Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
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International journal of nursing education scholarship
Leadership education for nurse practitioners: a systematic review of interventions, pedagogies and gaps
Nurse practitioners (NPs) often lead interprofessional healthcare teams, yet many receive little or no formal leadership training. As healthcare systems grow in complexity and demand greater accountability, the need for strong and effective NP leadership has intensified. However, leadership development within NP education remains poorly defined and often lacks theoretical grounding. This systematic review explores interventions designed to build NP leadership skills. Following PRISMA and BEME Guide No. 13 guidelines, a search (July 2022, updated April 2024) identified peer-reviewed English-language articles from 1980 onward. Studies involving NPs at any training or practice stage were included if they described a leadership intervention. Of 3,058 articles, eight met inclusion criteria. Most studies originated in the U.S., featured isolated leadership interventions, and lacked NP clinical faculty involvement. Experiential learning and mentorship were common. Leadership domains emphasized cognitive and emotional intelligence, with little focus on leader character development. Evaluation of leadership interventions were limited. Overall, few theoretically informed, robust NP leadership interventions exist. Future efforts should prioritize comprehensive, longitudinal, and theory-based approaches to strengthen leadership capacity within NP education and practice.
24 June 2026
Read appraisal →JMIR nursing
Digital Leadership Scale for Clinical Nurses: Development and Validation of an Instrument
BACKGROUND: The rapid advancement of digital technologies, combined with the evolving complexity of health care environments, has introduced a new paradigm in nursing practice. Clinical nurses are now required not only to deliver safe and effective patient care but also to demonstrate competencies in digital literacy and innovation. Among these emerging competencies, digital leadership has become a critical attribute-enabling nurses to lead digital transformation, ensure patient safety, enhance care quality, and support system-level change within health care organizations. Despite its increasing relevance, there is a notable absence of validated measurement tools tailored to assess digital leadership in clinical practice. OBJECTIVE: This study aimed to develop and psychometrically validate a Digital Leadership Scale for Clinical Nurses (DLS-CN) to systematically evaluate the digital leadership capabilities of nurses working in clinical settings. METHODS: The scale development process followed a rigorous multistep procedure. Initial items were derived from previous qualitative research involving a literature review and in-depth interviews, complemented by an additional literature review conducted in this study. The content validity of 38 preliminary items was evaluated by 9 experts over 2 rounds. A pilot test was conducted with 30 nurses, followed by cognitive interviews with 5 nurses to refine item clarity and relevance. The final set of items was administered to 446 clinical nurses across various health care institutions. Data were randomly split for exploratory factor analysis and confirmatory factor analysis. Additional analyses were conducted to evaluate item discrimination, convergent validity, and internal consistency using IBM SPSS 25.0 and AMOS 23.0. RESULTS: The finalized DLS-CN consists of 29 items grouped under four domains: (1) ability to use digital technology, (2) digital safety management, (3) digital collaboration mindset, and (4) organizational influence. These 4 factors explained 56.9% of the total variance. The scale showed strong internal consistency (Cronbach α=0.95). Convergent validity was demonstrated through strong positive correlations with the Nursing Informatics Competency Scale (Pearson correlation coefficient r=0.82; P<.001) and the Self-Leadership Scale (Pearson correlation coefficient r=0.83; P<.001). CONCLUSIONS: The DLS-CN is a valid and reliable instrument for measuring digital leadership among clinical nurses. It offers a practical tool for educators, administrators, and researchers to assess and enhance digital leadership capabilities-ultimately supporting the digital transformation of health care systems.
24 June 2026
Read appraisal →Critical care explorations
Multiagent First-Person Perspective Analysis for Leadership Assessment in Pediatric Emergency Simulations: A Feasibility Study
BACKGROUND: Conventional leadership assessments provide structured ratings but offer limited observer-independent metrics. Because leadership and teamwork are interdependent, capturing team dynamics requires multiagent, time- and space-synchronized analysis. This pilot study examined the feasibility of applying multiagent, spatiotemporally synchronized first-person perspective analysis (FPA) in emergency simulations. METHODS: This exploratory simulation study was conducted in a real patient-care room within the PICU of our institution. Two physicians-a critical care specialist (L1) and a pediatric resident (L2)-each completed one scenario as team leader. Leadership behaviors were evaluated using the Ottawa Global Rating Scale, focusing on Situational Awareness and Communication. Wearable smart glasses recorded first-person video and gaze data, enabling identification of fixations within five predefined areas ("patient," "member," "device," "screen," and "unknown"). Eye-contact events were quantified using face detection based on You Only Look Once, version 8, a deep learning-based object detection model, combined with gaze-vector estimation, and analyzed in relation to the timing of verbal communication. RESULTS: Multiagent, time-synchronized FPA was implemented without device- or software-related interruption, and no critical data loss occurred. The mean analyzable session duration relative to total operating time was 77.1%, and the mean percentage of frames excluded from object tracking was 29.3%, primarily due to target objects being outside the field of view. As secondary, illustrative findings, Ottawa Global Rating Scale scores indicated that both leaders were rated within the competent range. FPA further showed that both leaders spent approximately 80% of the scenario fixating on predefined relevant areas (L1: 599/731 s; L2: 565/693 s). Greater patient-directed fixation and balanced gaze transitions were observed in L1, whereas L2 showed prolonged fixation within nonspecific areas. L1 also established eye contact with team members more frequently during direct orders or information sharing. CONCLUSIONS: This study demonstrates the feasibility of multiagent, time-synchronized FPA for extracting gaze-based behavioral information relevant to leadership assessment in emergency simulations.
