The Journal of Nursing Theory and Practice (JNTP) is an open access publication using the Open Journal Systems (OJS) resources contracted by the University of Lancashire. We aim to publish online bi-annually and welcome articles on nursing, healthcare and midwifery topics that develop a critical conversation. We welcome articles generated by our students, staff and externally, whether inexperienced or experienced authors.
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From novice to expert: Exploring surgical First Assistants and the conceptual integration of their role in robotic surgery
Competing demands and pressures in health services in the United Kingdom have led to the creation of specialist roles in nursing. One such role is that of Surgical First Assistant (SFA). SFAs are specialist nurses or operating department practitioners who work in operating theatre departments and provide clinical assistance to surgeons and the wider clinical team. In this article, Benner’s novice to expert framework is adopted to examine the progression and abilities of SFAs at different stages. A case study is also used to examine a nurse specialist’s transition into the SFA role. This article conceptualises the development and training needs of a SFA in an era where robotic surgery is enhancing practice in many specialities. Each SFAs journey is unique depending on their experiences and encounters within their operating theatre environment, and this may influence their progress and skill development which can affect their ability to maintain an expert level in practice. This paper suggests that through the development of a formalised and specialist robotics training pathway, SFAs may have scope for further practice development in this area.
Copyright (c) 2026 Journal of Nursing Theory and Practice https://creativecommons.org/licenses/by/4.0
Digital Health; A concept analysis using the Walker and Avant Framework.
Objectives: This concept analysis analyses the concept of digital health in relation to contemporary nursing practice to enable a shared language to avoid confusion around terminologies. Design: A concept analysis was undertaken using Walker and Avant’s framework. Data Sources: Database searches were completed using CINAHL Ultimate with the inclusion criteria to include peer reviewed papers written in English with full text availability dated from 2015 to retrieve up to date papers. Review methods: A concept analysis was undertaken to define the concept of digital health and identify key characteristics. Results: The concept of digital health emerged as an umbrella term that encapsulated multiple sub-terms linked to the delivery of health care using technology. Conclusion: Digital health has implications for nurses linked to ethical and safe use within patient care with increasing accountability for professionals. Digital health has the potential to improve patient outcomes and requires ongoing development to ensure staff and patient education is optimised. This concept emerged as an umbrella term that offers opportunity as a construct to link related technologies.
Digital health; Nursing technology; Digital nursing.
Interventions for improving international interpersonal communication
International nurses have supported the National Health Service (NHS) since its early years. The recruitment of international nurses presents challenges. One of these factors can be communication. Good communication in healthcare has been shown to reduce burnout and increase satisfaction in staff, whilst having a positive influence on health outcomes. This commentary aims to critically appraise and evaluate a systematic review on educational interventions for communication and contextualise the findings with specific reference to international nurses.
Exploring the barriers and effectiveness of larvae therapy in chronic wound management in community nursing
Aim: This paper critically evaluates the effectiveness of larvae therapy, also known as maggot debridement therapy, in managing chronic wounds and its potential for wider implementation within community nursing settings. Larvae therapy, as a biological method of debridement, has been used for centuries, with recent advancements renewing the interest due to its ability to cleanse necrotic tissue effectively. Methodology: The methodological approach follows the PICO framework and includes an integrative literature review process based on the PRISMA guidelines. Findings: Larvee therapy is clinically effective in improving wound healing and dissolving necrotic tissue, yet challenges persist, such as patient/clinician acceptance, stigma, lack of awareness, insufficient training and finances influencing nurse-led management. Conclusion: Enhancing the integration of community nursing practice will require overcoming key barriers. These include, public, nurse and patient acceptance; clinical policy and evidence-based guidelines; continuing professional development; allocation of resources based on cost benefit analysis, while also prioritising further research into patient experience.
Does blood transfusion education identify the emotional components of transfusion care?
