Tiffany Conroy

Importance: An improved understanding of the organizational influences on adult in-hospital mobility is essential to develop and sustain interventions to prevent functional decline. Objective: The objective was to map contemporary evidence about organizational barriers and enablers of adult patient mobility in general acute hospital units, the participants reporting these barriers and enablers, and how mobility was defined. Data Sources: A systematic search was conducted in Embase, Emcare, EBSCO Cumulative Index to Nursing and Allied Health Literature Complete, Cochrane Library, Joanna Briggs Institute, MEDLINE, ProQuest (Health Research Premium Collection), PsycINFO, Scopus and Web of Science for studies published in English from January 2013 to October 2024 inclusive. Study selection: Based on eligibility criteria, 2 reviewers independently screened title/abstracts and full texts. Data extraction and synthesis: Two reviewers independently extracted study characteristics and mobility definitions. Organizational barriers and enablers of mobility were mapped to the Consolidated Framework for Implementation Research 2.0 outer (community and jurisdiction) and inner setting (hospital) domains. Main outcomes: Fifty-one studies were included (45 primary studies and 6 reviews). Fourteen studies reported organizational barriers and enablers of mobility in the outer setting. All 51 studies reported inner setting mobility barriers and enablers, mostly related to infrastructure, culture, and available resources. Most participants were patients or health professionals providing direct patient care. Few studies defined mobility, and definitions were inconsistent. Conclusions and relevance: Studies reported many organizational barriers and enablers of mobility at the hospital level, with far fewer reported at the community and jurisdiction level. Few studies reported the perspectives of health service leadership, and investigating their perspective may provide greater insights to address these barriers. Consistent definitions of mobility could enable progress in research and practice. Greater insights into community and jurisdictional barriers and enablers of mobility from the perspective of health care leaders are required to address organizational barriers.

Background: The Fundamentals of Care (FoC) Framework emphasises that care quality depends not only on clinical tasks but also on interpersonal relationships and the organisational context in which care is delivered. Although patient‐reported outcome and experience measures (PROMs and PREMs) have gained relevance in capturing these aspects, tools based on the FoC Framework remain limited in non‐English‐speaking settings. Objectives: To psychometrically validate the Spanish version of the FoC Intelligence Modelling Tool (FoC‐IMT) and explore predictive relationships among the FoC dimensions: Context, Relationship and Integration of Care. Methods: A cross‐sectional study was conducted with 1053 hospitalised patients in southern Spain. Exploratory and confirmatory factor analyses (EFA and CFA) were performed, alongside a mediation analysis using partial least squares structural equation modelling (PLS‐SEM) to examine directional relationships among constructs. Results: EFA and CFA supported a two‐factor model—Context and Integration of Care—with excellent internal consistency (Cronbach's α and McDonald's ω = 0.97). CFA showed a moderate correlation between these factors. However, PLS‐SEM mediation analysis revealed a directional model in which Context influences Relationship ( β = 0.39), which in turn predicts Integration of Care ( β = 0.89). Although embedded within Integration under CFA, the Relationship showed independent predictive power in PLS‐SEM, validating its conceptual importance. This aligns with the foundational assumption of the FoC Framework: that caregiving quality is shaped not only by tasks or procedures but by the broader environment and interpersonal relationships in which care occurs. Conclusions: The Spanish FoC‐IMT Tool is a valid, reliable instrument for assessing person‐centred care. The predictive model highlights the pivotal role of therapeutic relationships in delivering integrated, high‐quality care. Patient or Public Contribution: Hospitalised patients contributed directly by responding to the FoC‐IMT survey, thereby shaping the psychometric validation and predictive model. Patients were not involved in the study design, conduct or manuscript preparation.

Aim: To examine the feasibility of using a large language model (LLM) as a screening tool during structured literature reviews to facilitate evidence‐based practice.Design: A proof‐of‐concept study.Methods: This paper outlines an innovative method of abstract screening using ChatGPT and computer coding for large scale, effective and efficient abstract screening. The authors, new to ChatGPT and computer coding, used online education and ChatGPT to upskill. The method was empirically tested using 400 abstracts relating to public involvement in nursing education from four different databases (CINAHL, Scopus, ERIC and MEDLINE), using four versions of ChatGPT. Results were compared with a human nursing researcher and reported using the CONSORT 2010 extension for pilot and feasibility trials checklist.Results: ChatGPT‐3.5 Turbo was most effective for rapid screening and had a broad inclusionary approach with a false‐negative rate lower than the human researcher. More recent versions of ChatGPT‐4, 4 Turbo, and 4 omni were less effective and had a higher number of false negatives compared to ChatGPT‐3.5 Turbo and the human researcher. These more recent versions of ChatGPT did not appear to appreciate the nuance and complexities of concepts that underpin nursing practice.Conclusion: LLMs can be useful in reducing the time nurses spend screening research abstracts without compromising on literature review quality, indicating the potential for expedited synthesis of research evidence to bridge the research–practice gap. However, the benefits of using LLMs can only be realised if nurses actively engage with LLMs, explore LLMs' capabilities to address complex nursing issues, and report on their findings.Implications for the Professional and/or Patient Care: Nurses need to engage with LLMs to explore their capabilities and suitability for nursing purposes.Patient or Public Contribution: No patient or public contribution.