14 June 2026
Read appraisal →JMIR nursing
Association Between Electronic Health Record-Based Nursing Workload and Turnover: Retrospective Cohort Study
BACKGROUND: Nurse turnover remains a major challenge for health systems, yet objective, scalable measures of workload that predict turnover are limited. Electronic health record (EHR) audit logs offer a potential data source to quantify nursing work patterns. OBJECTIVE: This study aimed to evaluate the association between EHR-derived measures of nursing workload and turnover among inpatient nurses. METHODS: We analyzed work-related activities of staff nurses from medical and surgical inpatient units at a large academic medical center from January 1, 2022, to December 31, 2022. Data included deidentified demographics (age, sex, years since licensure, and service group), shift characteristics (number of shifts worked, proportion of night shifts, timing, and location), and measures of work activities derived from EHR audit logs. Audit logs were used to develop measures related to nurse workload, including (1) nurse activities (information review, medication administration, alert management, navigation, documentation, and communication), (2) patient load (based on the number of unique patient charts accessed), and (3) cognitive load (based on the number of patient switches). For nurses who left, we excluded the 6 weeks immediately preceding termination (washout period) and measured workload during the preceding 6-week period; for those who remained, a random 6-week working period was selected. Associations between workload measures and turnover were assessed using mixed-effects logistic regression, adjusting for demographics and shift-related characteristics. RESULTS: Among 432 nurses (n=363, 84% female; median age 27, IQR 23-36 years), contributing 6812 shifts and approximately 13 million audit log actions, 84 (19%) left the institution in 2022. A higher proportion of medication administration actions was associated with higher odds of turnover (odds ratio [OR] 2.20, 95% CI 1.36-3.54), whereas greater alert engagement (OR 0.48, 95% CI 0.32-0.72) and more years since licensure (OR 0.57, 95% CI 0.38-0.84) were associated with lower odds of turnover. CONCLUSIONS: EHR-derived workload measures, particularly greater medication administration burden and lower alert engagement, were independently associated with the risk of nurse turnover. Patterns of EHR use may help identify nurses at higher risk of leaving an institution and can potentially inform targeted workforce retention strategies.
13 June 2026
Read appraisal →Journal of health organization and management
Predicting CSR authenticity in healthcare organizations: an integrated SEM-IPMA-ANN approach through the lens of self-compassion theory
PURPOSE: As healthcare business organizations face mounting pressure from civil society to act responsibly, they are expanding and strategically restructuring their CSR activities. Under the umbrella of CSR, cause-related marketing (CRM) campaigns are a means of fundraising available to healthcare firms engaging in socially responsible activities to improve global health. While healthcare organizations increasingly emphasize CSR implementation, its precise nature within the context of CSR authenticity has not been systematically investigated. Adopting self-compassion theory as a platform, this study has demonstrated novel relationships for gaining deeper insights into the key predictors of CSR authenticity in healthcare organizations. DESIGN/METHODOLOGY/APPROACH: The authors collected 882 responses and adopted the hybrid SEM-IPMA-ANN (Structural Equation modelling- Importance Performance Map Analysis- Artificial Neural Network) method to confirm the proposed model's significant predictors influencing CSR authenticity. FINDINGS: The findings provide an extended knowledge of self-compassion theory, thus contributing to the extant literature on CSR domain and healthcare marketing. The ANN findings established that social connectedness was the strongest predictor of CSR authenticity, followed by trust in the CRM campaign, isolation, mindfulness, common humanity, self-kindness, over-identification, and self-judgement. The IPMA result, consistent with ANN findings, revealed that social connectedness and trust in CRM campaigns were of relatively higher importance when predicting CSR authenticity. ORIGINALITY/VALUE: The study contributes to our knowledge, and the findings would have implications for CSR practitioners in developing effective CRM campaigns for healthcare organizations. The conclusions would offer invaluable intelligence to CRM marketers, healthcare service practitioners, ad-campaign business professionals, and non-profit managers to manage critical and informed decisions.
20 Apr 2026
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