Journal Of Advanced Nursing[JOURNAL]
Sun
200 papers
Strategies to Position the Clinical Academic Nurse in University, Teaching and General Hospitals.
Henderikx S, Heinen M, Vermeulen H … +1 more , Van Oostveen CJ
J Adv Nurs · 2026 May · PMID 41793239 · Full text
AIM: Explore the perspectives of Clinical Academic Nurses and stakeholders on strategies for positioning Clinical Academic Nurses in Dutch hospitals. DESIGN: A descriptive qualitative study. METHODS: Semi-structured inte...
AIM: Explore the perspectives of Clinical Academic Nurses and stakeholders on strategies for positioning Clinical Academic Nurses in Dutch hospitals. DESIGN: A descriptive qualitative study. METHODS: Semi-structured interviews and focus groups were conducted with Clinical Academic Nurses and stakeholders from five hospitals involved in the positioning of Clinical Academic Nurses. Data was analysed using thematic analysis to identify strategies for positioning these nurses. RESULTS: Four themes emerged: (1) 'Supportive vision and culture' is crucial for a shared vision and enables a culture for consistent support in the positioning, (2) A clear defined and strategic 'Position of Clinical Academic Nurses' is needed for uniform positioning, (3) 'Research infrastructure' describes the important supportive elements, and (4) 'Leadership' describes Clinical Academic Nurses' pioneering role in aligning research with organisational goals which strengthens their position. CONCLUSION: Positioning Clinical Academic Nurses in hospitals requires a vision, well-defined positions, a research infrastructure, and leadership support. Long-term strategic investments are needed to integrate research into clinical nursing practice and recognise Clinical Academic Nurses as strategic assets. IMPLICATIONS FOR POLICY AND PRACTICE: Positioning Clinical Academic Nurses requires visionary leadership, institutional commitment and investment in research infrastructure. The Nurse Advisory Board should support this by aligning positioning, support and evaluation with strategic policies. Strategic hospital-academic partnerships foster research, education, mentorship and grant support. Clinical Academic Nurses should set measurable goals, proactively align research with clinical priorities and increase visibility to advance nursing practice. IMPACT: This study identifies empirically grounded insights into strategies to position Clinical Academic Nurses and offers actionable insights for management, policymakers and Clinical Academic Nurses to strengthen knowledge infrastructure and improve patient care. REPORTING METHOD: COREQ. PATIENT OR PUBLIC CONTRIBUTION: Limited patient and public involvement, focusing on feedback on preliminary results.
Humanising Child Death: The Creation and Subsequent Development of Children's Palliative Care as a Distinct Clinical, Educational and Research Speciality.
Noyes J
J Adv Nurs · 2026 Jul · PMID 41792961 · Publisher ↗
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Doctoral Education: The Need for Radical Reform.
McCormack B, Stirling C, Salamonson Y … +1 more , Jackson D
J Adv Nurs · 2026 May · PMID 41792939 · Publisher ↗
In this final editorial of our group of four, we take up the challenge of thinking about radical reform of doctoral education. We contend that without decisive action, nursing risks losing its capacity to shape the futur...
In this final editorial of our group of four, we take up the challenge of thinking about radical reform of doctoral education. We contend that without decisive action, nursing risks losing its capacity to shape the future of healthcare. Therefore we suggest there is a need for radical reform of doctoral education, focusing on three key areas.
Effects of Performance and Effort Expectancy on AI-Generated Information Adoption Among Chinese Nursing Professionals: Survey-Based SEM Analysis.
Chen L, Huang Y, Sun L … +3 more , Zhang J, Xu M, Zuo Y
J Adv Nurs · 2026 Mar · PMID 41789939 · Publisher ↗
AIM: To examine determinants of nurses' adoption of generative artificial intelligence outputs in clinical practice using a technology acceptance model and an integrated structural equation modelling framework. DESIGN: C...
AIM: To examine determinants of nurses' adoption of generative artificial intelligence outputs in clinical practice using a technology acceptance model and an integrated structural equation modelling framework. DESIGN: Cross-sectional online survey. METHODS: Registered nurses in mainland China completed an anonymous questionnaire assessing perceived performance benefits, perceived ease of use, perceived information quality, perceived source credibility, social influence, facilitating conditions, adoption intention and adoption behaviour. Structural equation modelling was used to evaluate the measurement model and estimate a primary mediation model in which perceived performance benefits and perceived ease of use predicted adoption intention, and adoption intention predicted adoption behaviour. An integrated model added information quality, source credibility, social influence and facilitating conditions as additional determinants. Sensitivity analyses were conducted using an ordinal estimator to assess robustness. RESULTS: The analytic sample comprised 330 nurses. In the primary model, higher perceived performance benefits and greater perceived ease of use were associated with stronger adoption intention, and stronger adoption intention was associated with higher self-reported adoption behaviour. The integrated model showed that perceived information quality contributed to adoption intention beyond core expectancy beliefs, while perceived source credibility showed a small direct association with adoption behaviour. Social influence demonstrated a modest association with adoption intention, whereas facilitating conditions showed weaker associations after accounting for other determinants. Model conclusions were consistent across estimation approaches. CONCLUSION: Nurses' adoption of generative artificial intelligence outputs is shaped by perceived performance benefits, ease of use and perceived information quality, with adoption intention functioning as the proximal determinant of self-reported use. Implementation strategies should focus on demonstrable workflow gains, reducing interaction burden and strengthening governance and verification to support safe adoption.