Aim: The aim of this scoping review protocol is to explore the current blood transfusion administration training and education system within the United Kingdom (UK) for healthcare professionals and if it identifies or includes the emotional components of transfusion care such as empathy and compassion. Background: Blood transfusions are commonly performed procedures within healthcare and carry significant safety related responsibilities for those administering them, with potentially significant emotional and psychological consequences for recipients. The emotional and relational aspects of blood transfusion education for healthcare professionals in the UK remains underexplored whilst technical competence is widely discussed in literature. There can be emotional responses to receiving a blood transfusion and this protocol will review the inclusion of a patient’s emotional experience of receiving a blood transfusion within contemporary training. Design: This scoping review protocol is guided by the JBI methodology for scoping reviews using the Population, Concept and Context (PCC) framework to define inclusion and exclusion criteria. This protocol has been uploaded to the Open-Source framework. A protocol is the first stage of a scoping review preceding a research study on the project. Method & analysis: A comprehensive search of e-databases will be conducted including the following e-databases: CINAHL Complete, Embase, Scopus, MEDLINE (via PubMed), Web of Science, and ERIC. The searches will include educational materials, reports, and research articles available in English language. The inclusion criteria are broad to include any material referencing blood transfusion training that does not fit into straight forward categorisation. This scoping review protocol will use the PCC template to guide identification and selection of relevant search terms, ensuring a systematic and structured search by three independent reviewers. An initial search to test the viability of the hypothesis found n=307, reduced to n=11 and after application of the inclusion and exclusion criteria reduced to n=3, reinforces the need for a scoping review.
A Foucauldian perspective on electronic nursing documentation
This paper aims to demonstrate the relevance of Michel Foucault’s work for revealing how electronic nursing documentation is enmeshed in processes of power. Applying Foucault’s concept of biopower, provides a critical perspective on the increasing use of artificial intelligence and the commodification of patient data, outlining how these may undermine person-centred care and health equality. Arguing that nurses should take a leadership role in shaping the future of technology in healthcare, this paper suggests that Foucault’s concepts of counter-conduct, counter-discourse and care of the self, invites nurses to imagine how they can move from being agents of biopower to agents of rebellion.
‘Foucault’, ‘electronic nursing documentation’, ‘electronic health record’, ‘data sharing’, ‘artificial intelligence’, ‘nurses’, ‘resistance’, ‘biopolitics’
Copyright (c) 2025 Journal of Nursing Theory and Practice https://creativecommons.org/licenses/by/4.0
Common factors affecting quality of life scores for patients with newly formed stomas: A review of the literature
Introduction: Nurses have a key role in promoting and optimising the quality of life of patients adapting post-operatively to newly formed stomas. There are common factors negatively impacting on nursing care such as inconsistent Government strategy, poor evidence-based care informing organisations and inadequate resource allocation in localised care. Due to the number of patients living with stomas expected to rise to impact on service provision, this literature review aims to identify key factors nurses should be aware of when promoting health-related quality of life care post-operatively. Methodology: A search was conducted using CINAHL Ultimate and Medline to identify key factors affecting the quality of life of patients with newly formed stomas. n=66 papers were identified using search-specific criteria between 2014 and 2024. n=26 research studies were retrieved, and after inclusion and exclusion criteria were considered, n= 7 papers were critically appraised. Findings: Common factors identified were the importance of quality-of-life assessment tools used to assess health related quality of life, peristomal skin issues (inflammation, injury or damage to surrounding), and a lack of available suitable facilities affecting privacy. Discussion: It is important to understand the difficulties ostomates face post-operatively and follow evidence-based guidelines irrespective of national pandemic emergencies. Conclusion: This paper highlights a significant research gap into the facilities available for people living with a stoma; and the evidence identifies negative factors impacting on quality-of-life scores for both male and female ostomates.
Exploring the importance of daily weights for patients diagnosed with chronic heart failure: A review of the literature
Aim: The importance of recording the daily weight of hospital in-patients suffering with congestive heart failure is reinforced in the European Society of Cardiology and NICE (2021) guidelines, yet inconsistencies in nursing care remain in the United Kingdom. Identifying the reasons and barriers for inconsistency is important to promote optimal fluid management and up-titrating therapy. Methods: A review of the literature using the electronic database CINAHL Ultimate searched for research studies between 2013 and 2024, and from n=505 research studies, n=62 were reduced and n=11 appraised. Findings: Three themes were found: first, recording congestive heart failure patients’ daily weights correlates to the effectiveness of congestive heart failure decongestion because it is a biomarker or measurable indicator to inform diuretic protocols and accurately titrate diuretics. Second, barriers and obstacles in obtaining daily weights relate to training and knowledge, poor task delegation and insufficient or broken equipment. Third, daily weighing and optimal fluid management reduces 30-day re-admissions, attendance at an emergency department and improved mortality rates. Conclusion: The recording of a patient’s daily weight enables nurses to determine accumulated fluid retention, inform a multi-disciplinary treatment response, predict mortality, accurately titrate medications, and reduce 30-day re-admissions.
