Journal of Clinical Nursing最新文献

{"title":"Evaluating Leadership and Teamwork Competency Acquisition Through Clinical Simulation: Development of the Clinical Simulation Learning Leadership and Teamwork Scale.","authors":"Rafael González-Moret, Beatriz Rodríguez Díez-Caballero, Manuel Romero-Saldaña, Daniel García-Gutiérrez, Cristina García-Salido, Estel la Ramírez-Baraldes, Isabel Serra Guillén","doi":"10.1111/jocn.70030","DOIUrl":"10.1111/jocn.70030","url":null,"abstract":"<p><p>Advanced simulation is a methodology that allows the development of technical skills and transversal skills such as teamwork and leadership. There are tools to measure the development of technical competencies and student satisfaction with the methodology, but not to measure the development and use of transversal competencies in the clinical practice setting.</p><p><strong>Aim of the study: </strong>To develop and validate a scale to measure the impact of clinical simulation on the development and application of teamwork and leadership competencies.</p><p><strong>Design: </strong>A multicentre study was carried out in two Spanish universities in which the Clinical Simulation Learning Teamwork and Leadership Scale was developed and validated.</p><p><strong>Methods: </strong>The study was carried out in several phases: development of the questionnaire using a Delphi method, pilot test and validation of the construct with a sample of 207 nursing students. Reporting of this research adheres to STROBE guidelines.</p><p><strong>Results: </strong>Content validity was checked according to Aiken's V for the three attributes of the questionnaire. Reliability or internal consistency was assessed with Cronbach's α and the sensitivity analysis showed no significant variation when any item was eliminated. On the other hand, McDonald's Omega statistic was used. Intraobserver reliability was taken from a sample of 47 students, in which it was observed that the intraclass correlation was positive.</p><p><strong>Conclusions: </strong>The Clinical Simulation Learning teamwork and leadership scale is a valid instrument for measuring the development of transversal competencies.</p><p><strong>Implications for the profession and/or patient care: </strong>This scale will provide information to evaluate the weight of the clinical simulation in the students' knowledge.</p><p><strong>Impact: </strong>It is a tool for evaluating transversal skills that is proven valid and will improve the training of students.</p><p><strong>Reporting method: </strong>The instructions of the STROBE checklist have been followed.</p><p><strong>Patient or public contribution: </strong>The students have participated in the knowledge transfer self-assessment.</p>","PeriodicalId":50236,"journal":{"name":"Journal of Clinical Nursing","volume":" ","pages":"4285-4294"},"PeriodicalIF":3.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13569312/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144585488","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Scoping Review of Malnutrition Risk Prediction Models in Cancer Patients","authors":"Nianfei Tang,&nbsp;Huiru Zeng,&nbsp;Biao He,&nbsp;Ying Zheng,&nbsp;Qing Li,&nbsp;Fangyi Li,&nbsp;Tian Xiao,&nbsp;Linyu Zhou,&nbsp;Ao Tang,&nbsp;Xiaoju Chen","doi":"10.1111/jocn.70418","DOIUrl":"10.1111/jocn.70418","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To systematically review the existing literature on risk prediction models for malnutrition in cancer patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Malnutrition is highly prevalent among cancer patients, and timely identification and intervention can improve patient outcomes and quality of life. Risk prediction models can forecast the future disease risk of patients. This study aims to conduct a comprehensive scoping review of malnutrition risk prediction models for cancer patients developed domestically and internationally, analyse current gaps in the field, and provide references for clinical practice and future research.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This review followed the PRISMA Extension for Scoping Reviews and the Arksey and O'Malley framework, and the study was conducted in accordance with the CHARMS checklist. Systematic searches were conducted in PubMed, Web of Science Core Collection, the Cochrane Library, EMbase, CINAHL, CNKI, Wanfang, and Sinomed, with the search period spanning from database inception to October 23, 2025. Original studies reporting the development or validation of malnutrition risk prediction models in cancer patients were eligible for inclusion.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 36 studies were included in this scoping review. Extracted data included study characteristics, model development methods, predictors included, and performance evaluation metrics. Considerable overlap was observed in the development methods across models, with traditional statistical analysis being predominant. Retrospective data collection was applied in the majority of the included studies. These prediction models covered multiple malignancies, including rectal, liver, nasopharyngeal, gastric, and oesophageal cancers. A wide range of predictors was used, with age and BMI being the most frequently included.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This review maps cancer patients' malnutrition prediction models. Existing models screen malnutrition but have flaws in construction and validation. Future studies will adopt longitudinal, multimodal data and AI to optimize tools for early screening and intervention.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50236,"journal":{"name":"Journal of Clinical Nursing","volume":"35 11","pages":"4662-4687"},"PeriodicalIF":3.