Journal of Clinical Nursing最新文献

{"title":"Interoception and Emotional Experiences in Stroke Survivors: A Descriptive Phenomenological Study.","authors":"Ya-Ting Liu, Yi-Nan Shi, Shan-Shan Wang, Si-Xun Zhang, Kwan Ching Wong, Nuo Shi, Zhen-Xiang Zhang, Su-Yan Chen, Bei-Lei Lin, Yong-Xia Mei","doi":"10.1111/jocn.70390","DOIUrl":"10.1111/jocn.70390","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to explore stroke survivors' interoceptive and emotional experiences. Interoception, defined as the perception and interpretation of internal bodily states, may influence emotional regulation after stroke.</p><p><strong>Design: </strong>This study employed a descriptive phenomenological study.</p><p><strong>Methods: </strong>This study was conducted in the Neurology and Rehabilitation Departments of a tertiary hospital in Zhengzhou, China. Semi-structured interviews were undertaken with stroke survivors receiving rehabilitation services. Sixteen stroke survivors were recruited through purposive sampling and conducted face-to-face semi-structured in-depth interviews. Data collection and analysis were conducted simultaneously, and the Colaizzi seven-step analysis method was used to code and extract themes from the transcripts.</p><p><strong>Results: </strong>A total of five themes and 13 sub-themes were summarised, including: (1) Physical 'disconnection'-interoceptive experience disorders; (2) Interconnected bodily sensations and emotional experiences; (3) Gradually learning to understand and regulate bodily sensations; (4) Perceptual regulation empowerment and limitations in social relationships; (5) The Social-Cultural context of expressing internal feelings.</p><p><strong>Conclusion: </strong>Stroke survivors may frequently experience significant interoceptive dysfunction, which is closely related to emotional state, cultural cognition, and social support.</p><p><strong>Reporting method: </strong>This study followed the Consolidated Criteria for Reporting Qualitative Research checklist.</p><p><strong>Patient or public contribution: </strong>Stroke survivors participated through semi-structured interviews, and four survivors reviewed the interview guide before data collection to improve question clarity and relevance.</p><p><strong>Implications for the profession and/or patient care: </strong>The findings of this study have important implications for clinical practice and nursing education. Healthcare providers should pay greater attention to stroke survivors' bodily perceptions and emotional experiences during rehabilitation. Interoceptive awareness strategies, such as mindfulness, breathing exercises, and body awareness training, could be incorporated into rehabilitation programmes to help patients better regulate emotions. In addition, nursing education could strengthen training related to emotional assessment and interoceptive awareness to promote more holistic and patient-centred care.</p>","PeriodicalId":50236,"journal":{"name":"Journal of Clinical Nursing","volume":" ","pages":"4957-4968"},"PeriodicalIF":3.6,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148279719","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":"Patient Participation as Expectation or Exception? Negotiating Responsibility Among Patients, Families and Nurses in Chronic Illness Care: A Focused Ethnography.","authors":"Yin Wang, Lian Zhu, Yu Liu, Ying Zhang, Xiaoning Fan, Lissette Avilés, Colin Chandler, Jingfang Hong","doi":"10.1111/jocn.70610","DOIUrl":"https://doi.org/10.1111/jocn.70610","url":null,"abstract":"<p><strong>Aim: </strong>To examine how responsibilities for patient participation are understood, distributed and negotiated among chronically ill patients, family members and nurses in everyday nursing care.</p><p><strong>Design: </strong>Focused ethnography.</p><p><strong>Methods: </strong>The study was conducted in a public hospital in China. Data comprised 90 h of participant observation and 30 semi-structured interviews with nurses, patients and family members. Data were analysed using inductive and abductive reflexive thematic analysis.</p><p><strong>Results: </strong>Participation was enacted through role-based and relational expectations. Patients were expected to cooperate with treatment, report symptoms and contribute to recovery; family members provided practical and emotional support; and nurses educated, coordinated, monitored and safeguarded care. However, responsibilities were often assumed rather than explicitly clarified, making participation dependent on adjustment, mediation and workarounds. Responsibility enabled participation, but also made it conditional and uneven when transferred without supervision, when protection constrained patient voice, or when responsibilities became burdensome.