{"title":"Illegitimate tasks, overqualification, organizational obstruction, and workplace deviance among nurses: A two-wave cross-sectional survey","authors":"Shuai Yuan , Yu Yan","doi":"10.1016/j.ijnurstu.2025.105173","DOIUrl":"10.1016/j.ijnurstu.2025.105173","url":null,"abstract":"<div><h3>Background</h3><div>Illegitimate tasks - defined as duties that violate professional role norms and identity - are increasingly acknowledged as stressors in clinical environments. Although existing theories such as Stress-as-Offense-to-Self and social exchange theory emphasize emotional responses, they insufficiently explain the cognitive pathways leading to deviant behaviors among nursing staff. Grounded in social information processing theory, this study proposes a cognitive mechanism linking illegitimate tasks to workplace deviance via perceived organizational obstruction, encompassing three stages: encoding of task characteristics, interpretation of organizational signals, and selection of behavioral responses. The study also examines whether perceived overqualification intensifies this process, as nurses with advanced skills may be particularly sensitive to task-role misalignments.</div></div><div><h3>Objective</h3><div>This study investigates whether perceived organizational obstruction mediates the relationship between illegitimate tasks and workplace deviance among nurses, and whether this indirect effect is moderated by perceived overqualification.</div></div><div><h3>Methods</h3><div>A two-wave, time-lagged survey design was implemented among 261 registered nurses from two public hospitals in central China. At Time 1, respondents (mean age = 31.4 years, SD = 6.2; 89 % female) reported perceived overqualification, illegitimate tasks, and perceived organizational obstruction. One month later (Time 2), they reported levels of organizational and interpersonal deviance. Hierarchical regression analysis and moderated mediation tests were used to examine the hypotheses.</div></div><div><h3>Results</h3><div>Illegitimate tasks significantly increased perceived organizational obstruction (β = 0.53, 95 % CI = [0.38, 0.69], <em>p</em> < 0.001), which in turn predicted both organizational deviance (β = 0.17, 95 % CI = [0.10, 0.24], <em>p</em> < 0.001) and interpersonal deviance (β = 0.13, 95 % CI = [0.08, 0.18], <em>p</em> < 0.001). The indirect effects of illegitimate tasks through obstruction were significant for both organizational (indirect effect = 0.09, 95 % CI = [0.02, 0.18]) and interpersonal deviance (indirect effect = 0.07, 95 % CI = [0.02, 0.13]), with stronger effects on organizational deviance, indicating a preference for covert organizational retaliation over interpersonal conflict.</div><div>Perceived overqualification exacerbated this process, with stronger indirect effects for those reporting higher overqualification on both organizational (indirect effect = 0.10, 95 % CI = [0.02, 0.20]) and interpersonal deviance (indirect effect = 0.07, 95 % CI = [0.02, 0.14]).</div></div><div><h3>Conclusions</h3><div>Illegitimate tasks promote workplace deviance by fostering negative organizational perceptions. This process is amplified among highly qualified employees. These findings highlight the need for clearer task allocati","PeriodicalId":50299,"journal":{"name":"International Journal of Nursing Studies","volume":"170 ","pages":"Article 105173"},"PeriodicalIF":7.1,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144756688","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Complex determinants of hospital discharge readiness among patients with acute myocardial infarction: A fuzzy-set qualitative comparative analysis","authors":"Dandan Chen , Li Xu , Geraldine Lee , Xiyi Wang","doi":"10.1016/j.ijnurstu.2025.105172","DOIUrl":"10.1016/j.ijnurstu.2025.105172","url":null,"abstract":"<div><h3>Background</h3><div>Hospital discharge readiness is a crucial concept, influenced by various individual, interpersonal, and institutional factors in populations experiencing acute myocardial infarction. However, there is a gap in the exploration of these interactive variables, particularly regarding integrated configurations that facilitate readiness for hospital discharge.</div></div><div><h3>Objective</h3><div>This study aimed to explore the complex determinants affecting hospital discharge readiness from an integrated perspective, based on the Middle-Range Theory of Adaptation to Chronic Illness.</div></div><div><h3>Methods</h3><div>A cross-sectional observational study was conducted from July 2021 to March 2024 at a tertiary hospital in Shanghai, China. The study assessed individual demographics, family dynamics, quality of discharge teaching, adaptive capacity, and hospital discharge readiness among post-acute myocardial infarction patients. Fuzzy-set qualitative comparative analysis was employed by performing necessity and sufficiency analyses of discharge readiness.