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148370620","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding Risks in the Care of People With Dementia in Acute Hospital Settings: Definitions, Types and Management Strategies—A Scoping Review","authors":"Ashitha Bhaskaran,&nbsp;Kate Irving,&nbsp;Eileen Courtney,&nbsp;Bert Gordijn,&nbsp;Marie Cantwell","doi":"10.1111/jocn.70433","DOIUrl":"10.1111/jocn.70433","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Aims&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;This scoping review explores how risk is defined, managed and mitigated in the care of people with dementia in acute hospital settings.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;This scoping review followed Arksesy and O'Malley's five-stage framework (2005) and was guided by the Joanna Briggs Institute methodology. A literature search was conducted in October 2023 and updated in December 2024 across Web of Science, MEDLINE, CINAHL, Academic Search Complete and PsycINFO databases. The results were reported as per PRISMA-ScR guidelines.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;A total of 3916 articles were screened, 181 full-text articles assessed and 61 studies included in the final review. The literature on the care of people with dementia in acute hospital settings demonstrates an implicit understanding of risk, focusing mainly on physical risks with less emphasis on psychological, social and spiritual aspects. Identified risk management strategies include targeted screening, dementia-specific interventions, environmental modifications, non-pharmacological approaches, person-centred family-inclusive care and workforce competency enhancement. Limited studies address positive risk-taking, and ethical considerations are often overlooked, indicating a need for a more balanced approach to risk in the care of people with dementia in acute settings.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusion&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;This review highlights critical gaps in the conceptualisation and management of risk in the care of people with dementia in acute settings. A dominant focus on physical safety often overshadows other essential aspects of well-being, and ethical issues are rarely discussed. The findings underscore the urgent need for person-centred, ethically informed approaches that balance safety with autonomy and quality of life.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Patient or Public Contribution&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;No patient or public involvement was included in this review.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Implications for the Profession&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;This review addresses significant gaps in understanding and managing risks in the care of people with dementia in acute settings. It serves as a vital resource for healthcare professionals to better understand risks in the care of people with dementia in acute settings and consolidate actionable insights that s","PeriodicalId":50236,"journal":{"name":"Journal of Clinical Nursing","volume":"35 11","pages":"4708-4724"},"PeriodicalIF":3.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jocn.70433","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148690200","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhancing Communication and Empathy Skills in Geriatric Care: Nurses' Reflections on Simulation-Based Training for Patient Interaction and Education.","authors":"Sobhia Ahmed Abdel Kader Mohammed, Mostafa Shaban","doi":"10.1111/jocn.17662","DOIUrl":"10.1111/jocn.17662","url":null,"abstract":"<p><strong>Aim: </strong>To explore the impact of simulation-based training on communication and empathy skills among nurses working with elderly patients in the Abha region of Saudi Arabia. The study also aimed to identify the barriers and facilitators to applying these skills in real-world clinical practice.</p><p><strong>Design: </strong>A qualitative study.</p><p><strong>Method: </strong>Semi-structured interviews were conducted between June and July 2024 with 17 nurses from urban and rural healthcare settings in the Abha region. Data were analysed using both deductive framework analysis, guided by social support theory, and inductive thematic analysis to identify key themes related to communication, empathy, and the application of simulation-based skills in practice. We adhered to the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist.</p><p><strong>Results: </strong>The study involved 17 participants aged 22-50 years, with diverse educational backgrounds and work experience. The findings indicated that simulation-based training significantly improved nurses' confidence in delivering difficult news and their ability to empathise with elderly patients. Nurses working in urban settings with regular access to simulation training reported better outcomes compared to those in rural settings with less frequent training opportunities.</p><p><strong>Conclusion: </strong>Simulation-based training has a positive impact on enhancing communication and empathy skills among nurses, but challenges in real-world application remain. Efforts should be made to improve the accessibility of simulation training and address the barriers preventing its effective implementation in clinical practice.</p><p><strong>Implication for the profession and/or patient care: </strong>Healthcare practitioners and policymakers should prioritise simulation-based training in nursing education and professional development to improve the quality of care for elderly patients.</p><p><strong>Reporting method: </strong>The Consolidated Criteria for Reporting Qualitative Research (COREQ).</p><p><strong>Patient or public contribution: </strong>The engagement and interview data from nursing participants provided valuable insights into the impact of simulation-based training on communication and empathy in elderly care.</p>","PeriodicalId":50236,"journal":{"name":"Journal of Clinical Nursing","volume":" ","pages":"4401-4411"},"PeriodicalIF":3.