine PACE structure, implementation and outcomes. Data sources included peer-reviewed studies, federal legislation, policy documents and grey literature published between 2020 and 2025, supplemented by international integrated care literature. FINDINGS: PACE demonstrates strong efficacy and effectiveness, with fully integrated interdisciplinary teams and reduced institutionalisation for enrolled older adults. However, the program falls short on equity and justice due to limited geographic reach, racial and ethnic disparities in enrollment, exclusion of Medicare-only populations and persistent nursing workforce challenges. CONCLUSION: PACE exemplifies a high-functioning integrated model of community-based long-term care, but current policy constraints prevent it from achieving scale and equity. Without eligibility expansion, financing reform and workforce investment, its transformative potential will remain unrealised. Nurses are central to this vision and must be empowered as clinical leaders and policy advocates to sustain care coordination and advance health equity in aging populations.
Which Aspects of Abortion Care Do Healthcare Practitioners in Britain Think Nurses/Midwives Should Provide? Findings From the SACHA Study.
Fulton A, McCarthy O, Shawe J … +9 more , Meiksin R, Lewandowska M, Palmer M, Scott R, Wellings K, Lohr P, Wong G, Sheldon S, Rebecca French and The SACHA Study Team
J Adv Nurs · 2026 Mar · PMID 41906412 · Publisher ↗
AIM: To explore the views of healthcare practitioners in Britain regarding the role of midwives and nurses in the delivery of medical and surgical abortion. DESIGN: An observational study of the Shaping Abortion for Chan...
AIM: To explore the views of healthcare practitioners in Britain regarding the role of midwives and nurses in the delivery of medical and surgical abortion. DESIGN: An observational study of the Shaping Abortion for Change study healthcare practitioner survey (2021-2022). METHODS: Relationships between healthcare practitioner type, participant characteristics, knowledge of and attitudes towards abortion, and views about nurses' and midwives' role in abortion care were examined using Pearson's Chi-squared tests of association and multivariable logistic regression. RESULTS: Amongst 763 participants including doctors, nurses, midwives and pharmacists, 71.6% supported specialist nurses in sexual and reproductive health and abortion clinics and hospitals, expanding their roles to include prescribing abortion medications and surgical abortion methods. Support was lower for midwives (35.8%) and primary care nurses (32.5%). There was considerable support for all nursing and midwifery groups to be involved in adjacent tasks of abortion care. Differences in support by healthcare practitioner type persisted after adjustment for exposure variables. CONCLUSION: There is strong support for specialist nurses to expand their role in abortion care. This change could be implemented following clarification of the legal position. Some healthcare practitioner groups are more reluctant to support broader involvement of nurses and midwives in abortion provision. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Expanding specialist nurses' role in abortion care could increase service capacity and improve patient access and experience. Understanding and addressing the concerns of healthcare practitioners opposing this change is critical for successful implementation and patient safety. IMPACT: This study addresses the potential for nurse and midwife role expansion in abortion care. The findings highlight broad support for specialist nurses whilst identifying barriers to wider role expansion. The research informs policy discussions on workforce optimisation and access to abortion services across Britain. REPORTING METHOD: This study adheres to the STROBE guidelines for reporting observational studies. PATIENT OR PUBLIC INVOLVEMENT: In the SACHA study, patient and public involvement was included at all stages to inform study design, recruitment, data collection and analysis.
Social Isolation and Loneliness Among Older Asian Immigrants Through the Lens of Sense of Coherence: Systematic Review of Qualitative Studies.
Maneze D, Smith BW, Aldahmashi H … +5 more , Chan A, Ramjan L, Montayre J, Alex J, Salamonson Y
J Adv Nurs · 2026 Mar · PMID 41891501 · Publisher ↗
AIM: To explore the meaning older Asian immigrants attribute to social isolation and loneliness, their management strategies, utilisation of resources and impact on health. DESIGN: Systematic review of qualitative studie...