Fostering Healthy Work Environments Through Interprofessional Simulation: Teamwork, Communication, Psychological Safety-Systematic Review of Randomised Controlled and Quasi-Experimental Studies.
Sarıköse S, Sengul T, Lopez V … +1 more , Kirkland-Kyhn H
J Adv Nurs · 2026 Mar · PMID 41789869 · Publisher ↗
AIM: To evaluate the effectiveness of simulation-based interprofessional education (IPSE) interventions on teamwork, communication and psychological safety outcomes among healthcare professionals and students. DESIGN: A...
AIM: To evaluate the effectiveness of simulation-based interprofessional education (IPSE) interventions on teamwork, communication and psychological safety outcomes among healthcare professionals and students. DESIGN: A systematic review. DATA SOURCES: Searches were conducted across PubMed, CINAHL, Scopus, Web of Science and Cochrane CENTRAL, supplemented by manual reference and citation tracking. REVIEW METHODS: The search strategy was developed with an academic librarian to ensure thoroughness and relevance. The review included randomised controlled trials (RCTs) and quasi-experimental studies published between 2010 and 2025. Eligible studies reported quantitative outcomes of IPSE interventions involving at least two healthcare professions. Risk of bias was assessed using RoB 2 for RCTs and ROBINS-I for quasi-experimental studies. RESULTS: Thirty studies (14 RCTs, 16 quasi-experimental) from 16 countries were included. Most studies reported positive effects on teamwork, including improved coordination, role clarity and adherence to structured protocols. Communication outcomes showed enhanced information exchange, clarity and structured behaviours, such as SBAR and closed-loop communication, although some studies noted inconsistent safety practices. Psychological safety outcomes demonstrated gains in self-confidence, self-efficacy, leadership and safety climate, with several studies also reporting reduced anxiety. However, findings on stress, workload and attitudinal change were mixed. Overall, RCTs were judged methodologically robust, and quasi-experimental studies were largely low risk with some moderate concerns. CONCLUSION: Simulation-based interprofessional training enhances teamwork, communication and psychological safety in fostering a healthy work environment, though effects vary by context and population. IMPACT: This review synthesises evidence from 30 trials, offering guidance for educators and policymakers on advancing interprofessional collaboration. Integrating IPSE into health curricula and clinical training can strengthen collaboration and contribute to safer patient care. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution. REPORTING METHODS: The review adhered to PRISMA 2020 guidelines, and the protocol was registered in the PROSPERO international prospective register of systematic reviews (ID: CRD420251039410).
Care Needs for Patients Screened Positive for Cognitive Impairment and Delirium: A Cross-Sectional Observational Study.
Mudge AM, Anderson S, Arjunan A … +13 more , Byrnes M, Cahill M, Craswell A, Dulhunty J, Fox A, Gavin NC, Lawrenson P, Lee-Steere K, Lin HS, Teodorczuk A, Treleaven E, White L, Yap C
J Adv Nurs · 2026 Mar · PMID 41787740 · Publisher ↗
AIM: To describe the point prevalence of cognitive impairment in hospitalised adults and evaluate the association with care needs and perceived risks of complications. DESIGN: Multi-site cross-sectional study on a single...
AIM: To describe the point prevalence of cognitive impairment in hospitalised adults and evaluate the association with care needs and perceived risks of complications. DESIGN: Multi-site cross-sectional study on a single day in May 2023. METHODS: Trained clinician auditors screened adult inpatients in acute medical, surgical, oncology, geriatric, mental health, convalescent, and rehabilitation wards for cognitive impairment using the 4AT in seven healthcare facilities and recorded need for support with basic activities of daily living, incontinence, and perceived risks of complications (falls, pressure injuries, and malnutrition). Data were summarised and compared across 4AT categories, and the strength of association between 4AT and each outcome was estimated using multivariable regression models. RESULTS: Data were available for 1145 inpatients on 68 wards (mean age 68 years [SD = 18], 583 [58.9%] female, 449 [39.2%] on acute medical units). Cognitive impairment (4AT of 1 or more) was identified in 482 (42.1%) participants. Participants with 4AT 1-3 had 2.0-3.6 times the odds of need for supervision or assistance with activities of daily living, while those with 4AT 4 or more had 2.9-5.3 times the odds of need for assistance. CONCLUSION: Cognitive impairment is very common in adult inpatients and is associated with significantly higher physical care needs. IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE: Hospital care models must support staff to address the higher care needs in people with cognitive impairment to protect a large patient group from hospital-acquired harm. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution. REPORTING METHOD: This study adheres to the STROBE reporting guidelines.