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13569113/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142985227","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role Transition of Recent Nurse Graduates Into Practice in Long-Term Care and Home and Community Care Sectors: A Scoping Review","authors":"Melissa E. Hay,&nbsp;Denise M. Connelly,&nbsp;Hailey Killeen,&nbsp;George Triantafillakis","doi":"10.1111/jocn.70425","DOIUrl":"10.1111/jocn.70425","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Aim&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;To explore transition experiences of newly graduated nurses transitioning into long-term care and home and community care.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Design&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Scoping Review.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Joanna Briggs Institute framework and Arksey &amp; O'Malley's principles for scoping reviews were used. Covidence facilitated evidence selection. Two independent reviewers screened and extracted data, with a third resolving disputes. NVivo 14.0 supported data analysis, and thematic analysis highlighted transition experiences.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Data Sources&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Data retrieved from Medline, EMBASE, CINAHL, PsycINFO, Scopus, Google Scholar and Google for published and grey literature; searched February 2026.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;From 27 articles, analysis revealed four themes: (1) A Different World: Contextual Challenges in Long-Term Care and Home and Community Care Sectors, (2) Navigating as a New Graduate Nurse: Knowledge, Skills, and Behaviours, (3) Support and Guidance, (4) Emergence of Professional Self as a Nurse in Long-Term Care and Home and Community Care.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusion&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;This review emphasized the need for addressing clinical and emotional aspects of transition, including proper orientation, tailored nurse residency programs, and workload management for facilitating integration and supporting development of nurses' professional identity.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Implications for the Profession and/or Patient Care&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;This review may guide healthcare leaders in refining support systems for new nurses, ultimately elevating patient care standards in these sectors.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Impact&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Addressing challenges new nurses face when assimilating into long-term care and home and community care environments may enhance nurse confidence, job satisfaction, recruitment, and retention.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Reporting Method&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;The EQUATOR guidelines for PRISMA-ScR.&lt;/p&gt;\u0000 ","PeriodicalId":50236,"journal":{"name":"Journal of Clinical Nursing","volume":"35 11","pages":"4688-4707"},"PeriodicalIF":3.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jocn.70425","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148382783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on “The Meaning of Surveillance in Women With a Hereditary Risk of Breast Cancer: A Hermeneutic Phenomenological Study”","authors":"Vijay Kumar K. V.,&nbsp;Pankaj Kshirsagar,&nbsp;Mansi Mishra,&nbsp;Surbhi Panwar","doi":"10.1111/jocn.70389","DOIUrl":"10.1111/jocn.70389","url":null,"abstract":"","PeriodicalId":50236,"journal":{"name":"Journal of Clinical Nursing","volume":"35 11","pages":"4505-4506"},"PeriodicalIF":3.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148058092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparing Safety and Accuracy of Standardised Versus Subjective Triage Code Assignment by Nurses: A Multicenter Observational Simulated Study.","authors":"Arian Zaboli, Francesco Brigo, Gloria Brigiari, Magdalena Massar, Gabriele Magnarelli, Norbert Pfeifer, Tiziano Garbin, Patrick Clauser, Serena Sibilio, Gianni Turcato","doi":"10.1111/jocn.17615","DOIUrl":"10.1111/jocn.17615","url":null,"abstract":"<p><strong>Background: </strong>Standardised triage systems have been in place for decades with minor modifications, while nurses' skills and knowledge have significantly advanced.</p><p><strong>Aim: </strong>To determine whether nurses' clinical expertise outperforms triage systems in simulated clinical cases.</p><p><strong>Design: </strong>A multicenter simulated observational study.</p><p><strong>Methods: </strong>The study was conducted from January 1, 2024 to March 31, 2024, in four Italian emergency departments, enrolling triage-performing nurses. Thirty clinical cases, based on real patients representing daily emergency department influx, were reconstructed. The primary outcome was the agreement between the triage code assigned by the Manchester Triage System and the code assigned based on clinical expertise. The secondary outcome compared the predictive ability of the codes assigned by nurses regarding clinical outcomes, such as death within 72 h, the need for hospitalisation, and the need for life-saving intervention. The study was reported in accordance with the STROBE statement.</p><p><strong>Results: </strong>Seventy-seven triage nurses completed the 30 vignettes. The agreement between the MTS-assigned code and the clinical expertise triage reported a Cohen's kappa of 0.576 (95% CI: 0.564-0.598). For death within 72 h, the clinical expertise code reported better results than the Manchester Triage System. For life-saving interventions, the Manchester Triage System reported a lower performance than clinical expertise. The variability in triage code assignment was higher for clinical expertise compared to the Manchester Triage System.</p><p><strong>Conclusions: </strong>Triage codes assigned by nurses based on clinical expertise perform better in terms of clinical outcomes, suggesting a need to update triage systems to incorporate nurses' knowledge and skills. However, standardised triage systems should be maintained to reduce variability and ensure consistent patient classification.</p><p><strong>Reporting method: </strong>The study was conducted and reported according to the STROBE statement.