Journal of Clinical Nursing

Aim To explore flight nurses' experiences with interhospital transportation of critically ill patients in fixed‐wing aircraft. Design The study had a qualitative explorative and descriptive design. Research Methodology Nine flight nurses working at five different air bases across Norway were interviewed. Systematic text condensation was used to analyse the data. The study was reported according to the COREQ checklist. Findings The data analysis resulted in three categories: Flight nurses being one step ahead when preparation for transporting patients in out‐of‐hospital environments, Flight nurses' strategies for effective and safe patient transport within the aircraft environment, and Flight nurses' need for a structured and organised handover of patients. Conclusion The flight nurses emphasised the need for extensive preparation prior to aeromedical transport to enhance patients' safety. The aircraft environment was a challenge that required them to be creative with the limited resources available and to have a well‐functioning interprofessional teamwork. Implications for Clinical Practice Knowledge about flight nurses' experiences with interhospital transportations could provide a path to standardisation and inform strategies to enhance interprofessional teamwork. Such knowledge could also contribute to humanising nursing practice during the transportation of critical care patients. Patient or Public Contribution There were no patient or public contributions.

Aims The purpose of this study was to describe the strategies older adults use to maintain their balance and prevent themselves from falling in the hospital. Design The Expanded Health Belief Model served as the theoretical framework for this qualitative descriptive study. Methods Audio‐recorded, semi‐structured interviews were conducted with 15 (N = 15) older adults (female 53.3%), mean age of 77 (SD 9.9) admitted to a rural community hospital in the United States. Each transcript was analysed independently by two researchers using content analysis before reaching consensus. Sample size was guided by thematic saturation. Trustworthiness was ensured by using the criteria outlined by Lincoln and Guba. Results Four main themes emerged: My Balance Problem is My Personal Responsibility, Self‐efficacious Common‐Sense Balance Management Strategies, Hospital Staff as Contributors or Disruptors of My Balance Management, and My Needs for Balance Management Support. The older adults used extensive mental efforts in planning and executing personal strategies to maintain balance and viewed this as their personal responsibility. Their self‐efficacious balance management strategies included observing the environment, assessing furniture and equipment, staying focused, and moving slowly. Assistance from hospital staff members either supported or disrupted the older adults' balance management efforts. The older adults desired to learn more about fall prevention in the hospital. The older adults found physical guidance, demonstration and verbal guidance to be the preferred method of learning. Conclusion Rurally hospitalised older adults employ independent, self‐efficacious balance management strategies. Implications Older adults' personal balance management strategies must be recognised by healthcare workers. Impact Future inpatient fall prevention interventions and policies must focus on exploring hospitalised older adults' optimal and suboptimal balance management behaviours to develop patient‐centred fall prevention interventions to decrease inpatient falls among older adults. Reporting Method The Consolidated Criteria for Reporting Qualitative Research. Patient or Public Contribution No patient or public contribution.

Aims To identify subgroups of dyadic coping discrepancies between adolescents with chronic diseases and their parents using latent profile analysis, and to examine variations among these subgroups in socio‐demographic characteristics, family resilience and psychological adjustment outcomes. Design Cross‐sectional study. Methods Between June 2022 and August 2023, 318 adolescent–parent dyads were recruited from three paediatric hospitals in China. Adolescents and their parents completed the General Information Questionnaire, the Dyadic Coping Inventory, the Chinese version of the Family Resilience Scale and the Chinese version of the Psychological Adjustment Scale. Results A three‐class solution provided an optimal fit, identifying the following subgroups: adolescent–parent dyadic coping similarity group (61%), low adolescent–high parent dyadic coping group (20%) and high adolescent–low parent dyadic coping group (19%). Multiple logistic regression analyses indicated that family resilience among adolescents and their parents significantly influenced the classification of dyadic coping discrepancies. A one‐way ANOVA demonstrated significant differences in psychological adjustment among the three subgroups. Conclusion This study identified distinct patterns of dyadic coping discrepancies between adolescents with chronic diseases and their parents, highlighting the variability in coping strategies within these dyads. Family resilience significantly influenced dyadic coping patterns, with higher levels of family resilience associated with more effective dyadic coping. Furthermore, the dyadic coping profiles were significantly associated with the psychological adjustment of adolescents and parents, highlighting the critical role of dyadic coping in individual well‐being. Reporting Method This study adhered to the STROBE checklist. Patient or Public Contribution No patient or public contribution. Impact Our findings provide valuable insights for health professionals to design tailored interventions and implement stratified care addressing the unique needs of adolescents and their parents. Prioritising support for individuals with lower family resilience is critical, as are targeted dyadic coping interventions is essential to enhance the psychological adjustment of adolescents with chronic diseases and their parents.