Correlates of Mortal Distress Among Healthcare Staff in Hospitals: A Systematic Review and Meta-Analysis.
Wang JJ, Ning J, Xu JL … +2 more , Ng YH, Chui EW
J Adv Nurs · 2026 Mar · PMID 41782413 · Publisher ↗
BACKGROUND: Mortal distress encompasses emotional, cognitive, physical and behavioural responses to death and dying among healthcare staff who frequently encounter mortality in hospital settings. Healthcare workers often...
BACKGROUND: Mortal distress encompasses emotional, cognitive, physical and behavioural responses to death and dying among healthcare staff who frequently encounter mortality in hospital settings. Healthcare workers often experience heightened levels of mortal distress due to their regular exposure to patient deaths, which can negatively impact both their personal and professional lives, leading to burnout and high turnover rates. AIM: To identify and quantitatively synthesise correlates of mortal distress among hospital healthcare staff and examine moderating factors affecting these relationships. DESIGN: Systematic review and meta-analysis following PRISMA 2020 guidelines METHODS: Two independent reviewers screened and extracted data from studies published between January 1990 and December 2024 across eight databases (five English: CINAHL, MEDLINE, ProQuest, PubMed, Scopus; three Chinese: Airiti, CNKI, Wanfang). Quality assessment was conducted using the Mixed Methods Appraisal Tool. Meta-analysis was performed using Comprehensive Meta-Analysis 3.0. RESULTS: Analysis of 94 studies identified three factor domains: personal, job-related and situational. Four job-related factors demonstrated the strongest correlations with mortal distress: competence in coping with death in healthcare contexts, needs for death-related or hospice care training, quality of end-of-life communication, and working in departments with high patient mortality rates. Four significant moderators influenced correlation strength: publication language, geographic region, study quality, and measurement tools used for assessing mortal distress. CONCLUSIONS: This synthesis provides evidence regarding the magnitude and strength of factors associated with mortal distress among healthcare staff. The identification of main and moderator effects emphasises the critical need for developing culturally sensitive, tailored interventions to help healthcare workers navigate mortality-related challenges. IMPLICATIONS: The results can guide healthcare organisations in developing targeted interventions and training programs, inform medical and nursing education curricula by encouraging the inclusion of life and death education, and ultimately enhance staff well-being while improving the quality of patient and family care, especially in palliative care contexts. NO PATIENT OR PUBLIC CONTRIBUTION: This study did not include patient or public involvement in its design, conduct, or reporting. TRIAL REGISTRATION: PROSPERO number: CRD42021275460.
Mixed Methods Research on Family Caregiving for Stroke Survivors: A Methodological Systematic Review.
Ananzeh T, Telfah R, Bakas T … +2 more , Tawalbeh R, Plano Clark VL
J Adv Nurs · 2026 Mar · PMID 41778502 · Publisher ↗
AIM: To examine how mixed methods research has been applied in studies of family caregiving for stroke survivors, focusing on key methodological components (rationale, design types, integration strategies, and use of joi...
AIM: To examine how mixed methods research has been applied in studies of family caregiving for stroke survivors, focusing on key methodological components (rationale, design types, integration strategies, and use of joint displays). DESIGN: Methodological systematic review. METHODS: A systematic search of five databases yielded 17 studies. The extraction focused on mixed methods features (rationale, design, integration, joint displays), and quality was appraised using the Mixed Methods Appraisal Tool. DATA SOURCES: PubMed, CINAHL, Scopus, Web of Science, and PsycINFO were searched for relevant studies published from 2010 to 2025. RESULTS: The included studies addressed topics such as caregiver burden, coping, resilience, and intervention outcomes. Convergent and explanatory sequential designs predominated. Complementarity was the most frequent rationale for mixing methods. Integration occurred mainly through merging, with fewer instances of connecting or building. Three studies included joint displays to integrate the results. CONCLUSION: Mixed methods research is increasingly applied in family caregiving. To advance the field, researchers should strengthen integration during analysis and results and improve transparency in reporting key design features. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Strengthening methodological rigour in mixed methods studies on stroke caregiving will improve the evidence base for nursing practice. Intentional and meaningful integration of qualitative and quantitative evidence can better inform effective interventions and support programs, ultimately enhancing care for stroke survivors and their families. IMPACT: This review evaluates how mixed methods research is applied in family caregiving studies. It identifies significant methodological gaps, including unclear reporting of design and limited use of advanced integration techniques. The recommendations provide practical guidance for researchers to improve reporting and integration, yielding richer evidence to inform interventions and policies that support family caregivers. REPORTING METHOD: The review followed the PRISMA 2021 guidelines for transparent reporting of systematic reviews. PATIENT OR PUBLIC CONTRIBUTION: No patient or public involvement.
Is Mental Health Nursing Facing a Slow Death or Clinical Excellence and Advancement? Future Perspectives for the Flemish Context (Belgium).
Desmet K, Luts I, Antierens A … +3 more , Deproost E, Vandecasteele T, Verhaeghe S
J Adv Nurs · 2026 Mar · PMID 41778498 · Publisher ↗
AIMS: To critically and constructively explore the future of mental health nursing in Flanders (Belgium) by examining the historical evolution, current challenges, and potential strategies for clinical excellence and adv...
