Artificial Intelligence in nursing: trustworthy or reliable?

Background: Trustworthiness in Artificial Intelligence (AI) innovation is a priority for governments, researchers and clinicians; however, clinicians have highlighted trust and confidence as barriers to their acceptance of AI within a clinical application. While there is a call to design and develop AI that is considered trustworthy, AI still lacks the emotional capability to facilitate the reciprocal nature of trust. Aim: This paper aims to highlight and discuss the enigma of seeking or expecting trust attributes from a machine and, secondly, reframe the interpretation of trustworthiness for AI through evaluating its reliability and validity as consistent with the use of other clinical instruments. Results: AI interventions should be described in terms of competence, reliability and validity as expected of other clinical tools where quality and safety are a priority. Nurses should be presented with treatment recommendations that describe the validity and confidence of prediction with the final decision for care made by nurses. Future research should be framed to better understand how AI is used to deliver care. Finally, there is a responsibility for developers and researchers to influence the conversation about AI and its power towards improving outcomes. Conclusion: The sole focus on demonstrating trust rather than the business-as-usual requirement for reliability and validity attributes during implementation phases may result in negative experiences for nurses and clinical users. Implications for practice: This research will have significant implications for the way in which future nursing is practised. As AI-based systems become a part of routine practice, nurses will be faced with an increasing number of interventions that require complex trust systems to operate. For any AI researchers and developers, understanding the complexity of trust and creditability in the use of AI in nursing will be crucial for successful implementation. This research will contribute and assist in understanding nurses' role in this change.

Enhancing Disability Nursing Practice in Australia: Addressing Educational Preparedness.

People with intellectual disabilities (IDs) face significant health challenges, including poor outcomes, limited access to health care, and a 26-year life expectancy gap compared with the general population. This highlights the need for improved public health and social policies to enhance the quality of care in hospital and community settings. An integrated literature review was conducted to examine the state of disability nursing practice in Australia following the implementation of the National Disability Insurance Support (NDIS) scheme. The review included English-language studies published from 2010 to 2023. Systematic searches in five databases resulted in a final sample of 28 studies. The data were then thematically analysed, and the following three themes emerged: Workforce development and professional standards, hospital experience and support needs of individuals with IDs, and nursing curriculum and ID. Study findings suggest that nurses lack preparation for effective health communication with individuals with IDs and their families. Evidence is insufficient to guide nursing practice and policies in ID care. Varying understandings of practice standards exist among nurses. Nursing curriculums in Australia fail to adequately prepare students to manage the unique needs of individuals with IDs, perpetuating the high mortality rates in this population. Specialised nursing practice areas are vital for meeting the complex needs of individuals with IDs. Reintroducing a disability nursing specialty and integrating dedicated study units and clinical placements in undergraduate programmes are recommended steps to improve care outcomes and support the overall well-being of this population.

Disproportionate mental health presentations to emergency departments in a coastal regional community in Australia of first nation people.

Emergency department (ED) presentations for mental health (MH) help-seeking have been rising rapidly in recent years. This research aims to identify the service usage demographic for people seeking MH care in the ED, specifically in this case, to understand the usage by First Nation people. This retrospective cohort study examined the sociodemographic and presentation characteristics of individuals seeking MH care in two EDs between 2016 and 2021. Data were collected using existing records and analysed using descriptive univariate analysis with statistical significance between the two sites determined using chi-squared test, p < 0.05. The overall data presented in this analysis show an overall ED mental health presentation rate of 12.02% for those who identified as 'Aboriginal but not Torres Strait Islander origin', 0.36% as 'Both Aboriginal and Torres Strait Islander' and 0.27% as 'Torres Strait Islander' totalling 12.63%. This is an overrepresentation compared to the regional population of 4.9%. One site recorded 14.1% of ED presentations that identified as Aboriginal and/or Torres Strait Islander, over double the site's demographic of 6.3%. Given the disproportionately high representation of First Nation people in MH-related ED presentations, further research is required to prioritise a First Nation research perspective that draws on First Nation research methods, such as yarning and storytelling to understand the unique cultural needs and challenges experienced by First Nation people accessing MH care via ED. Understanding the demographic is but one step in supporting the Cultural Safety needs of First Nation people. Additionally, research should be designed, governed and led by First Nation researchers.

Oral care practices and hospital-acquired pneumonia prevention: A national survey of Australian nurses.