</div></div><div><h3>Results</h3><div>A total of 240 patients participated in this study. The findings indicated that no single determinant independently achieved hospital discharge readiness. Six configurations or pathways leading to high readiness were identified, classified into three patient types: (i) hospital-driven, (ii) family-hospital-driven, and (iii) individual-family-hospital joint-driven. Among these, the most significant configuration involved high family dynamics, high quality of teaching prior to discharge, high adaptive capacity, and low-income levels. Substitutability was observed between income levels and family functions across two configurations.</div></div><div><h3>Conclusion</h3><div>Hospital discharge readiness among post-acute myocardial infarction patients arises from interactions of multiple determinants spanning individual, interpersonal, and institutional levels. These insights can inform healthcare providers to prioritize identifying these factors and developing personalized interventions that enhance adaptive capacity, family dynamics, and teaching quality during transitional care.</div></div>","PeriodicalId":50299,"journal":{"name":"International Journal of Nursing Studies","volume":"170 ","pages":"Article 105172"},"PeriodicalIF":7.1,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144750287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"“The unseen struggle” - Nurses' perspectives on challenges to quality of death in rural Chinese cancer patients: A qualitative study","authors":"Changhui Song , Min Feng , Yuting Chen , Hui Xie","doi":"10.1016/j.ijnurstu.2025.105163","DOIUrl":"10.1016/j.ijnurstu.2025.105163","url":null,"abstract":"<div><h3>Background</h3><div>Cancer incidence and mortality have risen significantly worldwide, with China accounting for a substantial proportion of new cases and deaths. Despite national efforts to expand palliative care, the quality of death remains suboptimal in rural areas due to limited healthcare infrastructures, cultural barriers, and uneven rural development.</div></div><div><h3>Objective</h3><div>This qualitative study aimed to explore the quality of death among advanced cancer patients in rural Henan Province, China, from the perspectives of oncology nurses. It sought to identify key challenges and inform strategies to improve palliative care in resource-constrained rural settings.</div></div><div><h3>Methods</h3><div>A phenomenological approach was employed. Seventeen semi-structured interviews were conducted in July 2024 with oncology nurses from a county-level tertiary hospital in northern Henan. Respondents were recruited via purposive and snowball samplings. Thematic analysis was used to identify recurring patterns and challenges.</div></div><div><h3>Findings</h3><div>Eight major themes were identified across individual, family, and healthcare levels. At the individual level, unmanaged symptoms (e.g., pain and dyspnea) and heightened death anxiety - exacerbated by low health literacy and health beliefs - negatively impacted end-of-life experiences. At the family level, cultural norms, such as filial piety complicated communication and medical decision-making, often resulting in overtreatment and prolonged suffering in patients. Financial constraints and limited family support further compromised care and quality of death. At the healthcare system level, staff shortages, heavy workloads, and insufficient palliative care training hindered the delivery of patient-centered palliative care.</div></div><div><h3>Conclusions</h3><div>The study reveals a complex interplay of economic, cultural, and systemic factors that shape quality of death from various levels in rural China from the lens of oncology nurses. Addressing these barriers requires targeted interventions, including enhanced palliative care training, financial protections, and culturally sensitive public education on death and dying in rural settings.</div></div>","PeriodicalId":50299,"journal":{"name":"International Journal of Nursing Studies","volume":"170 ","pages":"Article 105163"},"PeriodicalIF":7.5,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144665023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jung Min Yoon , Alison M. Trinkoff , Victoria Selby , Eunjin Kim
{"title":"The association between self-reported substance use and work schedule characteristics among nurses: A cross-sectional study","authors":"Jung Min Yoon , Alison M. Trinkoff , Victoria Selby , Eunjin Kim","doi":"10.1016/j.ijnurstu.2025.105162","DOIUrl":"10.1016/j.ijnurstu.2025.105162","url":null,"abstract":"<div><h3>Background</h3><div>Job stress due to adverse work schedules has been associated with negative effects on nurses, including substance use. Nurses' potentially harmful substance use related to adverse schedules amid the COVID-19 pandemic may be of critical concern for nurse wellness and patient safety.</div></div><div><h3>Objective</h3><div>This study aims to examine relationships between substance use and work schedule characteristics among nurses.</div></div><div><h3>Design</h3><div>A cross-sectional design was applied.