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Journal Of Advanced Nursing[JOURNAL]

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Clinical Supervision and Burnout Among Nurses: A Scoping Review.

Rodrigues CR, Rocha S, Trigo S … +3 more , Silva L, Silva M, Rosinhas A

J Adv Nurs · 2026 Jul · PMID 42402940 · Publisher ↗

AIM: To map existing scientific evidence on the relationship between clinical supervision and burnout and burnout-related outcomes among nurses in clinical practice. DESIGN: Scoping review. METHODS: The review followed t... AIM: To map existing scientific evidence on the relationship between clinical supervision and burnout and burnout-related outcomes among nurses in clinical practice. DESIGN: Scoping review. METHODS: The review followed the Joanna Briggs Institute methodology for scoping reviews. A total of 1396 records were identified and imported into Rayyan for screening. Data were synthesised descriptively using absolute and relative frequencies and presented in narrative and tabular form. DATA SOURCES: Searches were conducted in February 2025 in CINAHL Complete, Nursing & Allied Health Collection: Comprehensive, MedicLatina, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, PubMed, and Web of Science Core Collection. Grey literature was searched in OpenGrey and the Portuguese Open Access Scientific Repository (RCAAP). No time or language restrictions were applied. RESULTS: Twenty studies were included. The evidence base was heterogeneous and predominantly cross-sectional. Clinical supervision in Nursing (CSN) was mainly delivered face-to-face and most frequently in group formats, with considerable variability in frequency, duration and theoretical grounding. Burnout was primarily assessed using validated instruments, particularly the Maslach Burnout Inventory. Nine studies reported inverse statistical associations between CSN and burnout or burnout-related outcomes. CONCLUSION: Clinical supervision is frequently associated with burnout and burnout-related indicators among nurses. Clearer intervention reporting, stronger theoretical grounding, and research designs capable of exploring temporal and contextual dynamics are needed to advance the field. IMPLICATIONS FOR HEALTHCARE MANAGEMENT: Clinical supervision may represent a context-sensitive organisational support strategy within broader workforce well-being frameworks, particularly when structurally defined and supported by leadership. IMPACT: This review clarifies how clinical supervision has been conceptualised and evaluated, identifying reporting gaps and priorities for future research. REPORTING METHOD: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Review. PATIENT OR PUBLIC CONTRIBUTION: No stakeholder consultation was undertaken. Future research should consider involving practising nurses and supervisors to define core CSN components. TRIAL REGISTRATION: The protocol was registered in the Open Science Framework.
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Exploring the Effectiveness of Practice Development Interventions on Patient and Staff Outcomes: A Systematic Review.

Smith HA, Carter V, Phillips C … +7 more , Ataiyero Y, Dube A, Odell J, Latham C, Hardy S, Leary A, Jones S

J Adv Nurs · 2026 Jul · PMID 42401994 · Publisher ↗

AIM: To explore Practice Development interventions and associated contextual factors to understand their impact on patient and staff outcomes and experiences in healthcare settings. DESIGN: Systematic review. METHODS: Pr... AIM: To explore Practice Development interventions and associated contextual factors to understand their impact on patient and staff outcomes and experiences in healthcare settings. DESIGN: Systematic review. METHODS: Preferred Reporting Items for Systematic Reviews and Meta-analysis informed design, conduct and management. A systematic approach was taken, utilising multiple reviewers and consensus methods. Mixed Methods Appraisal Tool informed quality appraisal. Qualitative findings were analysed using Reflexive Thematic Analysis. Quantitative results are presented as a narrative summary. DATA SOURCES: CINAHL; MEDLINE; PubMed; Scopus; ScienceDirect; Nursing and Allied Health; Cochrane Library; Internurse.com; The Kings Fund; GOV.UK and Trip Database were searched between 1st January 1980 to 5th January 2026. RESULTS: Twenty-nine studies were included. Eighteen studies met all quality assessment criteria. Limited quantitative data was available, and inconsistent outcome measures constrained quantitative analysis. Qualitative analysis generated three themes: (1) Shaping Practice: the interplay of organisational context, culture, and structure, (2) Enablers and constraints in Practice Development, (3) Collective empowerment. CONCLUSION: Across diverse study designs, the majority of studies indicate that PD contributes positively to staff working environments and the contexts in which patient care is delivered. However, current findings do not demonstrate consistent improvements in clinical outcomes or quality of life. IMPLICATIONS FOR PRACTICE: Practice Development may contribute to improvements in care environments for patients and staff, respectively. This review highlights knowledge gaps in the generalisability and transferability of Practice Development that would benefit from further exploration. IMPACT: Practice Development may enhance healthcare environments, but further research is needed to determine if these benefits impact upon clinical outcomes. REPORTING METHOD: Preferred Reporting Items for Systematic reviews and Meta-Analyses. NO PATIENT OR PUBLIC INVOLVEMENT: No patient or public contribution. TRIAL REGISTRATION: PROSPERO registration number: CRD42024557949.
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A Study of the Correlation Between Vulnerability to Psychological Crisis and Self-Disclosure in Elderly Patients With Multimorbidity: A Mixed-Methods Study.