Aim This study was conducted to determine the impact of regular visits by Generation Z individuals on the psychological well‐being and optimism–pessimism levels of elderly people in a nursing home. Methods The study employed a quasi‐experimental design with a single group, utilising pre‐test and post‐test measurements. “Psychological Well‐Being Scale,” and the “Optimism‐Pessimism Scale‐Adult Form” were used. Study reported in accordance with STROBE Checklist. Results The participants (n = 201) had a mean age of 72.40 ± 7.72 years, with most residing in the nursing home for over 5 years. A significant difference was observed between the mean psychological well‐being scores of participants before and after the visit. Also, there was a significant difference in the optimism–pessimism dimension scores on the Optimism–Pessimism Scale before and after the visit. Conclusion It was established that regular intergenerational visits had a beneficial impact on the psychological well‐being of the elderly in nursing homes, resulting in an increase in optimism and a reduction in pessimism. Relevance to Clinical Practice Intergenerational programs are gaining more and more attention every day due to their potential to benefit young people, older people, and society. Thus, it may be possible to increase the social support levels of the elderly and prevent negative age discrimination.

Aim The aim of this study was to investigate the effect of postoperative thirst on patient comfort and quality of recovery in patients undergoing colorectal surgery. Design This study is an analytical cross‐sectional study. Methods This study was conducted between July 2022 and January 2023 in the general surgery clinics of a university hospital in Ankara, Türkiye. The study sample consisted of 110 patients. Patient Identification Form, Thirst Symptom Assessment Scale (TSAS), Numeric Rating Scale (NRS), Perianesthesia Comfort Scale (PCS) and Quality of Recovery‐40 questionnaire (QoR‐40) were used for data collection. The severity of thirst was assessed three times: at the time of arrival to the postoperative clinic, at the 8th hour, and at the 24th hour, and the PCS and QoR‐40 scales were administered at the 24th hour. Results In this study, more than half of the patients were male (62.7%) and the mean age was 61.35 ± 13.79 years. The mean thirst severity of the patients was 12.25 ± 4.65, 12.36 ± 4.49 and 11.27 ± 4.76 according to the TSAS, 7.27 ± 2.39, 7.27 ± 2.01 and 6.17 ± 2.89 according to the NRS, respectively. The mean total score of PCS was 5.12 ± 0.43 and the mean total score of QoR‐40 was 171.58 ± 10.33. Postoperative 8th hour thirst severity according to NRS, PCS total score level and postoperative thirst severity measured by TSAS at three times were found to have a significant effect on QoR‐40 total score level in a decreasing direction. PCS total score was found to have a significant effect on QoR‐40 total score level in an increasing direction. Conclusions The results obtained in this study showed that the thirst symptom experienced by the patients was moderate. It was determined that an increase in the severity of thirst decreased patients' comfort and quality of recovery levels, whereas an increase in comfort level increased the level of quality of recovery. Implications for the Profession and/or Patient Care It is recommended that the severity of thirst should be assessed frequently with appropriate scales and appropriate nursing care should be provided for thirst management in order to increase the postoperative comfort of patients and to improve their recovery more positively. Impact No study has been found to describe and compare the effect of postoperative thirst on comfort and quality of recovery in patients undergoing colorectal surgery. In this study, it was found that an increase in the severity of postoperative thirst decreased the level of postoperative comfort and quality of recovery, whereas an increase in the level of postoperative comfort increased the level of quality of recovery. This information can be used to optimally manage the symptom of thirst after colorectal surgery, develop evidence‐based nursing interventions, and improve the quality of care. Reporting Method This study was reported according to the STROBE checklist. Patient or Public Contribution Patients answered the scales with their voluntary consent. There is no public contribution.

