International Journal of Nursing Studies最新文献

{"title":"Implementation of a task-shifting and task sharing intervention: A case of ward assistants in Kenyan neonatal units","authors":"Vincent A. Kagonya ,&nbsp;Nancy Odinga ,&nbsp;Onesmus Onyango ,&nbsp;Caroline Waithira ,&nbsp;Abdulazeez Imam ,&nbsp;Edna Mutua ,&nbsp;Dorothy Oluoch ,&nbsp;Michuki Maina ,&nbsp;Kenneth Karumba ,&nbsp;Irene Amadi ,&nbsp;Sebastian S. Fuller ,&nbsp;David Gathara ,&nbsp;Mike English ,&nbsp;HIGH-Q Hospital Group","doi":"10.1016/j.ijnurstu.2025.105176","DOIUrl":"10.1016/j.ijnurstu.2025.105176","url":null,"abstract":"<div><h3>Background</h3><div>Nurses working in intermediate care neonatal units in Kenya often experience workload that is six times greater than global recommendations, and this presents quality and safety concerns. Fiscal constraints often limit nurse recruitment. Therefore, addressing workforce shortages to improve quality of care requires careful consideration of skill-mix. We evaluated the feasibility of a task-shifting and task sharing intervention that involved (re)distribution of non-clinical roles from nurses to ward (care) assistants in Kenyan neonatal units.</div></div><div><h3>Methods</h3><div>We conducted a mixed methods convergent study. We enhanced staffing by adding three trained ward assistants to each of four Kenyan neonatal units. Pre- and post-intervention data were collected on a cumulative set of 593 babies using a structured Nursing Care Index tool that involved over 6520 person-hours of direct observation and was complemented by 1340 h of non-participant ethnographic observation and 47 in-depth interviews of nurses and ward assistants. Integration occurred at the analysis, results synthesis, and interpretation stages.</div></div><div><h3>Results</h3><div>After introducing ward assistants, the pattern of bedside care delivered remained largely unchanged; nurses continued to directly deliver an average of 32 % of the expected care bundle, ward assistants delivered only 1–2 % bedside care while about 19 % of overall expected care remained undone. Although they delivered little directly observed bedside care qualitative data confirmed that ward assistants took up 27 different tasks that we broadly categorized as routine newborn care, vital signs, catering, messenger, porter, customer care, cleaning and general housekeeping roles. Nurses and mothers appreciated ward assistants' work. While there was some element of extended roles, there was very minimal evidence of ‘role creep’.</div></div><div><h3>Conclusion</h3><div>Ward assistants undertook non-clinical roles as envisioned, and nurses viewed them as valuable additions to the workforce. In a care setting with constrained nurse staffing, introducing ward assistants to undertake non-technical tasks present an opportunity to support nurses and improve some aspects of care quality.</div></div>","PeriodicalId":50299,"journal":{"name":"International Journal of Nursing Studies","volume":"171 ","pages":"Article 105176"},"PeriodicalIF":7.1,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144903562","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":"Effects of non-pharmacological interventions on physical activity and sedentary behaviour among patients with coronary heart disease: A systematic review and meta-analysis","authors":"Elaine Yi Ning Miu ,&nbsp;Stanley Kam Ki Lam ,&nbsp;Mengqi Xu ,&nbsp;Ho Yu Cheng","doi":"10.1016/j.ijnurstu.2025.105180","DOIUrl":"10.1016/j.ijnurstu.2025.105180","url":null,"abstract":"<div><h3>Background</h3><div>Coronary heart disease is the leading cause of death worldwide. Adequate physical activity is a well-known protective factor against recurrent cardiac events. Emerging evidence also showed that sedentary behaviour is an independent cardiovascular risk factor. It is thereby essential to identify effective strategies that improve these movement behaviours, physical activity and sedentary behaviour, among patients with coronary heart disease.</div></div><div><h3>Aims</h3><div>This systematic review aims to identify the best available evidence on the effectiveness of non-pharmacological interventions in promoting physical activity and/or reducing sedentary behaviours among patients with coronary heart disease.</div></div><div><h3>Methods</h3><div>Randomised controlled trials that examine the effects of non-pharmacological interventions on physical activities or sedentary behaviours or both among patients with coronary heart disease were included. A systematic search was conducted in eight English and Chinese electronic databases from inception to July 2025. Version 2 of the Cochrane risk-of-bias tool for randomised trials was used to assess the risk of bias in included studies. Meta-analyses were performed by using the Review Manager 5.4 when appropriate. A narrative summary was provided when meta-analysis was not feasible.</div></div><div><h3>Results</h3><div>A total of 25 studies (28 articles) involving 5608 coronary heart disease patients were included. The interventions were categorised into two types: those using behavioural change techniques alone (<em>k</em> = 17) or those combining motivational strategies and behavioural change techniques (<em>k</em> = 8). Nineteen included studies provided sufficient information for meta-analyses, with narrative summaries provided for the remaining studies. Meta-analyses showed that interventions combing motivational strategies and behavioural change techniques (<em>k</em> = 2, SMD 0.34, 95 % CI: 0.24, 0.45, <em>p</em> &lt; 0.001, <em>I</em>² = 9 %) and those using behavioural change techniques alone (<em>k</em> = 4, SMD 0.30, 95 % CI: 0.12, 0.47, <em>p</em> &lt; 0.001, <em>I</em>² = 0 %) both significantly increased the total physical activity time. Both types of interventions demonstrated significant improvement in the moderate-to-vigorous physical activity time (<em>k</em> = 12, SMD 0.23, 95 % CI: 0.12, 0.35, <em>p</em> &lt; 0.001, <em>I</em>² = 0 %). However, no significant improvement in sedentary behaviours (<em>k</em> = 10) was found in the meta-analysis.