</p><p><strong>Patient or public contribution: </strong>No patient or public contribution.</p>","PeriodicalId":50236,"journal":{"name":"Journal of Clinical Nursing","volume":" ","pages":"4265-4272"},"PeriodicalIF":3.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13569225/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142796470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on \"Latent Profile Analysis of Preoperative Frailty in Cardiac Surgery Patients: Implications for Individualised Nursing Care\".","authors":"Veena D Sakhardande, Shubhangi Gaikwad, Monita Thokchom","doi":"10.1111/jocn.70292","DOIUrl":"10.1111/jocn.70292","url":null,"abstract":"","PeriodicalId":50236,"journal":{"name":"Journal of Clinical Nursing","volume":" ","pages":"4475-4476"},"PeriodicalIF":3.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13569381/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147482106","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating Large Language Model-Assisted Emergency Triage: A Comparison of Acuity Assessments by GPT-4 and Medical Experts.","authors":"Gal Ben Haim, Mor Saban, Yiftach Barash, David Cirulnik, Amit Shaham, Ben Zion Eisenman, Livnat Burshtein, Orly Mymon, Eyal Klang","doi":"10.1111/jocn.17490","DOIUrl":"10.1111/jocn.17490","url":null,"abstract":"<p><strong>Aim: </strong>To evaluate the accuracy of the Emergency Severity Index (ESI) assignments by GPT-4, a large language model (LLM), compared to senior emergency department (ED) nurses and physicians.</p><p><strong>Method: </strong>An observational study of 100 consecutive adult ED patients was conducted. ESI scores assigned by GPT-4, triage nurses, and by a senior clinician. Both model and human experts were provided the same patient data.</p><p><strong>Results: </strong>GPT-4 assigned a lower median ESI score (2.0) compared to human evaluators (median 3.0; p < 0.001), suggesting a potential overestimation of patient severity by the LLM. The results showed differences in the triage assessment approaches between GPT-4 and the human evaluators, including variations in how patient age and vital signs were considered in the ESI assignments.</p><p><strong>Conclusion: </strong>While GPT-4 offers a novel methodology for patient triage, its propensity to overestimate patient severity highlights the necessity for further development and calibration of LLM tools in clinical environments. The findings underscore the potential and limitations of LLM in clinical decision-making, advocating for cautious integration of LLMs in healthcare settings.</p><p><strong>Reporting method: </strong>This study adhered to relevant EQUATOR guidelines for reporting observational studies.</p>","PeriodicalId":50236,"journal":{"name":"Journal of Clinical Nursing","volume":" ","pages":"4249-4255"},"PeriodicalIF":3.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13569248/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142752204","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"When Ethics Hurts: The Causes and Impact of Moral Distress on Emergency Department Nurses: A Scoping Review","authors":"C. Walters,&nbsp;M. Murray,&nbsp;C. Young","doi":"10.1111/jocn.70391","DOIUrl":"10.1111/jocn.70391","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Aim&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;To explore the extent and range of published research on the nature of moral distress in emergency nurses.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Design&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Scoping review.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;The review followed the Joanna Briggs Institute methodology for scoping reviews and was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. Searches were undertaken with a date limit of 2015–2025. Reference lists of included papers were also screened. Two reviewers independently screened and extracted data, with disagreements resolved through discussion or third-party review.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Data Sources&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Searches were undertaken in August 2025 in CINAHL, MEDLINE, Scopus, and PsycINFO.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Included studies were across diverse international settings with sample sizes ranging from 169 and 390. Thematic analysis identified four overarching themes: factors contributing to moral distress; situational triggers; the impact of moral distress; and interventions and support strategies.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusion&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;The scoping review identified moral distress as a complex phenomenon that undermines nurse well-being, reduces professional satisfaction, and compromises care delivery. Common causes include organisational constraints and the depersonalisation of care, with demographic and contextual factors shaping experiences. Most studies focused on describing the experience of moral distress. Few studies considered evaluating interventions or organisational supports. No longitudinal studies were identified, and variation in tools limited comparability. Future research should focus on interventions and longitudinal designs to investigate how moral distress evolves in the emergency nurse population over time and across various stages of practice.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Implications&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Establishing evidence-based strategies to mitigate moral distress is essential for supporting emergency nurses and reducing attrition.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Impact&lt;/h3&gt;\u0000 \u0000 ","PeriodicalId":50236,"journal":{"name":"Journal of Clinical Nursing","volume":"35 11","pages":"4549-4566"},"PeriodicalIF":3.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jocn.70391","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148228870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}