AIMS: To critically and constructively explore the future of mental health nursing in Flanders (Belgium) by examining the historical evolution, current challenges, and potential strategies for clinical excellence and advancement. DESIGN: This study used a historically informed and contextualised grounded analyses to envision future perspectives that support strategically targeted perspectives in compact regions such as Flanders (Belgium). METHODS: A synthesis of published literature, policy documents, academic sources, and Flemish nursing research was conducted to identify key directions. RESULTS: By addressing local challenges, particularly related to education and labor market scarcity, this paper proposes three key directions for progress: 'Back to good basics', 'Reclaiming the driver's seat of clinical advancement' and 'Revitalizing clinical excellence from within clinical nursing practice'. IMPACT: These interlinked perspectives provide a framework for revitalising mental health nursing in Flanders, supporting clinical excellence and development while responding to the most pressing contemporary challenges. Although rooted in a compact regional context, the insights and proposed directions may inspire similar reflections and initiatives in international mental health nursing contexts.
Doctoral Education in Nursing Is a 'Special Issue'.
McCormack B, Stirling C, Salamonson Y … +1 more , Jackson D
J Adv Nurs · 2026 May · PMID 41761694 · Publisher ↗
The extent to which the analysis of the state of play of doctoral education and suggested ways forward are seen as being radical is of course dependent on the context within which nursing research programs currently exis...
The extent to which the analysis of the state of play of doctoral education and suggested ways forward are seen as being radical is of course dependent on the context within which nursing research programs currently exist. We are aware that no one size fits all contexts, but we are also aware of a critical need to challenge dominant perspectives and practices and work toward a radical repositioning of the nursing PhD. At a time when the narrative of nursing shortages is pervasive, we need to be positioning nursing research and researchers at the heart of the solution. Without a radical reconsideration of how we build sustainable research teams, the opportunity will bypass us. The special issue on doctoral education deliberately set out to be disruptive, to surface critical questions and trigger a conversation that needs to be had. We are open to continuing this conversation.
Home Care Organisational Models in Italy: A Cross-Sectional Study of Cluster Analysis and Stakeholder Perceptions.
Marcomini I, Caponnetto V, Zaghini F … +15 more , Cesare M, Di Nitto M, Iovino P, Burgio A, Cicala SD, Bagnasco A, Cicolini G, Lancia L, Manara DF, Rasero L, Rocco G, Zega M, Mazzoleni B, Sasso L, Alvaro R
J Adv Nurs · 2026 Feb · PMID 41761436 · Publisher ↗
AIM: To classify Italian home care models based on structural characteristics, process factors and stakeholder perceptions. DESIGN: This is a secondary analysis of the AIDOMUS-IT multicentre cross-sectional study, conduc...
AIM: To classify Italian home care models based on structural characteristics, process factors and stakeholder perceptions. DESIGN: This is a secondary analysis of the AIDOMUS-IT multicentre cross-sectional study, conducted in Italy between July 2022 and December 2023. METHODS: Data were collected via online surveys completed by 33 Local Health Authority Nursing Directors, home care nurses and patients. Hierarchical cluster analysis was used to classify different organisational models based on structural and process-related factors. Nurses' and patients' perceptions of care were described for each identified cluster. RESULTS: The analysis identified three distinct organisational home care models: The 'multidisciplinary model', in which nurses reported high dissatisfaction due to organisational complexity and excessive workloads. In the 'nurse-centred model', characterised by publicly employed nurses, strong leadership, and a supportive work environment, patients reported high levels of satisfaction. The 'performance-based model', which operated with a lower nurse-to-patient ratio, reduced service hours, and greater reliance on external professionals. Nurses in this model reported high job satisfaction but also a greater intention to leave, while patient satisfaction was lower. CONCLUSIONS: This study underscores the importance of leadership, resource management, and a supportive work environment in influencing both job satisfaction and patient outcomes in home care settings. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENTS CARE: Policymakers could use these findings to refine care models and improve service delivery. IMPACT: Limited research has examined the organisational structures of home care services, which are important for professionals' organisational well-being, patient safety, and quality of care. This study identified three distinct organisational home care models that could be used to refine care approaches and improve service delivery. REPORTING METHOD: This study respects the EQUATOR guideline for observational studies (STROBE). PATIENT OR PUBLIC CONTRIBUTION: This study did not include patient or public involvement in its design, conduct, or reporting.
Intensive Care Unit Nurses' Perceptions of Work Environments: A Cross-Sectional Study From Five European Counties.
Georgiou Ε, Mpouzika M, Llaurado-Serra M … +12 more , Friganović A, Sabou A, Gutysz-Wojnicka A, Constantinescu-Dobra A, Alfonso-Arias C, Curado-Santos E, Slijepcevic J, Coțiu MA, Penar-Zadarko B, Režić S, Dobrowolska B, Kyranou M
J Adv Nurs · 2026 Feb · PMID 41761430 · Publisher ↗
AIM: To explore intensive care nurses' perceptions of their work environments at the unit and organisational levels according to the American Association of Critical Care Nurses standards, their impact on care quality, n...