</p><p><strong>Conclusion: </strong>Responsibility is not merely an individual duty or policy demand, but a relational and culturally situated practice shaping when, how and for whom participation becomes possible.</p><p><strong>Implications for the profession and/or patient care: </strong>Nurses should move beyond broad calls for shared responsibility by clarifying expectations, supporting patients and families to take on responsibilities safely, and negotiating responsibilities when routines, family involvement or patient preferences create uncertainty.</p><p><strong>Impact: </strong>This study addresses the overlooked role of responsibility in patient participation. Participation depends on how responsibilities are distributed, assumed, transferred and negotiated among patients, family members and nurses. The findings may inform chronic illness and family-involved nursing care.</p><p><strong>Reporting method: </strong>COREQ.</p><p><strong>Patient or public contribution: </strong>Patients and family members contributed to data generation through participation in observations and interviews. They were not involved as research partners in the study design, data analysis or interpretation or manuscript preparation.</p>","PeriodicalId":50236,"journal":{"name":"Journal of Clinical Nursing","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149229334","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":"From AI Dilemma to Course-Level Governance: Nursing Educators Need Not Wait for Institutional Policy.","authors":"Bing Zhang","doi":"10.1111/jocn.70618","DOIUrl":"https://doi.org/10.1111/jocn.70618","url":null,"abstract":"","PeriodicalId":50236,"journal":{"name":"Journal of Clinical Nursing","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149229296","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":"Bridging the Gap: A Reflexive Thematic Analysis of the Value of Developmental Disabilities Nurses.","authors":"Melissa L Desroches","doi":"10.1111/jocn.70572","DOIUrl":"https://doi.org/10.1111/jocn.70572","url":null,"abstract":"<p><strong>Aims: </strong>To explore how developmental disabilities nurses conceptualise their specialty's contribution to health and well-being.</p><p><strong>Design: </strong>Qualitative study informed by critical realism and reflexive thematic analysis.</p><p><strong>Methods: </strong>Eighteen experienced developmental disabilities nurses recruited at the 2023 Developmental Disabilities Nurses Association conference completed semi-structured interviews. Data were analysed using Braun and Clarke's reflexive thematic analysis.</p><p><strong>Results: </strong>Participants described developmental disabilities nursing as bridging the gap between people with developmental disabilities and care systems. This bridge integrated embodied values, specialist expertise and person-centered knowing and connecting throughout the nursing process. Key activities included figuring it out, aggressive advocacy, cultivating understanding and care planning and oversight, helping ensure nothing fell through the cracks and supporting longer, fuller lives.</p><p><strong>Conclusion: </strong>Developmental disabilities nursing integrates specialist expertise, values and person-centered care to bridge fragmented systems and address health inequities.</p><p><strong>Implications for the profession and/or patient care: </strong>Education and workforce development should recognise and strengthen developmental disabilities nurses' specialist contributions. WHAT PROBLEM DID THE STUDY ADDRESS?: This is the first empirical US study examining how developmental disabilities nurses conceptualise their specialty's contribution. WHAT WERE THE MAIN FINDINGS?: Developmental disabilities nurses bridge fragmented systems through specialist expertise, embodied values, person-centered care and distinctive nursing interventions. WHERE AND ON WHOM WILL THE RESEARCH HAVE AN IMPACT?: Findings inform nurses, educators, organisations, policymakers, researchers, people with developmental disabilities and families.</p><p><strong>Reporting method: </strong>This study adhered to the Standards for Reporting Qualitative Research and was informed by the Reflexive Thematic Analysis Reporting Guidelines.</p><p><strong>Patient or public contribution: </strong>Theme development was refined through professional dialogue with Developmental Disabilities Nurses Association members during an interactive conference presentation and optional survey.