British Journal of Nursing

The growing pressures on global healthcare systems, driven by an ageing population and increasing care complexity, necessitate innovative alternatives to traditional inpatient care. The ‘Hospital in the Home’ (HITH) model, offering acute-level care in patients' homes, is an emerging solution that has gained traction in both the UK and Australia. This article outlines the establishment and development of a HITH service within one of Australia's busiest tertiary referral hospitals, located in a socioeconomically deprived region in South Western Sydney. It examines how the service has evolved over time, significantly reducing hospital bed occupancy, managing diverse clinical conditions, and adapting to the specific needs of the local population. The analysis also offers insights into the challenges and future directions of the HITH model.

Prostate cancer remains a significant health concern, particularly among older men. This article provides an in-depth examination of prostate cancer, focusing on the critical role of nurses in managing this condition. It covers the pathophysiology, diagnosis and treatment options for prostate cancer, emphasising the importance of patient education, psychosocial support and holistic care. Through a detailed exploration of evidence-based practices, this article aims to enhance nurses' understanding of the subject and their ability to deliver comprehensive care to patients with prostate cancer, ultimately improving patient outcomes and quality of life.

Background When a loved one is hospitalised in the intensive care unit (ICU), the family members' attention is on the patient's condition. This can interfere with family members' own needs and affect psychological wellbeing. Aims To investigate the needs and stressors of family members of patients in ICU and their associations with symptoms of anxiety and depression during the COVID-19 pandemic. Methods A cross-sectional study was conducted with 340 family members of patients admitted to the ICU of a public hospital in São Paulo state, Brazil, between January 2020 and August 2022. Data on sociodemographic characteristics were collected. The Critical Care Family Needs Inventory (CCFNI) and the Hospital Anxiety and Depression Scale (HADS) were administered. Results Family members of patients in the ICU placed a very high level of importance on their needs (median=172). Although the family members were satisfied, not all their needs were met (median=116). In the multivariate analysis, the variables that influenced the CCFNI Importance/Satisfaction score were age (P<0.001), marital status (P<0.001), education level (P<0.001), Catholic religion (P<0.001), previous hospitalisation experience (P<0.001), and HADS depression (P=0.026/P=0.002). The variables that influenced the HADS score included female sex (P<0.001), age (P<0.001), direct relation to the patient (P<0.001), Catholic religion (P<0.001), living with the patient (P<0.001), and CCFNI Importance/Satisfaction (P<0.001). Conclusions Family members of patients in the ICU have essential, but not completely satisfied, needs. HADS was positively associated with the importance of needs and inversely related to the satisfaction of needs. Age and the Catholic religion were the only common variables affecting the variations in needs constructs.

Background Italy's ageing healthcare workforce has led to a demographic imbalance where older nurses (aged 50 years and above) outnumber younger colleagues (aged under 35 years). This has created challenges in intergenerational teamwork and knowledge transfer. Aim To understand how generational differences influence nursing practice, specifically regarding fostering collaboration and improving patient care. Methods This quantitative study surveyed 889 Italian nurses using a self-reported questionnaire, the Multidimensional Nursing Generations Questionnaire (MNGQ). The study analysed generational differences across key dimensions, including adaptability, intergenerational conflict, patient safety perspectives and teamwork. Findings The analysis identified significant generational differences. Younger nurses (Generation Y and Generation Z) reported higher levels of conflict compared to Baby Boomers and Generation X. Younger generations perceived themselves as more adaptable than older colleagues. Baby Boomers and Generation X scored higher than Generation Y (P=0.038) and Generation Z (P=0.027) on patient safety perspectives. Younger nurses reported more complex interactions with colleagues, reflected in higher scores. No statistically significant differences were observed across generations regarding how they worked in a team. Younger generations showed a higher inclination for work engagement compared to Baby Boomers. Conclusions Generational differences among Italian nurses influence perceptions of key aspects of nursing practice, particularly adaptability, patient safety and intergenerational dynamics. These findings emphasise the importance of fostering collaboration through mentoring and knowledge sharing to bridge generational gaps. Promoting multigenerational teamwork can enhance patient care quality and support workforce cohesion in an ageing healthcare system.

Vision, planning and a focus on staff wellbeing is essential if the nursing and midwifery professions are to meet the challenges of tomorrow. Chief Nursing Officers for Scotland, Wales, Northern Ireland and England Anne Armstrong, Sue Tranka, Maria McIlgorm and Duncan Burton reflect on the importance of supporting nurses and midwives as their professions evolve to meet patient need.