Aims To determine the treatment effectiveness associated with mobile health‐delivered cognitive behavioural therapy for insomnia (mCBT‐I) interventions for adults with insomnia and to identify the potential characteristics associated with better treatment outcomes. Design A systematic review and meta‐analysis was conducted following the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA 2020) guidelines. Methods Seven English‐ and two Chinese‐language databases were searched, without restrictions on publication dates, up to July 2024. Reference lists of relevant reviews and grey literature were included in the search. Randomised controlled trials evaluating mCBT‐I in adults with insomnia and published in either English or Chinese were included in this meta‐analysis. A random‐effects model was used for data analysis, accompanied by additional subgroup analyses and meta‐regression. Results Sixteen studies involving 2146 participants were included in this meta‐analysis. mCBT‐I interventions were associated with significantly reduced insomnia symptoms and improved sleep quality at post intervention, at 1–3‐month follow‐up, and at 4–6‐month follow‐up. Interventions that included five components of CBT‐I, were delivered for 6 weeks or longer, and were conducted in a group format were linked to better treatment outcomes; the differences in other subgroup categories were not statistically significant. Studies involving participants with comorbid conditions showed a greater effect in reducing insomnia symptoms than those without such participants. In addition, mCBT‐I interventions delivered by healthcare professionals resulted in statistically larger effect sizes for improving sleep quality than self‐help regimens. Conclusions The systematic review and meta‐analysis identified the effectiveness of mCBT‐I in reducing insomnia symptoms and improving sleep quality and offered practical implications for the development of effective mCBT‐I interventions in clinical practice. However, future robust studies are needed to explore the long‐term effects of mCBT‐I interventions. Patient or Public Contribution No patient or public contribution. Trail Registration PROSPERO CRD: 42023454647

Background and Aim The geriatric nutritional risk index (GNRI) predicts adverse outcomes in chronic diseases, but its prognostic value for major adverse limb events (MALE) in elderly patients with peripheral artery disease (PAD) remains unverified; thus, this study aimed to establish the association between GNRI and MALE. Design A multicenter, prospective study. Methods From January 2021 to August 2022, 1200 patients with PAD aged ≥ 60 years were enrolled. Patients were stratified by GNRI value (At‐risk group: ≤ 98 vs. No‐risk group: > 98). Data were analysed through Kaplan–Meier curves, multivariable Cox regression, restricted cubic spline (RCS) modelling, and subgroup analyses. Results Among 1036 completers (13.7% attrition rate), 275 (26.5%) developed MALE during a mean follow‐up of 18.9 ± 8.0 months. Kaplan–Meier analysis demonstrated significantly higher MALE incidence in patients in the At‐risk group (log‐rank p < 0.001). Adjusted Cox models revealed a 45% increased MALE risk in patients in the At‐risk group (HR 1.45, 95% CI 1.12–1.86, p = 0.005). RCS identified a non‐linear L‐shaped relationship (p = 0.006) with inflection at GNRI = 95: Below 95, each 1‐unit GNRI increase reduced MALE risk by 9% (HR 0.91, 95% CI 0.88–0.95, p < 0.001), while no significant association existed above 95. Subgroup analyses confirmed consistency across subgroups (all p‐interaction > 0.05). Conclusions GNRI exhibits a non‐linear L‐shaped association with MALE risk in elderly patients with PAD, demonstrating critical prognostic utility below the 95 inflection point. Routine GNRI monitoring should be prioritised for patients with GNRI < 95 to guide preventive interventions. Relevance to Clinical Practice GNRI should be incorporated as a routine risk assessment tool for elderly patients with PAD, with particular vigilance required for those with GNRI < 95. Prioritising nutritional screening and intervention in patients with GNRI < 95 may potentially improve clinical outcomes. Patient or Public Contribution Patients contributed to this study by completing follow‐up assessments. Reporting Method This study followed the STROBE guidelines.