Fu D, Tang Y, Zhao L … +3 more , Cai Z, Li Y, Wang X

J Adv Nurs · 2026 Jul · PMID 42400254 · Publisher ↗

AIM: This study examined the factors influencing psychological crisis vulnerability (PCV) in older patients with multimorbidity and identified barriers/facilitators to expressing psychological distress. This was aimed at... AIM: This study examined the factors influencing psychological crisis vulnerability (PCV) in older patients with multimorbidity and identified barriers/facilitators to expressing psychological distress. This was aimed at supporting clinical interventions and ageing policies. DESIGN: A cross-sectional study. METHODS: This study was designed using explanatory sequential mixed methods. In the quantitative study, 685 older patients in the inpatient and outpatient clinics of a tertiary hospital were selected using convenience sampling, and a cross-sectional survey was conducted using the Psychological Crisis Vulnerability Scale (PVS). In the qualitative study, 14 older patients with multiple chronic diseases in the geriatric department were interviewed in depth, and the interaction mechanism between vulnerability and self-disclosure was analysed. Qualitative themes on disclosure barriers/facilitators were contextualised within the high PCV subgroups (scores ≥ 80), demonstrating how vulnerability modulates self-disclosure. RESULTS: The quantitative study showed that the PCV score of older patients with multimorbidity (69.4 ± 12.8) was significantly lower than that of the community older norm, indicating that their PCV was at the lower to middle level. Multifactorial analysis showed that residence status, economic situation, marital status, age, type of chronic disease, and hospitalisation in the preceding 6 months were the main factors affecting PCV. The qualitative study extracted hindering factors (e.g., introverted personality, family atmosphere, negative cognition, economic pressure, negative feedback, insufficient knowledge, and time weakening) and facilitating factors (e.g., perceived benefits after disclosure, a good support system, and a strong willingness to express oneself) affecting self-disclosure. CONCLUSION: PCV in older patients with multimorbidity emerges from multidimensional determinants and complex self-disclosure dynamics. IMPACT: Strategic improvements in risk assessment protocols, positive expressive behaviour cultivation, layered psychosocial support frameworks, and healthy ageing policy execution collectively enhance mental well-being and sustainable ageing trajectories. REPORTING METHOD: The study follows the STROBE guidelines. PATIENT OR PUBLIC CONTRIBUTION: Older patients from tertiary hospitals participated in this study.
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Elderspeak in Healthcare Settings: How Care, Control and Personhood Intersect in Care Communication-A Qualitative Meta-Synthesis.

Lillekroken D, Röthig A, Bjørnnes AK

J Adv Nurs · 2026 Jul · PMID 42383511 · Publisher ↗

AIM(S): To synthesize qualitative evidence on how healthcare personnel experience, perceive and enact elderspeak, patronizing speech and infantilizing communication in interactions with older adults across healthcare con... AIM(S): To synthesize qualitative evidence on how healthcare personnel experience, perceive and enact elderspeak, patronizing speech and infantilizing communication in interactions with older adults across healthcare contexts. DESIGN: Qualitative meta-synthesis. METHODS: A systematic database search identified studies reporting healthcare personnel's experiences, perceptions and use of elderspeak and other patronizing communication with older adults. Findings from the included studies were synthesized and interpreted. DATA SOURCES: Medline, Embase, APA PsycINFO, CINAHL and Scopus were searched in July 2024 and updated in November 2025. RESULTS: Thirteen qualitative studies were included. Two descriptive themes were generated: (i) Elderspeak as a communication practice that erodes personhood and (ii) Elderspeak as an institutionalized and normalized communication as behavioural regulation. These informed the analytical theme: Elderspeak as a tension between care, control and personhood. Findings suggest that elderspeak is often used with caring intentions and to facilitate care delivery, cooperation and organizational routines. However, these communication practices may simultaneously constrain older adults' autonomy, participation and personhood. CONCLUSION: Elderspeak is not merely an individual communication habit but a socially and institutionally embedded practice normalized in everyday care. While it may support care routines and cooperation, it can also position older adults as dependent, less competent or less autonomous, contributing to the erosion of personhood despite caring intentions. Addressing elderspeak requires attention to both communication practices and the organizational contexts in which they occur. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Reducing elderspeak requires educational and reflective initiatives that help healthcare personnel recognize how communication practices, such as collective pronouns, terms of endearment, directive language and speaking on behalf of older adults, may unintentionally undermine autonomy and personhood. Promoting person-centred, dignity-affirming communication should be integrated into professional development and quality-improvement initiatives. REPORTING METHOD: Reported in accordance with the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) guidelines. PATIENT OR PUBLIC CONTRIBUTION: This study is a meta-synthesis; therefore, it does not include patient or public involvement in its design, conduct or reporting. TRIAL REGISTRATION: PROSPERO: CRD42024557148.
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A Model for Sustaining Second Victim Peer Support Programs in Healthcare: A Delphi Study.

Bertrand PO, Enriquez M, Merandi JM … +1 more , Scott SD

J Adv Nurs · 2026 Jun · PMID 42374801 · Publisher ↗

AIM(S): To identify essential attributes supporting the success and long-term sustainability of healthcare's second victim peer support programs. DESIGN: The Delphi technique and purposive sampling identified peer suppor... AIM(S): To identify essential attributes supporting the success and long-term sustainability of healthcare's second victim peer support programs. DESIGN: The Delphi technique and purposive sampling identified peer support team coordinators who served as the expert panellists in this study. METHODS: Panellists completed three Delphi rounds. Round 1 open-ended responses were analysed using content analysis to identify themes and sub-themes. In Rounds 2 and 3, panellists rated the importance of each theme using a 4-point Likert scale. RESULTS: Coordinators representing 23 healthcare organisations across 15 states identified core attributes for sustaining peer support programs. Key findings included the need for strong executive leadership commitment, adequate staffing through dedicated coordination, a culture of psychological safety, and peer supporter competency (empathy, communication skills, and confidentiality). Reported challenges included balancing competing responsibilities for both coordinators and peer supporters, maintaining peer supporter engagement, and addressing stigma related to help-seeking. These findings informed the development of the 5Cs Framework, a structured model illustrating how key priorities collectively support program sustainability and strengthen a culture of workplace well-being. CONCLUSION: Experienced peer support team coordinators highlighted the organisational structures and institutional drivers perceived to support the sustainability of peer support programs. The 5Cs Model is presented as a practical guide for long-term success. Findings can be used to help strengthen program sustainability and support effective responsive support team operations. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: This study identified essential elements for optimizing peer support teams that support clinician well-being, normalise help-seeking, and promote a culture of psychological safety with implications for patient safety. IMPACT: Many healthcare organisations have embraced peer support teams to help staff cope with emotionally challenging clinical events. Sustaining these programs remains a common challenge. This study identified expert opinions on the attributes of successful peer support teams and introduced the novel 5CsModel to guide implementation and long-term sustainability within broader workforce well-being efforts. REPORTING METHOD: DELPHISTAR guidelines were followed. PATIENT OR PUBLIC CONTRIBUTION: None.
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The Practice Experience of ICU Nurses in Preventing Pressure Injuries: A Qualitative Meta-Synthesis.