AIM: To explore the meaning older Asian immigrants attribute to social isolation and loneliness, their management strategies, utilisation of resources and impact on health. DESIGN: Systematic review of qualitative studies. DATA SOURCES: AgeLine, CINAHL, MEDLINE, ProQuest, PsycINFO, Scopus, and Web of Science databases were searched in September 2024. METHODS: Inclusion criteria: participants were Asian immigrants to Western countries aged 65 and over, community-living and experiencing social isolation and loneliness. Antonovsky's Sense of Coherence was used to frame the thematic analysis. RESULTS: Ten papers were included and analysed deductively using elements of the sense of coherence framework: • Comprehensibility: Social isolation and loneliness are viewed as multifaceted, influenced by cultural and environmental dislocation, language barriers, intergenerational conflicts, deteriorating health and mobility, and socioeconomic challenges. • Manageability: included engaging in culture-specific community programs, family and ethnic community support and living within ethnic enclaves mitigated isolation and loneliness. • Meaningfulness: Strong family ties, active community involvement, spirituality, volunteerism, and cultural practices fostered resilience. However, accepting the changing values of their new world, living independently, and carving their own niche provided meaning to their transformed reality. CONCLUSION: Older Asian immigrants experience social isolation and loneliness through a cultural lens, shaped by migration experiences, language barriers, and shifting family dynamics. Cultural roots, family ties, spirituality, community, acceptance, and independence enhance sense of coherence. Recognising the dynamic interplay between cultural identity, resilience, and adaptation is key to understanding their lived experience. IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE: This review informs culturally sensitive interventions, guiding healthcare, community services, and policy to support social participation, mitigate loneliness through ethno-specific activities, and improve the quality of life for aging immigrant populations in Western countries. REPORTING METHOD: The review was undertaken and reported using the PRISMA guidelines. PATIENT OR PUBLIC INVOLVEMENT: None. PROTOCOL REGISTRATION: PROSPERO (CRD42023425752).
Public Attitudes Towards Expanding the Role of Advanced Practice Nurses in Germany: A Cross-Sectional Survey Study.
Jäckle S, Valenta S
J Adv Nurs · 2026 Mar · PMID 41885582 · Publisher ↗
AIM: To assess public support and predictors of favourable or unfavourable views towards expanding Advanced Practice Nurse (APN) roles in Germany. DESIGN: A quantitative, cross-sectional survey using Germany as a nationa...
AIM: To assess public support and predictors of favourable or unfavourable views towards expanding Advanced Practice Nurse (APN) roles in Germany. DESIGN: A quantitative, cross-sectional survey using Germany as a national case study. METHODS: Data came from the Politikpanel Deutschland, an online survey conducted 15-28 July 2024. After exclusions, 6733 respondents were included. Data were weighted by age, gender, federal state, and voting intention. Descriptive statistics, subgroup comparisons, and multinomial logistic regression were applied to analyse attitudes towards APNs, with results reported as average marginal effects and predicted probabilities. RESULTS: Overall, 52.8% of respondents supported expanding APN roles, 25% opposed, and the remainder were undecided. Support was stronger among younger, male, and highly educated respondents, and those open to digital health technologies. Support was lower in East Germany and the city-states Berlin and Bremen, while it was higher in the south-west and north. Political ideology strongly predicted attitudes: supporters of right-wing parties were more likely to oppose, whereas left-leaning voters were more supportive. CONCLUSIONS: Public support for expanding APN roles in Germany is moderate but uneven across demographic, regional, and political cohorts. Younger individuals and those favouring digital health technologies may drive future acceptance, while political resistance and regional disparities remain barriers. IMPACT: This first, large-scale survey of German public attitudes towards APNs suggests that policymakers should (i) link APN role expansion with digital health innovations, (ii) address regional differences through tailored communication, and (iii) ensure that patients, physicians, and healthcare professionals perceive APN integration as enhancing, not diminishing primary care quality. Strengthening legal and educational frameworks and fostering collaboration between physicians and nurses will not only be essential to integrate APNs into Germany's healthcare system and, thereby, mitigate physician shortages, but also to foster public acceptance of APNs. PATIENT OR PUBLIC CONTRIBUTION: None. REPORTING METHOD: CROSS-checklist.