Aim(s) To explore which regularly prescribed medications are most commonly administered to older adults in aged care facilities in Australia, by whom and when, and to identify the prevalence of polypharmacy in this population group. Design Retrospective descriptive study. Methods This study involved exploratory analysis of de‐identified medication administration records from March 17, 2023–March 18, 2024. Older adults' demographic and medication administration data were requested from two electronic medication chart providers in Australia. For inclusion, older adults must have been living in an aged care facility for the entire timeframe. Data were analysed using descriptive statistics, activity pattern analysis, Welch two sample t‐tests, ANOVA and independent sample t‐tests. The STROBE checklist was used to report this study. Results In all, 12,438 older adults were included, with a median age of 87, spanning 287 aged care facilities across Australia. Nervous system medications (over 16 million doses) and alimentary tract/metabolism medications (over 12 million doses) were the most administered. Within these, paracetamol 500 mg tablets and docusate sodium 50 mg + sennoside B 8 mg tablets were the most common. Quetiapine, a strong anticholinergic medication, was also present in the top 30 most administered medications. Certified nursing staff were the primary administrators of medication (66% of actions), followed by non‐nursing staff (27%). Medications were predominantly administered before 10 am and after 10 pm. With a median of 8 regular medications administered per older adult per day, 78% experienced polypharmacy. Conclusion The most common regular medications administered in aged care facilities were non‐opioid analgesics and laxatives. Many medications were administered in the late evening, where staffing levels were likely to be limited. There was a high prevalence of polypharmacy, and non‐nursing staff were involved in medication administration. Implications for the Profession and/or Patient Care This study offers important insights and new knowledge around use of regular medications in aged care facilities, using a nationally representative sample from Australia. It highlights the high volume of non‐opioid analgesics and laxatives administered to older adults, some of which may be optimised, modified or replaced with nonpharmacological alternatives to reduce medication burden. This study also notes that not all regular medications are being administered in Australia by certified nursing staff, and that medication administration activity peaks during both breakfast and late evening rounds. These are important considerations for aged care facilities when assessing staffing ratios, rostering, and how to reduce competing demands for aged care staff. Although much attention has been placed on reducing polypharmacy and optimising medications for older adults, this study also identifies that polypharmacy is prevalent, with 78% of older adults experiencing this through use of regular medications alone. The findings of this study will enable more informed discussions between nursing staff, prescribers, pharmacy and potentially older adults and their families around regular medication and its administration in aged care facilities. Reporting Method The STROBE checklist was followed. Patient or Public Contribution No patient or public contribution.

Aims To examine a model of the caregiving adaptation process among family caregivers supporting care recipients at home. Background Global demand for the support of adults with long‐term care needs and family caregivers is increasing. Caregivers' quality of life is affected by positive and negative appraisals of care; however, few studies have simultaneously investigated these factors. Design A cross‐sectional study. Method The STROBE checklist for cross‐sectional studies was followed. Seventy‐four randomly selected home‐visit nursing stations in Japan participated in this study from June 2023 to June 2024. A self‐administered anonymous questionnaire was provided to family caregivers with care recipients at home. A total of 168 questionnaires were analysed. The variables included in the model were the European Quality of Life five‐dimension five‐level (EQ‐5D‐5L) instrument, positive and negative appraisals of care scale, four external resources and three internal resources, and six characteristics of caregivers and care recipients. Descriptive statistics and correlations between variables were analysed. The model was tested using structural equation modelling. Results Family caregivers' negative appraisal of care directly and negatively affected quality of life, and positive appraisal of care had no statistically significant association with quality of life. Positive appraisal of care had a direct negative association with negative appraisal of care. External resources such as support from nurses directly affected the positive appraisal of care. Internal resources such as caregivers' coping strategies had a significant negative effect on negative appraisal of care. Conclusion The findings suggest that improving caregivers' quality of life requires support to decrease negative appraisal of care by increasing internal resources and increase positive appraisal of care by providing external resources. Understanding the caregivers' adaptation process model is essential to prevent the deterioration of their quality of life. Reporting Method STROBE guidelines. Patient or Public Contribution Seventy‐four home visit nursing stations and participants who care for family members through home visit nursing were involved in the survey investigation and answering the questionnaires. Implications for the Profession and Patient Care For supporting family caregivers' QoL, a reduction in negative appraisals of care is essential, increasing internal resources such as caregivers' coping and positive appraisal of care directly reduces negative appraisal of care.

Aim To analyse existing knowledge on the psychometric properties of the Braden Scale when used within the acute care setting. Design Systematic review and narrative synthesis. Methods A database search was conducted in June 2023 and updated in February 2024, seeking studies testing the psychometric properties of the Braden scale in the acute care setting. Data were sourced from five electronic databases (CINAHL, EMBASE, MEDLINE, Scopus and Web of Science). Study selection, data extraction and assessment of risk of bias were completed, with two reviewers independently conducting each stage and an independent reviewer arbitrating discrepancies. Data were extracted using a customised template and synthesised narratively. Risk of bias was assessed using the COnsensus‐based Standards for the selection of health Measurement INstruments (COSMIN) checklist. Results Thirty‐seven studies met the inclusion criteria. Internal consistency was reported between 0.64 and 0.78 (Cronbach's alpha). Inter‐rater reliability was high, reported as ranging from 0.946 to 0.964 (intra‐class correlations) or 0.86 to 0.949 (Pearson's correlation). Most validity studies tested predictive validity with wide variances reported. Conclusion The Braden Scale is reliable for assessing the risk of PI in acute care, but the validity of the scale is variable. Further research investigating validity beyond predictive validity is required. Relevance to Clinical Practice Nurses working in acute care can use the Braden Scale with confidence of scale reliability. However, validity is variable and warrants a cautious approach. The true value resides in the capacity to trigger recognition of pressure injury risk. Trial Registration: The protocol was registered a priori with the International Prospective Register of Systematic Reviews PROSPERO ref: CRD42023407545