Huang S, Yang M, Xu F … +5 more , Huang Y, Liu L, Ren J, Xiong Z, Xu J

J Adv Nurs · 2026 Jun · PMID 42362388 · Publisher ↗

AIM: This study sought to synthesize qualitative evidence pertaining to intensive care unit (ICU) nurses' experiences in pressure injury prevention and thereby to systematically delineate the facilitators and barriers sh... AIM: This study sought to synthesize qualitative evidence pertaining to intensive care unit (ICU) nurses' experiences in pressure injury prevention and thereby to systematically delineate the facilitators and barriers shaping these behaviors so as to support the formulation of targeted intervention strategies. DESIGN: A qualitative meta-synthesis was conducted following the Joanna Briggs Institute methodology and was underpinned by the Theoretical Domains Framework alongside the Capability-Opportunity-Motivation-Behaviour (COM-B) model. METHODS: A systematic search was performed across nine databases-namely PubMed, Web of Science, Cochrane Library, Embase, CINAHL, China National Knowledge Infrastructure (CNKI), Wanfang Database, VIP Database and China Biomedical Literature Database-covering the period from database inception to 21 January 2026. Two researchers independently undertook study screening and data extraction. Study quality was evaluated using the 2016 iteration of the Qualitative Research Quality Assessment Tool developed by the Joanna Briggs Institute. Extracted findings were subsequently mapped and synthesized according to the Theoretical Domains Framework and the COM-B model. DATA SOURCES: PubMed, Web of Science, Cochrane Library, Embase, CINAHL, CNKI, Wanfang Database, VIP Database and China Biomedical Literature Database. RESULTS: Twelve studies were included from which 52 discrete findings were derived. Following a process of mapping and synthesis guided by the Theoretical Domains Framework and the COM-B model, the various facilitators and barriers associated with ICU nurses' pressure injury prevention practices were consolidated into 13 distinct categories and two overarching synthesized findings. CONCLUSION: Pressure injury prevention practices among ICU nurses constitute a complex behavioral process whose formation involves multiple interacting elements. Future intervention efforts should therefore adopt coordinated strategies that simultaneously address the enhancement of knowledge and skill development alongside the optimization of resource and environmental conditions while also reinforcing individual beliefs and motivation so as to elevate the overall quality of preventive care. IMPLICATIONS: Healthcare providers are encouraged to implement multi-component approaches that concurrently support the development of nurses' clinical competencies and the improvement of organizational resources and that further cultivate sustained motivation, thereby ensuring the delivery of high-quality pressure injury prevention within intensive care environments. IMPACT: By systematically identifying the principal facilitators and barriers that influence ICU nurses' pressure injury prevention practices, this study offers an evidence-informed basis for designing comprehensive interventions aimed at improving prevention quality and patient outcomes in critical care settings. REPORTING METHOD: This study adheres to the Joanna Briggs Institute methodology for meta-aggregation and its reporting conforms to the ENTREQ guideline. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution was made. TRIAL REGISTRATION: PROSPERO database: CRD420261286790.
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Capturing the Work of Nurses in General Practice: Development and Testing of the OCEAN-GPN Tools.

Halcomb E, Mursa R, Randall S … +5 more , Gordon J, Lu Y, Henderson J, Beattie A, Harrison C

J Adv Nurs · 2026 Jun · PMID 42333027 · Publisher ↗

AIM: To provide a worked example of the process used in developing data collection tools to measure the profile and practice of Australian general practice nurses (GPNs). DESIGN: Methodological discussion. METHODS: An it... AIM: To provide a worked example of the process used in developing data collection tools to measure the profile and practice of Australian general practice nurses (GPNs). DESIGN: Methodological discussion. METHODS: An iterative design process encompassing the steps of sandpit development, alpha, beta and pilot (field) testing, alongside stakeholder consultations, was used to develop the Occasions of Care Explained and Analysed (OCEAN)-GPN tools. At each stage, the 'think-aloud' method was used to collect qualitative data and a user survey measured satisfaction with tool development. RESULTS: The application of user-centred design principles shows how the data collection tools were developed for this major national study. Examples of iterative testing strategies illustrate how participants' experiences can inform data-collection processes. CONCLUSION: The OCEAN-GPN tools have been rigorously developed to capture Australian GPNs' profile and clinical activity. The iterative processes and extensive consultation ensured that the tools were fit for purpose and met user needs. Collection of study data using these tools will enable evaluation to inform policy, research, education and clinical practice.
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The European Parliament's Vote on the EU Health Workforce INI Report: An EFN Commentary.

