Nursing Skills Research Articles

Effect of mindfulness training program on well-being and leadership skills of psychiatric nurses

BackgroundNursing leaders need mindfulness, which is an effective intervention for reducing stress, promoting well-being, and enhancing their leadership skills. PurposeTo explore the effect of a mindfulness training program on the well-being and leadership skills of head nurses. MethodsA quasi-study design was used and conducted in a psychiatric and neurological university hospital on a convenience sample of 40 head nurses. Using the cognitive and affective mindfulness scale, the mindful attention awareness scale, the leadership skills questionnaire, and the mindfulness program. FindingsThe findings resulted in a significant difference in the effect of the mindfulness program before and after training when applied to leadership skills, especially conceptual and administrative skills. DiscussionManagers must adopt a mindfulness program, integrate it into nursing intervention protocols, and circulate it to all nursing staff because it has a noticeable impact if it is practiced seriously and its results are benefited from.

Results of a Feasibility Pilot Pragmatic Trial Implementing Palliative Care in Skilled Nursing Facilities.

Background: Seriously ill older adults are admitted for post-acute care in skilled nursing facilities (SNFs) for curative, rehabilitative treatments, yet experience high rates of re-hospitalization, and death. The primary palliative care in post-acute care (PPC-PAC) intervention is an evidence-based approach designed to help people with serious illness align treatment plans with goals of care, optimize quality of life, and improve satisfaction with their care. Objectives: To conduct a preliminary study and evaluate the feasibility of implementing the PPC-PAC intervention in the post-acute care SNF setting. Design: Two-group, multisite feasibility pilot pragmatic clinical trial with a non-equivalent design. Measurements: Primary outcome measures-eligibility, enrollment, and data collection rates; consultation satisfaction; and fidelity. Effectiveness outcome measure-quality of life using the Palliative Outcomes Scale version 2. Results: Close to 70% of those who were eligible and approached by the study team (45/65) enrolled in the trial throughout 12 SNFs in the Northeast and Mid-Atlantic United States. Thirty-five were enrolled from intervention sites; 10 were enrolled from control sites (usual care). Most participants (80%) expressed general satisfaction with PPC-PAC, and 90% of clinicians implemented the PPC-PAC intervention as intended. At 21 days follow-up, there were no significant differences in effectiveness outcomes. Conclusion: Implementation of the PPC-PAC intervention proved to be feasible and acceptable among older adults and clinicians. Future research should focus on testing the effectiveness of PPC-PAC and explore strategies for optimal intervention implementation and SNF staff engagement in the post-acute care setting.

Effects of single- and double-shift work on hand and cognitive functions in nurses.

This study aims to examine the influence of single and double-shift work schedules on hand function and cognitive capacities, specifically working memory, attention, and response time in nurses. Shift work, particularly in extended formats, is known to affect various physical and cognitive functions critical to nursing duties. Understanding these impacts is vital for managing nurse schedules to minimize health risks and maximize performance. With an increase in demands on healthcare systems, nurses often endure prolonged working hours, which may impair their cognitive and manual abilities, thereby affecting patient care quality. This study involved 45 nurses aged 20-40 years from shift-oriented units providing direct patient care. Hand function was assessed using the Nine-Hole Peg Test (9-HPT). Cognitive functions such as working memory, attention, and response time were evaluated using the digit span task and the Stroop test, respectively. Two-way analysis of variance (ANOVA) was used for statistical analysis, assessing the interactions of time and shift type, with a significance level set at p<0.05. The results revealed significant changes in all tested variables between pre- and post-shift assessments and between single and double-shift conditions. Notably, the double-shift work significantly exacerbated declines in all measured functions. These findings suggest that double shifts may intensify the deterioration of essential nursing skills, potentially compromising patient care. This study underscores the detrimental effects of extended shift work on nurses' cognitive and manual functions. These insights should guide healthcare institutions in revising nurse scheduling practices to safeguard their well-being and maintain high standards of patient care.