Aim To examine the feasibility of using a large language model (LLM) as a screening tool during structured literature reviews to facilitate evidence‐based practice. Design A proof‐of‐concept study. Methods This paper outlines an innovative method of abstract screening using ChatGPT and computer coding for large scale, effective and efficient abstract screening. The authors, new to ChatGPT and computer coding, used online education and ChatGPT to upskill. The method was empirically tested using 400 abstracts relating to public involvement in nursing education from four different databases (CINAHL, Scopus, ERIC and MEDLINE), using four versions of ChatGPT. Results were compared with a human nursing researcher and reported using the CONSORT 2010 extension for pilot and feasibility trials checklist. Results ChatGPT‐3.5 Turbo was most effective for rapid screening and had a broad inclusionary approach with a false‐negative rate lower than the human researcher. More recent versions of ChatGPT‐4, 4 Turbo, and 4 omni were less effective and had a higher number of false negatives compared to ChatGPT‐3.5 Turbo and the human researcher. These more recent versions of ChatGPT did not appear to appreciate the nuance and complexities of concepts that underpin nursing practice. Conclusion LLMs can be useful in reducing the time nurses spend screening research abstracts without compromising on literature review quality, indicating the potential for expedited synthesis of research evidence to bridge the research–practice gap. However, the benefits of using LLMs can only be realised if nurses actively engage with LLMs, explore LLMs' capabilities to address complex nursing issues, and report on their findings. Implications for the Professional and/or Patient Care Nurses need to engage with LLMs to explore their capabilities and suitability for nursing purposes. Patient or Public Contribution No patient or public contribution.

Background The effect of prehabilitation on reducing the level of postoperative stress and facilitating recovery has been proven to be controversial in previous studies involving patients with cancer. This review contributes to the improvement of an intervention programme by qualitatively integrating the prehabilitation experiences of patients with cancer. Objective This review aimed to integrate the individual experiences of patients with cancer who had received prehabilitation interventions to identify the barriers and facilitators to implementation, which can be used to understand patients' adherence behaviours. Design This was a qualitative evidence synthesis review. Methods Articles were systematically searched from inception to February 18, 2025, using four English databases and three Chinese databases. Keywords and Medical Subject Headings were used to identify potential studies written in both Chinese and English. This study was performed using the Joanna Briggs Institute qualitative systematic review methodology. Results Twenty‐five articles were included in this review. Guided by the Theoretical Domains Framework (TDF), eight synthesised findings were extracted, focusing on the representation of factors influencing the adherence of patients with cancer to prehabilitation, including the domains of knowledge (two facilitators), reinforcement (two facilitators), beliefs about consequences (two facilitators), beliefs about capabilities (two barriers), environmental context and resources (two barriers, one intervention preference factor), social influence (one facilitator, one intervention preference factor), emotion (one barrier, one facilitator) and behavioural regulation (one facilitators, two intervention preference factors). Conclusion Our findings indicate that the adherence to prehabilitation among patients with cancer is shaped by a dynamic interplay of determinants. Structured assessments, self‐monitoring, tailored interventions and tele‐prehabilitation can improve patients' self‐efficacy, perceived benefits and access to resources, which in turn can facilitate their completion of prehabilitation. Impact This study deepens our understanding of behaviours related to adherence to prehabilitation among patients with cancer and provides valuable guidance for the formulation and optimisation of subsequent prehabilitation intervention programmes. Reporting ENTREQ. Patient or Public Contribution No patient or public contributions. Trial Registration PROSPERO CRD: 42024553972