De Raeve P, Ballotta M, Žilić I

J Adv Nurs · 2026 Jun · PMID 42295037 · Publisher ↗

AIM: To discuss the implications of the European Parliament's vote on the Own-Initiative Report (INI) on the EU Health Workforce for nursing policy, workforce sustainability and healthcare systems across Europe. DESIGN:... AIM: To discuss the implications of the European Parliament's vote on the Own-Initiative Report (INI) on the EU Health Workforce for nursing policy, workforce sustainability and healthcare systems across Europe. DESIGN: Critical commentary. METHODS: Critical analysis of the European Parliament's INI Report on the EU Health Workforce, informed by nursing workforce policy priorities and existing evidence on workforce sustainability, patient safety and professional development. RESULTS: The INI Report provides important political support for key nursing priorities, including safe staffing levels, advanced practice nursing, implementation of the Professional Qualifications Directive, ethical recruitment, occupational health and safety, workforce investment, preparedness and co-created digitalisation. The report highlights the importance of strengthening workforce sustainability and improving patient safety across the European Union. CONCLUSION: The European Parliament's recommendations represent a significant opportunity to advance nursing workforce policy at EU level. However, translating these recommendations into effective legislative and operational measures will require sustained political commitment, investment and implementation across Member States.
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Social Avoidance Trajectories, Core Characteristics and Maintenance Factors in Postoperative Breast Cancer Patients: A Longitudinal Mixed-Methods Study.

Chunyan H, Xiaoping D, Xiao P … +2 more , Chao W, Baohua C

J Adv Nurs · 2026 Jun · PMID 42286942 · Publisher ↗

AIM: To examine the trajectories, core characteristics, and maintenance factors of social avoidance in patients with breast cancer during the first postoperative year. DESIGN: Longitudinal, explanatory sequential mixed-m... AIM: To examine the trajectories, core characteristics, and maintenance factors of social avoidance in patients with breast cancer during the first postoperative year. DESIGN: Longitudinal, explanatory sequential mixed-method design. METHODS: This longitudinal study enrolled 176 postoperative breast cancer patients, conducting six follow-up assessments over 1 year. Latent class growth analysis was employed to identify heterogeneous trajectories of social avoidance behaviour, with multivariate logistic regression subsequently analyzing predictive factors. Building on these quantitative findings, semi-structured in-depth interviews were administered to target individuals identified through the analysis. Phenomenological methods were then utilized to elucidate core manifestations and maintenance factors of social avoidance. RESULTS: Among the 176 enrolled breast cancer patients, 138 completed all six follow-up assessments. Latent class growth analysis identified two distinct subgroups with significant differences in social avoidance trajectories: 'persistent high social avoidance' and 'persistent low social avoidance group'. Logistic regression revealed melancholic temperament as an independent risk factor for 'persistent high social avoidance group', while choleric temperament demonstrated protective effects. Phenomenological analysis of qualitative data systematically identified four core themes: (1) affective manifestations, (2) behavioural patterns, (3) psychological drivers, and (4) environmental determinants of social avoidance. CONCLUSION: This study revealed heterogeneous dynamic trajectories of social avoidance behaviour in breast cancer patients, with core manifestations encompassing both affective and behavioural dimensions, sustained by multiple factors of personality, psychology, and environment. IMPACT: This mixed-methods study systematically examined the developmental trajectories, core manifestations, and sustaining factors of social avoidance behaviour in breast cancer patients. The results provide robust evidence to inform precision screening for social avoidance risk, early prevention initiatives, and tailored intervention strategies in clinical nursing practice. REPORTING METHOD: Journal article reporting standards for mixed-methods research. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.
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Broken Links: Gender Disparities Across the Chain of Survival in Out-Of-Hospital Cardiac Arrest.

Rasmussen R, Watson A

J Adv Nurs · 2026 Jun · PMID 42272123 · Publisher ↗

AIM(S): To examine gender-based disparities across each link of the American Heart Association's Chain of Survival for women experiencing out-of-hospital cardiac arrest, highlighting systemic, cultural and educational ba... AIM(S): To examine gender-based disparities across each link of the American Heart Association's Chain of Survival for women experiencing out-of-hospital cardiac arrest, highlighting systemic, cultural and educational barriers that compromise equitable outcomes. DESIGN: A discursive review synthesizing epidemiological studies, public health data and qualitative research on cardiac arrest and gender disparities. METHODS: A comprehensive search of databases including PubMed and CINAHL identified studies on gender differences in out-of-hospital cardiac arrest recognition, bystander intervention, emergency response and post-arrest care. Literature was critically analyzed using constant comparative analysis and organized according to the five links of the American Heart Association's Chain of Survival to identify recurring themes and evidence of disparity. RESULTS: Significant disparities were identified at every link in the Chain of Survival. Women are less likely to have cardiac symptoms recognized, receive bystander cardiopulmonary resuscitation or defibrillation and experience timely or guideline-concordant advanced life support and post-resuscitation care. Contributing factors include implicit bias, underrepresentation of women in resuscitation training materials and social norms that hinder rapid intervention. CONCLUSION: Gender disparities in cardiac arrest survival are systemic and multifactorial, resulting in 'broken links' across emergency response systems, public perceptions and healthcare education. Addressing these inequities requires reforms in public education, resuscitation training and clinical protocols that prioritize gender-sensitive and inclusive care. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Nurses, as educators, advocates and caregivers, are uniquely positioned to drive transformational change in emergency and cardiac care. By championing women-centered and gender-sensitive resuscitation education, implementing inclusive practices and addressing intersectional barriers, nurses can help ensure equitable, responsive and just care. Advancing these priorities is essential for improving survival and neurological outcomes for women and advancing health equity in global healthcare. REPORTING METHOD: We adhered to the principles of the EQUATOR guidelines. This discursive paper did not meet the criteria for a specific standardized checklist. PATIENT OR PUBLIC CONTRIBUTION: No patient or public involvement. This study did not include patient or public involvement in its design, conduct or reporting.
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The Parent Support Team Programme: A Mixed-Methods Evaluation of an Early Intervention-Focused Child and Family Health Nursing Programme.

