Search Results (562)

Background: Cardiac telemetry monitoring represents an important aspect of in-hospital patient safety in both telemetry and critical care settings. Despite technological advancements, telemetry effectiveness may be diminished due to systemic failures including operational processes, instructional policies, and human factors. Alarm fatigue, recognized by the Joint Commission as a leading contributor to serious patient harm, lies at the forefront of these failures. Objective: This narrative review utilized and synthesized sources indexed through PubMed, PubMed Central, MEDLINE, Web of Science, Google Scholar, Directory of Open Access Journals (DOAJ), and Scopus to illustrate the factors involved in hospital related monitoring failures. We purport that alarm fatigue and telemetry monitoring failures are the result of complex systemic failures comprising technological and human failures. Through this narrative, we propose an evidence-based framework known as the Safer Telemetry Architecture (STA) to pinpoint redundancies and promote closed-loop communication regarding alarm management. Conclusions: Monitored in-hospital environments represent a key area of preventable morbidity and mortality due to systemic design flaws. Our STA framework addresses such flaws via improvements in nurse-driven protocols, alarm routing, mandatory coverage standards for backup, and increased performance auditing. Systemic improvements via such a framework may represent an important institutional strategy for hospitals with cardiac monitoring, but requires further prospective validation. Managing redundancies in alerts and sounds, improving backup and nursing telemetry protocols, and promoting closed or continuous loops targeting alarm response times and telemetry utilization are key to effectively improving patient safety. Full article

Background: Culturally and Racially Marginalised (CaRM) communities in Australia encounter subtle and covert forms of prejudice, commonly referred to as “new racism”. Within healthcare settings, these experiences can shape trust, engagement, and patterns of help-seeking. Mental health nurses are often the first point of contact in care delivery, and their ability to recognise, respond to, and mitigate the impacts of new racism is critical for fostering therapeutic relationships and supporting equitable access. Understanding how CaRM communities perceive the conditions that influence their mental health service use is fundamental for informing more equitable and culturally responsive care. Objective: This study explored the viewpoints of CaRM community members regarding the factors they consider important for addressing new racism in healthcare systems and supporting engagement with mental health services. Design: Q methodology was used to identify statistically derived viewpoints that reflect shared viewpoints about the conditions perceived as critical for addressing the impacts of new racism on mental health service use. Setting: Participants were recruited from culturally and linguistically diverse communities across Australia through community settings, social media, and professional networks. Participants: Thirty-five individuals from CaRM backgrounds completed the Q-sort. Methods: This Q methodology consisted of five steps: (1) set up of the Q-sorting instrument, (2) selection of participants, (3) data collection, (4) factor analysis, and (5) factor interpretation. Results: Three distinct viewpoints were identified: (1) raising awareness of mental health issues within CaRM communities (community-focused), (2) providing visible anti-racism and culturally safe services (service-focused), and (3) recognising and formally addressing new racism within healthcare systems (policy-focused). Conclusions: This study offers the first empirically derived, community-informed set of viewpoints on addressing new racism in Australian mental healthcare. While exploratory, the findings highlight multi-level considerations that are potentially relevant to mental health nursing practice, and may be useful to inform future research, policy development, and service redesign aimed at strengthening cultural responsiveness and equity in mental health systems. Full article