Implementing an obstetric simulation training protocol in a critical access hospital

BackgroundA high-fidelity (HF) simulation training protocol was implemented to improve nurses' knowledge, skills, and self-confidence to improve patient quality of care and safety, thus ultimately having an impact on decreasing maternal mortality rates. SampleThe sample consisted of 16 participants including nurses, a physician, emergency medical technicians (EMTs), and paramedics. MethodsThis project used a self-confidence and competence assessment prior to and following participation to determine statistical significance. In addition, review of the National League for Nursing Student Satisfaction and Self-Confidence in Learning tool data was done to determine the overall success of implementing a HF simulation training protocol. ResultsSuccess of the simulation and content was determined by a reported increase in self-confidence and competence post-simulation. The summative evaluation revealed that participants felt that implementing a HF simulation training protocol, in general, was useful for training. ConclusionWhile this project focused on obstetrics, the premise of the project can be applied to many subject areas to advance practice in rural health. Findings suggest that use of a high-fidelity simulation training protocol is beneficial.

Effect Of Communication Training Rubric On Empathic Communication Skills Of Nurses At A Tertiary Care Hospital: A Randomized Controlled Trial

Effect Of Communication Training Rubric On Empathic Communication Skills Of Nurses At A Tertiary Care Hospital: A Randomized Controlled Trial

Evaluation of the Beneficial Parenting Partnership Model Assimilation in Parent-Infant Centers

Abstract Background The Beneficial Parenting Partnership (BPP) model is being implemented in Parent-Infant Centers (PIC) across Israel to improve the partnership skills of PIC nurses when working with parents, promote child development, and enhance parental well-being. This initiative is being led by the Israeli Ministry of Health, Goshen NGO, and Lotem company and is supported by the Yad Hanadiv and Bernard van Lear foundations. Methods The first data collection (T1) was held from December 2022 to January 2023 among 706 parents of children aged two weeks to 36 months (M = 8.17 months, SD = 7.48) who visited one of 18 PICs. Research assistants approached the parents and asked for their agreement to fill in the study questionnaire. Of these, 328 parents agreed to participate in the follow-up study (T2) held in January-February 2024 using a telephone survey. Differences in the parent’s satisfaction, visit experience, and parental well-being were assessed using parried sample T-tests. A linear regression model was calculated to assess the factors predicting the increase in the parent’s visit satisfaction. Results Significant differences were measured between T1 and T2 in parental satisfaction (M = 4.51 and 4.71 retrospectively, P &amp;lt; 0.001), parental positive visit experience (M = 4.58 and 4.68 retrospectively, P = 0.019), and parental well-being (M = 3.81 and 3.97 retrospectively, P &amp;lt; 0.001). Findings suggest a marked improvement in satisfaction, visit experience, and reported well-being after a year of BPP model assimilation among PIC nurses. The regression model, explaining 42% of the variance in increased parental satisfaction, indicated that a higher increase could be predicted by a higher increase in positive visit experience and a higher trust level in the PIC nurse at T1. Conclusions The BPP model’s assimilation among Israeli PIC nurses was successful, resulting in improved parent experience, satisfaction, and well-being. Key messages • The Beneficial Parenting Partnership model is well-suited for implementation among nurses working with parents of babies and toddlers to promote collaborative nurse-parent communication. • During routine meetings at Parent-Infant Centers, nurses can act as a catalyst for promoting parental well-being.

The Effect of Perceptions of Evidence-Based Practice on Endotracheal Cuff Pressure Management in Critical Care Nurses: A Correlational Cross-Sectional Multicentre Study.

This correlational cross-sectional multicentre study aims to achieve two objectives. Firstly, to assess nurses' knowledge and practice of endotracheal cuff pressure management. Secondly, to examine the relationship between endotracheal cuff pressure management knowledge and evidence-based practice leadership and work environment. A correlational cross-sectional multicentre study design. This study was conducted among 144 intensive care nurses in Turkey. Data collection included descriptive characteristics and cuff pressure management of nurses, the Evidence-Based Practice Leadership Scale and Evidence-Based Practice Work Environment Scale. Descriptive statistics, chi-square test, Pearson correlation and receiver operating characteristics analysis were conducted. A STROBE checklist was the reporting guide for this study. The success status of nurses in terms of knowledge related to cuff pressure was found significantly different according to the type of intensive care unit working in and the status of receiving training on evidence-based practice. A positive, strong relationship was found between nurses' mean scores on the Evidence-Based Practice Leadership Scale and the Work Environment Scale. There was a very weak positive correlation between the mean scores of the Evidence-Based Practice Leadership Scale and the cuff pressure management. Adherence by nurses to current evidence-based practice for cuff pressure monitoring is essential for safe patient care and improved quality of care. It is recommended to provide both a supportive working environment and training programmes for intensive care nurses to perform cuff pressure management in line with evidence-based practice. Providing educational programs, an appropriate clinical environment, support from health managers and access to appropriate tools are important considerations in increasing the knowledge and skills of intensive care nurses to effectively monitor and manage cuff pressure. Our study complies with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Checklist: cross-sectional studies. No patient or public contribution.