</p>","PeriodicalId":50236,"journal":{"name":"Journal of Clinical Nursing","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149229301","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":"Beyond Technical Tasks: Making Nursing Care Visible in Nurse Anaesthesia Practice-A Focused Ethnography.","authors":"Aina L Bjerkeli Lekens, Sigrunn Drageset, Inger Brit T Bakkalia, Britt Sætre Hansen","doi":"10.1111/jocn.70614","DOIUrl":"https://doi.org/10.1111/jocn.70614","url":null,"abstract":"<p><strong>Aim: </strong>To explore how nursing care is enacted in daily nurse anaesthesia practice when caring for patients requiring anaesthesia services.</p><p><strong>Design: </strong>A focused ethnography.</p><p><strong>Methods: </strong>The study involved non-participant observation of nine nurse anaesthetists totalling 63 h, along with nine semi-structured individual interviews at a Norwegian university hospital. Data were analysed using inductive reflexive thematic analysis.</p><p><strong>Findings: </strong>The overarching theme, Striving to provide holistic nursing care, captured how NAs integrate clinical, technological, relational and organisational competencies in complex, high-risk environments while navigating tensions between efficiency demands and person-centred care principles.</p><p><strong>Conclusion: </strong>Nursing care in nurse anaesthesia practice is enacted through the continuous integration of clinical, technological, relational and organisational competencies. While nurse anaesthetists strive to provide holistic, person-centred care, practice is shaped by tensions between efficiency demands, organisational constraints and patient-centred priorities. Despite these challenges, nurse anaesthetists play a key role in maintaining patient safety, continuity of care and high-quality anaesthesia services.</p><p><strong>Implications for the profession and patient care: </strong>This study sheds light on the often-overlooked relational, holistic, and coordinative dimensions of nurse anaesthesia practice. By making these contributions more visible, the findings may support service development, enhance collaborative models of care, and strengthen the utilisation of nursing expertise in anaesthesia services. The findings also highlight the broad scope of nurse anaesthesia practice and may inform future professional, organisational, educational, and workforce-related discussions.</p><p><strong>Impact: </strong>This study contributes to a broader reconceptualisation of nurse anaesthesia practice, with relevance for education, leadership and quality of care, and may inform countries seeking to integrate nurse anaesthetists to improve access to safe anaesthesia care.</p><p><strong>Reporting method: </strong>The Standard for Reporting Qualitative Research (SRQR) checklist was used to enhance trustworthiness and transparency.</p><p><strong>Patient or public contribution: </strong>No patient or public contribution.</p>","PeriodicalId":50236,"journal":{"name":"Journal of Clinical Nursing","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149229368","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":"Registered Nurses' Experiences of Clinical Decision-Making: A Qualitative Descriptive Study to Inform Artificial Intelligence-Assisted Decision Support in Nursing.","authors":"Suonnansalo Petra, Härkönen Henna, Alastalo Mika, Zhou Wentao, Jansson Miia","doi":"10.1111/jocn.70595","DOIUrl":"https://doi.org/10.1111/jocn.70595","url":null,"abstract":"<p><strong>Aim: </strong>To describe registered nurses' experiences of clinical decision-making and identify needs that may inform future development of artificial-intelligence-assisted clinical decision support systems in nursing.</p><p><strong>Design: </strong>A qualitative descriptive study.</p><p><strong>Methods: </strong>Data were collected between 2022 and 2025 through 16 semi-structured interviews with registered nurses working in inpatient wards at a Finnish university hospital. The data were analysed using inductive content analysis.</p><p><strong>Results: </strong>Perceived challenges in clinical decision-making were related to organisational issues, multiprofessional collaboration, nurse-patient interactions, professional factors and availability and trustworthiness of data. The findings also identified support needs related to health information management, clinical workflows and quality of nursing care that may inform future artificial intelligence-assisted clinical decision support system development.