Background/Objectives: Digital technologies and data-driven approaches are rapidly transforming healthcare practice and enabling more personalized and preventive care. As personal health data becomes increasingly embedded in healthcare systems, understanding how future healthcare professionals interpret these developments is essential for shaping responsive health education. This study aims to identify the factors that students in health-related programs consider important regarding the increasing use of personal health data in healthcare. Methods: An exploratory qualitative focus group study was conducted between March 2024 and July 2025 across five higher education institutions in Australia, Canada, and the Netherlands. Seven focus groups were conducted with forty students from health-related programs, including nursing, public health, occupational therapy, and social work. Participants discussed the use of personal health data in healthcare and reflected on short fictional future scenarios designed to stimulate discussion about possible developments in data-driven healthcare. Data were analyzed using reflexive thematic analysis using ATLAS.ti. Results: Three overarching domains were identified: (1) personalization and prevention, (2) data quality and ethical considerations, and (3) organizational implications and conditions. Students described personal health data as a powerful tool for personalization, prevention, and informed decision-making. At the same time, they raised concerns about data reliability, overreliance on automated systems, patient anxiety, potential dehumanization of care, privacy risks, and emerging inequalities related to access to and representation within data systems. Overall, students appeared neither purely techno-optimistic nor technophobic, but articulated nuanced ethical, cultural, and professional tensions surrounding data-driven care. Conclusions: Preparing future healthcare professionals for data-driven healthcare requires integrating critical data literacy, ethical reflection, interdisciplinary collaboration and opportunities to critically engage with the societal and professional implications of data-driven technologies into health professional education, while ensuring that organizational conditions support the responsible use of personal health data. Full article

Background/Objectives: Older adults with cancer in the postoperative environment face complex vulnerability, exacerbated by the frailty of ageing and the aggressiveness of surgical treatment. In this highly demanding context, nurses play a crucial role as patient advocates. However, there is a knowledge gap regarding how advocacy is perceived and experienced by the nurse-patient dyad. This qualitative study aims to explain the practice of advocacy by comparing the perspectives of nurses and patients in order to construct part of a substantive theory on the subject. Methods: The Grounded Theory methodological approach was adopted. The sample included 6 specialist nurses and 10 older cancer patients from the ICU. Data collection consisted of participant observation and semi-structured interviews with both groups of participants. The analysis followed the constant comparison method, using MAXQDA software (version 24.10.0; VERBI Software; Berlin, Germany), allowing for the systematic and comparative identification of codes and categories from the two data sources. Results: The core process, defined as The Advocacy-Adjustment Dyad, reveals how older adult cancer patients navigate critical care through a symbiotic interplay of coping and support. Patients autonomously deploy Internal Adjustment mechanisms namely, Shielding the Emotional Self, to mitigate disease stress. Concurrently, the nurse operationalizes the Dynamic Expert Nurse Advocacy Cycle through a Therapeutic Alliance that prioritizes the patient’s best interest, integrates the Family as an anchor, and ensures a meaningful understanding of information. This dyadic interaction transforms the ICU from a purely technological setting into a therapeutic space, ensuring the Preservation of Personhood and the safeguarding of the patient’s self-determination. Conclusions: This study is pioneering in integrating the patient’s voice into the construction of a theory on advocacy in critical care, demonstrating that its effectiveness is a process of mutual interaction and not merely a unilateral function of the nurse. The findings emphasise the need to actively include the patient’s perspective in training and policy, offering valuable implications for optimizing older adult-centered care. Full article

Burnout among intensive care unit (ICU) nurses is an escalating occupational health concern due to the high psychological and physical demands of critical care, with implications for staff well-being, patient safety, and healthcare quality. Despite its importance, limited evidence exists on burnout among ICU nurses in Saudi Arabian tertiary hospitals. This study investigated the prevalence of burnout, associated factors, and potential interventions to reduce stigma and support mental health among ICU nurses at a tertiary healthcare setting, Saudi Arabia. A quantitative cross-sectional design was employed using the Maslach Burnout Inventory–Human Services Survey (MBI-HSS). Simple random sampling selected 250 registered ICU nurses with at least six months of experience. Data was analysed using SPSS v30 with descriptive statistics, and chi-square tests at a significance level of p < 0.05. Findings indicated a high prevalence of burnout, with 52% of nurses reporting elevated emotional exhaustion. Burnout was significantly associated with overtime hours (χ² = 29.155, df = 12, p = 0.015), nurse-to-patient ratios (χ² = 36.170, df = 20, p = 0.015), shift patterns (day: χ² = 4.931, df = 8, p = 0.765; night: χ² = 263 4.226, df = 8, p = 0.836; rotating: χ² = 3.739, df = 4, p = 0.442), living arrangements ((χ² = 13.153, df = 16, p = 0.662), and perceived impact on patient outcomes. Participants identified mental health education, anonymous support programmes, psychological check-ins, and leadership encouragement as helpful coping strategies. The study concludes that burnout among ICU nurses is influenced by workload, work schedules, and organisational support, underscoring the need for systemic interventions to enhance nurse well-being and sustain healthcare quality. Full article