Specialist domestic abuse training for emergency department clinical staff: A review of the literature
Aim: Emergency departments are often the first point of contact for women suffering from domestic abuse and identifying how healthcare staff can support women is important to tackle missed opportunities for timely intervention. Method: A review of research studies was undertaken between 2012 and 2024 using electronic databases AMED, CINAHL Ultimate, MEDLINE, EBSCO, and the RCNi. The search words “emergency department, ED, accident and emergency, A & E, domestic abuse, domestic violence, intimate partner violence, family violence, staff- training education, development, learning” were used and retrieved n=93, reduced n=18, and finally n=7. Findings: The findings identify a training and role-specific issue related to emergency department nursing, and the need to have a supportive environment for positive action to be taken on behalf of the victim and their families. Four themes were identified; “don’t ask,” “stereotyping,” moral distress” and “systemic support.” In ‘don’t ask’ the thread of conscious incompetence ensures staff reluctance to talk to women in case it opens a ‘can of worms.’ Discussion: The difficulties experienced by emergency nurses were compounded by staff being unaware of their departments policy on dealing with domestic abuse. Contrary to WHO recommendations, the evidence identified domestic abuse screening in most emergency departments happens on an ad-hoc basis and is subject to the experience and confidence of the individual clinician. Conclusion: Training is required to myth bust the factors related to domestic abuse, yet training is not enough, there needs to be a shift in attitudes toward domestic abuse, and in an institutional context, staff should feel supported and empowered to respond to women appropriately.
A multi-modal approach to promoting hand hygiene to reduce hospital acquired infection: A change management proposal for an intensive care unit
Aim: Using evidence from a previous literature review, a proposed plan was developed to promote hand hygiene and reduce the prevalence of hospital-acquired infections within an intensive care unit in the North-West of England. Methodology: The RE-AIM framework structured the implementation of the proposed plan with Lewin’s force field theory applied. The proposed plan was peer-reviewed for feedback on the change management plan. Finally, Gibbs’s model was used to reflect on the lead author’s independent learning journey undertaking a 3-year degree programme in adult nursing to reflect and identify opportunities for future development. Results: A multimodal change plan was developed with guidance from the evidence and identified themes. The peer review process highlighted areas for improvement and provided valuable feedback. The reflective process identified opportunities for professional development and developing nurse leadership skills. Discussion: The proposed plan was based on three hand hygiene themes identified in a previous literature review; education and understanding, direct observation, and reminders/ prompts. The change management phase highlighted important barriers to be addressed for the proposal to be successful. The peer review process facilitated innovative ideas and reflecting on the feedback given. The improvement process reinforced a need to listen to feedback throughout the negotiated change. Conclusion: A proposed plan focused on hand hygiene and healthcare acquired infections offers valuable insights related to change management plans in nursing.
What UK career guidance counsellors in high schools and further education think about nursing as a career for men
Aim: To identify why men in Western societies consistently make up between 9-11% of the nursing workforce and viable solutions to this Global recruitment issue. Methods: A review of the literature was undertaken using Cinhal Ultimate, Embase and Nursing and Allied Health search engine databases. n=490 studies were retrieved, reduced to n=65 with a final n=21 appraised. Findings: The identified themes were; promoting nursing in secondary school, and for career counsellors to suggest nursing as a career choice to adolescent boys. Discussion: Significant others such as family members, and friends influence on adolescent boys had a positive impact on the choice of career, and exposure as a patient or visitor to what nurses do, and outreach work in schools help to support an interest in nursing as a career. Adult partners were found to be instrumental in supporting a change of career later in life. The issue of job security, promotional prospects, and leaning towards more technical roles in nursing were motivational themes when choosing a career path, with friendliness, feeling included, and low pay, considered key factors. Lastly, the specific role of career guidance counsellors (CGS’s) was found to be instrumental in widening the choices for a career in nursing, with differences in attitudes and expectations for boys seen in private and public education. Conclusion: CGC’s can play a vital role in informing their male and female students about career opportunities in the caring profession although may need further support from industry experts. In addition, schools and colleges should be following benchmarks for good career guidance.