Prevention and management of medical adhesive-related skin injuries in tumor patients with peripheral central venous catheters: a best practice implementation project.

Peripheral central venous catheters are common vascular access devices used in patients with tumors. To prevent catheter shedding and displacement, it is essential to use medical adhesives to secure the catheters. Repeated adhesion and removal of medical adhesives can weaken the barrier function of the skin, leading to medical adhesive-related skin injuries (MARSI), which can increase the patients' pain and medical expenses. The objective of this project was to utilize the best evidence to prevent and manage MARSI in tumor patients with peripheral central venous catheters. This evidence-based audit and feedback project was theoretically informed by the JBI Evidence Implementation Framework. The framework involves seven phases in which a project team was established; measurable criteria were selected; baseline data were collected; improvement strategies were implemented to address gaps in compliance; a follow-up audit was conducted to assess improvements in compliance; and sustainability measures were considered. The project also used the JBI Practical Application of Clinical Evidence System (PACES) for project management, including data collection and analysis. The JBI Getting Research into Practice (GRiP) approach was also used to support implementation and compliance. In the baseline audit, the compliance rate for the nine audit criteria was low. In the follow-up audit, the compliance rate significantly improved, with each audit criterion exceeding a minimum of 80%, and four audit criteria reaching 100%. Knowledge of MARSI among nurses and patients significantly improved (p < 0.05) and the incidence of MARSI among patients with peripheral central venous catheters decreased. This project successfully enhanced nurses' compliance with MARSI prevention and management and increased the knowledge and skills of both nurses and patients about MARSI. http://links.lww.com/IJEBH/A285.

Application of clinical case-guided, task-driven escape room teaching in nursing education: A quasi-experimental study

BackgroundIn the new era, the professional ability requirements for nursing personnel are no longer limited to traditional nursing knowledge and skills, but pay more attention to the cultivation and enhancement of their diversified abilities, such as humanistic caring ability, creative thinking, and so on. As a new type of education model that integrates gamification, flipped learning, and problem-based learning, escape room teaching plays an important role in effectively developing and stimulating students' humanistic care ability and creative thinking. PurposeTo investigate the effectiveness of an Escape Room teaching approach, clinical cases (C) as guide (G) and task (T) as driver (D) , within the CGTD model in the undergraduate Adult Nursing course. MethodUsing purposive sampling, 108 undergraduate nursing students in the class of 2020 were selected as the study subjects, and 11 innovative escape room teaching activities were conducted. Real clinical cases were selected, so that the student teams were immersed in clinical scenarios to complete the escape room game focusing on circulatory care, and the humanistic caring and creative thinking of the students in the two groups were compared before and after the intervention. ResultsNursing students' humanistic care and creative thinking scores at the end of the instruction were significantly better than those before the escape room instruction (P<0.05). ConclusionThe use of the CGTD-based escape room teaching method applied to adult nursing practice courses is an innovative teaching strategy that integrates theoretical knowledge into the game, which can significantly improve undergraduate nursing students' humanistic caring ability and creative thinking.

Preparing Graduate Registered Nurses for Independence in Aged Care.

Graduate registered nurses (RNs) start their careers working in a variety of clinical areas including aged care. However, they may not be fully prepared to work in aged care settings that often require them to work independently as the only RN on the premises. A list of essential clinical skills is crucial for supporting the development and effective transition of graduate nurses into aged care. To identify and rank a list of essential clinical skills for graduate RNs working in aged care settings on commencement of practice. An explanatory sequential mixed-methods design was applied and included a modified Delphi Study and semi-structured interviews. Five expert aged care RNs engaged in the three iterative Delphi rounds and five graduate aged care RNs were interviewed to confirm the clinical skills and ranking from their perspective. Quantitative data were presented through descriptive statistics. Qualitative data were analysed using thematic analysis. Thirty-six essential clinical skills for graduate RNs working in aged care settings were identified and ranked by the experienced aged care RNs. Graduate RNs supported this list of essential clinical skills on commencement and identified palliative care as an additional skill required by graduate RNs working in aged care. The derived essential skills offer aged care a guided approach to ensure that graduate RNs are work-ready, safe practitioners and supported to work independently. The study recommends the essential clinical skills for graduate nurses transitioning in their role as RNs in aged care that will support safe, quality clinical care.