</div></div><div><h3>Setting</h3><div>This study utilized data from the Nurse Worklife and Wellness Study, which was collected between November 2020 and March 2021. Registered nurses with active licensure status were eligible to participate.</div></div><div><h3>Participants</h3><div>Nurses were randomly selected from 9 U.S. states, stratified to represent the nurse population per state, with 1170 usable responses.</div></div><div><h3>Methods</h3><div>The mixed-mode survey (online and mailed questionnaires) contained items regarding adverse work schedules and past year substance use. Adverse work schedules were measured using the Work Schedule Index (0–14 points) and divided into three groups per percentile: low (0–3), medium (4–6), and high levels of adverse work schedules (7 and more). Substance categories included any past year use of illicit drugs, nicotine, high alcohol intake, energy drinks, high caffeine consumption, and prescription drug misuse. Chi-square tests assessed the distribution of nurses' substance use by work schedule characteristics. Logistic regression was performed to estimate the odds of each substance use associated with adverse work schedule levels, and the regression models were adjusted for age.</div></div><div><h3>Results</h3><div>Almost half of the nurses reported using one or more substance categories listed above in the past year. Adverse work schedules, such as working other than day shifts only, extended work hours, lack of breaks between shifts, and full-time schedules, were positively related to nurses' substance use. In age-adjusted regression models, higher levels of adverse work schedules were related to greater odds of illicit drug use (aOR = 4.08, 95 % CI [1.49, 11.19]), high alcohol intake (aOR = 1.95, 95 % CI [1.27, 3.00]), high caffeine use (aOR = 2.25, 95 % CI [1.40, 3.62]). Higher odds of energy drink consumption were related to medium (aOR = 2.26, 95 % CI [1.13, 4.51]) and highly adverse schedules (aOR = 3.93, 95 % CI [1.96, 7.90]).</div></div><div><h3>Conclusions</h3><div>Adverse work schedules may encourage nurses' substance use to enhance alertness or cope with adverse work schedules; however, this can have negative implications for nurse health and patient safety. Considering these findings, solutions to reduce adverse schedules are critically needed.</div></div><div><h3>Registration</h3><div>Not registered.</div></div>","PeriodicalId":50299,"journal":{"name":"International Journal of Nursing Studies","volume":"170 ","pages":"Article 105162"},"PeriodicalIF":7.5,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144613285","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Erratum regarding missing declaration of competing interest statements in previously published articles","authors":"","doi":"10.1016/j.ijnurstu.2025.105148","DOIUrl":"10.1016/j.ijnurstu.2025.105148","url":null,"abstract":"","PeriodicalId":50299,"journal":{"name":"International Journal of Nursing Studies","volume":"170 ","pages":"Article 105148"},"PeriodicalIF":7.5,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144579510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Benjamin Wendt , Dorien L. Oostra , Steven Teerenstra , Minke S. Nieuwboer , Hester Vermeulen , Simone A. Van Dulmen , Getty Huisman-de Waal
{"title":"A tailored de-implementation strategy to reduce low-value home-based nursing care: A multiple interrupted time series study","authors":"Benjamin Wendt , Dorien L. Oostra , Steven Teerenstra , Minke S. Nieuwboer , Hester Vermeulen , Simone A. Van Dulmen , Getty Huisman-de Waal","doi":"10.1016/j.ijnurstu.2025.105159","DOIUrl":"10.1016/j.ijnurstu.2025.105159","url":null,"abstract":"<div><h3>Aim(s)</h3><div>To evaluate the effects of a multifaceted de-implementation strategy (RENEW) on the volume (time in minutes) of care spent by home-based nursing care teams on three widely used low-value nursing practices: (1) ‘washing the client with water and soap by default’ & ‘washing the client from head to toe daily’, (2) ‘application of zinc cream, powders or pastes when treating intertrigo’ and (3) ‘assisting with putting on/taking off compression stockings while the client can do this him/herself (possibly with an aid)’.</div></div><div><h3>Design</h3><div>A multicenter, quasi-experimental study using a multiple interrupted time series design.</div></div><div><h3>Methods</h3><div>The RENEW-strategy with components on education, persuasion, enablement, incentives and training was introduced in 31 Dutch home-based nursing care teams from two healthcare organisations. Data was collected before and after the implementation of the strategy (two before and three post measurements). For each team a separate Auto Regressive Integrated Moving Average model was fitted, looking for a difference in the underlying trend over time. The effect of the RENEW-strategy was based on a meta-analysis of the team effects using a weighted inverse-variance approach and stratified for the three low-value home-based nursing care practices.