</div></div><div><h3>Conclusions</h3><div>The review suggests that interventions that adopt both motivational strategies and behavioural change techniques could increase the time spent in total physical activity and moderate-to-vigorous physical activity. Further studies on developing and examining the effects of interventions aimed at improving movement behaviours are warranted for the cor","PeriodicalId":50299,"journal":{"name":"International Journal of Nursing Studies","volume":"171 ","pages":"Article 105180"},"PeriodicalIF":7.1,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144852489","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":"Healthcare professionals' perceived challenges and benefits of digital patient-reported data for in-hospital postoperative pain monitoring: A qualitative study","authors":"Cecilie Merethe Øvrebotten ,&nbsp;Runar Tengel Hovland ,&nbsp;Janne Cecilie Øvrevold Låver ,&nbsp;Signe Berit Bentsen ,&nbsp;Christian Moltu","doi":"10.1016/j.ijnurstu.2025.105174","DOIUrl":"10.1016/j.ijnurstu.2025.105174","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Pain is a common consequence of surgery, with many patients experiencing moderate to severe postoperative pain. Although self-reported pain remains the gold standard for assessment, there are barriers to implementing current assessment methods in clinical practice. Promising results from digital solutions for pain management underscore their potential for more efficient and personalised treatment, yet more research is needed for clinical integration. A new risk assessment system for chronic postsurgical pain is being developed, based on patient-reported data and digital acute pain monitoring. Innovations that align with existing practices are more likely to lead to successful implementation in healthcare settings.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Objective&lt;/h3&gt;&lt;div&gt;We aimed to explore healthcare professionals' perspectives on the use of digital solutions for postoperative pain assessment in the context of in-hospital clinical practice, as a first step in implementing digital patient-reported pain monitoring.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Design&lt;/h3&gt;&lt;div&gt;A qualitative exploratory study was conducted.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting&lt;/h3&gt;&lt;div&gt;This study was conducted in different hospital departments (post-anaesthesia care unit, general surgery wards, and orthopaedic wards) of two hospitals on Norway's west coast.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;This study used semi-structured focus group interviews of healthcare professionals who worked with postoperative hospitalised patients. Seven focus group interviews were conducted with 39 healthcare professionals. The data were analysed inductively and in accordance with Braun and Clarke's six steps of Reflexive thematic analysis.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Our analyses yielded two overarching themes: (1) Challenges associated with utilising digital pain intensity monitoring and (2) Perceived benefits of utilising digital pain measures in clinical practice. The three sub-themes, (1a) Pain assessment is an inseparable part of a complex care process, (1b) Subjective pain reports require contextual evaluation, and (1c) Variable patients and situational fits of digital self-reports, collectively reflected the perceived challenges of the usability and integration of digital pain intensity monitoring tools in the clinical practice of surgical care. The sub-themes, (2a) Preventing loss of control by mapping and (2b) Patient empowerment through enhanced communication, illustrated the potential benefits of digital pain monitoring in clinical practice.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;This study highlights the concern among healthcare professionals that digital systems reduce healthcare professionals' time with patients and undermine their clinical experience. Although digital pain monitoring might provide valuable information, clinical judgement remains essential due to the multifaceted nature of pain assessment. Involving stakeholders early in the implementation process provides valuable ins","PeriodicalId":50299,"journal":{"name":"International Journal of Nursing Studies","volume":"170 ","pages":"Article 105174"},"PeriodicalIF":7.1,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144772543","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":"Illegitimate tasks, overqualification, organizational obstruction, and workplace deviance among nurses: A two-wave cross-sectional survey","authors":"Shuai Yuan ,&nbsp;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> &lt; 0.001), which in turn predicted both organizational deviance (β = 0.17, 95 % CI = [0.10, 0.24], <em>p</em> &lt; 0.001) and interpersonal deviance (β = 0.13, 95 % CI = [0.08, 0.18], <em>p</em> &lt; 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 ,&nbsp;Li Xu ,&nbsp;Geraldine Lee ,&nbsp;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 ,&nbsp;Min Feng ,&nbsp;Yuting Chen ,&nbsp;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}

{"title":"The association between self-reported substance use and work schedule characteristics among nurses: A cross-sectional study","authors":"Jung Min Yoon ,&nbsp;Alison M. Trinkoff ,&nbsp;Victoria Selby ,&nbsp;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}

{"title":"A tailored de-implementation strategy to reduce low-value home-based nursing care: A multiple interrupted time series study","authors":"Benjamin Wendt ,&nbsp;Dorien L. Oostra ,&nbsp;Steven Teerenstra ,&nbsp;Minke S. Nieuwboer ,&nbsp;Hester Vermeulen ,&nbsp;Simone A. Van Dulmen ,&nbsp;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’ &amp; ‘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’ &amp; ‘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}

{"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 ,&nbsp;Zheng Lin ,&nbsp;Yang Lei ,&nbsp;Qingyu Wang ,&nbsp;Lichen Tang ,&nbsp;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}