Revisiting the Meaning of 'Value' in Value-Based Healthcare: A Concept Analysis.
Perron ME, Roux-Levy PH, Calleja S … +2 more , Poitras ME, Lambert SD
J Adv Nurs · 2026 Mar · PMID 41885568 · Publisher ↗
INTRODUCTION: Healthcare systems are undergoing major transformation driven by technological progress, growing patient involvement, workforce shortages, complex care needs, and rising costs. Against this backdrop, value-...
INTRODUCTION: Healthcare systems are undergoing major transformation driven by technological progress, growing patient involvement, workforce shortages, complex care needs, and rising costs. Against this backdrop, value-based healthcare has gained traction, yet the notion of 'value' remains ambiguously defined. AIM: To clarify the concept of 'value' in value-based healthcare. DESIGN: We conducted a concept analysis using Walker & Avant's eight-step method: (1) Select a concept; (2) Determine the aims; (3) Identify uses; (4) Define the concept's attributes; (5) Identify the model case(s); (6) Identify additional cases; (7) Identify antecedents and consequences; and (8) Define empirical referents. DATA SOURCES: Scoping review methods following the Joanna Briggs Institute (JBI) recommendations were used to introduce rigour in locating, screening, and extracting data. We used a deductive thematic analysis for data analysis. RESULTS: We selected the concept of value in value-based healthcare because it lacked conceptual clarity to support healthcare systems transformations. We propose that value arises when outcomes-to-costs ratios (empirical referents) are considered in processes (uses) addressing healthcare systems transformations, characterised by more informed and engaged patients and rising costs (antecedents). Model case included consideration for all components (health, non-health outcomes, and direct, indirect, social costs) of the ratio, whereas additional cases showed that consideration for most, not all, or none of these components led to partial or no value creation. Value is used from individual to collective dimensions and at clinical, organisational and system levels (attributes) to improve patient experience, care team well-being, health equity, and population health, and to reduce costs (consequences). CONCLUSION: A shared understanding of 'value' can guide its design, measurement, and implementation to support successful transformations toward value-based healthcare. IMPLICATIONS: Our conceptual proposition of 'value' within value-based healthcare establishes a framework for a common understanding of 'value' that enables the successful transformation of health systems toward value-based healthcare.
Wearable Electronic Monitoring of Vital Signs in Hospitalised Adults: A Nursing Focused Scoping Review of Clinical, Economic and Implementation Outcomes.
Shaw SM, Shaw SB, Janes G
J Adv Nurs · 2026 Mar · PMID 41884879 · Publisher ↗
AIM: To synthesise evidence on wearable devices for continuous vital signs monitoring in adult hospital inpatients, focusing on clinical effectiveness, nursing perspectives, workflow impact, patient experience and resour...
AIM: To synthesise evidence on wearable devices for continuous vital signs monitoring in adult hospital inpatients, focusing on clinical effectiveness, nursing perspectives, workflow impact, patient experience and resource implications. DESIGN: Scoping review. REVIEW METHODS: Joanna Briggs Institute methodology reported using PRISMA-ScR guidelines. DATA SOURCES: Six databases (CINAHL, MEDLINE, EMBASE, Scopus, Web of Science, Cochrane), Scite.ai, and hand searching for studies published between January 2015 and November 2025. Data were synthesised using reflexive thematic analysis. RESULTS: Sixty-seven studies from 19 countries were included. Four integrative themes were identified. (1) Enhancing clinical safety through continuous monitoring: wearable devices consistently enable earlier recognition of physiological deterioration; however, downstream outcomes such as length of stay and transfers to intensive care units were mixed and context dependent. (2) Transforming nursing practice and workflow integration highlighted improved situational awareness and potential efficiency gains, alongside challenges related to alarm overload, parallel documentation and implementation workload. (3) Patient experience of wearable monitoring: most patients reported reassurance and perceived safety, though experiences reflected a tension between monitoring as care and monitoring as surveillance; discomfort, anxiety, and privacy considerations were infrequently examined. (4) Economic and organisational consequences: potential system value was suggested through