Provision of palliative and end-of-life care by community health nurses: A scoping review on the challenges and potential solutions.

Recent advances in technology and the impact of COVID-19 have expanded the adoption of digital health. Synchronous collaborative telehealth between optometry and ophthalmology has been used to expedite specialist eye care in Western Australia since 2011. Optometrists perform an in-person assessment and participate in videoconferencing with ophthalmology to facilitate shared decision-making. This study utilises existing implementation theory to assess factors influencing implementation success, sustainability and scalability of this telehealth model. Regional, rural, and remote Western Australia. In-depth interviews were undertaken using an interview guide based on the Consolidated Framework for Implementation Research (CFIR). Deductive analysis was used to code themes to the framework, and inductive analysis was used for themes relating to sustainability and scalability. Sixteen clinical and non-clinical staff with experience in telehealth for eye care in rural Western Australia. Key themes identified using the CFIR included the relative advantage of telehealth (innovation), optimising workflow and role clarification (implementation process), funding (external setting), technological infrastructure (inner setting), a champion, and ownership and adaptability (individuals). Stakeholder buy-in, resource allocation, integration into public health infrastructure, asynchronous telehealth, and artificial intelligence were themes pertaining to both sustainability and scalability. This study proposes key considerations in the implementation and maintenance of a collaborative telehealth model for eye care in rural areas which may be used as a basis for guideline development or to replicate the model in other contexts.

Understanding oncology nurses' experiences with virtual care and interprofessional collaboration in Canada: A mixed-method study.

Development and validation of a questionnaire measuring healthcare professionals' individual perceptions of advanced practice nurses' contributions to team functioning: a modified international Delphi approach.

A description of emergency nursing in a Danish context through focus group interviews.

The western existing scales to measure employee burnout are often critiqued in relation to cultural sensitivity and early stage job frustration experience while being implemented in non-western settings as evidenced within the limitations of the local study findings. Therefore, since Omani society values social stability while being integrated with employment, there is a demanding necessity for developing a culture-sensitive scale to measure job frustration among healthcare workers (HCWs). This study aimed to develop and psychometrically validate the Omani Job Frustration Questionnaire (OJFQ), a culturally grounded instrument designed to assess early-stage occupational frustration among healthcare workers in Oman. The development of the scale was considered following a sequential mixed-methods approach. Set of six focus group discussions (FGDs) with 42 nurses in the mental health setting steered initial item generation guided by conceptual frameworks from the MARS model, and CBI. Expert reviews involving 16 professionals from Oman and Malaysia were conducted to refine the item pool ending up with a 45-item OJFQ initially. The newly developed scale was surveyed on 139 participants working in a mental health setting, primarily involving nursing professionals, getting a response rate of 99.3%. The data analysis was conducted in presenting details of descriptive statistics, Cronbach's alpha, exploratory factor analysis (EFA), item analysis and confirmatory factor analysis (CFA) to assess scale validity. The final scale included 37-item across five constructs after conducting EFA: (1) management and role clarity, (2) emotional regulation and professional coping strategies, (3) career development and engagement, (4) workplace bureaucracy and social challenges, and (5) workplace resources and stability. The scale demonstrated acceptable internal consistency (Cronbach's α = 0.774 for the final 37-item version), and all constructs were significantly correlated with the total score. CFA showed an acceptable chi-square ratio but suboptimal fit across most indices, providing preliminary support for the proposed factor structure. Both EFA and CFA were conducted on the same sample. In addition, there was no significant correlation (r = 0.032, p = 0.709) was found with the CBI, suggesting that the scale may capture a related but distinct construct. The OJFQ represents a culturally tailored instrument with preliminary psychometric support for assessing job frustration among healthcare workers with initial validation in a mental health nursing context in Oman. Its development may support early identification of occupational strain within culturally specific healthcare environments. Further refinement across diverse healthcare settings and populations are warranted.