Parker J, Johns A, Kepu K … +2 more , Livesey P, Kohlhoff J

J Adv Nurs · 2026 Jun · PMID 42249697 · Publisher ↗

AIMS: The Parent Support Team (PST) is an intensive early intervention home visiting programme delivered by child and family health nurses to families with infants aged 0-6 months experiencing psychosocial and health vul... AIMS: The Parent Support Team (PST) is an intensive early intervention home visiting programme delivered by child and family health nurses to families with infants aged 0-6 months experiencing psychosocial and health vulnerabilities. In contrast, mainstream services provide universal clinic-based care and scheduled developmental checks. This mixed-methods study aimed to: (1) describe demographic and psychosocial characteristics, service activity and well-baby check attendance among PST clients compared with mainstream service clients; (2) evaluate changes in maternal depressive symptoms following PST engagement; and (3) explore client experiences, including perceived outcomes and facilitators and barriers to change. DESIGN: Convergent parallel mixed-methods study. METHODS: Retrospective data were extracted from electronic medical records for PST clients (909 mothers; 1038 children) and mainstream service clients (17,707 mothers; 21,764 children) between August 2019 and December 2022. Quantitative analyses described demographics, psychosocial characteristics, service use and maternal depressive symptoms. PST client experience surveys (166 mothers) were analysed using descriptive statistics and thematic analysis. RESULTS: PST clients demonstrated greater psychosocial complexity and higher maternal depressive symptoms at entry than mainstream clients. PST mothers had more frequent service contacts and maintained stronger engagement with services after discharge. The proportion of mothers with clinically significant depressive symptoms decreased following programme participation. Survey findings indicated improved parenting confidence and practical skills. Positive outcomes were attributed to nurse qualities, opportunities to discuss concerns, a holistic care approach and the service model. Reported barriers included accessibility, scope of education topics and communication challenges. CONCLUSION: The PST programme effectively engages vulnerable families, supports maternal mental health and promotes sustained connection with child and family health services. IMPACT: Intensive early intervention home visiting programmes may improve outcomes for families with complex needs and warrant broader implementation. REPORTING METHOD: SRQR guidelines were followed. PATIENT OR PUBLIC CONTRIBUTION: None.
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The Impact of Assisted Dying Legislation on Nursing Practice in Palliative Care: A Scoping Review.

Werner M, Kreyer C, Pleschberger S

J Adv Nurs · 2026 Jun · PMID 42249635 · Publisher ↗

AIM: To review the literature on the state of research on the impacts of assisted dying on nursing practice within specialised palliative care. DESIGN: A scoping review was conducted in accordance with the Joanna Briggs... AIM: To review the literature on the state of research on the impacts of assisted dying on nursing practice within specialised palliative care. DESIGN: A scoping review was conducted in accordance with the Joanna Briggs Institute methodology for scoping reviews. DATA SOURCES: PubMed, Embase, CINAHL, PsycINFO and CENTRAL were searched between July and August 2024. METHODS: Articles were included if they referred to countries in which assisted dying is legally permitted and is understood as a practice that is not aligned with the philosophy of palliative care, enabling analysis of its impact on nursing practice in specialised palliative care. After the screening process, data were extracted and then synthesised using thematic analysis. RESULTS: Fifteen studies published between 2019 and 2024, all from Canada or the United States, met the inclusion criteria. Three themes were identified: (1) positioning and meaning, describing how nurses are required to position themselves and to renegotiate their values; (2) impact on core competencies, capturing changes in key nursing responsibilities; and (3) challenges in interpersonal relationships, referring to increased team conflicts and shifts in relationships with patients and their families. CONCLUSION: The legalisation of assisted dying impacts nursing practice in palliative care in various ways, challenging the established advanced practice role of specialist palliative care nurses. This calls for comprehensive ethical reflection within the nursing profession regarding its role and core values in this context. IMPACT: This review identifies significant challenges facing advanced nursing roles and the palliative care discipline. It provides a foundation for future research and ethical deliberation, with relevance for nurses, educators, policymakers and researchers involved in end-of-life care. PATIENT OR PUBLIC CONTRIBUTION: This study did not include patient or public involvement in its design, conduct or reporting.
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Prevalence and Types of Workplace Violence Against Clinical Nursing Students: A Systematic Review and Meta-Analysis.

Dai Q, Jin Y, Ren YL … +5 more , Guo J, Wang J, Chen J, Tung TH, Wang P

J Adv Nurs · 2026 Jun · PMID 42249625 · Publisher ↗

AIM: To assess the prevalence of workplace violence (WPV) against clinical nursing students during internships and quantify the prevalence of different types of violence, such as physical, verbal and sexual. DESIGN: Syst... AIM: To assess the prevalence of workplace violence (WPV) against clinical nursing students during internships and quantify the prevalence of different types of violence, such as physical, verbal and sexual. DESIGN: Systematic review and meta-analysis. METHODS: Eligible cross-sectional studies that reported WPV prevalence among clinical nursing students were included. Two researchers independently screened literature and extracted data. The Joanna Briggs Institute tool was used to evaluate bias risk. Pooled prevalence rates, heterogeneity and publication bias were examined. DATA SOURCES: A comprehensive search was conducted across eight databases, from the inception of each database to 31 March 2025. RESULTS: A total of 16 cross-sectional studies from eight countries involving 8037 nursing students were included in the analysis, with 11 studies (n = 5550) contributing to the overall pooled estimate. Using a random-effects model, the pooled prevalence of WPV of any type was found to be 40%, with substantial heterogeneity. Verbal violence emerged as the most prevalent subtype (47%), followed by sexual violence (12%) and physical violence (10%). Significant publication bias was detected for both physical and sexual violence, indicating a potential underestimation of the true prevalence. CONCLUSIONS: This systematic review indicated that WPV is a significant occupational hazard encountered by clinical nursing students across diverse international contexts represented during internships. IMPACT: These findings highlight the urgent need for educational and healthcare institutions and policymakers to implement coordinated measures, such as enhanced preventive training, comprehensive reporting and support systems and a zero tolerance safety culture to protect the future nursing workforce. REPORTING METHOD: This systematic review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PATIENT OR PUBLIC CONTRIBUTION: This study did not include patient or public involvement in its design, conduct or reporting. STUDY REGISTRATION: The research protocol was registered with PROSPERO (CRD420251027354).
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Thriving or Leaving? The Role of PERMA Being Associated With Thriving and Retention Among Early Career Nurses.

