Evidence suggests that APN-led models of care may be associated with favorable patient, family, and health system outcomes in Thailand, but these findings should be interpreted cautiously because the evidence was derived predominantly from non-randomized and observational studies, and the independent effects of APN practice could not always be isolated.
Abstract
Background and Objectives: Advanced practice nurses (APNs) play an increasingly important role in improving healthcare quality and outcomes. This systematic review synthesized evidence on APN roles and healthcare outcomes in Thailand. Methods: The review protocol was prospectively registered in PROSPERO (CRD420261331793). Four databases (PubMed, CINAHL, Scopus, and Thai Journals Online) were searched from inception to January 2026. Two independent reviewers performed study selection, data extraction, and methodological quality assessment using the Mixed Methods Appraisal Tool (MMAT, 2018) for mixed-methods studies and the Joanna Briggs Institute (JBI) critical appraisal checklists for quasi-experimental, analytical cross-sectional, and qualitative studies. A narrative synthesis was undertaken because of methodological heterogeneity. Results: Twenty studies were included, comprising eight quasi-experimental studies, six cross-sectional studies, four mixed-methods studies, one retrospective study, and one qualitative descriptive study. APNs performed diverse roles, including direct clinical care, care coordination, consultation, patient education, mentoring, and implementation of evidence-based practice. APN-led models of care were associated with favorable clinical outcomes, enhanced self-care and quality of life, increased patient and caregiver satisfaction, and reduced hospital length of stay and healthcare costs. Conclusions: The available evidence suggests that APN-led models of care may be associated with favorable patient, family, and health system outcomes in Thailand. However, these findings should be interpreted cautiously because the evidence was derived predominantly from non-randomized and observational studies, and the independent effects of APN practice could not always be isolated.
AIMS
This meta-synthesis of qualitative studies aimed to explore the experiences and perspectives of healthcare providers in the Intensive Care Unit (ICU) setting regarding the implementation of early mobilization.
DESIGN
A qualitative systematic review and meta-synthesis was conducted. The review protocol was registered with PROSPERO (CRD420251057721).
DATA SOURCES
Six databases (PubMed, EMBASE, Web of Science, CINAHL, CNKI and Wanfang Data) were searched from inception to March 5, 2025. A total of 759 records were identified, and 34 studies met the eligibility criteria and were included in the final meta-synthesis.
REVIEW METHODS
We evaluated the quality of the included studies using the Critical Appraisal Skills Programme-Qualitative Research Checklist.
RESULTS
Thirty-four studies conducted in 13 countries and involving 699 ICU healthcare providers were included. Four analytical themes were generated: characteristics of early mobilization, the inner setting of implementation, the key role system and core determinants of successful implementation.
CONCLUSION
Early mobilization in ICUs should be understood as a multidimensional implementation process rather than a single rehabilitation task. Sustainable practice depends on the characteristics of the intervention, organizational readiness, clearly defined interprofessional roles, patient engagement and process-level strategies such as preplanning, real-time monitoring, debriefing and feedback. The findings support the development of context-sensitive implementation strategies to translate early mobilization evidence into routine ICU care.
IMPACT
This review underscores the critical importance of organizational support, team collaboration mechanisms and the professional capacity building of healthcare providers in advancing early mobilization within ICU settings. Frontline clinicians should be equipped with targeted training and structured planning tools, while leadership is encouraged to foster a culture of shared responsibility and continuous improvement.
PATIENT OR PUBLIC CONTRIBUTION
This qualitative systematic review did not involve original patients or the public. Therefore, this is not applicable.
Xiaoyan Gong, Wei-Jing Sui, Xiang-Ping Chen et al.· Journal of Advanced Nursing· 0 citations
AIM
To systematically review the characteristics and educational outcomes of existing burn care programs for nurses and nursing students.
DESIGN
Systematic review.
DATA SOURCES
Five databases (OVID, EMBASE, Cochrane Library, CINAHL, and PsycINFO) were searched with no date restrictions up to February 2025. Grey literature was explored through ProQuest for doctoral dissertations, as well as the reference lists of included studies.
REVIEW METHODS
Two reviewers independently screened studies, extracted data, and assessed the risk of bias using validated tools. Discrepancies were resolved through discussion or consultation with a third reviewer. A narrative synthesis was conducted due to methodological heterogeneity.
RESULTS
Eighteen studies met the inclusion criteria, most published after 2016 and conducted in high-income countries. Most interventions used lecture-based or simulation formats, often delivered in single sessions longer than three hours. Programs largely focused on clinical skills such as wound care, pediatric burn management, and referral systems. While most studies reported positive cognitive and affective outcomes, only eight assessed psychomotor skills, and among them, just three demonstrated improvements. Furthermore, only one study evaluated patient-level outcomes, such as pain and distress levels.
CONCLUSIONS
Burn injuries remain a major global health concern yet burn care education within nursing curricula is fragmented and underprioritized. This review highlights the urgent need for sustained, learner-centered, and efficient programs integrating holistic competencies and validated assessments. Strengthening clinical preparedness through such initiatives, alongside robust policy support, is critical to improving outcomes with regard to burn care education and promoting global health equity.