BACKGROUND: Hospital-acquired pneumonia (HAP) also known as non-ventilator associated pneumonia, is one of the most common infections acquired in hospitalised patients. Improving oral hygiene appears to reduce the incidence of HAP. This study aimed to describe current practices, barriers and facilitators, knowledge and educational preferences of registered nurses performing oral health care in the Australian hospital setting, with a focus on the prevention of HAP. We present this as a short research report. METHODS: We undertook a cross sectional online anonymous survey of Australian registered nurses. Participants were recruited via electronic distribution through existing professional networks and social media. The survey used was modified from an existing survey on oral care practice. RESULTS: The survey was completed by 179 participants. Hand hygiene was considered a very important strategy to prevent pneumonia (n = 90, 58%), while 45% (n = 71) felt that oral care was very important. The most highly reported barriers for providing oral care included: an uncooperative patient; inadequate staffing; and a lack of oral hygiene requisite. Patients' reminders, prompts and the provision of toothbrushes were common ways believed to help facilitate improvements in oral care. CONCLUSION: Findings from this survey will be used in conjunction with consumer feedback, to help inform a planned multi-centre randomised trial, the Hospital Acquired Pneumonia PrEveNtion (HAPPEN) study, aimed at reducing the incidence of HAP. Findings may also be useful for informing studies and quality improvement initiatives aimed at improving oral care to reduce the incidence of HAP.

Supported decision-making interventions in mental healthcare: A systematic review of current evidence and implementation barriers.

BACKGROUND: There is a growing momentum around the world to foster greater opportunities for the involvement of mental health service users in their care and treatment planning. In-principle support for this aim is widespread across mental healthcare professionals. Yet, progress in mental health services towards this objective has lagged in practice. OBJECTIVES: We conducted a systematic review of quantitative, qualitative and mixed-method research on interventions to improve opportunities for the involvement of mental healthcare service users in treatment planning, to understand the current research evidence and the barriers to implementation. METHODS: Seven databases were searched and 5137 articles were screened. Articles were included if they reported on an intervention for adult service users, were published between 2008 and October 2023 and were in English. Evidence in the 140 included articles was synthesised according to the JBI guidance on Mixed Methods Systematic Reviews. RESULTS: Research in this field remains exploratory in nature, with a wide range of interventions investigated to date but little experimental replication. Overarching barriers to shared and supported decision-making in mental health treatment planning were (1) Organisational (resource limitations, culture barriers, risk management priorities and structure); (2) Process (lack of knowledge, time constraints, health-related concerns, problems completing and using plans); and (3) Relationship barriers (fear and distrust for both service users and clinicians). CONCLUSIONS: On the basis of the barriers identified, recommendations are made to enable the implementation of new policies and programs, the designing of new tools and for clinicians seeking to practice shared and supported decision-making in the healthcare they offer. PATIENT OR PUBLIC CONTRIBUTION: This systematic review has been guided at all stages by a researcher with experience of mental health service use, who does not wish to be identified at this point in time. The findings may inform organisations, researchers and practitioners on implementing supported decision-making, for the greater involvement of people with mental ill health in their healthcare.

Digital mental health interventions for the mental health care of refugees and asylum seekers: Integrative literature review.

This study aimed to provide a critical analysis of the current literature on the use of digital mental health interventions (DMHIs) for the management and treatment of mental health disorders among refugees and asylum seekers. These groups are among the most disadvantaged compared to the general population in terms of health and socio-economic status, due to conflicts and wars. The number of refugees fleeing their home countries is growing exponentially, and refugees experience trauma, torture, persecution and human right abuses, which have a profound effect on their mental health and overall well-being. The researchers conducted an integrative literature review from electronic databases Medline, CINAHL and Google Scholar, selecting articles published in English from 2010 to 2023. The thematic analysis of the 10 articles identified in the review revealed four main themes and two sub-themes: (1) types of digital health intervention/apps used; (2) barriers encountered in digital health intervention; (3) user experience of the digital health intervention and (4) mapping gaps. Two sub-themes were identified located in Theme 2: (2.1) Language and demographic barriers and (2.2) Structural barriers. The study showed that the use of DMHIs was associated with positive experiences among refugees and asylum seekers. Limited mental health care is offered to refugees and asylum seekers due to a range of logistical, political, economic, geographical, language, cultural and social barriers. DMHIs have the potential to overcome and/or moderate these barriers. The study concludes that the scaled implementation of effective DMHIs holds the possibility to improve the wider distribution of mental health care among refugees and asylum seekers. However, further research is needed to confirm the effectiveness of DMHIs and to scale up studies for their utilisation among this group. In summary, this study highlights the potential of DMHIs in improving the mental health care of refugees and asylum seekers. The results of this study have important implications for mental health service providers, policymakers and researchers to address the mental health needs of this vulnerable/priority group.