Terry D, Perkins AJ, Moloney W … +3 more , Jacobs S, Elliott J, East L

J Adv Nurs · 2026 Jun · PMID 42241018 · Publisher ↗

AIM: To examine which elements of thriving and PERMA may be associated with thriving and intentions to leave both the job and profession among early career nurses. BACKGROUND: Retention of early career nurses is a global... AIM: To examine which elements of thriving and PERMA may be associated with thriving and intentions to leave both the job and profession among early career nurses. BACKGROUND: Retention of early career nurses is a global concern, with up to 60% leaving the profession within 2 years. While organisational factors have been widely examined, psychological constructs such as thriving and well-being are underexplored. DESIGN: A cross-sectional design. METHODS: The study surveyed early career nurses (n = 90, response rate 34.1%) across Australia. Validated instruments assessed thriving, PERMA dimensions, organisational support and intention to leave. Multiple linear and logistic regressions identified key factors associated with thriving and intention to leave the job or profession. Reporting adhered to STROBE guidelines for observational studies. RESULTS: Thriving was a significant factor associated with engagement (β 0.039, p = 0.031), relationships with colleagues (β 0.167, p = 032), and occupational hardiness (β 0.502, p = 0.001), while accomplishment was a negative factor associated with thriving (β -0.163, p = 0.001). Intention to leave the job was linked to lower levels of thriving (β -1.303, p = 0.048), reduced perceived organisational support (β -0.180, p = 0.048), and higher negative emotions (β 0.747, p = 0.009). Intention to leave the profession was associated with accomplishment (β 0.222, p = 0.048), perceived organisational support (β 0.193, p = 0.001), and years since graduation (β 0.299, p = 0.016). CONCLUSIONS: Thriving was associated with engagement, peer support, and resilience, whereas attrition was associated with poor organisational support and negative affect. Accomplishment is negatively aligned with thriving and may reflect unmet expectations, increasing role strain, or other personal factors not directly related to organisational contexts. Results suggest psychologically supportive environments and PERMA-informed strategies may be important for enhancing early career nurse retention. Supporting nurses to thrive should be a key focus for managers seeking to sustain the nursing workforce. RELEVANCE TO CLINICAL PRACTICE: This study provides actionable insights for creating psychologically supportive environments that may be associated with improved early career nurse retention. By applying the PERMA framework, healthcare leaders may consider implementing targeted strategies, such as fostering engagement, informing the importance of collegial relationships, and promoting resilience, in order to positively inform well-being and achieve lower levels of attrition in clinical settings. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.
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Factors Influencing Nurses' Participation in Voluntary-Assisted Dying: A National Cross-Sectional Study.

Hewitt J, Bonner A, Wardrop R … +4 more , O'Connor M, Berquier I, Carlini J, Bloomer M

J Adv Nurs · 2026 Jun · PMID 42226469 · Publisher ↗

AIM: To identify nurse practitioners' and registered nurses' willingness to participate in voluntary assisted dying, and the factors that influence these decisions. DESIGN: A cross-sectional design. METHODS: An online su... AIM: To identify nurse practitioners' and registered nurses' willingness to participate in voluntary assisted dying, and the factors that influence these decisions. DESIGN: A cross-sectional design. METHODS: An online survey was disseminated to members of 16 professional nursing organisations and associations between April and August 2024. RESULTS: Responses from 396 participants were analysed. Most were registered nurses (n = 335, 84.6%), aged between 45 and 64 years (n = 217, 54.8%). Over half of the participants (n = 219, 55.3%) had some knowledge of voluntary assisted dying, and more than two-thirds (n = 274, 69.2%) strongly supported it. Respect for a person's rights (n = 345, 89.8%) and relieving suffering (n = 342, 89.1%) were the main reasons nurses participated. Most nurse practitioner participants would be prepared to assess a person's eligibility for voluntary assisted dying (n = 32, 82.1%) or prescribe a substance (n = 31, 79.5%), if permitted by law. Religion, age and years of experience were characteristics associated with reasons for participation. CONCLUSION: In Australia, some RNs and NPs are willing to participate in a range of VAD-related activities. However, in some jurisdictions, nurses' engagement is limited by legislative and policy settings. Reconsideration of nurses' roles may enhance access. IMPLICATIONS FOR THE PROFESSION: With appropriate support, nurses can make a valuable contribution to the sustainability of the voluntary assisted dying workforce.
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Antecedents and Outcomes of Workplace Loneliness in Finnish Nurses: A Cross-Sectional Survey Study.