AIM: To explore intensive care nurses' perceptions of their work environments at the unit and organisational levels according to the American Association of Critical Care Nurses standards, their impact on care quality, national differences, and demographic associations. DESIGN: Cross-sectional study using a survey design. METHODS: Study conducted between January 2021 and April 2022, using a convenience sample of intensive care unit nurses across Cyprus, Spain, Croatia, and Poland, Romania. The Critical Elements of a Healthy Work Environment Scale (CEHWES) developed by the American Association of Critical Care Nurses and cross-culturally adapted by the authors was used, which included four sections, including sociodemographic data and a total of 50 questions. The core section of the tool comprised 16 questions using Likert-type response (1-strongly disagree-4 strongly agree). Perception of fulfilment of healthy work environment standards was calculated using the aforementioned Likert-type scale. RESULTS: A total of 1183 nurses participated reporting moderate perception of fulfilment of the standards, with mean scores ranging from 2.6 to 2.8. Skilled communication and effective decision making were the highest rated. 56% (n = 662) reported awareness of some standards and while 25.8% (n = 305) reported full or significant implementation in their unit. Significant differences related to the perception of all standards were observed across countries. Implementation of the standards was significantly associated with higher quality of care having better perception when standards were fully implemented. CONCLUSIONS: This study shows moderate perception of healthy work environment standards among intensive care nurses. Country differences highlight the need for more awareness, training, and further implementation of the standards, which is linked to better care quality. IMPLICATIONS FOR THE PROFESSION: Work environment still need to improve and needs to be prioritised by organisations, considering local and national particularities. Having a measuring tool available in multiple languages facilitates comparisons and getting a global picture. IMPACT: The questionnaire used is validated in different languages, allowing results to be compared with other countries. Novel data from countries that were poorly investigated is now available. More evidence points out the need to prioritise work environment for maintaining quality in patient care. REPORTING METHOD: The study has been reported following the STROBE checklist. PATIENT OR PUBLIC CONTRIBUTION: This study did not include patient or public involvement in its design, conduct, or reporting.
Spherical Video-Based Virtual Reality for Nurses' Workplace Violence Management: A Convergent Mixed-Methods Study.
Lin YY, Lin TT, Hung YL … +3 more , Feng HP, Liang CY, Tzeng WC
J Adv Nurs · 2026 Feb · PMID 41733241 · Publisher ↗
AIM: To evaluate the feasibility, effectiveness, and acceptability of a spherical video-based virtual reality training programme aimed at helping nurses manage workplace violence. DESIGN: A convergent mixed-methods study...
AIM: To evaluate the feasibility, effectiveness, and acceptability of a spherical video-based virtual reality training programme aimed at helping nurses manage workplace violence. DESIGN: A convergent mixed-methods study. METHODS: This study included nurses from a tertiary medical centre in Taiwan. The training programme involved four interactive 360° scenarios focused on recognising, de-escalating, and responding to workplace violence. Quantitative measures included risk perception, confidence in coping with aggression, and technology acceptance. Qualitative measures included the participants' learning experiences. Quantitative and qualitative findings were integrated through joint displays. RESULTS: The programme was feasible, with all participants completing the training. Nurses reported high levels of perceived usefulness and ease of use. Quantitative data revealed considerable improvements in risk awareness and confidence in responding to incidents of violence. Qualitative data revealed that immersion and emotional resonance enhanced engagement, fostered self-reflection, and reinforced learning. Technical challenges included subtitle placement and speech recognition accuracy. CONCLUSION: Spherical video-based virtual reality is a feasible, acceptable, and effective training approach that improves nurses' preparedness for managing workplace violence by enhancing situational awareness and confidence in addressing high-risk situations. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Integrating spherical video-based virtual reality into continual education may strengthen nurses' workplace safety competencies, prevent harm from incidents of violence, and improve patient care in stressful environments. IMPACT: Workplace violence undermines nurse safety and patient care. Current training modules often lack contextual realism. Our programme improved nurses' awareness, confidence, and reflective learning and was feasible and well accepted. The findings are relevant to nursing educators, hospital administrators, and policymakers seeking sustainable strategies for addressing workplace violence. REPORTING METHOD: This study adhered to the Revised Standards for Quality Improvement Reporting Excellence. PATIENT OR PUBLIC CONTRIBUTION: Patients or the public were not involved in the design, conduct, or reporting of this study.
Head Nurse's Ethical Leadership, Work Environment and Patients' Outcomes: A Multicentre Cross-Sectional Multilevel Study.
Sili A, Fida R, Della Bella V … +2 more , Zaghini F, Fiorini J
J Adv Nurs · 2026 Feb · PMID 41732841 · Publisher ↗
AIM: To investigate the relationship between nursing ethical leadership style, work environment (workload, interpersonal conflicts) and patients' objective nursing-sensitive outcomes (accidental falls, pressure ulcers, n...
