Hussein Al-Qarni

Aim(s): To conduct a systematic concept analysis of Ceiling of Care to clarify its definition and distinguish its core features within acute care settings. Method: The Walker and Avant’s concept analysis method was applied. Data Sources: A systematic search of six databases (APA PsycINFO, CINAHL, the Cochrane Library, MEDLINE, ProQuest Central and Scopus) was conducted from inception to July 2026, supplemented by manual reference list searches and AI‐assistance tools. Result: Nineteen records met the inclusion criteria. Five defining attributes were identified: (1) patient‐centred collaborative decision‐making; (2) comprehensive and structured prognostic evaluation; (3) establishment of explicit therapeutic boundaries; (4) proactive and continuous care strategy and (5) standardised documentation and communication. Antecedents included predisposing, precipitating and contextual factors, while key consequences included reduced nonbeneficial treatment and enhanced decision‐making clarity. The analysis distinguishes Ceiling of Care as a broad, anticipatory framework rather than a reactive, single‐intervention directive such as a do‐not‐resuscitate order. Conclusions: Ceiling of Care is defined as an anticipatory, documented clinical decision‐making approach that establishes the maximum appropriate level of treatment escalation for an individual patient, based on clinical assessment, anticipated benefit and patient values. Implication for Nursing Management: This conceptual clarity provides a foundation for standardised implementation in acute care settings. Nurse managers need to lead the integration of Ceiling of Care frameworks within acute care settings; this could support nursing management in standardising clinical decision‐making, reducing nonbeneficial treatment escalation, strengthening communication across multidisciplinary teams and ultimately enhancing the quality and dignity of patient care.

A clinical quality registry (CQR) is a structured database that systematically collects data to monitor clinical quality and improve healthcare outcomes. The aims of CQRs are to improve treatment plans, assist in decision-making, increase healthcare value, enhance care quality, and reduce healthcare costs by providing feedback to healthcare providers. Feedback to clinicians is used as a quality improvement tool. It provides data to clinicians about their performance, which may contribute to improvement in healthcare outcomes. To the best of our knowledge, previous research on CQRs has primarily focused on factors affecting their use and their impact on healthcare outcomes. In this study, a scoping review is conducted to understand the barriers to and facilitators of using feedback systems from clinical quality registries in acute healthcare settings. For this review, Arksey and O’Malley’s framework for scoping reviews will be applied. The following electronic databases (MEDLINE via Ovid, CINAHL, and Scopus) and grey literature (Google Scholar) will be systematically searched for qualitative and mixed-method studies (only including qualitative findings) published after 2000 in the English language. Two reviewers will independently screen the articles and extract the data which, subsequently, will be mapped against the COM-B model. This review is conducted with the aim of providing valuable insights into the factors that influence the utilisation of feedback from Clinical Quality Registries by healthcare providers, which, in the context of quality improvement, may have significant implications for clinical research, registry science, health policy, and clinical practice. This protocol has been registered prospectively with the Open Science Framework (OSF) ( https://osf.io/fhm4n/ ).

Background A clinical quality registry (CQR) is a structured database that systematically collects data to monitor clinical quality and improve healthcare outcomes. The aims of CQRs are: to improve treatment plans, assist in decision-making, increase healthcare value, enhance care quality, and reduce healthcare costs by providing feedback to healthcare providers. Feedback to clinicians is used as a quality improvement tool. It provides data to clinicians about their performance, which may contribute to improvement in healthcare outcomes. To the best of our knowledge, previous research on CQRs has primarily focused on factors affecting their use and their impact on healthcare outcomes. In this study, a systematic scoping review is conducted to understand the barriers to and facilitators of using feedback systems from clinical quality registries in acute healthcare settings. Methods For this review, Arksey and O’Malley’s framework for scoping reviews will be applied. The following electronic databases (MEDLINE via Ovid, CINAHL, and Scopus) and grey literature (Google Scholar) will be systematically searched for qualitative and mixed-method studies (only including qualitative findings) published after 2000 in the English language. Two reviewers will independently screen the articles and extract the data which, subsequently, will be mapped against the COM-B model. Discussion This review is conducted with the aim of providing valuable insights into the factors that influence the utilisation of feedback from Clinical Quality Registries, which in the context of quality improvement, may have significant implications for clinical research, registry science, health policy, and clinical practice. Systematic review registration: This protocol has been registered prospectively with the Open Science Framework (OSF) (https://osf.io/fhm4n/ ).