Background Nursing migration to other countries has led to a reduction in the nursing workforce in Italy, resulting in increased workload and burnout for remaining staff. Aims To evaluate the perceptions and experiences of Italian nurses who decided to work abroad. Methods A cross-sectional study was conducted using an ad hoc online questionnaire. Findings This study explored the perceptions and experiences of 244 Italian nurses working abroad. The primary motivations included personal growth, economic dissatisfaction in Italy, and exposure to new cultures. Most participants worked in Europe, particularly England and Germany. Although 71% found the documentation process straightforward, 23% faced adjustment challenges, often citing cultural differences and language barriers. Nurses abroad reported high job satisfaction (mean score=135.13), linked to better salaries and career opportunities. Most participants (93%) recommended working abroad but emphasised systemic reforms in the Italian healthcare system, including competitive salaries, recognition of qualifications, and improved recruitment processes, to retain skilled nurses and prevent ‘brain drain’. Conclusion The Italian healthcare system must learn from the successful models adopted abroad to improve working conditions and counter the migration of skilled professionals. Beyond economic incentives, this study highlights the need for greater recognition of nurses' roles, both socially and professionally. Improving work environments and fostering respect and empowerment can reduce migration and ensure the sustainability of healthcare services while preparing future generations to deliver high-quality care.

John Tingle, Associate Professor, Birmingham Law School, University of Birmingham, discusses several reports on NHS patient safety culture development

Sam Foster, Executive Director of Professional Practice, Nursing and Midwifery Council, considers the problem of looking for reassurance that all is well, rather than watching for potential problems

Cancer treatment services face considerable pressures across the SACT pathway. The availability of a subcutaneous formulation of Tecentriq (atezolizumab) presents opportunities to decentralise SACT delivery to new treatment venues. With sufficient workforce training and flexibility, decentralisation could produce a lasting improvement in outcomes. Six case studies are presented highlighting successful examples of service decentralisation using subcutaneous (SC) atezolizumab, covering their impacts on patients.

Bowel dysfunction is widespread, and disorders including constipation and faecal incontinence can have profound impacts on physical health and psychosocial wellbeing, with a consequent financial burden on the wider healthcare system. Transanal irrigation (TAI) is a safe and effective treatment for chronic bowel dysfunction, but access to appropriate care is often delayed due to stigma, unclear treatment pathways or knowledge gaps among healthcare professionals (HCPs). An expert working group developed new guidance to empower HCPs with increased clinical confidence in appropriately implementing TAI, as well as simplify the journey to TAI with a clear, structured and easy-to-navigate approach to support consistent clinical decision-making. The TAI Guide is a visually impactful two-page resource that can used as a standalone tool or embedded into existing pathways, as well as used as a benchmark to support professional education.

Background Cardiac rehabilitation (CR) completion rates are higher in patients living in areas of low deprivation than in those living in areas of high deprivation, widening the health inequality gap. Aim A service evaluation was undertaken in the Coventry CR Service to explore the barriers to and facilitators of service completion among patients living in high-deprivation areas, to understand the most important factors to consider when undertaking service improvements. Design A process map was completed of the current service. Patients’ postcodes were matched with the Index of Multiple Deprivation and used to categorise a high-deprivation area. Purposive recruitment of patients took place during CR clinic appointments. Service users were then interviewed using a semi-structured questionnaire on discharge from the service, and enrolment was stopped at data saturation. Thematic analysis was used. The service was evaluated using the World Health Organization Building Blocks Framework and themes reviewed in terms of service delivery, health workforce, information, technology, and financing. Participants Twelve patients who took part in CR between May and August 2022 were interviewed. Facilitators of completion included: personalised CR programmes, work flexibility, social aspects, relating to others, enjoyment, staff and patient education. Barriers included: family commitments, work, not relating to others, parking, the gym environment and poor communication. Conclusion The two main ways the service could be improved to increase completion is to enhance programme flexibility and patient education in the home-based programme. Investment in technology may mean that facilitators of the gym-based programme, such as monitoring, two-way communication and exercise progression, can be replicated at home.