AIM: To investigate the relationship between nursing ethical leadership style, work environment (workload, interpersonal conflicts) and patients' objective nursing-sensitive outcomes (accidental falls, pressure ulcers, nosocomial infections, restraints and deaths). DESIGN: Nationwide multicentre cross-sectional multilevel survey. METHODS: Validated self-report scales were used to assess nurses' perceptions of ethical leadership, workload and interpersonal conflict. Nursing staffing and objective patient' nursing-sensitive outcomes were measured at the ward level. Descriptive and inferential analyses were conducted. Structural equation modelling examined the relationships among these variables based on Donabedian's conceptual framework. RESULTS: Data from 2349 nurses across 158 wards in 25 Italian acute care hospitals were analysed. The multilevel model showed an excellent fit. Ethical leadership was negatively associated with both workload and interpersonal conflict. Workload was significantly linked to higher rates of pressure ulcers, falls and deaths in patients. Ethical leadership was indirectly associated with improved patient outcomes through reduced workload. CONCLUSION: Head nurses' ethical leadership has a pivotal role in shaping the work environment and enhancing nursing-sensitive outcomes by reducing workload and fostering positive interpersonal dynamics. These findings emphasise the need for healthcare organisations to invest in ethical leadership development as a critical strategy for improving care quality and promoting better patient outcomes. IMPACT: These findings emphasise the need for healthcare organisations to invest in ethical leadership development as a critical strategy for improving care quality and promoting safer, more effective patient outcomes. REPORTING METHOD: The study adhered to The Strengthening the Reporting of Observational Studies in Epidemiology checklist. NO PATIENT OR PUBLIC CONTRIBUTION: This study did not include patient or public involvement. WHAT DOES THIS PAPER CONTRIBUTE TO THE WIDER GLOBAL CLINICAL COMMUNITY?: Cultivating moral values and principles in leadership enables leaders to effectively communicate these values to their staff. Addressing unethical behaviours, fostering open dialogue about organisational ethics, and supporting leaders in the ethical decision-making process contribute to a healthier nurses' work environment. Healthcare organisations investing in the development and promotion of ethical leaders improve care quality. PROTOCOL REGISTRATION: The study was registered in the research registry (www.researchregistry.com) under the record number (researchregistry7418), following a published protocol.
Psychological Outcomes of Family Members Related to a Loved One's Resuscitation in the Emergency Department: A Cross-Sectional Study.
Rahmawati I, Page T, Conlon L … +2 more , Setyarini A, Donnelly F
J Adv Nurs · 2026 Feb · PMID 41731712 · Publisher ↗
AIMS: This study aimed to assess the psychological outcomes of family members of patients who were resuscitated in the Emergency Department (ED) and analyse factors associated with these outcomes. DESIGN: This study util...
AIMS: This study aimed to assess the psychological outcomes of family members of patients who were resuscitated in the Emergency Department (ED) and analyse factors associated with these outcomes. DESIGN: This study utilised a cross-sectional design METHODS: Data were collected using a self-reported questionnaire sent to family members of patients who had undergone resuscitation in the ED from February 2024 to January 2025. Instruments for data collection included The Impact of Event Scale-Revised (IES-R), the short version of The Depression, Anxiety and Stress Scale-21 items (DASS-21), the Multicultural Quality of Life Index (MQLI) and questions related to demographic variables and the resuscitation event. RESULTS: A total of 106 family members completed the questionnaire. Of this, 64.2% (n = 68) reported witnessing the resuscitation attempt, and 35.8% (n = 38) did not witness the event. Family members who witnessed the resuscitation displayed more symptoms of post-traumatic stress disorder (PTSD), measured by the IES-R, compared to those who did not witness the event. A statistically significant negative correlation was found between the IES-R and the MQLI scores, indicating that higher PTSD symptoms correlate with lower quality of life (QoL) ratings. CONCLUSION: The findings of this study indicated that witnessing the resuscitation of a loved one in the ED is associated with increased PTSD symptoms. IMPLICATIONS FOR HEALTH PROFESSIONALS AND PATIENT CARE: Patients' and family members' cultural and religious needs should be acknowledged by the health care providers. Study findings indicate that family members prefer to be with the patient during the patient's resuscitation. However, without adequate support from hospital staff, this experience may cause adverse psychological effects. Strategies to support family members during and after resuscitation should be developed and integrated into the management of in-hospital resuscitation. REPORTING METHOD: This study followed the STROBE guidelines. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.
Frailty Trajectory Within 3 Months After Discharge Among Older Adults Living With Frailty Who Experience Hip Fracture Surgery and Predictors.
Guan Y, Zhu Y, Li B … +1 more , Zheng L
J Adv Nurs · 2026 Feb · PMID 41725115 · Publisher ↗
AIM: To identify the latent frailty trajectory and explore corresponding predictors among older adults living with frailty who experience hip fracture surgery within 3 months after discharge. DESIGN: From December 2022 t...