Aim: Exploring the concept of patient agitation in the intensive care unit. Background: Patient agitation in the intensive care unit is of widespread concern and linked to negative outcomes for patients, staff, and family members. There is currently no consensus on what constitutes agitation in the intensive care context, hindering effective and tailored prevention and management. Design: Concept Analysis. Method: Walker and Avant's eight‐step concept analysis approach. Data Sources: A comprehensive search was carried out in the databases MEDLINE, PsychINFO and CINAHL. A total of 32 papers published between 1992 and 2023 were included, reviewed, and analysed to explore definitions, attributes, antecedents and consequences of patient agitation. Results: Patient agitation in the intensive care unit is characterised by excessive motor activity, emotional tension, cognitive impairment, and disruption of care, often accompanied by aggression and changes in vital signs. Antecedents encompass critical illness, pharmacological agents and other drugs, physical and emotional discomfort, patient‐specific characteristics and uncaring staff behaviours. Consequences of agitation range from treatment interruptions and poor patient outcomes to the psychological impact on patients, families, and staff. Conclusion: Agitation in the intensive care unit is a complex issue which significantly impacts patient treatment and clinical outcomes. For healthcare professionals, patient agitation can contribute to high workloads and job dissatisfaction. Due to the complex nature of agitation, clinicians must consider multifaceted strategies and not rely on medication alone. Further research is needed to fully understand patient agitation in the ICU. Such understanding will support the development of improved strategies for preventing and managing the behaviours. Implications: A clearer understanding of patient agitation supports the development of tailored interventions that improve patient care, guide ICU training, and inform future research. Patient or Public Contribution: This concept analysis was developed with input from a patient representative.

Predictive modeling has advanced healthcare management by informing operational and strategic decisions; however, such models often exclude the fundamental care elements that shape patients' experiences, thereby limiting person-centered, quality-driven decisions. This gap is addressed by piloting a predictive model grounded in the Fundamentals of Care (FoC) Framework, which captures how system-level and policy-level conditions (Context of Care) influence care outcomes (Integration of Care) through the clinician–patient Relationship. A cross-sectional, exploratory design was implemented across Spain (hospital-based care, n = 55) and Australia (community-based care, n = 32). A culturally adapted, 41-item patient-reported experience measure was developed to operationalize the FoC Framework’s three core dimensions. Structural relationships were tested using Consistent Partial Least Squares Structural Equation Modeling to assess model feasibility. Results indicate that the Context of Care significantly predicted Relationship in both countries (Spain: β = 0.33; Australia: β = 0.68), which strongly predicted Integration of Care (Spain: β = 0.84; Australia: β = 0.92), fully mediating the effect of Context, which had no direct influence on Integration. Findings highlight a consistent structural pathway: Context of Care → Relationship → Integration of Care. This pilot demonstrates the feasibility of integrating patient-reported experience data into predictive modeling grounded in fundamental care delivery theory, offering transferable insights into how system- and policy-level conditions shape care quality through the Relationship dimension. The model supports early-stage decision-making tools for quality improvement, workforce planning, and system design, emphasizing the importance of a Context of Care that enables clinician-patient Relationships to achieve effective Integration of Care.

Aims: To describe the development and refinement of the Flinders Fundamentals of Care Assessment Tool for Clinical Practice through stakeholder feedback. The tool, based on the Fundamentals of Care Framework, supports healthcare leaders and clinicians in assessing fundamental care in a practical and user‐friendly manner that embraces rather than minimises the inherent complexity of this care delivery as it occurs in practice. Design: Multi‐method study informed by participatory action principles. Methods: Data collection involved an anonymous online survey and cognitive interviews with key stakeholders internationally to gauge perspectives on the clarity, usability, and acceptability of the tool. Data were collected between October–December 2023. Quantitative, categorical data were analysed using descriptive statistics. Qualitative data were analysed via content analysis. Results: Participants described the Tool as Comprehensive, Practical, and Useful. Participants liked the visual representation of results in the form of bar and radar diagrams, which aided in interpreting the outcomes. The main suggestions for improvement were: (1) Simplifying items relating to the ‘Context of Care’ dimension of the Fundamentals of Care Framework; (2) Reducing similarity between some items; (3) Separating or simplifying items with multiple components; and (4) Clarifying terminology. Conclusion: Based on stakeholder feedback, the Flinders Fundamentals of Care Assessment Tool for Clinical Practice is now digitised and includes a comprehensive instruction manual and definitions for each element of the Fundamentals of Care Framework assessed within the tool. The tool supports healthcare leaders and clinicians to assess fundamental care delivery at multiple levels—individual, team, unit/ward, organisational—identifying areas of strength and improvement to inform decision‐making, planning, and quality improvement. The tool offers a way of assessing fundamental care holistically as a multi‐dimensional construct rather than as a series of disaggregated tasks, better reflecting and capturing the complex reality of fundamental care delivery. Implications for the Profession and/or Patient Care: The Flinders Fundamentals of Care Assessment Tool for Clinical Practice supports real‐time feedback (i.e., immediate visualisation of results), facilitating its integration in clinical practice to support enhanced fundamental care delivery. Impact: Seeking stakeholder feedback has enhanced the relevance, acceptability, and feasibility of the Flinders Fundamentals of Care Assessment Tool for Clinical Practice, facilitating its use as a decision‐making and planning tool to support improved fundamental care delivery across clinical settings. Reporting Method: This study is reported using the CROSS and SRQR guidelines. Patient or Public Contribution: No Patient or Public Contribution.