Aim To examine the evidence from systematic reviews on the development, implementation, and/or sustainability of age‐friendly cities and communities programmes. Design This review was informed by the Joanna Briggs Institute umbrella review methodology. Methods Critical appraisal, data extraction, and synthesis were carried out according to the Joanna Briggs protocol for undertaking umbrella reviews. Data Sources An extensive CINAHL, MEDLINE, PsychINFO, PubMed and Scopus search was conducted for literature published from January 2007 to July 2024. Finalised search terms included ‘age‐friendly’, ‘age‐friendly cities and communities’ ‘systematic review’, meta‐analysis', ‘integrative review’, ‘narrative review’, ‘scoping review’, ‘rapid review’ and ‘scientometric review’ in combination with index terms were utilised to locate relevant literature. Results Ten reviews were included comprising 4 scoping reviews, 1 interpretive review, 1 integrative review, 2 systematic reviews, 1 rapid review and 1 structured literature review. Synthesised findings were presented under the categories of ‘Development’; ‘Implementation’; and ‘Sustainability’. Conclusion The findings are relevant to policy, practice and research. Longitudinal and evaluation research is needed to determine the long‐term sustainability of AFCC programmes. More evidence is required on the success of programmes in marginalised communities and low to middle‐income countries. Designing appropriate environments for ageing in place has far‐reaching implications for the health and well‐being of communities, especially our oldest citizens. This is particularly salient in this time of unprecedented population ageing. Nurses must have an in‐depth understanding of the broader determinants of health, including ensuring environments are fit for purpose and meet the needs of older communities. Implications for the Profession and/or Patient Care Understanding the importance of ensuring our cities and communities are age‐friendly will positively influence the health and social care provided by nurses to older adults. Reporting Method The Preferred Reporting Items for Systematic Reviews and Meta‐Analyse checklist were used to report the screening process. Patient or Public Contribution There was no patient or public contribution to this umbrella review. Trial Registration The PROSPERO registration number: CRD42023413096 (https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=413096)

Aims This study was to create an interpretable machine learning model to predict the risk of mortality within 90 days for ICU patients suffering from pressure ulcers. Design We retrospectively analysed 1774 ICU pressure ulcer patients from the Medical Information Mart for Intensive Care (MIMIC)‐IV database. Methods We used the LASSO regression and the Boruta algorithm for feature selection. The dataset was split into training and test sets at a 7:3 ratio for constructing machine learning models. We employed logistic regression and nine other machine learning algorithms to build the prediction model. Restricted cubic spline (RCS) was used to analyse the linear relationship between the Braden score and the outcome, whereas the SHAP (Shapley additive explanations) method was applied to visualise the model's characteristics. Results This study compared the predictive ability of the Braden Scale with other scoring systems (SOFA, APSIII, Charlson, SAPSII). The results showed that the Braden Scale model had the highest performance, and SHAP analysis indicated that the Braden Scale is an important influencing factor for the risk of 90‐day mortality in the ICU. The restricted cubic spline curve demonstrated a significant negative correlation between the Braden Scale and mortality. Subgroup analysis showed no significant interaction effects among subgroups except for age. Conclusions The machine learning‐enhanced Braden Scale has been developed to forecast the 90‐day mortality risk for ICU patients suffering from pressure ulcers, and its efficacy as a clinically reliable tool has been substantiated. Patient or Public Contribution Patients or public members were not directly involved in this study.

Aim To explore the experiences of new graduate registered nurses in caring for the deteriorating patient in rural areas. Background New graduate registered nurses often feel unprepared to care for the deteriorating patient. Whilst literature has recognised new graduate registered nurses working within metropolitan areas feel ill‐equipped to care for deteriorating patients, there is a paucity of literature focused on experiences within the rural context. Design Qualitative, descriptive phenomenological approach. Methods In‐depth interviews were undertaken with 7 participants in rural Eastern Australia with collected data being subject to thematic analysis. Results Three themes were identified that shares the lived experiences of the participants as they transitioned into the rural team: First encounters—Transition to the rural team; Practice support for managing deterioration; and The road to confidence. Conclusion New graduate registered nurses are unprepared to care for the deteriorating patient in rural areas. Practice support and barriers to ongoing education are influential on their experience with findings from this study supporting focused rural healthcare preparation from tertiary education providers, plus structured practice support from senior rural nurses and health facility orientation programs. Preparation should include the use of digital technologies and escalation and management of the deteriorating patient alongside rural policies and procedures to enhance patient safety and support new graduate rural nurses. Implications for the Profession and/or Patient Care The findings have implications for tertiary undergraduate nursing education and those supporting New Graduate Registered Nurses in their transition to practice in rural areas. Enhancement of new graduate nurses' skills and abilities in recognition and responding to patient deterioration through both technological and personnel support will enhance patient safety within rural health care. Reporting Method Standards for Reporting Qualitative Research (SRQR). Patient or Public Contribution 7 participants were involved in the study.