</p><p><strong>Conclusion: </strong>Nurses experienced multifaceted challenges and needs in clinical decision-making, shaped by organisational, professional, relational and information-related factors. Adoption of artificial intelligence-assisted decision support systems may represent one potential approach to optimising clinical decision-making, improving patient care quality and enhancing workflow efficiency. Realising these opportunities requires coordinated efforts at individual, organisational and societal levels, including competence development, workflow redesign, strong data governance and a culture that fosters trust in technology.</p><p><strong>Implications for the profession and/or patient care: </strong>The findings may inform the future development of artificial intelligence-assisted clinical decision support systems in nursing.</p><p><strong>Reporting method: </strong>The Consolidated Criteria for Reporting Qualitative Research checklist was used when reporting the results.</p><p><strong>Patient or public contribution: </strong>Registered nurses participated in the study.</p><p><strong>Impact: </strong>What problem did the study address? This paper addresses existing gaps and unmet needs in nursing clinical decision-making What were the main findings? The main findings highlight several key opportunities for artificial intelligence-assisted clinical decision support systems in nursing. Where and on whom will the research have an impact? The research may inform efforts to optimise health information management, streamline clinical workflows and improve the quality of nursing care.</p>","PeriodicalId":50236,"journal":{"name":"Journal of Clinical Nursing","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149220991","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":"Parents' Experiences With Community Health Nurses' Support in Light of Their Needs and Challenges in Early Parenthood: A Qualitative Study.","authors":"Lene Kierkegaard, Rikke Rothkegel Carlsson, Camilla Thørring Bonnesen, Rikke Fredenslund Krølner, Mette Rasmussen, Katrine Rich Madsen, Maiken Pontoppidan, Nanna Gram Ahlmark","doi":"10.1111/jocn.70609","DOIUrl":"https://doi.org/10.1111/jocn.70609","url":null,"abstract":"<p><strong>Aim: </strong>To explore parents' experiences of their needs for support in early parenthood and how these needs are addressed by community health nurses.</p><p><strong>Design: </strong>Qualitative interviews.</p><p><strong>Methods: </strong>We conducted 20 semi-structured interviews with parents from diverse socio-economic and ethnic backgrounds: nine with mothers, seven with couples, and four group interviews. We applied reflexive thematic analysis and were theoretically inspired by Mol's concept of logic of care and Social Support Theory.</p><p><strong>Results: </strong>Parents experienced that community health nurses provided context-specific and adaptive support, attentive to families' needs. We identified three themes, illustrating community health nurses' roles from parents' perspectives: (1) an informational and instrumental role; (2) an emotional role; and (3) a bridging role to the broader healthcare and welfare system. These roles must be understood in relation to parents' insecurities about navigating early parenthood, limited social network, and negative experiences with authorities.</p><p><strong>Conclusion: </strong>This study offers insight into how community health nurses deliver meaningful, family-centred support during infancy by combining practical guidance, emotional reassurance, and assistance in navigating healthcare and welfare systems.</p><p><strong>Implications for the profession and/or patient care: </strong>The role of community health nurses entails an adaptive, non-judgemental, situational approach, strong communication skills, and time to meet families' unique needs.</p><p><strong>Impact: </strong>The findings have direct implications for community-based nursing practice by demonstrating the importance of flexible, relational, and bridge-building support during early parenthood, particularly for families with limited social networks. The study is relevant for universal health systems seeking to strengthen early preventive support.</p><p><strong>Reporting method: </strong>COREQ guidelines.</p><p><strong>Patient or public contribution: </strong>Parents contributed through interviews. WHAT DOES THIS PAPER CONTRIBUTE TO THE WIDER GLOBAL CLINICAL COMMUNITY?: This study contributes empirically to debates on early intervention by illustrating how community health nurses combine instrumental, emotional, and bridging support within a universal service model. It highlights how flexibility and time allocation enable tailored, family-centred care and offers insights for developing context-specific interventions in healthcare settings.