Background and Objectives: Patient safety at hospital interfaces is shaped by organisational fragility, ethical obligations, and anticipated legal exposure. Reporting, disclosure, and speaking up have been studied separately, yet the way these pressures converge in ordinary hospital work remains insufficiently described. Materials and Methods: We conducted a qualitative study in a public hospital in Romania using semi-structured episodic interviews and the critical incident technique. Twelve clinicians participated: six nurses and six physicians working in intensive care, emergency medicine, general surgery, paediatrics, oncology day care, anaesthesia, obstetrics, and internal medicine/cardiology. Interviews were audio-recorded, transcribed verbatim in Romanian, anonymised, and analysed with the framework method from a critical realist perspective. A secondary cross-case coding of all 12 episodes was used for descriptive analytic displays. Results: Four mechanisms organised the material. First, local stop rules and cross-checks created temporary stability at fragile interfaces such as high-alert medication, patient identification, specimen labelling, and transfer documentation. Second, consent and confidentiality were repeatedly compressed by urgency, compromised capacity, public space, and family pressure; legitimacy depended on explicit reasoning rather than documentary completion alone. Third, speaking-up and near-miss reporting were governed by protocol-backed legitimacy, leader response, and the informal cost of interruption. Formal incident reporting was present in one episode, partial in one, and absent in 10. Fourth, documentation and disclosure redistributed accountability. Notes that recorded reasoning supported continuity of care, whereas protective opacity concealed near misses, infrastructural weakness, and interactional pressure. Documentation or disclosure pressure appeared in all 12 episodes. Conclusions: Safety in everyday hospital work was assembled through local barriers, moral triage, and selective visibility. Interface redesign, protected near-miss reporting, psychologically safe escalation, and structured support for urgent consent and post-incident communication would make transparent safety work more sustainable. Trustworthiness was strengthened through reflexive memoing by the physician-interviewer, an audit trail of coding decisions, comparison across professional groups, active attention to negative cases, and iterative assessment of meaning saturation at the level of explanatory mechanisms. Full article

Background/Objectives: Sustaining a stable and competent workforce in neonatal intensive care units (NICUs) is critical for ensuring high-quality care for vulnerable neonates. However, workforce-related challenges such as job dissatisfaction and turnover remain significant concerns in high-acuity settings. Guided by the ecological model, this study aimed to examine resilience, communication competence, and the nursing work environment as multilevel factors associated with nursing workforce sustainability, with job satisfaction serving as a proxy indicator related to workforce retention and sustainability. Methods: A descriptive cross-sectional survey was conducted among 145 NICU nurses from three tertiary and three general hospitals in South Korea. Data were analyzed using descriptive statistics, independent t-tests, one-way ANOVA, Pearson’s correlation coefficients, and multiple regression analyses using SPSS version 29.0. Results: Job satisfaction was positively associated with resilience (r = 0.67, p < 0.001), communication competence (r = 0.52, p < 0.001), and the nursing work environment (r = 0.57, p < 0.001). Multiple regression analysis indicated that resilience (β = 0.43, p < 0.001), nursing work environment (β = 0.30, p < 0.001), communication competence (β = 0.15, p = 0.040), and employment in a tertiary hospital (β = 0.12, p = 0.038) were significant factors associated with job satisfaction, explaining 55.1% of the variance (adjusted R²) in job satisfaction (F = 30.42, p < 0.001). Conclusions: Job satisfaction, used as a proximal indicator related to workforce sustainability, was associated with multilevel factors across intrapersonal, interpersonal, and organizational domains. Although resilience showed the strongest association, communication competence and the nursing work environment also showed meaningful associations with job satisfaction. These findings highlight the need for integrated, multilevel strategies to support nursing workforce sustainability and sustained nursing practice in NICU settings. Full article