Quality improvement (QI) plays a critical role in bridging the gap between research and practice in health care, particularly for disciplines that have historically been underrepresented in research, such as nursing and allied health professions. By focusing on real-world challenges and applying evidence-based solutions, QI allows health professionals to engage in research without the extensive time and resource demands of traditional studies. This article explores the value of QI initiatives in enhancing clinical practice, emphasising the importance of systematic approaches incorporating validated QI models. It highlights key barriers to QI adoption, including resource limitations, educational gaps, and inconsistent implementation, while offering strategies to overcome these obstacles. Case study discussion illustrates the potential of QI to improve patient outcomes and streamline healthcare processes, while the discussion of the integration of QI into nursing education and practice in the USA explores ideas that could be implemented here in the UK. Ultimately, embedding QI within healthcare systems fosters a culture of continuous improvement and research engagement, empowering nurses and allied health professionals to contribute to evidence-based care and the advancement of clinical research.

The NHS accounts for approximately 4% of carbon emissions in England. Aseptic techniques are an area where the use of consumables, and subsequent waste, may be high. Traditionally, administration of parenteral nutrition (PN) has been performed using a so-called sterile technique. The aim of this study was to compare the volume of waste generated from a traditional ‘sterile’ technique (Surgical-Aseptic Non-Touch Technique (ANTT)), using sterile gloves and a dressing pack, and Standard-ANTT, using non-sterile gloves, a general aseptic field and a micro-critical aseptic field where necessary in the administration of PN. Two procedure trays were arranged representing consumable equipment used in each procedure. All items including packaging were weighed. Standard-ANTT demonstrated an estimated 52% reduction in waste and carbon emissions. There is a pressing need for nurses to review practice and consider where more sustainable choices can be made in the administration of PN.

This article presents the findings of a 6-month service evaluation following the addition of a computed tomography (CT) abdomen scan to the gastrostomy placement pathway for patients with motor neurone disease (MND). Background: several patients had failed percutaneous endoscopic gastrostomy (PEG) placements. A CT scan was introduced to identify if it would be possible to place a PEG or another gastrostomy such as a radiologically inserted gastrostomy (RIG). Aims: To assess cost-effectiveness of adding a CT scan to the pathway and evaluate if it was improving patient experience. Method: Data from 1 February 2024 to 1 August 2024 indicated when the PEG was planned, CT outcomes and whether the gastrostomy was successful. Results: Results from patients (n=19) showed changes from the CT scan for 4 patients; 18 patients had a successful gastrostomy. There were cost savings from the implementation of the CT scan. There were minimal differences reported by patients in post-procedural complications. Conclusion: Incorporating a CT scan before gastrostomy procedures for patients with MND can enhance planning, reduce failures, and improve patient outcomes. Cost savings were evident.

Sam Foster, Executive Director of Professional Practice, Nursing and Midwifery Council, considers the vital numerical and qualitative data collected through local and population-based surveys of NHS services

Perianal fistulising Crohn's disease (PFCD) is a debilitating phenotype of Crohn's disease, with a lifetime incidence of 20–30% in people living with the disease. Symptoms include perianal pain, perianal discharge and faecal incontinence, with repercussions for a patient's physical and mental health, psychosocial wellbeing and productivity. PFCD is challenging to treat, with existing therapeutic options achieving modest fistula remission rates only. While research initiatives are under way to characterise PFCD pathogenesis and optimal treatment approaches, the focus should be on early diagnosis and prompt management. This can be achieved with patient education, effective co-ordination of care within the multidisciplinary team and an accessible inflammatory bowel disease (IBD) service. IBD specialist nurses may be the first health professionals to encounter a patient with a new diagnosis of PFCD or its complications. This review article summarises the existing evidence relating to clinical aspects of PFCD from a multiprofessional perspective and discusses the role of a dedicated IBD surgical link nurse in PFCD management in a tertiary centre setting.

This article aims to provide health professionals involved in diabetes management with nutrition options to support their advice and guidance when speaking to patients. The review examines dietary strategies for managing type 2 diabetes, focusing on their impact on glycaemic control, weight loss and long-term health outcomes. Diets and nutrition options, including the Mediterranean and Nordic diets, low calorie consumption and medical nutrition therapy, can be effective in regulating blood glucose levels, improving lipid profiles and reducing the risk of cardiovascular disease. Health professionals need a comprehensive understanding of optimal nutrition plans to personalise dietary interventions and improve patient outcomes.