AimThis study aimed to retrospectively describe the implementation barriers and facilitators when introducing a new nursing role (RPN) using the Consolidated Framework for Implementation Research (CFIR) and to map implementation strategies onto the Expert Recommendations for Implementing Change (ERIC) factors to identify relevant strategies supporting new role implementation in the acute care setting.DesignA qualitative descriptive study embedded in a multiphase implementation evaluation study.MethodsSemistructured interviews with organizational leaders, implementation leaders, and nurses, combined with document analysis, were analyzed using the CFIR deductively to identify barriers and enablers mapped to the ERIC tool for strategies guiding implementation.ResultsParticipants (N = 25) represented organizational leaders (n = 3), implementation leaders (n = 11), RNs (n = 4), and RPNs (n = 7) from October 2024 to January 2025. Seventeen CFIR constructs across five domains were identified. Common themes of enablers include factors in the inner setting, such as a tension for change, mission alignment, and innovation compatibility. Many enablers were also found in the implementation process, which involved teaming, assessing context and needs, engaging, tailoring strategies, and reflecting and evaluating. Barriers to implementation were found in the inner setting, including culture and limited access to knowledge and information about the role. Eleven implementation strategies were identified to address or amplify the barriers or enablers, including involving and preparing staff for the introduction, developing education material, and identifying champions.ConclusionThe introduction of the RPN role in acute care was shaped by organizational readiness, leadership support, and workforce needs, while challenges related to role clarity and team integration remained. Implementation science approaches may help guide strategies to support the successful integration of new nursing roles within hospital care delivery models.Reporting MethodThis study adhered to COREQ guidelines.Patient or Public ContributionNo patient or public contribution.

Improving Chest Compression Quality in Cardiac Arrest: A Multimodal Intervention Project in the Emergency Department.

Advocacy of public health principles (PHP) is crucial to tackling health inequities. Advocacy skills are therefore a core competency of Public Health speciality training in the UK. A survey of UK-trained specialist registrars found that the perceived ability to advocate for PHP varied significantly across work settings. This study explores barriers and enablers to PHP advocacy across workplaces, offering insights into how advocacy can be better supported in the UK public health landscape. An online survey was sent to UK-based public health specialty trainees, consultants, and public health practitioners on the portfolio route to consultant practice currently. Free-text survey responses were analysed using template analysis and the Theoretical Domains Framework. Sixty-four respondents completed the survey. This study found that role clarity, organizational support, and advocacy skills significantly affect public health specialists' ability to advocate. Barriers included unclear responsibilities, fear of consequences, resource constraints, and inadequate training and mentorship. Supportive leadership and shared values facilitated success. To promote advocacy, the Faculty of Public Health should ensure specialists are positioned as autonomous experts, address biases in recruitment, and integrate advocacy skills further into training. Organizations must evaluate how their structure, culture, and leadership support public health advocacy.

Older adults living in long-term care homes often experience impairment in mobility and function requiring physical therapy rehabilitation. Maintaining residents' physical function can promote quality of life, reduce pain and skin breakdown, and support the provision of personal care. Family/care partners notably contribute to resident well-being. Understanding engagement between physical therapists and family/care partners is essential to advancing resident rehabilitation and health outcomes, particularly as staffing capacity, time, and access to rehabilitation services become increasingly constrained. This review aimed to synthesise and assess the quality of the literature describing engagement between physical therapists and family/care partners of older adults in long-term care. A scoping review was conducted following Arksey and O'Malley's framework and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews checklist. Six databases and grey literature were searched without date restrictions. Papers were eligible for inclusion if they: (1) described engagement between physical therapists and family/care partners as reported by any participant group; (2) were conducted in a long-term care home or equivalent setting; (3) focused on physical rehabilitation for older adults; and (4) were available in English. Any study design was eligible. Data were analysed thematically and methodological quality was assessed. Of 3443 papers and records screened, nine studies were included. Most (n=8) were qualitative and conducted in high-income countries and all were rated as "good" quality. Four themes surfaced describing engagement between physical therapists and family/care partners in long-term care: (1) physical therapists support greater family/care partner involvement in rehabilitation; (2) opportunities to enhance structured communication between physical therapists and family/care partners; (3) misalignment of family/care partner expectations with physical therapy service capacity; and (4) enhancing role clarity and value of family/care partners in rehabilitation. Engagement between physical therapists and family/care partners in long-term care homes is underdeveloped despite recognition of its potential benefits. Clearer role definitions, structured communication, and supportive organisational policies are needed to enhance collaboration, reduce caregiver burden, and support manageable physical therapist workloads. Strengthening these partnerships could improve rehabilitation processes, resident health outcomes, and sustainability of long-term care services.