Mauno S, Mäkelä L, Mäkikangas A

J Adv Nurs · 2026 May · PMID 42216618 · Publisher ↗

AIM: This study provides up-to-date knowledge on the correlates of workplace loneliness among Finnish nurses in the post-COVID-19 era. We examined the factors (background, work-related and dispositional) that were associ... AIM: This study provides up-to-date knowledge on the correlates of workplace loneliness among Finnish nurses in the post-COVID-19 era. We examined the factors (background, work-related and dispositional) that were associated with loneliness among nurses. We also investigated the relationship between loneliness and job burnout, which was used as a mental health outcome in this study. BACKGROUND: Workplace loneliness can be a notable stressor in contemporary working life. However, it has received little attention in nursing since COVID-19. Consequently, the present study focused on the antecedents and outcomes of workplace loneliness in nursing. DESIGN: Cross-sectional survey design was used. METHOD: The dataset (n = 5893) was collected in the spring of 2024 from members of the Finnish Union of Practical Nurses. Analyses were conducted via regression analysis. FINDINGS: Regarding prevalence, over 20% of the nurses reported workplace loneliness at least occasionally. Psychosocial factors were most strongly related to greater loneliness: lack of co-worker and supervisory support, experiences of being bullied, and workaholism. Moreover, loneliness was also associated with the core symptoms of job burnout. CONCLUSION: Loneliness can be experienced in nursing in contemporary working life, and it is likely to be one potential risk factor for nurses' job burnout. Social interventions should be developed and implemented in nursing organisations to tackle workplace loneliness. These interventions should concentrate on providing social support, preventing bullying, and increasing awareness of the 'dark side' of workaholism.
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Shift-Specific Patterns of Nursing Workloads in the Emergency Department: AI Powered Analysis.

Kang Y, Park H, Park I … +2 more , Choi D, Kim S

J Adv Nurs · 2026 May · PMID 42216443 · Publisher ↗

AIM: To identify and differentiate workload patterns across shifts and to provide evidence for optimizing nursing workforce allocation in emergency departments: DESIGN: A cross-sectional study. METHODS: Real time data we... AIM: To identify and differentiate workload patterns across shifts and to provide evidence for optimizing nursing workforce allocation in emergency departments: DESIGN: A cross-sectional study. METHODS: Real time data were collected from an emergency department in a general hospital in Seoul, South Korea, between October 30, 2023 to October 24, 2024. Smartphones, beacons, and smartwatches were used to capture nursing time, physical activity, work-related characteristics, and location transitions across 238 shifts. A multiclass eXtreme Gradient Boosting model was developed and evaluated to classify working shifts (day, evening, night). Shapely Additive exPlanations were applied to identify key contributing features, and shift-specific differences were examined using analysis of variance with post hoc tests. RESULTS: The model demonstrated strong performance in distinguishing shifts. Key features included the number of admissions, discharges, assigned patients, and both direct and indirect nursing time, all of which varied across shifts. In contrast, location transition patterns were relatively consistent. CONCLUSION: Shift-specific nursing workloads in emergency departments can be effectively identified using multidimensional, real-world nursing activity data. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Findings support the development of staffing strategies that account for variation in workload across shifts, with potential to improve efficiency and maintain quality of care. IMPACT: This study addresses the lack of objective evidence for shift-specific workload differences in emergency nursing. It demonstrates that multidimensional activity data can distinguish workload patterns across shifts. The findings may inform staffing decisions for emergency department nurses and support improvements in workforce management and patient care. REPORTING METHOD: This study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology guidelines. PATIENT OR PUBLIC CONTRIBUTION: No patients or members of the public were involved in the design, conduct, analysis, or reporting of this study.
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Evaluation of Evidence-Based Intervention Implementation in Adult Intensive Care Settings: A Scoping Review.

Tarvainen S, Ylimäki S, Kääriäinen M … +7 more , Lemetti T, Qvick J, Jansson M, Meriläinen M, Sneck S, Parisod H, Tuomikoski AM

J Adv Nurs · 2026 May · PMID 42206319 · Publisher ↗

BACKGROUND: Although implementing evidence-based interventions has been shown to improve the quality of care, there is limited evidence evaluating how these interventions are implemented. In intensive care settings, the... BACKGROUND: Although implementing evidence-based interventions has been shown to improve the quality of care, there is limited evidence evaluating how these interventions are implemented. In intensive care settings, the use of evidence-based protocols, guidelines and care bundles has been associated with enhanced care quality and reduced burden on patients. AIM: To identify and map existing evidence on the evaluation of evidence-based intervention implementation in adults' intensive care. DESIGN: A scoping review was conducted by including original published and unpublished studies in English and Finnish. METHODS: The studies were retrieved from five databases (CINAHL, Scopus, Ovid Medline, Medic ja Mednar) from January 2000 to December 2024. The data search was performed on 29 November 2022 and updated on 10 December 2024. The results were synthesized and presented in a tabular and descriptive form. RESULTS: A total of 19 studies were included in the review. These studies evaluated the implementation of evidence-based interventions, focusing on nurse and patient outcomes. Nurse outcomes included measures such as compliance, knowledge and self-confidence. Patient outcomes included indicators such as body temperature, blood glucose, incidence of pressure ulcers and length of stay. CONCLUSION: The evaluation of evidence-based intervention implementation does not consistently extend to the evaluation of the entire implementation process. More consistent research reporting would improve disseminating the evidence. The evaluation implementation makes it possible to show the impact of nurse and patient outcomes. The evaluation results can reveal the success of the implementation. Further research on evaluation implementation, development of systematic and comprehensive evaluation implementation methods, or evaluation matrix is needed. IMPLICATIONS: The review will be useful for nursing professionals in planning evidence of implementation, developing or researching evaluation implementation. Promoting evaluation of evidence-based intervention implementation in Nursing can improve the quality of patient care, improve disseminating evidence and uniformities of care practice. IMPACT: What Problem Did the Study Address? There is limited evidence of evaluation of evidence-based interventions of implementation. Evaluating evidence-based implementation is important to ensure the quality of patient care and patient safety. What Were the Main Findings? Evaluation of implementation of evidence-based interventions focused on nurse and patient outcomes. Evaluation of the entire implementation process was not identified, and implementation strategies were not evaluated. Where and on Whom Will the Research Have an Impact? Evidence-based practice implementation in nursing for researchers, developers, nursing leaders and clinical nursing practitioners who implement and evaluate evidence-based practice implementation. REPORTING METHOD: PRISMA 2020 statement. PATIENT OR PUBLIC CONTRIBUTION: No Patient of Public Contribution: This study did not include patient or public involvement in its design, conduct or reporting.
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Caregiver Burden Among Families of Paediatric Patients With Tuberculosis: A Mixed-Methods Study.