workforce efficiencies, but economic benefits were largely inferred, with infrastructure and training costs often underreported. CONCLUSION: Wearable continuous monitoring technologies show clear potential to support nursing observations enabling improved early detection of deterioration. Realising these benefits depends on effective integration into workflows, robust governance, and sustained nursing leadership rather than technological capability alone. Significant evidence gaps remain regarding long-term outcomes, economic evaluation, and large-scale implementation. IMPACT: Wearable devices for continuous vital signs monitoring have the potential to transform inpatient surveillance by enabling earlier recognition of physiological deterioration and enhancing nurses' situational awareness. This scoping review synthesises international evidence demonstrating that, although wearable monitoring can improve patient safety and workflow efficiency, its impact depends on effective integration into nursing practice, governance structures, and organisational preparedness. Continuous monitoring also introduces new challenges including alert fatigue, data interpretation, and workflow redesigns, highlighting the vital role of nursing leadership in digital health implementation. The review also identifies critical evidence gaps, particularly concerning long-term clinical outcomes, patient experience, and cost-effectiveness, providing priorities for future research and policy to promote safe, ethical, and sustainable adoption. PATIENT OR PUBLIC INVOLVEMENT: None.
Fifty Years of Nursing Knowledge: A Conversation Between Generations.
Jackson D, Aveyard H, Brooke J … +7 more , Cleary M, Noyes J, Smith GD, Sharps P, Watson A, Yan H, Yu D
J Adv Nurs · 2026 Jul · PMID 41882838 · Publisher ↗
Abstract loading — click title to view on PubMed.
Compassion in Practice: A Realist Review of Mentorship as a Catalyst for Healthy Workplaces.
Bird M, Desveaux L, Lagunju A … +3 more , Carlin K, Panesar B, Steele Gray C
J Adv Nurs · 2026 Mar · PMID 41879490 · Publisher ↗
AIM: To examine the contexts and mechanisms that enable compassionate mentorship in healthcare, in order to generate evidence-informed insights for fostering healthier, more sustainable work environments. DESIGN: A rapid...
AIM: To examine the contexts and mechanisms that enable compassionate mentorship in healthcare, in order to generate evidence-informed insights for fostering healthier, more sustainable work environments. DESIGN: A rapid realist review. DATA SOURCES: Systematic searches were conducted in Ovid MEDLINE (1946-December 2024), Embase (1974-December 2024) and CINAHL (1981-December 2024). Additional sources included Google Scholar searches, reference list scanning and grey literature (e.g., practice guidelines, policy briefs, professional reports). The review was conducted between August 2024 and July 2025. REVIEW METHODS: Realist review methods were applied to answer the question: What works, for whom, under what circumstances and why? The review proceeded in four stages: defining scope and research questions with an expert panel; iterative searching and screening; data extraction and synthesis into context-mechanism-outcome configurations (CMOCs); and development of a programme theory. RESULTS: Twenty-two documents were included, spanning nursing, medicine, allied health and interdisciplinary contexts. Six CMOCs were identified, encompassing the following themes: (1) relationship compatibility; (2) vulnerability and self-exploration; (3) growth through untapped strengths; (4) anti-oppression and equity; (5) mentors' pride and confidence; and (6) culture of mentorship. The resulting programme theory conceptualises compassionate mentorship as a dynamic, multi-level process with cumulative impacts on individual well-being, professional development and organisational culture. CONCLUSION: Compassionate mentorship represents not only a relational practice but also a structural intervention for healthier workplaces. Programmes should prioritise compatibility, cultivate psychological safety, invest in mentee growth, embed equity, recognise mentor contributions and institutionalise mentorship culture. IMPACT: These strategies offer actionable pathways to strengthen workforce resilience, retention and sustainability. PATIENT OR PUBLIC CONTRIBUTION: One co-author is a retired nurse, ethicist and person with lived experience in the healthcare system. This co-author was integral to this project, serving on the scientific steering committee from project conceptualisation and funding application through study conduct and publication.
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