ABSTRACT This article analyzes the influence of the integration capability of management information systems (MIS) on job performance, with the intervention of internal process knowledge through MIS and role clarity in objectives and processes. Structural equation modeling was applied to the data from a survey with 257 public servants at an institution responsible for overseeing the judicial function of the State. Results indicate that the integration capability of MIS enhances job performance indirectly, mediated by internal process knowledge through MIS and role clarity in processes. The serial mediation reveals that the integration capability of MIS fosters internal process knowledge through MIS, which influences role clarity in processes, ultimately impacting job performance. Role clarity in objectives did not present statistical significance in the serial mediation, suggesting a greater focus on processes over objectives. The findings provide insights, consistent with the resource-based view (RBV), by demonstrating in serial mediation that interpersonal factors mutually reinforce each other to foster job performance. Understanding these complementarities enables the promotion of improvements in public services offered to citizens.

Effective interprofessional collaboration is essential to high-quality care, yet siloed training, unclear roles, and hierarchical structures frequently undermine teamwork in clinical care environments. Efforts to achieve sustained behavioral change have yielded inconsistent results despite decades of advocacy for interprofessional education. Time constraints, staff turnover, and limited opportunities for shared learning exacerbate these challenges, particularly in high-acuity settings. We developed the Strengthening Minds by Leveraging Education (SMiLESM) program to address these barriers and enhance teamwork within a Medical Intensive Care Unit. Co-designed by educators and frontline clinicians, the curriculum is grounded in transformative learning theory and structured using the RAPR model (Recognize, Analyze, Practice, Reflect). Sessions rotate through four core domains: role clarity, psychological safety, teaming, and empathy. SMiLESM was designed to be a low-burden educational activity that brings together weekly professionals from at least four professional groups, to reflect on challenges and learn with, from, and about each other. Between 2019 and 2023, 127 SMiLESM sessions were facilitated for caregivers from 15 professions, totaling 1,416 learning encounters. Qualitative narratives and focus group data reflected increased clarity around roles, enhanced use of structured communication, and improved team dynamics. Organizational surveys showed gains in psychological safety and teamwork among a high-acuity workforce. ACGME milestone ratings suggested growth in communication and professionalism competencies among GME trainees. SMiLESM is an adaptable and practical approach for improving team behaviors and cultivating collaborative culture in high-acuity environments like intensive care units. We find it to be a promising educational method to enhance interprofessional practice.

Mentoring in nursing is crucial for supporting newly qualified nurses, enhancing retention and promoting professional development. Despite its significance, limited research has explored nurse mentors' perspectives and their own development through mentoring. To explore how a structured mentoring intervention influences nurse mentors' clinical teaching behaviour, self-efficacy and experiences of their professional role development. A convergent mixed-methods study was conducted during a mentorship intervention across healthcare units in hospitals and municipalities in northern Sweden and Norway. Forty-one experienced registered nurses participated as nurse mentors. Quantitative data were collected via validated instruments on clinical teaching behaviour and self-efficacy before and twice after the intervention. Qualitative data were collected through post-intervention focus group interviews. Quantitative data were analysed using Wilcoxon signed rank test; qualitative data were analysed using qualitative content analysis. Findings were triangulated to identify convergence and divergence. Nurse mentors reported personal and professional growth, especially in relationship-building, mentoring skills and role clarity. Results showed consistently high ratings in clinical teaching behaviour and self-efficacy, with an increase in clinical teaching behaviour scores post-intervention. Structured mentoring interventions support nurse mentors' development, improving clinical teaching practices and reinforcing their professional identity-key factors in nurse retention. The findings highlight the need for sustained nurse mentor support and tailored mentorship frameworks to ensure effective, long-term mentoring in nursing. What problem did the study address? Mentoring is essential for supporting newly qualified nurses, improving retention and fostering their professional development. Most mentorship research focuses on mentees, with limited insight into nurse mentors' perspectives and development. What were the main findings? Nurse mentors experienced development in several areas throughout the intervention, particularly in building relationships, fostering meaningful mentoring skills and refining their role as nurse mentors. Where and on whom will the research have an impact? This study can inform policy and practice by contributing knowledge on the development of sustainable mentoring frameworks. These frameworks support the formation of collaborative and stable work groups in clinical settings, enhancing nurse retention, professional development and the overall quality of patient care. This study adhered to the Good Reporting of A Mixed Methods Study (GRAMMS) guidelines, by O'cathain etal. as recommended by the EQUATOR network. No patient or public contribution.