Integration of traditional therapies for first nations people within western healthcare: an integrative review.

AIMS: To conduct an integrative literature review to reveal any evidence supportive of the integration of traditional therapies for First Nations peoples in Australia within a western healthcare model, and to identify which, if any, of these therapies have been linked to better health outcomes and culturally safe and appropriate care for First Nations peoples. If so, are there indications by First Nations peoples in Australia that these have been effective in providing culturally safe care or the decolonisation of western healthcare practices. DESIGN: Integrative literature review of peer-reviewed literature. DATA SOURCES: Online databases searched included CINAHL, Medline, Scopus, ScienceDirect InformitHealth, and ProQuest. REVIEW METHODS: Databases were searched for papers with full text available and published in English with no date parameter set. The PRISMA guidelines were used during the literature review and the literature was critiqued using the Critical Appraisal Skills tool. RESULTS: Seven articles met the inclusion criteria and were included in the review. Four articles selected were qualitative, two used a mixed method design, and one used a quantitative method. Six themes arose: (i) bush medicine, (ii) traditional healers, (iii) traditional healing practices, (iv) bush tucker, (v) spiritual healing, and (vi) therapies that connected to cultures such as yarning and storytelling. CONCLUSION: There is limited literature discussing the use of traditional therapies in Western healthcare settings. A need exists to include traditional therapies within a Western healthcare system. Creating a culturally safer and appropriate healthcare experience for First Nations people in Australia and will contribute to advancement in the decolonisation of current healthcare models.

Motivational characteristics of recreational drug use among emerging adults in social settings: an integrative literature review.

Introduction: Recreational drug use by emerging adults has been identified as an increasingly normalized trend in social contexts. It has been documented that the consumption of these substances regularly occurs at music festivals, raves, nightlife and party settings. While it is known that emerging adults participate in these risk-taking behaviors, what is not known is their motivational characteristics for use. The aim of this review to identify and review literature describing the motivations for recreational drug use and drug choice (excluding alcohol, cannabis and tobacco) by emerging adults in social settings to inform selection of appropriately aligned harm reduction education and health messaging interventions. Methods: Whittemore and Knafl's (2005) integrative approach was used to conduct the review. This integrative review was based on a three-step search strategy identifying 2,772 articles published between 2000 and 2022. Eleven studies were included in the review. This review explores the following areas: drug use settings, concurrent drug use, consumer drug knowledge, motives of use including likes and dislikes and peer influence. Results: A range of factors influence motivations of emerging adults to participate in recreational drug use. Similar to the consumption of alcohol, the use of recreational drugs by emerging adults is motivated by their perceived benefits and personal motivations to achieve euphoria, emotional intimacy, social benefits, peer influence, increased confidence and to decrease inhibitions. The review findings suggest that motivational factors that reinforce recreational drug use correlate with the desire to break away from the mundane by seeking pleasure and for the opportunity to create novel experiences. Beliefs about the positive and negative impacts of drug use, together with the desire to achieve emotional satisfaction influence drug taking activity. Conclusion: Recreational drug use has become an increased societal norm amongst drug using peer groups and cannot be entirely prevented. It is to be noted that emerging adults have a basic understanding concerning recreational drugs, however, consumer drug knowledge and interventions that target illicit substances is lacking and should be addressed in future research. Festivals, raves and nightlife settings provide opportunity to implement health promotion as it reaches large number of vulnerable individuals in a short period of time.

The Use of mHealth Apps for the Assessment and Management of Diabetes-Related Foot Health Outcomes: Systematic Review.