Background/Objectives: Efficient patient flow in urgent urology services is critical to timely care delivery, yet workflow bottlenecks in specialty clinics remain underexplored. This study aimed to identify workflow bottlenecks, evaluate patient flow and staff attitudes, and explore clinician readiness for digital decision-support in a high-volume NHS emergency urology walk-in clinic. Methods: A two-week observational study was conducted at an emergency urology service in London. Time-stamped pathway data were collected for 80 patient journeys to identify total clinic duration. Differences associated with investigation ordering and senior escalation were analyzed using t-tests. Clinicians (n = 34) completed a questionnaire assessing perceptions of AI, and nursing staff provided qualitative feedback on operational pressures. Results: Mean total clinic journey time was 2 h 42 min, with the post-assessment phase accounting for 64% of total duration. Investigation ordering was the principal source of delay: patients undergoing investigations remained significantly longer in clinic than those who did not (3 h 17 min vs. 2 h 15 min, p < 0.05), and doctor-to-discharge time more than doubled (2 h 20 min vs. 1 h 2 min, p < 0.005). Senior escalation did not significantly prolong patient flow. Staff surveys demonstrated moderate trust in and comfort with AI as a decision-support tool. Nursing feedback highlighted inappropriate attendances, limited staffing, and workspace constraints as key stressors. Discussion: Delays were primarily driven by investigation ordering rather than senior review, identifying investigation timing as a potential target for future pathway optimisation. Conclusions: Investigation-related delays were the dominant workflow bottleneck. While no AI system was deployed in this study, these findings provide empirical groundwork to inform the design and prospective evaluation of AI-supported triage in specialty acute care settings. Full article

Background: Rural and remote health systems are diverse; while many of these settings face persistent workforce shortages and access gaps, not all are underserved. Nurses play a critical role in improving access, continuity, and quality of care in these contexts. However, evidence on their roles, the challenges they face, and the outcomes associated with their contributions remains fragmented. Objective: To map the roles, challenges, and reported outcomes of nurses working in rural and remote healthcare settings, and to examine the quality and scope of the available evidence. Design: This study employed JBI scoping review methodology and is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Methods: Eligible studies involved registered nurses (RNs) and nurse practitioners (NPs) providing care in rural or remote settings and reporting at least one outcome related to patients, services, or health systems. Six bibliographic databases (PubMed/MEDLINE, CINAHL, Embase, Scopus, Web of Science, Cochrane Library) plus Google Scholar for supplementary grey literature retrieval and targeted grey literature were searched (from 1 January 2000 to 30 September 2025). The lead author conducted screening and data extraction, supported by a 10% calibration pilot and structured peer debriefing. Design-specific critical appraisal was undertaken descriptively to inform interpretation but did not determine inclusion. Results: From 22 primary empirical studies (plus 2 contextual-only entries; 24 total, nurses’ roles clustered into direct clinical care, care coordination/navigation, telehealth facilitation, and health promotion. Reported outcomes were predominantly in access/utilization (e.g., time-to-care), quality and safety indicators, and patient-reported outcomes/experiences; clinical endpoints were less common. Conclusions: Nurses in rural and remote settings enact broad, adaptive roles that appear to support healthcare access and service continuity. The evidence base is predominantly descriptive, and causal claims about effectiveness cannot be drawn from the available studies. Standardized outcome frameworks, multi-reviewer methodologies, and effectiveness-focused primary research are needed to advance this field. Full article