The Importance of an Interdisciplinary Approach in the Transition of At-Risk Patients From Hospital to Skilled Nursing Facilities: A Case Report

The Importance of an Interdisciplinary Approach in the Transition of At-Risk Patients From Hospital to Skilled Nursing Facilities: A Case Report

RePAIRing the student nurse journey: empowering interrupted students through innovative support strategies.

This article reports on a study that evaluated an innovative 6-week summer returners' programme, part of the Health Education England RePAIR project, designed to support nursing students who have interrupted their studies. Held from May to July 2022, the programme addressed diverse needs through academic guidance, mental health and resilience workshops, creative arts, professional identity development, and practical nursing skills training. The programme ran alongside support from the programme team, student engagement services, and ongoing communication via phone and email. Despite non-mandatory sessions leading to varying attendance, the combined efforts facilitated the return of 67 out of 135 interrupted students. Thematic analysis identified four key themes: anticipation and fear, making contact and reaching out, preparing for return, and psychological wellbeing. The programme's effectiveness underscores the necessity of tailored support strategies to enhance retention and wellbeing. This innovative approach highlights the importance of personalised support in aiding nursing students' return to education and addressing nursing workforce shortages.

Preparedness of Practicing Nurses in the Care of Sexual and Gender Diverse People in the United States: A Scoping Review.

Sexual and gender diverse (SGD) people in the United States (US) experience health inequities due to societal stigma and marginalisation. The nursing workforce must provide evidence-based affirming, inclusive and culturally responsive care for SGD people to meet individual and community health needs and eliminate disparities. The purpose of this scoping review was to synthesise what is known about (1) nurses' knowledge, skills and attitudes related to caring for SGD people in the US and (2) the existence, development and evaluation of SGD-related educational offerings available to practicing nurses in the US to develop the knowledge and skills needed to promote the health and wellbeing of SGD individuals, families and communities. This review followed the scoping review methodology and PRISMA for Scoping Reviews (PRISMA-ScR). In conjunction with a health librarian, an electronic literature search was conducted using PubMed, LGBT Health, CINAHL, ERIC and Health Source-Nursing. Thirty-two studies were included in this review, including quantitative and qualitative studies that sought to understand the knowledge, attitudes and clinical experiences of nurses related to the care of SGD people; studies that tested educational interventions and studies that identified educational barriers and facilitators. Major gaps in education, practice and research, as well as methodological limitations of existing studies, were noted. Nurses would benefit from expanded access to effective standardised foundational SGD-related health continuing education to help prepare them to care for diverse patient populations. Equity, inclusivity and dignity are key values of the nursing profession. It is imperative that nurses have the knowledge and skills to apply these values consistently in day-to-day professional practice across populations and settings. There is an urgent need to develop standardised, easily accessible evidence-based educational content to address nurses' knowledge of and attitudes towards caring for SGD people. This study adhered to the PRISMA-ScR reporting guidelines. There was no patient or public contribution to this study.

Barriers and facilitators to narrative nursing implementation for junior nurses: A qualitative study.

This study aimed to explore the experiences of barriers and facilitators to the implementation of narrative nursing by junior nurses. Participants were recruited using purposive sampling. Semi-structured interviews were conducted from October 2023 to February 2024. Data were thematically analyzed using the Colaizzi seven-step method. Five barriers and 3 facilitators to the implementation of narrative nursing by junior nurses emerged in the study. Relevant barriers include lack of practical skills related to narrative nursing, neglect of the concept of humanistic care, negative events, high workload for junior nurses, restricted implementation environment. The facilitators contain patients' and family members' trust, training related to knowledge and skills, as well as harmonious and cooperative working atmosphere. There is still room for improvement in the implementation of narrative nursing for junior nurses, and the systematic training of narrative nursing knowledge and skills should be enhanced; the medical humanistic environment should be optimized; and the psychological resilience of junior nurses should be improved, so as to encourage them to actively implement narrative nursing at the early stage of their careers, and to deepen the high-quality development of nursing humanism.

