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Mixed-methods research leverages the strengths of qualitative and quantitative methodologies and methods to generate a comprehensive understanding of phenomena. There is ample guidance about traditional mixed-methods research, but limited discussion on critical mixed-methods research. To provide a conceptual framework and practical considerations for designing and conducting critical mixed-methods research. Contemporary and classical literature in critical research and mixed methods was used to guide the development of this framework. Critical mixed-methods research is informed by critical social theory, critical dialectical pluralism and transformative worldview. The seven core features of critical mixed-methods research are critique, insight, transformation, engagement, epistemic inclusion, critical reflexivity and intersectionality. Critical mixed methods is necessary and needed for studying social justice and equity-related research problems in health sciences and public health. Using the proposed framework and practical strategies can enable researchers to unravel complex social and healthcare phenomena through addressing power, oppression and social justice issues.

Purpose Occupational health nurses (OHN) play a key role in identifying and managing work ability risks, as they have close interaction with employees and the customer organization, and they monitor work ability in multiple ways. The study aimed to describe OHNs’ perceptions of work ability risk management and analysis (WARMA) and identify promoting and hindering factors. Methods A descriptive qualitative study with semi-structured thematic interviews was conducted in May–June 2023, using purposive sampling of ten OHNs. The data were analyzed using both inductive and deductive approaches. Findings OHNs perceived management and analysis of work ability risks as important work. The management and analysis of work ability risks was described as the central core work of occupational health care, which is carried out at the level of the customer organization and at the individual level. Factors promoting the management and analysis of work ability risks are electronic tools, time resources, occupational health cooperation, multi-professional cooperation, and personal experience. Factors hindering WARMA are insufficient time resources and productivity pressures. Conclusion OHNs’ perceptions of WARMA varied. There are multiple factors that promote or hinder WARMA which require consideration at individual and organizational levels. The findings of this study provide a basis for further research that could focus on measuring OHNs' overall competence in WARMA.

Background Wound care procedures can often cause intense and intolerable pain for patients and negatively affect their quality of life. Objective This study aimed to determine the impact of virtual reality applied in wound care procedures on pain management. Methods A systematic review and meta-analysis. From online databases, including PubMed, ScienceDirect, Scopus, EBSCO (MEDLINE) and Web of Science. Two independent systematic searches of databases were conducted by two researchers. Two independent systematic searches of databases were conducted by two researchers in April 2025. The search strategy was adapted to bibliographic databases. All relevant studies published until the end of April 2025 were included, with no time restrictions applied to capture the earliest research on VR in wound care. Then, two reviewers independently screened literature, and extracted data. After conducting a quality assessment of the included literature, meta-analysis was performed. The degree of heterogeneity was also indicated by using I 2 statistic. Results This systematic review and meta-analysis included seven randomized controlled trials. The results of the studies included in the systematic review revealed that VR effectively reduced pain during dressing changes, as reported in most included studies. However, our meta-analysis for pain, based on three studies, revealed substantial heterogeneity (I 2  = 86.19%) and did not show a statistically significant overall reduction in pain scores. Similarly, the meta-analysis for anxiety, derived from two studies, showed no heterogeneity (I 2  = 0%) and did not yield a statistically significant pooled effect for anxiety reduction. Conclusion Virtual reality shows promise in reducing pain during a wound care procedure. However, large-scale methodologically sound randomized controlled trials are recommended to determine its efficacy in reducing post-procedural pain and anxiety and its broader effect on vital signs. Clinical trial number Not applicable. Registration www.crd.york.ac.uk CRD420251021751, registered March 31, 2025.

Missed care, defined as any aspect of patient care that is omitted or delayed, is receiving increasing attention. It is primarily caused by the imbalance between patients' nursing care needs and the resources available, making it an ethical issue that challenges nurses' professional and moral values. In this scoping review, conducted using the five-stage approach by Arksey and O'Malley, our aim is to analyze the patients' perspective to missed care, as the topic has been mainly examined from nurses' perspective. The search was conducted in April 2019 in PubMed, CINAHL, PsycINFO, Web of Science, ProQuest and Philosophers Index databases using the following terms: omitted care, unfinished nursing care, care undone, care unfinished, missed care, care left undone, task undone and implicit rationing with no time limitation. The English-language studies where missed care was examined in the nursing context and had patients as informants on patient-reported missed care or patients' perceptions on nurse-reported missed care were selected for the review. Thirteen studies were included and analyzed with thematic content analysis. Twelve studies were quantitative in nature. Patients were able to report missed care, and mostly reported missed basic care, followed by missed communication with staff and problems with timeliness when they had to wait to get the help they needed. In statistical analysis, missed care was associated with patient-reported adverse events and patients' perceptions of staffing adequacy, and in patients' perception, it was mainly caused by lack of staff and insufficient experience. Furthermore, patients' health status, as opposed to gender, predicted missed care. The results concerning patients' age and education level were conflicting. Patients are able to identify missed care. However, further research is needed to examine patient-perceived missed care as well as to examine how patients identify missed care, and to get a clear definition of missed care.