Background and Clinical Significance: Kinesio tape (KT) has gained popularity as an adjunctive approach for treating edema during the rehabilitation phase, following traumatic events, as well as for managing edema in breast cancer patients. Its goal is to reduce swelling and improve mobility in the affected extremity; however, its use in critically ill patients remains limited. To our knowledge, this is the first report of its application in this population. Case presentation: This case series involved three patients in the Intensive Care Unit (ICU) who presented with lower extremity edema. One patient developed a cerebrovascular event secondary to moderate traumatic brain injury and two patients experienced sepsis. KT was applied, and extremity circumference, Godet sign, and Stemmer sign were assessed. The bandage was reapplied every 24 h over a 5-day period, with daily evaluations performed by the same nursing staff to ensure measurement consistency. All three patients exhibited a reduction in extremity circumference, along with improvement or resolution of the Godet and Stemmer signs. No adverse effects associated with KT were observed. Conclusions: Our results suggest that KT may be a beneficial adjunctive therapy for edema reduction in ICU patients. Larger-scale studies are needed to confirm its clinical value. Full article

Self-efficacy is a person’s belief in their ability to perform a task effectively despite difficulties and predicts future willingness to undertake similar tasks. The study’s aim was to determine the extent to which undergraduate nursing students develop their clinical performance self-efficacy beliefs throughout their degree. Using a cross-sectional survey design, Year 1, 2 and 3 students from a three-year undergraduate nursing program completed a clinical performance self-efficacy scale, comprising the domains of assessment, planning, implementation and evaluation. Welch’s one-way ANOVA and Games–Howell post hoc analyses compared self-efficacy scores across year levels. Self-efficacy predictors were identified with multiple linear regression. Descriptive statistics determined students’ confidence with clinical activities. Participants’ self-efficacy scores increased significantly from Year 1 to 2 and Year 2 to 3. Year level of study was the only unique positive predictor of scores. Over the years, participants were most confident implementing care and least confident planning and evaluating care. Given that clinical placement frequency was not a unique significant predictor of self-efficacy, but rather weakly correlated, future studies should examine if other learning activities such as high-fidelity simulation may play a greater role in its development. The lower confidence with planning and evaluation underscores the need for curricula that scaffold higher-order skills like critical thinking and reflection. Full article

Background/Objectives: Point-of-care ultrasound (POCUS) is increasingly used in intensive care units (ICUs) as a rapid bedside diagnostic tool supporting timely clinical assessment. The impact of nurse-performed POCUS on clinical management, procedural performance, and professional practice in adult ICUs has not yet been systematically synthesized. This review aimed to evaluate the integration of nurse-performed POCUS into nursing care and its effects on technical, decision-making, and professional outcomes. Methods: A systematic review was conducted in accordance with PRISMA 2020 and the JBI Manual for Evidence Synthesis. PubMed, Scopus, CINAHL, and Web of Science were searched without time restrictions. Original studies were included if they involved adult ICU patients and evaluated POCUS performed by nurses, reporting clinical, procedural, or professional outcomes. Methodological quality was assessed using JBI and MMAT checklists according to study design. Results: Eleven studies were included. The results were synthesized into four primary domains: (1) support for the clinical decision-making process, (2) technical performance and procedural outcomes, (3) diagnostic accuracy, and (4) professional autonomy, training, and sustainability of competencies. Nurse-performed POCUS was associated with management changes in 26–67% of assessments and improved first-attempt success in ultrasound-guided peripheral venous access. Diagnostic accuracy was acceptable when supported by structured training, with no reported increase in complications. Conclusions: Nurse-performed POCUS in adult ICUs appears safe and practice-enhancing, supporting decision-making and selected procedural outcomes. Further multi-center controlled studies are required to clarify its impact on major clinical endpoints and long-term outcomes. Full article