BACKGROUND: Globally, diabetes affects approximately 500 million people and is predicted to affect up to 700 million people by 2045. In Australia, the ongoing impact of colonization produces inequity in health care delivery and inequality in health care outcomes for First Nations Peoples, with diabetes rates 4 times those of non-Indigenous Australians. Evidence-based clinical practice has been shown to reduce complications of diabetes-related foot disease, including ulceration and amputation, by 50%. However, factors such as a lack of access to culturally safe care, geographical remoteness, and high costs associated with in-person care are key barriers for First Nations Peoples in accessing evidence-based care, leading to the development of innovative mobile health (mHealth) apps as a way to increase access to health services and improve knowledge and self-care management for people with diabetes. OBJECTIVE: This study aims to evaluate studies investigating the use of mHealth apps for the assessment and management of diabetes-related foot health in First Nations Peoples in Australia and non-Indigenous populations globally. METHODS: PubMed, Informit's Indigenous Collection database, Ovid MEDLINE, Embase, CINAHL Complete, and Scopus were searched from inception to September 8, 2022. Hand searches of gray literature and reference lists of included studies were conducted. Studies describing mHealth apps developed for the assessment and management of diabetes-related foot health were eligible. Studies must include an evaluation (qualitative or quantitative) of the mHealth app. No language, publication date, or publication status restrictions were used. Quality appraisal was performed using the revised Cochrane risk-of-bias tool for randomized trials and the Health Evidence Bulletins Wales checklists for observational, cohort, and qualitative studies. RESULTS: No studies specifically including First Nations Peoples in Australia were identified. Six studies in non-Indigenous populations with 361 participants were included. Foot care education was the main component of all mHealth apps. Of the 6 mHealth apps, 2 (33%) provided functionality for participants to enter health-related data; 1 (17%) included a messaging interface. The length of follow-up ranged from 1-6 months. Of the 6 studies, 1 (17%) reported high levels of acceptability of the mHealth app content for self-care by people with diabetes and diabetes specialists; the remaining 5 (83%) reported that participants had improved diabetes-related knowledge and self-management skills after using their mHealth app. CONCLUSIONS: The findings from this systematic review provide an overview of the features deployed in mHealth apps and indicate that this type of intervention can improve knowledge and self-care management skills in non-Indigenous people with diabetes. Future research needs to focus on mHealth apps for populations where there is inadequate or ineffective service delivery, including for First Nations Peoples and those living in geographically remote areas, as well as evaluate direct effects on diabetes-related foot disease outcomes. TRIAL REGISTRATION: PROSPERO CRD42022349087; https://tinyurl.com/35u6mmzd.

Exploring digital interventions to facilitate coping and discomfort for nurses experiencing the menopause in the workplace: An international qualitative study.

INTRODUCTION: The global nursing workforce is predominantly female, with a large proportion working in the 45-55 age group. Menopause is a transition for all women, and; therefore needs recognition as it can impact work performance and consequently staff turnover. BACKGROUND: Women will go through the menopause, but not all women are affected. The menopause transition presents a range of signs and symptoms both physical and psychological which can impact the quality of life and individuals' work/life balance. The nursing workforce is predominantly women that will work through the menopause transition. OBJECTIVES: The study explored perspectives on digital health interventions as strategies to support menopausal women and to understand the requirements for designing health interventions for support in the workplace. DESIGN: A qualitative explorative design. SETTINGS: Nurses working in a range of clinical settings in England, Finland, Denmark, New Zealand, Australia and USA. METHODS: Nurses (n = 48) participated in focus groups from six different countries from February 2020-June 2022 during the pandemic from a range of acute, primary care and education settings. Nurses were invited to participate to share their experiences. Thematic analysis was used. RESULTS: All participants were able to describe the physical symptoms of menopause, with some cultural and possible hemisphere differences; more noticeable was the psychological burden of menopause and fatigue that is not always recognized. Four themes were identified: Managing symptoms in the workplace; Recognition in the workplace; Menopause interventions; and Expectation versus the invisible reality. These themes revealed information that can be translated for implementation into digital health interventions. CONCLUSIONS: Managers of nursing female staff in the menopausal age range need greater awareness, and menopause education should involve everyone. Finally, our results demonstrate design attributes suitable for inclusion in digital health strategies that are aligned with likely alleviation of some of the discomforts of menopause. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Exploring the factors affecting home dialysis patients' participation in telehealth-assisted home visits: A mixed-methods study.

