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Background Obesity is a well-established risk factor for multi-morbidity and disability among older adults in the community and acute care settings. However, nursing home residents with body mass index (BMI) below 18.5 kg/m 2 and above 25.0 kg/m 2 have been understudied. We examined the prevalence of multi-morbidity and disability in activities of daily living (ADL) by BMI category and further investigated the association between BMI, multi-morbidity, and disability of ADL in a large cohort of older adults in nursing homes in New Zealand. Methods A retrospective review of nursing home residents’ data obtained from the New Zealand International Resident Assessment Instrument national dataset from 2015 to 2018. One hundred ninety-eight thousand seven hundred ninety older adults (≥60 years) living in nursing homes were included. BMI was calculated as weight in kilograms (kg) divided by height in meters squared (m 2 ). Multimorbidity was defined as the presence of ≥2 health conditions. The risk of disability was measured by a 4-item ADL self-performance scale. The prevalence ratio (PR) of the association between BMI and multi-morbidity and between BMI and disability in ADL was assessed using Poisson regression with robust variance. Results Of the 198,790 residents, 10.6, 26.6, 11.3 and 5.4% were underweight, overweight, obese, and extremely obese, respectively. 26.4, 31.3 and 21.3% had one, two and three disease conditions, respectively, while 14.3% had four or more conditions. 24.1% could perform only one ADL, and 16.1% could perform none. The prevalence of multi-morbidity increased with increasing BMI, whereas mean disability in ADL decreased with increasing BMI. The risk of multi-morbidity was higher for the overweight (PR, 95%CI: 1.03, 1.02–1.03) and obese (PR, 95% CI: 1.07, 1.06–1.08) compared to normal weight after controlling for age, sex, ethnicity, and region. BMI was inversely associated with mean ADL; β, 95% CI for overweight (− 0.30, − 0.32, − 0.28) and obese − 0.43, − 0.45, − 0.40 compared to normal weight. Conclusion Being underweight was associated with a decline in the performance of ADL in nursing home residents. In contrast, being overweight and obese positively affected functional performance, demonstrating that the obesity paradox plays an important role in this population. The observed associations highlight areas where detection and management of underweight and healthy aging initiatives may be merited.

ObjectiveEmpathy and empathy education have been reviewed a number of times through systematic reviews and meta-analyses; however, the topic of ‘empathetic communication’ remains poorly understood when considering engaging in hospital-based research. Therefore, this scoping review aimed to explore the existing literature concerning empathetic communication in hospital settings and to evaluate the definitions presented.DesignScoping review.Data sourcesSystematic searches of the PubMed, CINAHL, Cochrane, PsycINFO, and PsycArticles databases were conducted.Study selectionAll English studies in which empathetic communication in hospital settings were explored. The search terms used included empathy, communication, hospital settings, providers, and consumers.Data extractionData were assessed through the use of a pre-set analysis tool.ResultsAfter conducting the searches, 419 articles were identified, of which 26 were included in this review. No single article specifically defined the term ‘empathetic communication’; however, 33 unique definitions of ‘empathy’ were identified, of which 23 considered communication to be a component of empathy. There was a considerable lack of consistency between the empathy definitions, with some classifying communication in empathy as an ability and others classifying it as a dynamic process.ConclusionFuture and contextually focused research is needed to develop a consistent and clear definition of empathetic communication and empathy within a hospital setting to better build positive healthcare cultures.Practice implicationsInconsistencies between definitions of empathy in empathetic communication research could reduce the efficacy of future research gains and impact the translation of research findings into clinical practice.

Objective Patient experience significantly impacts healthcare quality, outcomes, resource utilisation and treatment adherence. Digital technologies offer promising approaches for capturing real-time, multi-faceted patient experiences. This scoping review investigated how digital technologies are used to capture patient experience during healthcare encounters and their potential to improve health service delivery and care. Methods A scoping review was conducted to determine associations between patients’ use of digital technology and subsequent outcomes. Four electronic databases were searched using six combination search terms in titles and/or abstracts published between 2016 and 2022. Inclusion criteria focused on studies where patients were primary users of digital technology, reporting on their experience during care. Studies had to report on at least one outcome: health service delivery, quality of care or patient experience. Screening, data extraction and analysis were performed systematically. Results Of the 377 studies retrieved, 20 were included. Most studies incorporated aspects allowing patients to share experiences with digital technologies. Eighty percent (n = 16) of studies reported improvements in patient experiences, 75% (n = 15) enhancements in service delivery aspects and 50% (n = 10) indicated improved quality of care associated with the use of digital technologies. Real-time journaling and narrative methods alongside treatment were linked to improved communication, healthcare efficiencies and patient agency. Technologies facilitating bidirectional communication were particularly associated with positive effects on patients’ sense of agency. Conclusion Digital technologies facilitating documentation of patient experiences demonstrate potential in enhancing care quality through increased patient voice, collaboration and agency. Technologies designed to map and evaluate patients’ healthcare experiences represent a promising approach to improving healthcare outcomes, service delivery and overall patient experience. Further research is needed to establish standardised methodologies and evaluate long-term impacts across diverse populations. Integrating digital narrative medicine principles may offer valuable insights for future interventions aimed at capturing and enhancing patient experiences in healthcare.