Objectives: Improving the interoperability of electronic health records is critical for efficient, cost-effective delivery of quality services, enhanced care coordination, and improved treatment outcomes within the United States healthcare system. Healthcare leaders and administrators often experience EHR interoperability issues, restricting communication between health systems and impacting electronic health data utilization. Methods: This systematic literature review explored innovative strategies to improve electronic health record interoperability between health information systems to enhance data exchange efficiency, accuracy, and security in U.S. healthcare settings. A search transpired using the Public Medline, Institute of Electrical and Electronics Engineers Xplore Digital Library, and Cumulative Index to Nursing and Allied Health Literature following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Results: Data from 24 relevant articles were analyzed using screening criteria revolving around the research question. Five themes emerged during data analysis. The themes included the utilization of blockchain-based EHR systems (67%), the drive of the Cures Act to achieve interoperability (17%), the advent of artificial intelligence and how it can be used (33%), how the Internet of Things drives the industry to strategically enhance the system (33%), and how the value of interoperability drives outcomes (79%). Conclusions: Findings indicate strategies from a technical perspective and from policy initiatives can improve communication between health information systems. Findings suggest that by strategically leveraging available resources and implementing innovative strategies, healthcare leaders can achieve comprehensive EHR interoperability long term. Full article

Background/Objectives: Anaesthetic nurses play a critical role during surgical procedures. However, research focusing on Australian anaesthetic nurses remains limited. While previous studies have identified inconsistencies in anaesthetic nurse education, the everyday experiences of these nurses have not been comprehensively examined. This study aimed to explore the barriers and enablers influencing anaesthetic nursing practice in Australia and to examine anaesthetic nurses’ views on their evolving roles and responsibilities. Methods: A hermeneutic phenomenological approach was employed to explore the lived experiences of Australian anaesthetic nurses. Semi-structured interviews were undertaken to enable in-depth exploration of participants’ experiences, thoughts, feelings, and beliefs. Participants were interviewed by telephone, videoconference, or in person. Data were transcribed verbatim into Microsoft Word and analysed using reflexive thematic analysis, informed by Gadamerian hermeneutics. Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines were followed. Results: Four overarching themes were identified, Culture, Education, Leadership, and Institution, each shaping anaesthetic nursing practice in distinct yet interrelated ways, with several subthemes emerging within each category. These interrelated factors contributed to perceptions of being undervalued, restricted career progression, and uncertainty regarding role sustainability. Conclusions: The findings highlight the need for enhanced support systems and system-level reform that addresses hierarchical power dynamics alongside standardised, context-specific education and training pathways. Addressing these interconnected issues is essential to better support anaesthetic nurses while ensuring competent, high-quality care is provided. Understanding the structural and cultural concerns underpinning anaesthetic nursing practice may inform the development of coherent curricula, visible nursing leadership, and clearer professional recognition and career pathways. Full article

Transgenerationality refers to the psychological and behavioral elements transmitted across generations. It is intrinsically linked to unelaborated content—such as trauma, grief, secrets, conflicts, and shame—operating through implicit and partially unconscious pathways that manifest in individual behavior. In the context of nursing, transgenerationality explores how nursing care is influenced by these dynamics and how the concept can be utilized to achieve superior health-related outcomes, such as facilitating more effective healthcare transitions. Specifically, it examines how experiences, vulnerabilities, resilience factors, and health-related patterns transmitted across generations affect overall health. As a humanistic profession rooted in person-centered care, nursing must remain cognizant of the impact of this concept on healthcare. This is particularly relevant in clinical settings where nurses are pivotal practitioners, such as mental health, health literacy, chronic disease management, and healthcare transitions. Healthcare transitions represent critical periods in a person’s life, and nurses are present across all contexts to facilitate these shifts. A primary example is the transition from hospital to home, which illustrates the importance of understanding transgenerationality within the roles of both patients and caregivers. Understanding how this concept impacts healthcare allows for the perception of transition as a holistic process. Awareness of these transgenerational operations leads to more personalized care, fostering healthier and more seamless healthcare transitions. The general purpose of this paper is to define and operationalize the concept of transgenerationality within nursing care, emphasizing its critical role in achieving better health outcomes, particularly during hospital-to-home transitions. Full article