Effectiveness of a task-sharing collaborative care model for the detection and management of depression among adults receiving antiretroviral therapy in primary care facilities in South Africa: A pragmatic cluster randomised controlled trial

BackgroundHIV is characterised by high rates of comorbidity with mental health conditions including depression, as such, the detection and treatment of comorbid depression is critical to achieve viral load suppression. This study evaluated the effectiveness of a collaborative care intervention for depression among adults with comorbid depression symptoms receiving ART in primary health care (PHC) facilities. MethodsWe conducted a pragmatic cluster-randomised trial in 40 clinics in the North West province of South Africa. PHC clinics were stratified by sub-district and randomised in a 1:1 ratio. Participants were ≥ 18 years, receiving ART, and had depression symptoms indicated by Patient Health Questionnaire-9 (PHQ-9) score ≥ 9. Intervention clinics received: i) supplementary mental health training and clinical communication skills for PHC nurses; ii) workshops for PHC doctors on treating depression; and iii) lay counselling services. Using mixed effects regression models, we assessed co-primary outcomes of PHQ-9 response at 6 months (≥50 % reduction in baseline PHQ-9 score) and viral load suppression at 12 months (viral load<1000 copies/mL). ResultsThe intervention had no effect in PHQ-9 response (49 % vs 57 %, risk difference (RD) = −0.08, 95 % CI = -0.19; 0.03, p = 0.184) or viral load suppression (85 % vs 84 %, RD = 0.02, 95 % CI = −0.01; 0.04, p = 0.125). Nurses referred 4298 clinic patients to counsellors, however, only 66/1008 (7 %) of intervention arm participants were referred to counsellors at any point during the study. LimitationsThe highly pragmatic approach of this trial limited exposure to the counselling component of the intervention and referral to doctors for initiation of antidepressant treatment was extremely low. ConclusionThe trial showed no effect of a district-based intervention to strengthen collaborative care for depression. The trial revealed the extent of the treatment gap in the context of scaling up mental health services. Trial registrationClinicalTrials.gov (NCT02407691); Pan African Clinical Trials Registry (201504001078347).

Development and evaluation of a spaced eLearning intervention for nurses in enhancing urinary catheter management - A co-design study in partnership with research end-users

BackgroundNurses play a critical role in supporting patients in self-managing their indwelling urinary catheters and preventing avoidable hospital presentations. This study aimed to explore the effectiveness of a co-designed educational approach developed to enhance nurses' ability to provide optimal care for patients with catheters. AimThe primary aim of this study was to enhance nurses' knowledge and skills in urinary catheterisation, care, and management. The secondary aim was to transform their current catheter management practices to improve patient outcomes. SettingNurses (n = 127) from one New South Wales, Australia region participated in the study. These nurses provided healthcare across various community settings. Ethics approval was received from the Local Health District (HREC/2019/ETH12575) and the study was registered in ANZCTR (ACTRN12621000683831). MethodsA mixed-methods approach was used, collecting data at baseline and after the intervention. Quantitative data were analysed using descriptive statistics, tests for normality, and bivariate analysis with the Wilcoxon Signed Ranks test to identify differences between variables. Qualitative data were analysed using a directed content analysis approach to categorise occurrences of specific phenomena. ResultsThe composite mean knowledge score increased from 65.03 to 84.30 following the intervention (p < 0.001). In addition, the magnitude of knowledge score improvement in seven out of eight questions following the intervention were: Financial support: 1.1 %; Bladder spasm/urine leakage: 3.3 %; Blockage: 3.5 %; Catheter-Associated Urinary Tract Infection (CAUTI): 4.4 %; Self-management: 6.1 %; Sexuality: 7.9 %; and Urinary catheterisation: 11.3 %. Qualitative findings confirmed that the eLearning module was effective in transforming participants' clinical practice, towards improving patient outcomes. ConclusionsThe co-designed eLearning module effectively addressed the learning needs of nurses, enhancing their knowledge and skills in urinary catheter management. Incorporating a theoretical model and contextual approach in the intervention delivery increased relevance, personalisation, and engagement, facilitating the behaviour change required to transform current practices.

The Experience of Women Receiving Mastectomy Care in an Acute Surgical Ward: A Qualitative Study.