Dong N, Zhang Y, Wei X … +6 more , Shen L, Tao Y, Wu Y, Arbing RHA, Chen WT, Zhang L

J Adv Nurs · 2026 May · PMID 42204780 · Publisher ↗

AIM: To assess caregiver burden and its relationship with health literacy, self-efficacy, stigma, and social support among caregivers of children with tuberculosis in Shanghai, China. DESIGN: Explanatory sequential mixed... AIM: To assess caregiver burden and its relationship with health literacy, self-efficacy, stigma, and social support among caregivers of children with tuberculosis in Shanghai, China. DESIGN: Explanatory sequential mixed-methods design. METHODS: In the quantitative phase, 132 caregivers were recruited from a Shanghai Hospital, and 21 participated in the qualitative interviews. Data were collected (April 2023-April 2025) using the Zarit Burden Interview scale, Chinese Health Literacy Scale for Tuberculosis, General Self-Efficacy Scale, Tuberculosis-related Stigma Scale, Multidimensional Scale of Perceived Social Support, and semi-structured interviews. Quantitative data were analysed using descriptive statistics and multiple regression analyses, and qualitative data were analysed using content analysis. RESULTS: Most caregivers were mothers (72.7%). Burden levels were classified as mild (58.3%), moderate (27.3%), or severe (2.3%). The quantitative analysis identified lower health literacy, limited social support, reduced self-efficacy, and being a female caregiver as significant predictors. Social support partially mediated and self-efficacy mediated the effect of perceived stigma and health literacy on caregiver burden, respectively. Qualitative themes revealed psychological and physical effects, impact on social life, and coping strategies. CONCLUSION: Caregiver burden in paediatric tuberculosis is multidimensional and influenced by complex mechanisms. Interventions should address health literacy gaps, enhance self-efficacy, strengthen social support systems, and implement targeted stigma-reduction strategies while considering developmental-stage-specific needs. IMPLICATIONS FOR PATIENT CARE: Healthcare systems should routinely assess caregiver burden, and multidisciplinary teams should be trained to provide integrated targeted support. IMPACT: This study demonstrates distinct stigma pathways and comprehensively shows that caregiver burden is significantly associated with modifiable psychosocial factors. Consequently, healthcare providers should develop targeted support interventions that address both psychological and practical caregiving challenges, ultimately contributing to improved patient care outcomes and caregiver well-being in tuberculosis management. REPORTING METHOD: This study adheres to the Good Reporting of A Mixed Methods Study checklist. PATIENT OR PUBLIC CONTRIBUTION: None.
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Attitudes Towards Remote Monitoring for Falls Prevention Among Staff, Patients, Residents and Families in Hospital and Aged Care: Scoping Review.

Stephen K, Pu D, Weller-Newton J … +2 more , Manohar R, Haines TP

J Adv Nurs · 2026 May · PMID 42198886 · Publisher ↗

AIM: To examine the reasons for and methods of using remote video monitoring to prevent falls across hospital and residential aged care, and explore how staff, patients, residents and families perceive its use and benefi... AIM: To examine the reasons for and methods of using remote video monitoring to prevent falls across hospital and residential aged care, and explore how staff, patients, residents and families perceive its use and benefits. DESIGN: Scoping Review. METHODS: Following JBI methodology, eight databases were searched in July 2025 with no date restrictions. Two reviewers independently screened studies using predefined criteria, and one reviewer extracted data. Narrative and thematic syntheses described how video monitoring is implemented for falls prevention and explored stakeholders' attitudes. RESULTS: Thirty-five studies were included, with 77% conducted in hospitals and 86% focusing on staff perspectives, highlighting a critical underrepresentation of patients/residents and families. Perceived effectiveness was shaped by underlying motivations-falls prevention, workforce optimisation, or cost reduction. Attitudes were influenced by workload impacts, video monitoring knowledge, ethical and liability concerns. Three remote video monitoring models were identified: technician-based, automated alerts, and nurse-observed without alerts. Technician-based systems were only in hospitals, with no equivalent in aged care. CONCLUSION: Research on remote video monitoring for falls prevention is heavily weighted towards hospitals and staff perspectives. Nurses generally viewed video monitoring as effective but still preferred in-person observers. Although there is interest in innovative monitoring systems in aged care that balance safety with a homelike environment, empirical research is lacking. Patient, resident, and family experiences remain underrepresented and require further research. IMPACT: Remote video monitoring has emerged as an alternative to mobilisation alarms, given their uncertain effectiveness and negative consequences for patients and nurses. Much U.S. hospital research reflects a cost-reduction paradigm aimed at replacing in-person observers, a trend not seen internationally or in aged care. This research is relevant to decision-makers considering technological options for falls prevention and to nurse leaders seeking insight into the appeal and apprehension surrounding video monitoring. REPORTING METHOD: PRISMA-ScR. PATIENT/PUBLIC CONTRIBUTION: None.
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