Occurrence of lower respiratory tract infections requires prior colonization of the upper respiratory tract with a pathogen. Most bacterial infection and colonization studies have been performed in murine and in vitro models due to the current invasive sampling methodology of the upper respiratory tract, both of which poorly reflect the complexity of host-pathogen interactions in the human nose. Colonization of the upper respiratory tract with Streptococcus pneumoniae is the precursor of pneumococcal pneumonia and invasive disease. Following exposure, however, it is unclear which human immune mechanisms determine whether a pathogen will colonize. We used a human challenge model to investigate host-pathogen interactions in the first hours and days following intranasal exposure to Streptococcus pneumoniae . Using a novel home sampling method, we measured early immune responses and bacterial density dynamics in the nose and saliva after volunteers were experimentally exposed to pneumococcus. Here, we show that nasal colonization can take up to 24 h to become established. Also, the following two distinct bacterial clearance profiles were associated with protection: nasal clearers with immediate clearance of bacteria in the nose by the activity of pre-existent mucosal neutrophils and saliva clearers with detectable pneumococcus in saliva at 1 h post challenge and delayed clearance mediated by an inflammatory response and increased neutrophil activity 24 h post bacterial encounter. This study describes, for the first time, how colonization with a bacterium is established in humans, signifying that the correlates of protection against pneumococcal colonization, which can be used to inform design and testing of novel vaccine candidates, could be valid for subsets of protected individuals. IMPORTANCE Occurrence of lower respiratory tract infections requires prior colonization of the upper respiratory tract with a pathogen. Most bacterial infection and colonization studies have been performed in murine and in vitro models due to the current invasive sampling methodology of the upper respiratory tract, both of which poorly reflect the complexity of host-pathogen interactions in the human nose. Self-collecting saliva and nasal lining fluid at home is a fast, low-cost, noninvasive, high-frequency sampling platform for continuous monitoring of bacterial encounter at defined time points relative to exposure. Our study demonstrates for the first time that, in humans, there are distinct profiles of pneumococcal colonization kinetics, distinguished by speed of appearance in saliva, local phagocytic function, and acute mucosal inflammatory responses, which may either recruit or activate neutrophils. These data are important for the design and testing of novel vaccine candidates.

Hospitalised patients with extreme obesity have poorer healthcare outcomes compared to normal weight patients. How hospital services are coordinated and delivered to meet the care needs of patients with extreme obesity is not well understood. The aim of the proposed evidence gap map (EGM) is to identify and assess the available evidence on healthcare interventions to improve healthcare outcomes for hospitalised patients with extreme obesity. This research will use standardised evidence gap map methods to undertake a five-stage process to develop an intervention–outcome framework; identify the current evidence; critically appraise the quality of the evidence, extract, code, and summarise the data in relation to the EGM objectives; and create a visualisation map to present findings. This EGM will provide a means of determining the nature and quality of health service initiatives available, identify the components of the services delivered and the outcome measures used for evaluation, and will identify areas where there is a lack of research that validates the funding of new research studies.

Timeline table The purpose of the table is to provide a timeline summary of key COVID-19 events in Aotearoa New Zealand and the response of the nursing profession to keep the community safe, care for those with COVID-19, support the nursing workforce, and adapt and support nursing students to complete their qualifications. Author. https://www.nursingcouncil.org.nz/NCNZ/Newssection/newsitem/2021/5/Guidance statement COVID19 vaccine and your professional responsibility.aspx Nursing Council New Zealand (NCNZ). Author. https://www.nursingcouncil.org.nz/NCNZ/Newssection/newsitem/2021/11/Guidance statement on providing car e to patients not vaccinated against COVID-19.aspx Nursing Council New Zealand (NCNZ).

Empathy is positively related to healthcare workers and patients’ wellbeing. There is, however, limited research on the effects of empathy education delivered in acute clinical settings and its impact on healthcare consumers. This research tests the feasibility and the potential efficacy outcomes of an immersive education programme developed by the research team in collaboration with clinical partners and a multidisciplinary advisory group. Healthcare worker participants in the intervention ward will receive an 8-week immersive empathy education. The primary outcome (feasibility) will be assessed by evaluating the acceptability of the intervention and the estimated resources. The secondary outcome (efficacy) will be assessed using a quasi-experimental study design. Non-parametric tests will be used to test healthcare worker participants’ empathy, burnout, and organisational satisfaction (within-group and across groups), and healthcare consumer participants’ satisfaction (between-group) over time. Despite growing interest in the importance of empathy in professional relationships, to our knowledge, the present pilot study is the first to explore the feasibility and efficacy of an immersive empathy education in New Zealand. Our findings will provide critical evidence to support the development of a randomised cluster trial and potentially provide preliminary evidence for the effectiveness of this type of empathy education.

[...]for doctoral candidates, it is very easy for us (as supervisors) to limit the way they think about their research projects, seeking the reassurance of a contained and controlled undertaking. For Aotearoa New Zealand nursing researchers, this dynamic can feel intensified by geographical isolation, and a small population size that promotes a sense of being remote and, possibly, overlooked. [...]discussions with colleagues that focus on ways to look at our research from a broader perspective are also valuable. Through cultivating a researchsupportive environment we aim to foster international engagement that offers a unique space within our programmes for our candidates to share their ideas, join in online learning modules, attend research school presentations, and connect with each other.

Aims to benchmark the quality of bariatric service delivery against moving and handling and patient care best-practice standards and to determine the prevalence of hospitalised patients admitted to Wellington Regional Hospital (WRH) requiring bariatric level care. Identifies areas for improvement in service delivery and provides recommendations relevant to Capital & Coast District Health Board (CCDHB) policies. Source: National Library of New Zealand Te Puna Matauranga o Aotearoa, licensed by the Department of Internal Affairs for re-use under the Creative Commons Attribution 3.0 New Zealand Licence.