BACKGROUND: Technology, such as telehealth, is increasingly used to support home dialysis patients. The challenges patients and carers face when home dialysis nursing visits are provided via telehealth have yet to be explored. OBJECTIVES: To explore patients' and carers' perspectives as they transition to telehealth-assisted home visits and identify the factors influencing their engagement in this modality. DESIGN: A mixed-methods approach, guideed by the behaviour change wheel using the capability, opportunity, motivation-behaviour model to explore individual's perceptions of telehealth. PARTCIPANTS: Home dialysis patients and their carers. MEASURUEMENTS: Suveys and qualitative interviews. METHODS: A mixed-methods approach was undertaken, combining surveys and qualitative interviews. It was guided by the Behaviour Change Wheel using the Capability, Opportunity, Motivation- Behaviour model to explore individuals' perceptions of telehealth. RESULTS: Thirty-four surveys and 21 interviews were completed. Of 34 survey participants, 24 (70%) preferred face-to-face home visits and 23 (68%) had previously engaged in telehealth. The main perceived barrier identified in the surveys was knowledge of telehealth, but participants believed there were opportunities for them to use telehealth. Interview results revealed that the convenience and flexibility of telehealth were perceived as the main advantages of telehealth. However, challenges such as the ability to conduct virtual assessments and to communicate effectively between clinicians and patients were identified. Patients from non-English speaking backgrounds and those with disabilities were particularly vulnerable because of the many barriers they faced. These challenges may further entrench the negative view regarding technology, as discussed by interview participants. CONCLUSION: This study suggested that a blended model combining telehealth and face-to-face services would allow patient choice and is important to facilitate equity of care, particularly for those patients who were unwilling or had difficulty adopting technology.

Scientific models for qualitative research: a textual thematic analysis coding system - part 2.

BACKGROUND: Models are central to the acquisition and organisation of scientific knowledge. They can be viewed as tools for interpretive description as well as cognitive representations of an empirical phenomenon. However, discussions about how to develop models in qualitative research - particularly in the literature on thematic analysis - are sparse. AIM: To discuss an approach to scientific qualitative modelling that uses the new technique described in the first part of this article ( Gildberg and Wilson 2023 ): the Empirical Test for Thematic Analysis (ETTA). DISCUSSION: The authors discuss scientific models and their inherent limitations and strengths, so that others may assess models and their potential. CONCLUSION: A limitation of ETTA is the risk that excessive rigour and systematisation could reduce creativity in the construction of models. However, on balance there is a scientific need for qualitative researchers to improve their capability to refine and describe the techniques they use to construct models, adequately explain the reliable generation of models, and improve transparency regarding the epistemological and methodological basis for the construction of models. IMPLICATIONS FOR PRACTICE: By using ETTA on qualitative data obtained from clinical practice it becomes possible to illuminate the interconnections among themes within the data. This approach not only assists in illustrating these connections, it also enables clinicians and researchers to gain a comprehensive understanding of specific clinical phenomena through the use of models. The process of developing and using these models enables the simulation and strategic intervention development based on data that addresses the specific problem being investigated.

Scientific models for qualitative research: a textual thematic analysis coding system - Part 1.

BACKGROUND: Models are central to the acquisition and organisation of scientific knowledge. However, there are few explanations of how to develop models in qualitative research, particularly in terms of thematic analysis. AIM: To describe a new technique for scientific qualitative modelling: the Empirical Testing Thematic Analysis (ETTA). Part 2 describes the ETTA model. DISCUSSION: ETTA generates a semantic structure expressed through theme-code, content and functionality. It highlights the importance of authenticity markings and taxonomical and functional semantic analysis. Its primary advantage is the sequential need to account for taxonomic analysis, functionality factors, preconditioning items, cascade directories and modulation factors; this results in the production of a sound, systematic, scientific development of a model. CONCLUSION: ETTA is useful for nurse researchers undertaking qualitative research who want to construct models derived from their investigations. IMPLICATIONS FOR PRACTICE: This article provides a step-by-step approach for researchers undertaking research that culminates in the construction of a model derived from qualitative investigations.

Artificial intelligence (AI) and machine learning (ML) based decision support systems in mental health: An integrative review.

An integrative review investigating the incorporation of artificial intelligence (AI) and machine learning (ML) based decision support systems in mental health care settings was undertaken of published literature between 2016 and 2021 across six databases. Four studies met the research question and the inclusion criteria. The primary theme identified was trust and confidence. To date, there is limited research regarding the use of AI-based decision support systems in mental health. Our review found that significant barriers exist regarding its incorporation into practice primarily arising from uncertainty related to clinician's trust and confidence, end-user acceptance and system transparency. More research is needed to understand the role of AI in assisting treatment and identifying missed care. Researchers and developers must focus on establishing trust and confidence with clinical staff before true clinical impact can be determined. Finally, further research is required to understand the attitudes and beliefs surrounding the use of AI and related impacts for the wellbeing of the end-users of care. This review highlights the necessity of involving clinicians in all stages of research, development and implementation of artificial intelligence in care delivery. Earning the trust and confidence of clinicians should be foremost in consideration in implementation of any AI-based decision support system. Clinicians should be motivated to actively embrace the opportunity to contribute to the development and implementation of new health technologies and digital tools that assist all health care professionals to identify missed care, before it occurs as a matter of importance for public safety and ethical implementation. AI-basesd decision support tools in mental health settings show most promise as trust and confidence of clinicians is achieved.