The research aim was to understand the inpatient experience of women who received postoperative care for mastectomy surgery in an acute surgical ward. A Qualitative Descriptive Research design was used. The lead researcher conducted individual semi-structured interviews with 10 women who received postoperative care following mastectomy surgery in an acute hospital surgical ward. The transcribed interview data was analysed using a thematic analysis. A mastectomy is a momentous event in any woman's life. In the initial post-operative phase, the physical intrusion of surgery, aesthetics of the ward, and mixed-gender rooms were all found to influence the women's journey towards holistic recovery. Therapeutic care from all in the healthcare team and a ward setting conducive to recovery were identified as favourable influences towards physical and emotional healing. Recognising that a mastectomy 'is not just physical' may help the breast care team optimise the first 24 h of postoperative care in preparation for the challenges the women may face on discharge. In an acute inpatient setting, a women's physical needs may be prioritised over the psychological and emotional ramifications of a mastectomy. Post-operative inpatient care for breast cancer surgery requires not only professional competency with clinical and technical tasks, but therapeutic nursing and communication skills to support women's psychological needs. The findings were drawn from 10 women, narrating their inpatient experience for breast cancer surgery. All women had undergone a unilateral or bilateral mastectomy following breast cancer.

Day in the Life of a Late-Stage Huntington’s Patient at a Skilled Nursing Home

Day in the Life of a Late-Stage Huntington’s Patient at a Skilled Nursing Home

Impact of functional recovery on patients having heart surgery.

To describe the results of a program developed to manage institutional postacute care (IPAC) (postacute skilled nursing, inpatient rehabilitation facility, and long-term acute care) in a CMS Bundled Payments for Care Improvement (BPCI) project for coronary artery bypass graft (CABG) surgery. We compared pre- and postutilization patterns during a 3-year period by evaluating risk-adjusted national, state, and other BPCI participant comparisons using a difference-in-differences (DID) analysis in a large urban community tertiary center with a CABG surgery program. Included in the analysis were all Medicare patients receiving CABG surgery at the institution (n = 504), across the nation (n = 213,423), and at other BPCI institutions (n = 4939). The intervention included (1) use of a standardized tool for evaluation and prognostication of patient placement, (2) programmatic changes to manage patient functional recovery, and (3) patient and family engagement in postacute placement and functional recoveryplan. Physical therapist/occupational therapist time with patients who had undergone CABG surgery increased by more than 179% between the pre- and postintervention periods. This was associated with a 41.2% and 51.6% decline in IPAC use at the institution on an observed basis and adjusted basis, respectively. DID comparison demonstrated a 14.40% (95% CI, -19.30% to -9.60%) greater reduction at the target hospital than at other participating BPCI hospitals. A strong association exists between a focused patient functional recovery program and IPAC use reduction after CABG surgery. Using a structured approach to clinical analytics and hypothesis testing of redesign efforts when managing postacute care populations removes waste from care delivery.

A philosophical exploration of rural health and nursing based on an undergraduate United States-Australian collaboration through the lens of 'positionality'.

Growing nursing workforce maldistributions impede rural healthcare access globally. In-depth exploration of underlying philosophical ideas about rural health in nursing curricular could support recruitment and retention of nurses who are well positioned to support and advocated for health care and services relevant to their communities. Through a lens of positionality, the purpose of this paper is to explore rural health and nursing within the United States and Australia from the perspective of undergraduate students. Recognizing that both countries have 'first world' health services, issues of access to services associated with systemic and structural biases were significant features identified by participants. Their perceptions were supported by discussion with attendees of the 26th International Nursing Philosophy Conference from several countries, during a presentation titled 'What is different about rural health nursing: A philosophical exploration.'This international consistency suggests that systemic and structural biases are global phenomena. While exposure to rural health and rural nursing may be beneficial for recruitment, preparing nurses for rural practice requires more than educating students to complete clinical tasks. Uncovering collaboration, advocacy and policy development opportunities for nurses in rural communities could move the dial from recruiting rural nurses to fulfill immediate needs to retention of well-educated and highly skilled nurses. Building a stronger philosophical base for rural healthcare inclusive of all people, honouring their distinguishing characteristics such as age, gender, ethnicity, is long overdue. Positionality can inform how nurses across the globe relate to other countries' governments, cultures, norms, values, expectations, etc., which can influence the advancement of the profession and address social inequities among rural populations.