The voices of implementers are crucial in enhancing policy implementation. In the North West Province of South Africa, there have been no studies on the implementation of national guidelines for patient safety incident reporting since its introduction. Hence, this study explored the implementation of the national guidelines for patient safety incident reporting in selected public hospitals in the Dr Kenneth Kaunda district from the implementers' perspectives. This study employed a qualitative exploratory design with purposive sampling of hospital leaders, nurses, doctors, physiotherapists, occupational therapists, and pharmacists, leading to a total of 23 focus group discussions, spread across three participating hospitals, with four to seven participants in each focus group. The policy triangle framework of context, content, actors, and process guided the development of the focus group discussion guide and informed a deductive thematic analysis. Seven themes emerged, including contextual issues leading to implementing guidelines, common incidents & contributing factors, clarity of policy content, actors' knowledge, role clarity, motivation, and implementation process. The context of implementing guidelines was a need to standardise reporting practices, improve record-keeping, and mitigate potential litigation risks. Key contributing factors to patient safety incidents were inadequate security response, staff shortages, and resource constraints. The content of standard operating procedures was clear, yet lengthy. Discrepancies between the reporting tool and standard operating procedures complicated the reporting process. The actors' knowledge gaps hindered accurate reporting. Managers lacked effective strategies for motivating their reporting staff, further impeding the system's efficacy. While intrinsic motivation, grounded in professional accountability, drove some reporting, fears of consequences were present. The process of reporting was considered burdensome, and insufficient feedback mechanisms left staff uncertain about the value of their contributions. To improve implementation of the patient safety incident reporting, a system-wide approach is necessary; healthcare providers and leaders' knowledge must be improved, strategies to motivate reporting must be explored, leaders must create environments conducive for reporting, including protection of the reporters, and improvements after every reported system-level weakness are mandatory in order to encourage reporting. If reporting is for learning, anonymous reporting should be emphasised. Reporting processes must be made easy and consider available technology.

Early integration of pediatric palliative care (PPC) is associated with improved symptom management, quality of life, and healthcare utilization for children with cancer. Despite this, variation persists in how PPC is understood, operationalized, and integrated within pediatric oncology programs. In particular, ambiguity surrounding the roles of oncology teams providing generalist palliative care and specialist PPC teams may contribute to delayed or inconsistent involvement. We conducted a qualitative study using a grounded theory approach as part of a larger multi-site project examining barriers and facilitators to early PPC integration in pediatric oncology. Semi-structured interviews were conducted with healthcare professionals from four Canadian pediatric centers, including oncologists, PPC physicians, nurses, social workers, and other interprofessional team members. Interviews explored definitions of PPC and perceived roles and responsibilities of oncology and PPC teams. Transcripts were coded iteratively using constant comparative analysis until thematic saturation was reached. Participants from both oncology and PPC teams demonstrated substantial concordance in defining PPC as holistic, family-centered care focused on quality of life, symptom management, psychosocial support, and goal-concordant decision-making. Both groups described overlapping responsibilities, particularly in symptom control and psychosocial care. However, specialist PPC teams identified additional roles including complex serious illness communication, bereavement support, funeral planning, and 24/7 availability that oncology teams did not consistently recognize as part of their role. Participants emphasized that PPC roles are fluid and context-dependent, shifting across disease trajectory, care setting, family needs and goals, and institutional resources. In pediatric oncology settings, overlap between generalist and specialist PPC reflects collaborative care rather than duplication. However, a lack of shared role clarity may impede timely specialist PPC involvement. Developing shared frameworks, institutional definitions, and ongoing interdisciplinary communication may support earlier, coordinated, and family-centered PPC integration for children with cancer.