Aims First, to investigate residential aged care staff's knowledge and understanding of residents after viewing their digital life story. Second, to examine the stability of this knowledge and understanding. Third, to explore staff's self‐reported care practices following digital life story viewing. Background Australian aged care quality standards include person‐centred care practices, although opportunity for residents' identity expression can be limited by the facility environment. Staff cannot implement such practices without first understanding residents' history, preferences, and values. Design The study used a convergent mixed methods design. Methods Residential aged care staff (n = 61) viewed a resident's digital life story and completed a measure of their knowledge and understanding of the resident at pre‐test, post‐test, and follow‐up. At post‐test and follow‐up, staff were also asked to indicate if viewing the story had improved their interactions and care practices with the resident and to describe changes in their practice. Pre‐test, post‐test and follow‐up scores of the measure were compared using a repeated measures analysis of variance with post hoc comparisons. Qualitative responses were analysed using thematic analysis. Results Scores at post‐test and follow‐up were significantly higher than at pre‐test, showing a stable improvement in knowledge and understanding of residents. Staff responses indicated their knowledge and understanding of residents' life story enhanced their care towards the residents. Conclusion Watching digital life stories was associated with stable improvements in staff's knowledge of residents, with staff feeling better equipped to personalise care practices. Impact on Clinical Practice Digital life stories about aged‐care residents may support staff's improved knowledge and understanding of their care‐recipients. With such understanding, staff are more equipped to implement person‐centred care practices by Australian aged care quality standards. Reporting Method The study adhered to guidelines for Revised Standards for Quality Improvement Reporting Excellence (SQUIRE 2.0). Patient or Public Contribution No patient or public contribution.

Background Adolescents with mental health difficulties often attend acute paediatric services. There is a need to establish how well these services address their difficulties. No systematic review of this issue for adolescents aged 12–17 has been published. Aim To explore perspectives of healthcare professionals, adolescents and families on the provision of care for adolescents with mental health difficulties in acute paediatric services. Design Mixed methods systematic review. Methods Authors screened published studies using Covidence for eligibility and extracted data. Findings were synthesised using qualitative convergent synthesis. Studies were critically appraised using the Mixed Methods Appraisal Tool (MMAT). Data Sources Five databases were searched: MEDLINE, PsycINFO, CINAHL, Embase and Web of Science Core Collection from June 2003 to July 2023. Results Sixteen studies were included. Eleven studies were good quality, three were low quality and two were fair quality. Healthcare professionals' perspectives consisted of two themes: barriers and facilitators of care. Adolescents' perspectives consisted of two themes: perceptions of care and supportive and unsupportive interpersonal interactions. One study explored families' experiences of care. Conclusion Perspectives of care were similar across various countries and suggest that acute paediatric services do not adequately address mental health difficulties. There is a need for more support and education for healthcare professionals, targeted interventions and further research. Reporting Method The SWiM guideline was used to ensure a transparent and systematic literature review. No patient or public contribution. Trial Registration PROSPERO: CRD42023443336 (https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=443336)

Background Many studies have identified the negative psychological impact of in vitro fertilisation and embryo transfer (IVF‐ET) on couples with infertility, but there remains a paucity of research clarifying both positive and negative effects within the context of Chinese culture. Aim To explore the dynamic psychosocial experiences and underlying mechanisms of couples in the whole process of IVF‐ET, and to construct a theoretical framework that elucidates this phenomenon within the context of Chinese social‐culture. Design A grounded theory study. Methods Guided by constructivist grounded theory methodology, semi‐structured face‐to‐face interviews were conducted in the reproductive medicine outpatient department of a tertiary‐level hospital located in northwest China between January and October 2023. Purposive and theoretical sampling methods were used to recruit couples undergoing IVF‐ET. Data were analysed through three iterative steps: initial coding, focused coding, and theoretical coding, utilising constant comparative methods and reflective memo‐writing. The study is reported using the COREQ checklist. Results Theoretical saturation was achieved after interviewing 22 couples. The substantive theory was synthesised into one core category: ‘forward or backward’, which captured the ambivalent psychosocial experiences of couples undergoing IVF‐ET within the context of Chinese culture. This theory described three overarching stages: making the decision, undergoing the treatment, and facing the result, with each stage linked to specific promoting and hindering factors. Conclusion This study establishes a theoretical foundation for further implementation of comprehensive reproductive health management within the Chinese sociocultural context. It is crucial for healthcare providers and policymakers to focus on the dyad of couples undergoing IVF‐ET, pay attention to both negatively and positively psychosocial fluctuations, and enhance both medical care and sociocultural support systems accordingly. Patient or Public Contribution No patient or public contribution.