</p>","PeriodicalId":50236,"journal":{"name":"Journal of Clinical Nursing","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149221021","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":"Nurses Have Always Diagnosed: The Historical, Legal and Scientific Case for Nursing Engagement in Diagnosis.","authors":"Gene Elizabeth Harkless, Kelly T Gleason, Cara Jefferies","doi":"10.1111/jocn.70596","DOIUrl":"https://doi.org/10.1111/jocn.70596","url":null,"abstract":"<p><strong>Aim: </strong>To review the historical, legal, theoretical and evidentiary foundations for registered nurse engagement in diagnosis and to argue for systematic inclusion of nursing's diagnostic contributions in team-based diagnosis.</p><p><strong>Background: </strong>Diagnosis has been a constitutive element of nursing practice since the profession's earliest years, yet nursing's diagnostic authority has been persistently contested, constrained by legislation and rendered invisible in health information systems and diagnostic safety frameworks.</p><p><strong>Design: </strong>Discursive paper.</p><p><strong>Methods: </strong>Drawing on published research, regulatory and historical analysis, and interprofessional policy literature, the paper traces nursing's diagnostic role from early public health nursing through legislation, case law and standardized nursing language, and current evidence on diagnostic safety and education.</p><p><strong>Results: </strong>Nursing diagnosis is not a novel aspiration or an expansion of scope but a documented feature of practice across more than a century; as Christman and Safriet argued, no discipline owns knowledge, and diagnostic language serves the patient, not professional territory. Team-based diagnosis including nurses improves quality and reduces error, yet scope-of-practice barriers and a preparation-to-practice gap in clinical judgement constrain nursing's contribution.</p><p><strong>Conclusion: </strong>Systematic inclusion of nursing's diagnostic contributions is essential to achieving high-quality, equitable, team-based diagnosis. Realizing this requires removing regulatory and structural barriers and strengthening nurses' preparation in clinical reasoning and diagnostic articulation.</p><p><strong>Implications for the profession and/or patient care: </strong>Making nursing's diagnostic work visible, standardized, and integrated into health information systems can strengthen diagnostic safety, support interprofessional collaboration and reduce diagnostic error.</p><p><strong>Impact: </strong>Nursing is largely excluded from diagnostic frameworks despite nurses' proximity to patients. Its systematic inclusion improves diagnostic quality and safety. The findings are relevant to nurses, educators, regulators and health-system leaders internationally.</p><p><strong>Reporting method: </strong>Not applicable; as a discursive paper, no EQUATOR reporting guideline applies.</p><p><strong>Patient or public contribution: </strong>No patient or public contribution.</p>","PeriodicalId":50236,"journal":{"name":"Journal of Clinical Nursing","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149220986","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":"Navigating Difficult Conversations: Factors Influencing Paediatric Nurses' Bad News Delivery and Their Professional Coping Responses.","authors":"Xuetang Zhao, Aijuan Fan, Xin Zhang","doi":"10.1111/jocn.70579","DOIUrl":"https://doi.org/10.1111/jocn.70579","url":null,"abstract":"<p><strong>Background: </strong>Breaking bad news (BBN) is a cognitively and emotionally demanding communication task for paediatric nurses, yet empirical evidence on its determinants remains scarce. This study aimed to assess the current status of BBN competence and identify demographic, professional, and training-related factors associated with this competence among paediatric nurses.</p><p><strong>Methods: </strong>A cross-sectional survey was conducted among 382 paediatric nurses using a Breaking Bad News Ability Scale. The scale demonstrated good psychometric properties (Cronbach's α = 0.91; test-retest reliability = 0.85; S-CVI/Ave = 0.94). The instrument comprises five dimensions: pre-disclosure preparation, communication strategy, empathic response, child/family specificity, and communication/self-reflection. The study was designed and reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement. Univariate analysis, Pearson's correlation, and multiple linear regression were performed.