This study focuses on analysing the onboarding process and its impact on employee engagement at Sundaram Finance. Onboarding is a crucial human resource function that helps new employees adapt to the organizational environment, understand their roles, and become productive members of the workforce. Employee engagement, on the other hand, plays a significant role in determining organizational performance, employee satisfaction, and retention. The primary objective of this study is to evaluate the effectiveness of the onboarding process and examine its relationship with employee engagement levels. The study also aims to identify the key factors influencing employee perception of onboarding and suggest improvements to enhance the overall experience. Data for the study was collected through a structured questionnaire distributed among employees, covering various aspects such as recruitment experience, orientation, training, role clarity, communication, and engagement levels. The analysis of the data reveals that the onboarding process at Sundaram Finance is generally well-structured and effective. Most employees expressed satisfaction with the recruitment procedures, orientation programs, and support provided during the initial stages of employment. The findings indicate a strong positive relationship between onboarding and employee engagement, as employees who experienced a smooth and informative onboarding process reported higher levels of motivation, emotional connection, and job satisfaction. However, the study also identifies certain areas for improvement, including the need for more interactive sessions, practical training, and enhanced communication. Strengthening these aspects can further improve employee experience and engagement levels. The study concludes that an effective onboarding process is essential for building a committed and high-performing workforce, and it significantly contributes to employee retention and organizational success.KEYWORDS: Onboarding Process, Employee Engagement, Human Resource Management, Employee Satisfaction, Organizational Performance, Training and Development, Recruitment Experience, Employee Experience.

Parental engagement is a critical determinant of the sustainability and effectiveness of school feeding initiatives, particularly in day public secondary schools where learners depend heavily on community support. This study examined the factors influencing parental engagement in school feeding initiatives in Nyamagana District, Tanzania. Anchored in Social Capital Theory, the study adopted a mixed-methods approach within a pragmatic research paradigm. Quantitative data were collected from parents using structured questionnaires, while qualitative data were obtained through semi-structured interviews with school heads, ward education officers, and district education officials. Quantitative data were analysed using descriptive statistics, correlation, and multiple regression analysis, while qualitative data were analysed thematically. The findings reveal that parental engagement is significantly influenced by socio-economic factors, parental awareness and attitudes, and school-related institutional factors. Economic capacity, clarity of parental roles, effective communication, and inclusive school leadership emerged as key predictors of engagement. The study concludes that strengthening parental engagement requires deliberate strategies that address structural economic constraints, enhance awareness, and foster participatory school governance. The study recommends targeted parental sensitisation, flexible participation mechanisms, and strengthened school–community partnerships to enhance the sustainability of school feeding initiatives.

Paramedic involvement in general practice has expanded rapidly in response to workforce pressures and rising patient demand. Feedback and educational support are recognised as essential for clinician development, wellbeing, and patient safety. While existing studies have explored paramedics' transition more broadly, little is known about the experiences of non-roadmap paramedics (NRPs), who fall outside structured supervision frameworks. To explore how NRPs experience feedback and educational support in primary care, and how these processes influence professional learning, role integration, and wellbeing. A qualitative study was conducted with eight NRPs working in English general practice. Participants were recruited via purposeful and snowball sampling. Semi-structured interviews were undertaken online, transcribed, and analysed thematically using Braun and Clarke's framework. Reflexivity and supervision supported rigour and credibility throughout. Four themes were identified. First, participants described adjusting from ambulance service feedback, based on negative events, to a more educational model in general practice. Second, ad hoc case-based discussions were the most common form of feedback, valued for their immediacy and reassurance. Third, time and organisational constraints limited structured learning opportunities, with formal appraisals often absent or superficial. Finally, autonomy was both empowering and isolating, influencing opportunities for feedback and role clarity. Supportive practice cultures fostered feedback as a routine and developmental process, aiding integration. Feedback is central to NRPs integration and professional growth in general practice. However, reliance on ad hoc exchanges and lack of structured support risk undermining development. Sustainable integration requires time, mentoring, and educational investment to normalise feedback as a shared responsibility.

Becoming a midwife in Saudi Arabia: A qualitative study of the professional identity formation of students.

Development of meta-inferences using joint displays in mixed-methods nursing research: An illustrative study of an evidence-based practice educational intervention.