</div></div><div><h3>Results</h3><div>The RENEW-strategy reduced the weighted mean time per client per week, spent on (1) ‘washing the client with water and soap by default’ & ‘washing the client from head to toe daily’ by 13.61 min (95 % CI 12.04 to 15.18) and for the practice (3) ‘assisting with putting on/taking off compression stockings while the client can do this him/herself (possibly with an aid) by 4.42 min (95 % CI: 2.49 to 6.35). However, the strategy increased the time spent on ‘application of zinc cream, powders or pastes when treating intertrigo’ by 1.25 min (95 % CI: 1.04 to 1.45). The small and limited changes in time trends indicate that the effects for practices (1) and (2) were sustained for three months after the implementation phase.</div></div><div><h3>Conclusion</h3><div>The RENEW-strategy is capable to lead to a reduction of widely used low-value care for two of the three selected low-value care practices. The increase in time of one practice, is surpassed by the savings in time of the other two practices. By making use of available alternatives, care aids and working according to clinical nursing guidelines, this study supports the hypothesis that reducing low-value nursing care saves time to deliver more appropriate, high-value care (for example: health promotion and patient education) and work on professional development.</div></div><div><h3>Reporting method</h3><div>Standards for Reporting Implementation Studies (StaRI) guidelines.</div></div><div><h3>Registration</h3><div>Not registered.</div></div>","PeriodicalId":50299,"journal":{"name":"International Journal of Nursing Studies","volume":"170 ","pages":"Article 105159"},"PeriodicalIF":7.5,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144613286","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jiali Chen , Zheng Lin , Yang Lei , Qingyu Wang , Lichen Tang , Hantian Cheng
{"title":"Facilitators and barriers affecting the implementation of diabetes prevention programs in primary care settings: A qualitative meta-synthesis from a multi-stakeholder perspective","authors":"Jiali Chen , Zheng Lin , Yang Lei , Qingyu Wang , Lichen Tang , Hantian Cheng","doi":"10.1016/j.ijnurstu.2025.105156","DOIUrl":"10.1016/j.ijnurstu.2025.105156","url":null,"abstract":"<div><h3>Background</h3><div>The implementation of diabetes prevention programs in primary care settings faces numerous challenges. Integrating the perspectives of various stakeholders is crucial for understanding these challenges. This meta-synthesis aims to identify and synthesize current evidence on the perceived facilitators and barriers of implementing diabetes prevention programs in primary care settings from the viewpoint of different stakeholders.</div></div><div><h3>Methods</h3><div>Six databases (Pubmed, Web of Science, Cochrane, Embase, CINAHL, and PsycINFO) were searched to identify qualitative studies. Potential studies were assessed for eligibility based on pre-set criteria. Quality appraisal was done on the included studies, and data were analyzed using inductive thematic analysis and synthesized using Normalization Process Theory.</div></div><div><h3>Results</h3><div>A total of 27 studies involving 481 patients and 297 stakeholders were included. Facilitators for patient engagement in diabetes prevention programs included accurate risk perception, recognition of program benefits, effective communication and promotion of program, tailored intervention content, supportive relationships with stakeholders, and ongoing monitoring and feedback. Barriers included risk underestimation, limited program awareness, complex or unclear intervention designs, constrained resources, and insufficient post-program support. For stakeholders, key facilitators were pre-implementation training, clear role assignment, inter-organizational collaboration, and effective feedback mechanisms to assess program quality. Barriers included communication breakdowns, undefined responsibilities, and limited time, staffing, and funding. These findings, mapped to the Context–Mechanism–Outcome framework, revealed multi-level factors influencing the implementation and sustainability of diabetes prevention programs.</div></div><div><h3>Conclusions</h3><div>This meta-synthesis highlights the importance of targeted education and structured risk communication to enhance patient awareness of prediabetes risks and program benefits. Personalized and actionable intervention strategies, combined with timely monitoring and feedback, can support patient adherence. Effective implementation also requires well-trained stakeholders, clearly defined roles, and adequate resources. To ensure long-term impact, future research should address the sustainability and cost-effectiveness of implementing diabetes prevention programs in primary care settings.</div></div>","PeriodicalId":50299,"journal":{"name":"International Journal of Nursing Studies","volume":"170 ","pages":"Article 105156"},"PeriodicalIF":7.5,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144613287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Qianyin Zhu , Peipei Gu , Yandie Wang , Fei Zeng , Meijuan Lan