Background Person-Centered Care is often seen as an indicator of quality of care. However, it is not known whether and to what extent person-centered care can be enhanced by continuing education interventions in older people’s long-term care settings. This systematic review aimed to analyze and synthesize the existing research literature about person-centered care-based continuing educational interventions for nurses working in long-term care settings for older people. Methods Five databases were searched 6/2019 and updated 7/2020; PubMed (Medline), CINAHL, PsycINFO, Cochrane and Eric using the keywords person-centered car* OR person-centred car * OR patient-centered car* OR client-centered car* OR tailored car* OR resident-centered car* OR individualized car* AND older* OR elder* OR old person* AND Long-Term Care OR Nursing home OR 24-h treatment OR long-term treatment. Twenty-seven full texts from 2587 initially retrieved citations were included. Results The continuing educational interventions found were divided into five themes: person-centered interventions focusing on medication; interaction and caring culture; nurses’ job satisfaction; nursing activities; and older people’s quality of life. The perspective of older people and their next of kin about the influence of continuing education interventions were largely absent. The background theories about interventions, the measurements taken, and the clarity around the building blocks of the continuing-care interventions need further empirical verification. The pedagogical methods used were mainly quite behavioristic mostly lectures and seminars. Conclusion Most of person-centered care continuing education interventions are effective. Still more empirical research-based continuing education interventions are needed that include learner-centered pedagogical methods, with measurable outcomes that consider the opinions of older people and their next of kin. Continuing educational interventions for nurses need to be further developed to strengthen nurse’s competence in person-centered care, job satisfaction and for better quality of care.

Background Work ability risk management and analysis (WARMA) requires professional competence to ensure effective, consistent, and high-quality occupational health nursing. Occupational health nurses (OHNs) play a central role in identifying and addressing work ability risks; however, no comprehensive instrument currently exists to assess their competence. This study aimed to develop and psychometrically evaluate such an instrument. Methods A descriptive, exploratory, and methodological design was applied. Instrument development followed a three-phase process comprising theory-based item generation, expert panel evaluations with consensus meetings, and empirical testing. Data were collected using two online surveys including the newly developed Competence in Work Ability Risk Management and Analysis (Comp-WARMaA) instrument. Psychometric properties were examined using classical and modern test theory methods, focusing on content validity, internal consistency, and structural validity. Results The final Comp-WARMaA instrument comprised 40 items covering four competence domains: objective knowledge, perceived knowledge, attitudes and values, and case-based performance. Content validity was confirmed by experts. Internal consistency was acceptable across subscales. Principal component analysis supported the multidimensional structure, whereas confirmatory factor analyses (CFA) and Rasch analyses yielded mixed findings, indicating the need for further refinement and psychometric testing in independent samples. Conclusions The Comp-WARMaA instrument demonstrated strong content validity and acceptable internal consistency. Structural analyses yielded mixed findings, indicating the need for further refinement and psychometric testing in independent samples. The instrument provides a structured framework for assessing OHNs’ competence in WARMA and may inform systematic competence evaluation and professional development in occupational health nursing. Clinical trial number Not applicable.

In this article, we compared the content validity of two instruments used in measuring pediatric pain knowledge and attitudes. This was considered necessary due to the universal differences in culture, semantics and healthcare resources in different parts of the globe. Thirteen (13) pediatric experts in Ghana assessed the content validity of two instruments: the 42-item Pediatric Nurses' Knowledge and Attitudes Survey Regarding Pain (PNKAS) and the 41-item Pediatric Healthcare Providers’ Knowledge and Attitudes Survey Regarding Pain (PHPKASRP). The relevance and clarity of each item on these instruments were rated on a four-point likert scaled options from 1 (not relevant/ not clear) to 4 (very relevant/ very clear). The item-level content validity index (I-CVI) was calculated by dividing the number of experts who rated an item with 3 or 4 by the total number of experts. The average scale-level content validity index (S-CVI/Ave) was also estimated by summing up the I-CVIs of all items and dividing them by the total number of items. The I-CVIs on the PNKAS ranged from 0.62 to 1.00 for the relevance component and 0.69 to 1.00 for the clarity component. The I-CVIs on the PHPKASRP ranged from 0.62 to 1.00 for both the relevance and clarity components. The S-CVI/Ave were 0.87 and 0.89 for the relevance and clarity aspects on the PNKAS respectively. The S-CVI/Ave for the PHPKASRP instrument were 0.86 and 0.89 for the relevance and clarity aspects correspondingly. At the end of the validation process, 5 items were revised on both instruments whilst 37 and 36 items were maintained on the PNKAS and PHPKASRP instruments respectively. The PNKAS and PHPKASRP have an acceptable level of content validity in the Ghanaian context and recommended for educational and research purposes. Other forms of validity and reliability of these instruments should also be examined in future studies.