Objectives This study explored the multiple mediating roles of sense of coherence (SOC) and coping styles in the relationship between caregiver burden and family adaptation among family caregivers of patients with stroke. Method A cross‐sectional study of 347 family caregivers of patients with stroke was conducted in China. Data were collected using a general information questionnaire, Zarit Caregiver Burden Interview and other questionnaires, and were analysed using descriptive, Pearson's correlation and path analyses. Results SOC–positive and SOC–negative coping styles played a fully parallel chain‐mediating role in the relationship between caregiver burden and family adaptation among family caregivers of patients with stroke. Conclusions Improving caregivers' SOC and encouraging them to adopt positive coping styles are crucial for reducing the negative impact of caregiver burden on family adaptation. Implications for Patient Care This study provides a new perspective for medical staff to improve the family adaptation of family caregivers of patients with stroke. Targeted interventions aimed at improving the SOC level and enhancing positive coping styles of the family caregivers of patients with stroke are necessary to improve their family adaptation. Impact Our study provides insights into the potential influencing mechanism of caregiver burden on family adaptation in family caregivers of patients with stroke, providing a new perspective for developing effective and precise intervention strategies to maintain better family adaptation. Reporting Method This study adhered to the STROBE checklist. What Does This Paper Contribute to the Wider Global Clinical Community? Promoting SOC and focusing on the transformation of negative coping styles into positive ones may be crucial in developing nursing programmes for family adaptation. Patient or Public Contribution No patient or public contribution.

Background The relationship between occupational stress and the quality of nursing care in the operating room (OR) is an area that has not been thoroughly explored in the literature. The present study was designed to examine the correlation between job‐related stress and the quality of care delivered by nurses in the OR setting. Methods A cross‐sectional survey was administered to OR nurses at our institution from 1 April to 30 April 2023. Participants were asked to complete a demographic questionnaire and several validated scales: the Good Perioperative Nursing Care Scale (GPNCS), the Operating Room Nurses' Job Stressor Scale (ORNJSS), the Self‐rating Anxiety Scale (SAS), and the Self‐rating Depression Scale (SDS). Results A total of 171 OR nurses participated. The mean score for nursing quality was 143.01 (SD 19.44), job stressors scored an average of 94.12 (SD 22.57), anxiety scores averaged 54.13 (SD 15.76), and depression scores averaged 59.41 (SD 15.03). A robust inverse correlation was identified between the nursing quality score and the job stressor score (r = −0.641). Furthermore, the nursing quality score exhibited significant negative correlations with both anxiety (r = −0.658) and depression (r = −0.626) scores. Conclusions The findings of this study demonstrate a substantial inverse correlation between the quality of perioperative nursing care and the intensity of occupational stressors, as well as the prevalence of anxiety and depressive symptoms among OR nurses. It is imperative for hospital management to contemplate and implement interventions aimed at mitigating work‐related stress and bolstering the psychological well‐being of OR nursing staff.

Aim To review primary research reporting the inclusion of informal carers in caring for older people in the emergency department. Design An integrative review employing Whittemore and Knafl's updated integrative review methodology. Methods A systematic search was undertaken between November 2023 and September 2024. Ten articles met the inclusion criteria of primary research reporting the inclusion of carers in the care of older adults in the emergency department. Exclusion criteria included studies conducted outside of the emergency department, not carer‐related, and those not restricted to carers of older adults. The Mixed Method Appraisal Tool (MMAT) was used to assess the quality of the articles. Data Sources Medline @ Ovid, EBSCO, Wiley Online Library, Cochrane, EMBASE and SCOPUS. Results Thematic analysis produced two reoccurring themes: Carers as advocates and Carers as outsiders. Through sharing of information and support of the older adult, carers can act as advocates. Restrictive admission policies, exclusion from decision‐making processes, and failure to be heard by the healthcare professional resulted in carers feeling like outsiders. Conclusion Including carers is essential to support the care of vulnerable older adults in the emergency department. Care partnerships between healthcare professionals and carers can be enhanced with education on effective and respectful communication processes and support of carer well‐being. Implications for the Profession and/or Patient Care This review highlights the essential nature of care partnerships involving informal carers in the emergency department for providing high‐quality care to older adults with complex care needs. An appropriate carer inclusion programme could support emergency department clinicians, carers and older adults. Reporting Method The PRISMA 2020 checklist was used to ensure adherence to review processes. Patient or Public Contribution No patient or public contribution.