{"title":"Exploring the exercise experiences of lung transplant recipients during the waiting list period: A qualitative study","authors":"Qianyin Zhu , Peipei Gu , Yandie Wang , Fei Zeng , Meijuan Lan","doi":"10.1016/j.ijnurstu.2025.105160","DOIUrl":"10.1016/j.ijnurstu.2025.105160","url":null,"abstract":"<div><h3>Background</h3><div>Lung transplantation is a crucial intervention for end-stage lung disease. However, the shortage of donor lungs often results in prolonged waiting times, during which some patients may experience disease deterioration or even death. Exercise during the waiting list period has been shown to improve cardiopulmonary function and postoperative outcomes in lung transplant candidates. Nevertheless, existing studies primarily focus on physiological indicators, with limited exploration of patients' subjective experiences.</div></div><div><h3>Objective</h3><div>To explore the exercise experiences and perspectives of lung transplant recipients during the waiting list period.</div></div><div><h3>Design</h3><div>A descriptive qualitative design was used.</div></div><div><h3>Setting</h3><div>A tertiary hospital in Zhejiang Province, China.</div></div><div><h3>Participants</h3><div>Fourteen lung transplant recipients (mean age 53, range 25–74; mean wait time 54 days, range 23–123) participated in the study.</div></div><div><h3>Methods</h3><div>A purposive sampling method was used to select lung transplant recipients from a tertiary hospital in Zhejiang Province, China, between December 2024 and February 2025. A content analysis approach was conducted to analyze the qualitative data.</div></div><div><h3>Result</h3><div>Four main themes emerged. The first theme, the duality of exercise experiences, included cumulative benefits, adverse physiological responses, and anxiety regarding exercise risks. The second theme, drivers of sustained exercise, involved intrinsic motivation and extrinsic incentives. The third theme, needs for professional support, reflected expectations for personalized exercise plans, safety monitoring and symptom guidance. The final theme, needs for informal support networks, underscored the necessity of family presence, peer interaction, and accessible exercise settings for emotional and practical support.</div></div><div><h3>Conclusion</h3><div>Exercise among lung transplant candidates during the waiting period is shaped by diverse physical responses, emotional attitudes, and social influences. These findings underscore the importance of tailoring exercise interventions to individual capabilities, concerns, and support needs. Combining personalized professional guidance with flexible informal support may reduce perceived risks and improve engagement with physical activity.</div></div>","PeriodicalId":50299,"journal":{"name":"International Journal of Nursing Studies","volume":"170 ","pages":"Article 105160"},"PeriodicalIF":7.5,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144611591","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Zi Rong Lee , Ling Jie Cheng , Ying Yee Yeo , Darryl Rolfson , Xi Vivien Wu
{"title":"Measurement properties of the Edmonton Frail Scale in older adults: A systematic review and meta-analysis","authors":"Zi Rong Lee , Ling Jie Cheng , Ying Yee Yeo , Darryl Rolfson , Xi Vivien Wu","doi":"10.1016/j.ijnurstu.2025.105161","DOIUrl":"10.1016/j.ijnurstu.2025.105161","url":null,"abstract":"<div><h3>Background</h3><div>Frailty is a clinical condition characterised by heightened vulnerabilities to stressors and negative health consequences. The Edmonton Frail Scale is a prominent multidimensional tool for assessing frailty across various settings.</div></div><div><h3>Objectives</h3><div>This review aimed to synthesise and evaluate the certainty of evidence and the quality of Edmonton Frail Scale in older adults aged 60 and above with respect to its reliability (test–retest, inter-rater) and construct validity (convergent, known-group).</div></div><div><h3>Design</h3><div>Systematic review and meta-analysis.</div></div><div><h3>Setting and participants</h3><div>Older adults across clinical and community settings.</div></div><div><h3>Methods</h3><div>A comprehensive search was conducted across eight databases from inception to 29 January 2024. An updated search in MEDLINE (PubMed) on 10 April 2025 identified no additional eligible articles. COSMIN risk-of-bias checklist was used for quality appraisal, and evidence synthesis followed COSMIN guidelines. Random-effects meta-analysis and univariate logistic regression was used to quantitatively synthesise evidence for reliability and construct validity, respectively.