AIM: To identify the latent frailty trajectory and explore corresponding predictors among older adults living with frailty who experience hip fracture surgery within 3 months after discharge. DESIGN: From December 2022 to November 2024, 178 individuals were consecutively enrolled in a longitudinal observational study conducted at a tertiary hospital in Zhejiang Province, China. METHODS: The Reported Edmonton Frail Scale measured the frailty level at 5 points, which included baseline (pre-fracture), at discharge, 2 weeks, 1 and 3 months after discharge. Latent class growth models were set up for the frailty trajectory. Multinomial logistic regression was performed to explore the predictors of frailty trajectory classes. RESULTS: One hundred fifty-three participants completed the full follow-up. Latent class growth models identified 3 frailty trajectories. Class 1: moderate frailty transformed to severe frailty (n = 27; 17.65%); Class 2: mild frailty transformed to moderate frailty (n = 86; 56.20%); Class 3: pre-frailty transformed to mild frailty (n = 40; 26.15%). A higher-level D-Dimer at admission and the five-item version of the Geriatric Depression Scale increased the incidence of Class 2 compared to Class 3. The higher scores of the Abbreviated Mental Test decreased the incidence of Class 2 compared to Class 3. Longer surgical waiting time, a higher-level five-item version of the Geriatric Depression Scale and the Age-Adjusted Charlson Comorbidity Index increased the incidence of Class 1 compared to Class 3. The higher scores of the Abbreviated Mental Test and Mini Nutritional Assessment Short Form decreased the incidence of Class 1 compared to Class 3. CONCLUSIONS: Three frailty trajectory classes were identified among older adults living with frailty who experience hip fracture surgery after discharge within 3 months. D-Dimer at admission, surgical waiting time, depressive symptoms, cognitive status, comorbidity index and nutritional status are associated with these fluctuating frailty trajectories. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Modifiable factors such as improving nutrition and cognitive status and managing depression, comorbidities and preoperative evaluations provide methods for future interventions to prevent or mitigate frailty among this population. IMPACT: What problem did the study address? Frailty is an inherent dynamic among older adults living with frailty who experience hip fracture surgery after discharge within 3 months. Some factors affect the mitigated frailty process in this population. What were the main findings? Three frailty trajectory classes were identified in this study. And the level of their frailty worsens 3 months after surgery compared to pre-fracture. D-Dimer at admission, surgical waiting time, depressive symptoms, cognitive status, comorbidity index and nutritional status are associated with these fluctuating frailty trajectories. Where and on whom will the research have an impact? The findings of this study provide screening, intervention and discharge plan evidence for healthcare workers in orthopaedics and geriatrics Departments. Helping community healthcare workers and primary caregivers set the theoretical basis for home-based intervention programs. REPORTING METHOD: We have adhered to relevant EQUATOR guidelines using the STROBE reporting method. PATIENT CONTRIBUTION: No patient or public contribution.
Standards for Hospital Falls Prevention and Management: An International Comparative Analysis.
McKercher JP, Peiris CL, Thwaites C … +4 more , Heng H, Gleeson D, Janes G, Morris ME
J Adv Nurs · 2026 Feb · PMID 41709691 · Publisher ↗
BACKGROUND: Hospital falls and associated injuries are a global issue associated with harm and significant costs to individuals and society, especially for older adults. Hospital standards specify the minimum level of ca...
BACKGROUND: Hospital falls and associated injuries are a global issue associated with harm and significant costs to individuals and society, especially for older adults. Hospital standards specify the minimum level of care required to optimise patient safety, quality and outcomes. Standards are often used during hospital accreditation. This investigation analysed the content and quality of hospital falls standards across the globe. METHODS: Hospital standards were located by searching online databases (PubMed, CINAHL, Google Scholar, MEDLINE), ChatGPT, the grey literature via internet search engines, and websites of accreditation agencies, government agencies, and other relevant organisations. We searched for standards from the 60 largest countries by population plus the 60 countries with the highest gross domestic product (n = 82 after accounting for duplicates). For inclusion, hospital standards had to mention 'fall/s'. Data were analysed using a deductive framework synthesis and content analysis to identify emergent themes. RESULTS: Forty-one standards used by at least 72 countries were identified from our search. Sixteen were excluded from detailed analysis because they did not mention falls and 3 could not be retrieved. A total of 22 standards were included in the final detailed analysis. Included standards showed wide variations in content and quality. Seven were assessed as high quality, 12 medium quality, and 3 were deemed to be of low quality. Some lacked details on hospital falls screening, assessment, prevention, and management. Consumer engagement in development, implementation, or evaluation was not mentioned in all standards. Procedures for falls data collection and reporting were seldom documented. Hospital standards infrequently referred readers to contemporary research or clinical practice guidelines. CONCLUSION: There are variations in the quality and content of standards on hospital falls. International collaboration is recommended to increase the consistency and validity of hospital falls standards across nations, in order to optimise healthcare outcomes. IMPACT: The findings of this global analysis of hospital falls standards have the potential to impact falls rates and fall-related injuries in hospital patients by providing data to inform the content, evidence base and use of hospital standards to optimise the safety and quality of care delivery. The findings inform the review, design and implementation of hospital accreditation procedures to improve patient outcomes, patient experiences, and service quality.