Artificial intelligence: An eye cast towards the mental health nursing horizon.

There has been an international surge towards online, digital, and telehealth mental health services, further amplified during COVID-19. Implementation and integration of technological innovations, including artificial intelligence (AI), have increased with the intention to improve clinical, governance, and administrative decision-making. Mental health nurses (MHN) should consider the ramifications of these changes and reflect on their engagement with AI. It is time for mental health nurses to demonstrate leadership in the AI mental health discourse and to meaningfully advocate that safety and inclusion of end users' of mental health service interests are prioritized. To date, very little literature exists about this topic, revealing limited engagement by MHNs overall. The aim of this article is to provide an overview of AI in the mental health context and to stimulate discussion about the rapidity and trustworthiness of AI related to the MHN profession. Despite the pace of progress, and personal life experiences with AI, a lack of MHN leadership about AI exists. MHNs have a professional obligation to advocate for access and equity in health service distribution and provision, and this applies to digital and physical domains. Trustworthiness of AI supports access and equity, and for this reason, it is of concern to MHNs. MHN advocacy and leadership are required to ensure that misogynist, racist, discriminatory biases are not favoured in the development of decisional support systems and training sets that strengthens AI algorithms. The absence of MHNs in designing technological innovation is a risk related to the adequacy of the generation of services that are beneficial for vulnerable people such as tailored, precise, and streamlined mental healthcare provision. AI developers are interested to focus on person-like solutions; however, collaborations with MHNs are required to ensure a person-centred approach for future mental healthcare is not overlooked.

Integrated nursing care for people with combined mental health and substance use disorders.

Many health problems arise from mental, neurological, and substance use disorders. These disorders are highly prevalent and complex and contribute to poor health outcomes, premature mortality, security risk, social isolation, and global and national economic loss. Mental health and substance use disorders are among Australia's top four causes of disease burden. Our objective was to investigate and synthesize contemporary literature regarding factors that influence nurses' delivery of integrated care to people with combined mental health and substance use disorders within mental health services. We systematically searched five electronic databases with a limit on publications from 2009 to 2021. The search yielded 26 articles. Following thematic analysis, three themes were identified: individual nursing characteristics, nursing education, and professional development characteristics, and organizational factors. This study reveals that there is a fundamental absence of adequate integrative models of care within mental health services to enable the optimal nursing care of people with combined mental health and substance use disorders. Future research is needed to determine nurses' perceptions and factors influencing their role as participants in integrative care. The results could strengthen nurses' contributions in developing/adopting integrative models of care and contribute to clinical, educational, and organizational development.

Nursing care of people with dementia in an orthopaedic acute care setting: An integrative literature review.

AIMS AND OBJECTIVES: This integrative literature review is to collect what is known about the care of people with dementia when they require a hospital admission for an orthopaedic surgical procedure and to contribute to developing an evidence-base to support nursing practice when caring for people with dementia in an orthopaedic setting. BACKGROUND: People with a dementia diagnosis are increasingly common in acute orthopaedic care settings and the admission exposes people with dementia to risks during their hospital stay. In addition, nurses find people with dementia challenging to care for due to the complexity of dual conditions. Little is known specifically about the care requirements for people with dementia in orthopaedic settings. DESIGN: Integrative literature review. METHODS: An integrative literature review and qualitative deductive content analysis using McCormack and McCance's theoretical nursing framework (Person-Centred Nursing Framework) of nine studies were undertaken. The process of the review was guided by PRISMA checklist. RESULTS: The care environment and resistance either in passive form, or through physical intervention, is common in orthopaedic nursing. Planning and delivering care for physical, cognitive and emotional needs is identified as being difficult, resulting in a lack of inclusion for patients, partly due to communication challenges. Finding ways to implement tailored care plans within standard ward routines proves difficult, and the consequence is a less than optimal care experience with adverse effects on patients characterised by an increase in dementia symptoms. CONCLUSIONS: Care for people with dementia in an orthopaedic setting is complex. It needs to be further studied so that more evidence and supporting literature can contribute to improved care for this group of patients. RELEVANCE TO CLINICAL PRACTICE: This study describes the complexity of providing fundamental care for people with dual conditions of dementia and orthopaedic injury and suggests opportunities for improvement.