Objective Nurses and care workers who provide in-home services play important roles in assessing and providing care for older people who lack foot self-care abilities. We aimed to evaluate the development process and effects of a foot care program with educational tools for nurses and care workers as in-home service providers. This is a process evaluation with a descriptive mixed-methods study of quantitative and qualitative data conducted from July to October 2019 in Japan. Results Foot care education tools were developed to address the issues faced by participants with various work patterns and insufficient foot care education in Japan. The contents of these tools were discussed by a panel and reviewed by experts. Three outcomes were analyzed using descriptive statistics and Pearson’s correlation. Changes in foot care practice scores were significantly correlated with performance scores. The evaluations of five of the eight field nurses suggested that excess information was included in the foot care booklet. Overall, 29 nurses and care workers showed higher than average evaluation scores [3.8–4.1 (standard deviation, 0.62–0.91)] for the motion pictures and PowerPoint presentation. A program according to this conceptual framework must be established and periodically evaluated for refinement. Trial Registration The trial registration number for the University Hospital Medical Information Network is UMIN000036307. Registration Date—2019/07/25

Background Reliable and valid measurement is the foundation of evidence-based practice. The self-administered Foot Health Assessment Instrument (S-FHAI) was recently developed to measure patients’ evaluations of their own foot health. Evidence regarding the psychometric properties of the S-FHAI is limited. The aim of this study was to investigate those properties by using a Rasch analysis. Methods This methodological study analysed secondary data that was collected from nurses ( n  = 411) in 2015. The psychometric properties of the S-FHAI were evaluated using the Rasch model. Unidimensionality was analysed first, followed by item functioning, person misfit and differential item functioning (DIF). Results The S-FHAI demonstrated evidence of unidimensionality, with an acceptable item fit according to the Rasch model. Person fit and person separation were low, however, indicating restricted separation among different respondents. Item separation was high, demonstrating clear discrimination between the items. No DIF was detected in relation to gender, but significant DIF was demonstrated in relation to age for 6 of the 25 items. Conclusions The S-FHAI has potential for use in investigating self-reported foot health. The Rasch analysis revealed that the psychometric properties of the instrument were acceptable, although some issues should be addressed to improve the scale. In future, it may be beneficial to analyse the sensitivity of the items and to test the S-FHAI in more diverse patient populations.

Background Dyspnoea is one of the most prevalent and distressing symptoms among patients with advanced cancer receiving palliative care. Nurses, particularly in non-specialist settings, often report insufficient preparedness in managing dyspnoea. Despite its clinical relevance, existing tests inadequately assess nurses’ knowledge of dyspnoea care. This study aimed to develop and evaluate the Knowledge of Dyspnoea Care in Patients with Cancer Receiving Palliative Care (DysPalKT) to address this gap. Methods The DysPalKT was developed through a multi method approach including literature synthesis, expert panel validation, and pilot testing. A cross-sectional psychometric evaluation was conducted with 84 registered nurses working in general inpatient wards across seven district hospitals in Finland. Psychometric properties were analysed using the Kuder-Richardson Formula 20 (KR-20) and Rasch modelling. Results The final test comprised 16 items across three domains. Content validity was supported by expert evaluations (I-CVI ≥ 0.83). However, KR-20 (0.306) indicated weak internal consistency, and Rasch analysis revealed low person separation and multidimensionality. Most items were too easy, limiting the test’s ability to differentiate between knowledge levels. Conclusions The DysPalKT shows promise for assessing nurses’ knowledge of dyspnoea care in palliative care settings, but further refinement is needed. Increasing item difficulty and expanding the item pool may improve its reliability and discriminatory power. These improvements could enhance the knowledge test’s ability to identify learning needs, thereby supporting the design and targeting of future educational interventions in non-specialist palliative care.