</div></div><div><h3>Results</h3><div>Twenty studies involving 3852 older adults were included. The original Edmonton Frail Scale demonstrated sufficient construct validity across most populations, supported by high certainty of evidence. However, construct validity was inconsistent in acute care populations and in studies using modified Edmonton Frail Scale versions, where content adaptations (e.g., omission of performance-based items) may have affected psychometric performance. Meta-regression revealed that modified versions were significantly less likely to yield positive validity ratings compared to the original Edmonton Frail Scale (OR = 0.29; 95 % CI: 0.09–0.95; p = 0.042). Test–retest and inter-rater reliability were sufficient, though heterogeneity was considerable, and certainty of evidence remained moderate.</div></div><div><h3>Conclusion</h3><div>The Edmonton Frail Scale shows good overall reliability and validity in assessing frailty among older adults, particularly in stable clinical or community settings. However, caution is warranted when using modified versions or applying the tool in acutely ill populations. Future studies should validate Edmonton Frail Scale adaptations and enhance the precision of reliability estimates, especially in underrepresented regions and high-risk subgroups.</div></div><div><h3>Registration</h3><div>The protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) database (CRD42024504735).</div></div>","PeriodicalId":50299,"journal":{"name":"International Journal of Nursing Studies","volume":"170 ","pages":"Article 105161"},"PeriodicalIF":7.5,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144613370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Fang Yan , Lily Xiao , Chongmei Huang , Siyuan Tang , Li Li
{"title":"Effectiveness of a nurse-led hybrid self-management program for community-dwelling older people with urinary incontinence: A randomized controlled trial","authors":"Fang Yan , Lily Xiao , Chongmei Huang , Siyuan Tang , Li Li","doi":"10.1016/j.ijnurstu.2025.105157","DOIUrl":"10.1016/j.ijnurstu.2025.105157","url":null,"abstract":"<div><h3>Background</h3><div>Evidence-based guidelines recommend multicomponent interventions including behavior interventions and lifestyle interventions to optimize effects on the urinary incontinence in older people. However, few studies have trialed these interventions led by nurses in primary care setting using hybrid (offline and online) self-management strategies for community-dwelling older people with urinary incontinence.</div></div><div><h3>Objectives</h3><div>To evaluate the effectiveness of a nurse-led hybrid self-management program on self-efficacy, severity of urinary incontinence, urinary incontinence related knowledge and attitude, quality of life, adherence to pelvic floor muscle training and anxiety and depression among community-dwelling older people with urinary incontinence, compared to the existing usual nursing care.</div></div><div><h3>Design</h3><div>A single-blind, two-arm parallel randomized controlled trial with a repeated measures design.</div></div><div><h3>Settings and participants</h3><div>We recruited community-dwelling older people with mild or moderate severity of urinary incontinence.</div></div><div><h3>Methods</h3><div>Eligible participants were randomly assigned (1:1) to either the intervention group (a nurse-led hybrid self-management program) or usual care group (usual nursing care) in the primary care. Outcomes were measured at baseline (T0), 3 months (T1) and 6-months (T2) post-baseline.</div></div><div><h3>Results</h3><div>Sixty-six participants were recruited and randomly assigned to the intervention group (N = 33) or the usual care group (N = 33). Of those, 95.5 % completed the 3-month follow-up after the completion of intervention. The intervention group demonstrated a statistically significant higher score of self-efficacy (Mean Difference (MD) = 45.3, 95 % CI: 38.9, 51.8, <em>p</em> < 0.001), urinary incontinence related knowledge (MD = 10.5, 95 % CI: 8.8, 12.2, <em>p</em> < 0.001), attitude (MD = 4.1, 95 % CI: 3.0, 5.1, <em>p</em> < 0.001), quality of life (MD = 19.3, 95 % CI: 15.4, 23.2, <em>p</em> < 0.001) and lower score of severity of urinary incontinence (MD = 4.1, 95 % CI: 2.8, 5.4, <em>p</em> < 0.001) than the usual care group at T2. The proportion with high adherence to pelvic floor muscle training was statistically significant larger in the intervention group than in the usual care group (33.3 % vs. 12.1 %, Risk Difference (RD) = 0.21, 95 % CI: 1.0, 12.9; χ<sup>2</sup> = 4.23, <em>p</em> = 0.040) at T2. However, no statistically significant differences were observed in anxiety (MD = 0.3, 95 % CI: −<!--> <!-->1.6. 0.9, <em>p</em> = 0.600) and depression (<em>p</em> > 0.05) at T2.</div></div><div><h3>Conclusion</h3><div>The nurse-led hybrid self-management program demonstrated positive effects on the self-efficacy, severity of urinary incontinence, urinary incontinence related knowledge and attitude, adherence to pelvic floor muscle training and quality of life for commun","PeriodicalId":50299,"journal":{"name":"International Journal of Nursing Studies","volume":"170 ","pages":"Article 105157"},"PeriodicalIF":7.5,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144579509","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}