Double Burdens and Double Resilience: Dynamic Interactions in Older Couples Living With Multimorbidity.
Zhang Y, Song J, Fang M … +2 more , Liu Z, Jin Y
J Adv Nurs · 2026 Feb · PMID 41708124 · Publisher ↗
AIMS: To explore the lived experiences and daily interactions of older couples living with multimorbidity. DESIGN: A descriptive-interpretive qualitative study based on a generic interpretive description framework. METHO...
AIMS: To explore the lived experiences and daily interactions of older couples living with multimorbidity. DESIGN: A descriptive-interpretive qualitative study based on a generic interpretive description framework. METHODS: A total of 20 dyads were recruited using a purposive sampling strategy, and 24 semi-structured in-depth interviews were conducted between May 2023 and January 2025. Reflexive thematic analysis was used to analyse data. RESULTS: Four overarching themes were generated: (1) dynamic relationship structures; (2) diverse interaction patterns; (3) double burdens; and (4) double resilience. Dynamic relationship structures occurred in dyadic and triadic forms. Diverse interaction patterns involved independence, interdependence and dependence. Double burdens manifested as physical toll, financial hardship, emotional contagion and perceptual misalignment, whereas double resilience was reflected in the nudge effect, emotional resonance and promotion of family ownership of health. CONCLUSION: This study adopted a dyadic perspective to explore the experiences and interactions of older couples living with multimorbidity. The caring dynamics and blurred roles of patient and care partner deviate from the traditional unidirectional, linear model of 'one person caring for the other'. Formal or informal caregiving support from third parties, as well as the nudge effect and emotional resonance between spouses, may help orient older couples as they navigate the challenges associated with multimorbidity. IMPLICATIONS FOR THE PROFESSION: Our findings indicate that community nurses can play a proactive role in identifying older couples living with multimorbidity through routine care attendance and assessments, enabling early recognition of health management needs. Geriatric nurses can leverage insights into couples' interaction patterns to tailor more effective care plans at different stages of illness, monitor emerging risks and identify optimal timing for third-party support. By facilitating a responsive triadic network, nurses can help ensure continuous and sustainable health care. REPORTING METHOD: Adhered to SRQR guidelines for qualitative research. PATIENT OR PUBLIC INVOLVEMENT: This study did not include patient or public involvement in its design, conduct, or reporting.
Success by Design: Senior Leadership Perspectives on Optimising the Role of Clinical Nurse Specialists.
Lauck SB, Lambert LK, Prodan-Bhalla N … +7 more , Havaei F, Bryant-Lukosius D, Kaur J, Hare K, Kensall SL, Palmer B, Thorne S
J Adv Nurs · 2026 Feb · PMID 41705632 · Publisher ↗
AIMS: To report on the unique perspectives of senior nursing leaders on the value proposition of the Clinical Nurse Specialist (CNS) role, their organisational experience and the barriers and facilitators to optimise and...
AIMS: To report on the unique perspectives of senior nursing leaders on the value proposition of the Clinical Nurse Specialist (CNS) role, their organisational experience and the barriers and facilitators to optimise and promote the long-term sustainability. DESIGN: A qualitative sub-study of a larger multi-method study focused on informing policy recommendations to optimise the CNS workforce, informed by integrated knowledge translation. METHODS: Chief Nursing Officers (CNOs) and other senior leaders in all health authorities in British Columbia, Canada, were invited to participate in semi-structured interviews via video call between August-December 2023. We recruited 13 participants from diverse health regions, including 5 CNOs. RESULTS: Leaders collectively conveyed a renewed interest in the CNS role to support nursing and multidisciplinary teams to better meet patient and system needs, and a sense of urgency to optimise the role in diverse settings. The overarching theme of "success by design" was supported by three thematic priorities: (1) understanding the CNS role, (2) a role that needs protection and connections and (3) moving forward together. Views were aligned to co-construct implementation-ready policy recommendations to guide provincial strategies. CONCLUSION: Senior leaders reported a common understanding of the value-add of the CNS workforce and had a shared experience of barriers to optimisation. Contemporary policy guidance is needed to equip health systems to address this gap. IMPACT: Across international regions, the role of CNSs is not fully optimised. This is a wasted opportunity to address the pressing need for nursing practice leaders to transform health systems and improve outcomes. This study provides new knowledge about the perspectives of Chief Nursing Officers and other nursing leaders to shape comprehensive and targeted policy recommendations and address enduring and new challenges to realise the full impact of the CNS workforce. REPORTING METHODS: We have adhered to COREQ reporting guidelines (See supplemental file). PATIENT AND PUBLIC INVOLVEMENT: This study did not include patient or public involvement in its design, conduct, or reporting.
Continuing Excellence in Maternal-Child Health Nursing: The Future With Artificial Intelligence Technology.
Sharps PW
J Adv Nurs · 2026 Jul · PMID 41705628 · Publisher ↗
Abstract loading — click title to view on PubMed.
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