</p><p><strong>Results: </strong>Total scores range from 20 to 100; each of the five dimensions ranges from 4 to 20. Higher scores indicate greater competence. The mean total score was 69.0 ± 6.3, indicating a moderate level of ability. Empathic response scored highest (14.2 ± 2.0), whereas pre-disclosure preparation (13.5 ± 2.2) and child/family specificity (13.6 ± 2.2) were the lowest-performing dimensions. Univariate analysis revealed significant differences by age, educational attainment, professional title, years of paediatric nursing experience, communication training within the preceding 6 months, and clinical department (all p < 0.01). Recent communication training demonstrated the strongest positive correlation (r = 0.419, p < 0.001), followed by years of experience (r = 0.392) and professional title (r = 0.376). Multiple linear regression (R² = 0.394, p < 0.001) identified recent training (b = 2.09, p < 0.001), professional title (b = 1.20, p = 0.002), years of experience (b = 0.29, p = 0.007), and age (b = 0.15, p = 0.013) as independent positive predictors.</p><p><strong>Conclusion: </strong>Paediatric nurses demonstrated moderate BBN competence, with notable deficiencies in pre-disclosure preparation and family-specific tailoring.</p><p><strong>Patient or public contribution: </strong>Communication training within the preceding 6 months emerged as the strongest modifiable predictor. Nurses in intensive care settings, despite frequent exposure to high-stakes disclosures, warrant targeted competency development.</p>","PeriodicalId":50236,"journal":{"name":"Journal of Clinical Nursing","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149217289","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":"Patterns of Stakeholder Participation in Advance Care Planning for Older Adults With Alzheimer's Disease in China: A Cross-Sectional Study.","authors":"Sijie Wang, Tian Wang, Xinyi Liu, Rui Wang, Menglian Zhang, Mingli He, Jianhong Zhou, Minmin Shi","doi":"10.1111/jocn.70604","DOIUrl":"https://doi.org/10.1111/jocn.70604","url":null,"abstract":"<p><strong>Aims: </strong>To examine advance care planning (ACP) participation among older adults with Alzheimer's disease (AD), their family caregivers, and healthcare professionals in China, and to identify key influencing factors and challenges from a stakeholder perspective.</p><p><strong>Design: </strong>A cross-sectional survey guided by stakeholder theory. The study was reported in accordance with the The STROBE checklist.</p><p><strong>Methods: </strong>A cross-sectional study was conducted from December 2024 to July 2025 in two tertiary hospitals and one social welfare center in Hangzhou, China. Convenience sampling was used to recruit healthcare professionals, older adults with early-stage AD, and family caregivers of AD patients. Structured questionnaires assessed ACP preparedness or participation. Data were analysed using descriptive statistics, correlation analyses, and multiple linear regression.</p><p><strong>Results: </strong>Healthcare professionals demonstrated high ACP knowledge and positive attitudes but low engagement in ACP-related behaviours. Older adults with early-stage AD showed moderate ACP preparedness, characterized by strong beliefs and motivation but relatively low attitudinal readiness. Family caregivers reported moderate-to-high ACP participation while experiencing substantial decision conflict. Stakeholder theory was used to interpret group differences in ACP preparedness, participation, and decision conflict. The findings reflect inherent disparities in decision-making power, accessible resources, and interest demands among patients, family caregivers, and healthcare professionals.</p><p><strong>Conclusions: </strong>ACP participation in Chinese families affected by AD remains fragmented and structurally constrained. Although stakeholders recognize ACP's value, disparities in roles, resources, and power hinder patient-centered decision-making.</p><p><strong>Implications for clinical practice: </strong>This study provides references for the clinical implementation of Advance Care Planning (ACP) for dementia patients, the construction of multidisciplinary collaboration models, and the development of caregiver support strategies in the Chinese cultural context.</p><p><strong>Patient and public contribution: </strong>Healthcare professionals, patients, and family members participated in data collection, providing comprehensive empirical evidence on ACP-related attitudes, behaviours, and decision conflicts for the study.</p>","PeriodicalId":50236,"journal":{"name":"Journal of Clinical Nursing","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149217309","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}