Daehee Lee, In-Woong Park, E. Suh· Nurse Education Today· 0 citations
ABSTRACT Background Evidence‐based practice (EBP) is essential in contemporary high‐pressure healthcare environments, yet its implementation remains challenging. Despite the pivotal role of leadership, the lack of pooled quantitative evidence limits understanding of implementation leadership levels and the identification of development needs. Aim To investigate the pooled mean levels of implementation leadership in EBP among healthcare professionals and managers. Design Systematic review and meta‐analysis. Methods This systematic review followed the Joanna Briggs Institute methodology and utilized the PRISMA statement. Findings were synthesized using random‐effects meta‐analyses of mean levels. Heterogeneity was assessed using the I 2 statistic. A systematic search was conducted in November 2025 in MEDLINE (Ovid), CINAHL, Scopus, Web of Science, ProQuest, and Medic with no date or geographical limits. Studies in English, Finnish, and Swedish were included. Results A total of 22 studies published between 2014 and 2025 across nine countries, involving 9970 participants, were included. The overall pooled mean level of implementation leadership in EBP, measured using the Implementation Leadership Scale (range 0–4), was 2.66 (95% CI: 2.49–2.83). Subscale pooled means were highest for supportive leadership (3.00, 95% CI: 2.83–3.16), followed by knowledgeable (2.78, 95% CI: 2.57–3.00), perseverant (2.77, 95% CI: 2.58–2.96), and proactive leadership (2.43, 95% CI: 2.25–2.61). Subgroup analyses showed pooled means of 2.47 (95% CI: 1.98–2.97) for managers and 2.70 (95% CI: 2.52–2.88) for professionals. Considerable heterogeneity was observed across studies. Linking Evidence to Action Strengthening implementation leadership to support EBP is needed across healthcare. Organizations should invest in structured, targeted leadership development initiatives that cultivate supportive, knowledgeable, perseverant, and especially proactive leadership behaviors, while ensuring programmes are context‐sensitive and adaptable to variability across healthcare settings. In addition, role‐based differences highlight the need for tailored support for managers that reflect the complexity and accountability of their leadership responsibilities. Trial Registration PROSPERO ID: [CRD420251241584]
Suvi Kuha, J. Miettunen, O. Kanste· Worldviews on Evidence-Based...· 0 citations
Objectives To map existing literature on nurses’ contributions to medical decision-making in hospital care, the factors influencing their involvement and how both nurses and physicians perceive this contribution. Design A scoping review was conducted following Arksey & O'Malley’s framework and reported in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA)-Systematic Review and Meta-Analyses extension for Scoping Reviews (ScR) checklist Data sources A broad literature search was conducted in PubMed, CINAHL and the Cochrane Library. The initial search was performed in October–November 2023 and updated in December 2025, with no time or language restrictions. Eligibility criteria Empirical studies were screened by two independent researchers and included if they reported on nurses’ involvement in or attempts to contribute to decision-making regarding medical treatments for adult patients in the hospital. Data extraction and synthesis Data were charted using a predefined extraction form. Extracted data were coded, grouped and examined inductively to identify recurring patterns, which were discussed and refined by the two reviewers. Results A total of 111 studies were included, encompassing a wide range of study designs and clinical settings. Studies have reported that nurses often contribute to decision-making in subtle ways during ward rounds, multidisciplinary meetings and informal interactions, drawing on their observations and advocating for patients’ interests. Nurses reported moderate involvement, while physicians acknowledged nurses’ expertise but did not consistently recognise their input. We developed a model that illustrates how the interplay between personal, organisational and cultural factors determines whether nurses’ clinically relevant observations are acknowledged and integrated into medical treatment decisions. Conclusion Nurses contribute to medical treatment decision-making in various but often subtle, ways. Unfortunately, their contributions are not consistently recognised within decision-making processes.
V. W, Stoffels M, Kusurkar R. A. et al.· BMJ Open· 0 citations
Understanding patients' lived experiences of advanced practice nursing can help nurses and healthcare organizations strengthen patient-centred care and highlight the importance of protecting time for listening, supporting clear and individualized communication, building trustful partnerships, encouraging patient participation, and recognizing APNs' role in coordinating care across complex healthcare systems.
Qin Hu, Wei-Yan Tan, Shanshan Liu et al.· Journal of Nursing Scholarsh...· 0 citations
Purpose: This study aimed to identify the factors associated with nurse–parent partnerships in pediatric settings and examine the elements involved in their formation based on national and international literature. The findings aim to inform future research directions.Methods: A scoping review was conducted in February 2025 following established methodological frameworks. Studies published in English or Korean were searched across electronic databases, including RISS, KMbase, KoreaMed, NDSL, DBpia, PubMed, CINAHL, MEDLINE, and Web of Science. In total, 912 records were identified, and 35 were included in the final analysis.Results: Most studies were descriptive in design and were published after 2016, with a predominance of research conducted in South Korea. Nurse-related factors, including self-efficacy, emotional labor, emotional intelligence, communication competence, and clinical decision-making, were associated with nurse–parent partnerships. Parent-related factors were relatively limited. Researchers reported significant correlations between several variables, including nursing professionalism, intention to stay, and fatigue, and nurse–parent partnerships. Outcomes associated with nurse–parent partnerships included quality of care, job satisfaction, job stress, and nursing competence. Parent-related outcomes included anxiety, parental satisfaction, self-efficacy, and readiness for discharge. The major elements of partnership formation included respect, communication, information sharing, emotional support, individualized care, and parental participation.Conclusion: Future research should expand experimental studies to promote nurse–parent partnerships. Researchers should include parents in future studies given their significance in pediatric settings. Additional research is needed to identify antecedent and outcome factors by incorporating a broader range of related variables.
Hye-yoon Bae, Haeryun Cho· Journal of Korean Maternal a...· 0 citations
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