Aim: To provide an overview of clinical supervision models and frameworks used in nursing and map them to their areas of use in nursing.Design: A scoping review guided by JBI methodology for scoping reviews.Methods: A systematic search using CINAHL, Medline, PsycINFO, ERIC, and Emcare databases for English‐language papers published at any time and ProQuest and Google Scholar databases for unpublished guidelines was conducted in June 2023 and repeated in June 2024.Results: Thirty‐nine papers covering thirty‐three clinical supervision models and frameworks highlighted conceptual confusion, lack of evidence for informed choices, and a need for balanced clinical supervision to enhance the reflective, critical thinking, and support of nurses transitioning to advanced practice.Conclusion: Further development is needed for clinical supervision models to support nurses transitioning to advanced practice.Implications for the Profession: A clearer understanding of clinical supervision within contemporary nursing practice to support nurses' critical reflective thinking for advanced practice.Impact: A clearer understanding of clinical supervision within contemporary nursing practice. Importance of meta‐communication skills training for nurses and supervisors. Structured clinical supervision content should be based on nurses' clinical specialty and experience. Reporting Method: Reporting was guided by The Preferred Reporting Items for Systematic Reviews and Meta‐Analyses extension for Scoping Reviews.Patient or Public Contribution: No patient or public contributions were included as secondary data was used.

Aim(s): To operationalize the Caring Life Course Theory (CLCT) as a framework for improving cardiac rehabilitation (CR) engagement and informing ways to address disparities in rural, low socio‐economic areas. Methods: A secondary analysis of data collected from 15 CR programmes to identify CR patterns through the CLCT lens using a mixed‐methods approach. All analytical processes were conducted in NVivo, coding qualitative data through thematic analysis based on CLCT constructs. Relationships among these constructs were quantitatively assessed using Jaccard coefficients and hierarchical clustering via dendrogram analysis to identify related clusters. Results: A strong interconnectedness among constructs: ‘care from others’, ‘capability’, ‘care network’ and ‘care provision’ (coefficient = 1) highlights their entangled crucial role in CR. However, significant conceptual disparities between ‘care biography’ and ‘fundamental care’ (coefficient = 0.4) and between ‘self‐care’ and ‘care biography’ (coefficient = 0.384615) indicate a need for more aligned and personalized care approaches within CR. Conclusion: The CLCT provides a comprehensive theoretical and practical framework to address disparities in CR, facilitating a personalized approach to enhance engagement in rural and underserved regions. Implications: Integrating CLCT into CR programme designs could effectively address participation challenges, demonstrating the theory's utility in developing targeted, accessible care interventions/solutions. Impact: Explored the challenge of low CR engagement in rural, low socio‐economic settings. Uncovered care provision, transitions and individual care biographies' relevance for CR engagement. Demonstrated the potential of CLCT to inform/transform CR services for underserved populations, impacting practices and outcomes. Reporting Method: EQUATOR—MMR‐RHS. Patient Contribution: A consumer co‐researcher contributed to all study phases.

Oral healthcare is one of the most missed aspects of fundamental care. Failure to provide reliable and effective daily oral healthcare for older patients can lead to hospital‐acquired pneumonias, longer hospital stays, increased health costs, and poor patient experience. The objective of this study was to codesign, implement, and evaluate an oral healthcare intervention for older adults in a geriatric unit. This mixed methods implementation project combined the hospital's quality improvement processes with the i‐PARIHS knowledge translation framework. Multilevel facilitation guided the development of multidisciplinary implementation strategies, which were co‐designed, tailored, and implemented at the ward and organizational level, targeting: awareness/engagement; clinical guideline development; building workforce capacity; access to appropriate products; patient awareness and support; utilization of multidisciplinary/dental referral pathways; and systematizing oral healthcare documentation. Gaps between evidence‐based and current oral healthcare practice were identified through audits of practice and interviews with patients. Interviews and surveys with staff evaluated the feasibility and acceptability of the oral healthcare intervention and the success of implementation strategies. At the conclusion of the project, awareness, attitudes, and capacity of staff had increased, however, we could not demonstrate change in multidisciplinary oral healthcare practices or improvements for individual patients. Despite mixed success, the project informed discussions about including oral healthcare as a national healthcare standard for the acute care sector in Australia. Attempts to address oral healthcare may have started locally, but its impact was through policy change, which will empower health practitioners and managers to support practice change more widely.