Effective methods of promoting hand hygiene to reduce hospital acquired infections: A literature review
Aim: A literature review aimed to explore the most effective methods of promoting hand hygiene in nursing to reduce the prevalence of hospital acquired infections (HAIs). Methodology: A literature search was conducted using AMED, British Education Index, CINAHL Ultimate, ERIC and MEDLINE with the search terms “hand hygiene, hospital acquired infection, reduction, and promotion” between 2014 and 2024. A PICO framework helped to create a search hypothesis and a PRISMA flowchart used. The search was later repeated between 2017 and 2024 to be relevant post Covid 19 pandemic. Results: n=9 research studies were retrieved, reduced to n=6. The research studies were critically appraised to identify themes and relevant discussion. Findings: The reviewed research studies had a variety of methodologies used, sample size and time periods. Three key themes were first, education and knowledge; second, direct observation, and third, reminders/ prompts. All research studies demonstrated a correlation between promoting hand hygiene and a reduction in hospital acquired infections. Discussion: The cost of HAIs was an issue in terms of a negative effect on hospital resources (beds, staffing costs, equipment) and positive patient outcomes. Despite WHO (2020) and organisational guidelines of best practice, education and training, hand hygiene frequency had improved at the beginning of the Covid 19 pandemic, with healthcare staff being key to reduce HAIs but hand hygiene later became less observed due to high staff workload and burnout. The research findings reinforce WHO guidelines, and indicate a need for regular training, reminders, and updates in clinical practice to promote hand hygiene to reduce the incidence of HAIs. Conclusion: HAIs have a negative impact on patients’ treatment outcomes, cost, and resource implications and despite WHO (2020) guidelines, continue to have a negative impact on patients’ health outcomes. Nurses dealing with a high workload and burnout are at risk of forgetting the importance of hand hygiene and evidence-based practice, yet hand hygiene is most cost-effective method of reducing HAIs.
Prescriptive language in NMC nursing standards
This paper examines imperative language in the professional Code of conduct in Nursing and Midwifery (NMC, 2018), using the philosophical arguments of moral ethics through the lens’ of Immanuel Kant (1785) and Richard Hare (1952). A professional code is used in many high-risk professions to set industry standards and parity across the workforce. Professions usually adopt a code of standards, ethics, or conduct (Crystal & Giesel, 2024). It is argued here that the equivocation is a key indicator that sets nursing and midwifery apart from other professions. Codes of standards and ethics align more readily with how a person behaves in practice; whereas codes of conduct govern beyond the workplace and include personal attributes (Aibar-Guzmán et al., 2023). The shift, from principles that adopt characteristics of performance, to attributes which espouse essential behaviours, suggests the differences becomes functional as the language used to ascribe behaviour has to perform differently (alongside those adhering to it). Used in an unchecked way, a code can neutralise autonomy and creativity and, in the extreme, can neutralise the professional’s career entirely (Mishra & Aithal, 2023). Any code is predicated on language and Kant (1785) and Hare (1952) were interested in the language that accompanied everyday life in what is more formally recognised as the logical study of the language of morals (Hare, 1952). Some of the separate positionalist critiques of Kant and Hare are used here to support an analysis of the Code and its use of language in determining professional character and behaviour. It is argued that while a code is needed, the NMC rests on the axle of good and bad which challenges the writings of Kant and Hare, who open moral language to one that tries to work out the tension between that dialectic.
A literature review on the effectiveness of prophylactic foam dressings and pressure ulcer prevention in intensive care nursing
Aim: This article reviews the literature on the strategies for mitigating pressure ulcers through the formulation and execution of minor modifications within hospital settings. Methodology: A search of the University’s e-databases Cumulative Index, Nursing and Allied Health Ultimate, CINHAL Ultimate and Medline retrieved n=37 research studies and n=2 found to meet the inclusion and exclusion criteria. A hand search identified a further n=6 to total n=8 research studies. Findings: Each research study aimed to reduce the incidence of hospital acquired pressure ulcers in intensive care units, improve routine practice and compare the effectiveness of multi layered foam dressings for prevention. Three common themes were identified: first, evaluating the effectiveness of prophylactic sacral dressings. Second, educating nurses on improving clinical outcomes and third, the use of various interventions to prevent hospital acquired pressure ulcers in intensive care units. Discussion: Intensive care unit patients are at significant risk of developing pressure ulcers due to a variety of contributing factors such as vulnerability, lack of movement, a need to physically examine skin, medical device use, managing continence, poor nutrition, repositioning and applying prophylactic multi layered foam dressings. Conclusion: Properly addressing risk factors and harmonising preventive protocols is essential in minimising pressure ulcer development and improving overall patient care in an intensive care unit and other cases involving at risk patients.